HOW is
NEW RESEARCH TIES
HOME MEDICAL
EQUIPMENT TO BETTER PATIENT OUTCOMES
science backing HME
CGMs: Why the provision channel matters ALSO INSIDE
Big Data & HME
We’ve known for decades that home medical equipment (HME) is a wise investment. HME is efficacious, cost effective and supports patients where they want to live: at home.
M ore and more, we’re seeing research results that reach that same conclusion. So in this ebook, we take a look at how science is confirming that HME improves patients’ lives.
Starting on page 4, read how a new study demonstrated that patients with diabetes who received continuous glucose monitors (CGMs) and supplies from HME providers fared better than patients who received supplies from pharmacies. And read why providers are making such a difference.
O n page 7, learn about the terrible toll of daytime sleepiness as reported by the American Academy of Sleep Medicine — and why sleep apnea interventions are so important.
T he list goes on. As the Centers for Medicare & Medicaid Services (CMS) called for public comments on noninvasive ventilation to treat patients with chronic obstructive pulmonary disease (COPD) with chronic respiratory failure, industry members surely recalled a study, published in Respiratory Medicine, that said, “Early initiation of NIVH [noninvasive ventilation at home] for hypercapnic [high levels of carbon dioxide in the blood] COPD-CRF patients was associated with reductions in the risk of death and in total Medicare spending.” The study used CMS’s patient data; VieMed Chief Medical Officer William Frazier, M.D., was one of the study’s authors.
And the new Supplemental Oxygen Access Reform Act (SOAR) of 2025 — which would exclude oxygen services and equipment from Medicare’s competitive bidding program — is supported by 30 associations, including the American College of Chest Physicians (CHEST), who sent a letter urging support for the House and Senate bills. Advocating for liquid oxygen for patients with significant oxygen needs, CHEST said, “Due to the inadequate reimbursement rates, suppliers have been unable to continue providing liquid oxygen widely, leaving patients with few viable options. Without access to appropriate supplemental oxygen, patients are at higher risk for worsening health, avoidable emergency room visits, hospitalizations and the devastating prospect of being homebound.”
W hen every day is a reimbursement battle, it can be difficult to see how research can help. It can be hard to recognize allies. But science is on HME’s side. Researchers are examining big data and confirming what we’ve long known. HME saves lives. HME improves quality of life. And HME saves money for funding sources, thereby stretching health-care dollars.
H uzzah for the spotlight science shining on you and your colleagues. HMEB
Laurie Watanabe, Editor lwatanabe@wtwhmedia.com
April-May 2025
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HME Business (ISSN 1940-6479) is published 4 times a year: January/February, April/May, July/August, and October/ November, by WTWH Media, LLC., 1111 Superior Avenue, 26th Floor, Cleveland, OH 44114.
© Copyright 2025 by WTWH Media, LLC. All rights reserved. Reproductions in whole or part prohibited except by written permission. Mail requests to “Permissions Editor,” c/o HME Business, 1111 Superior Avenue, 26th Floor, Cleveland, OH 44114.
The information in this magazine has not undergone any formal testing by WTWH Media, LLC, and is distributed without any warranty expressed or implied. Implementation or use of any information contained herein is the reader’s sole responsibility. While the information has been reviewed for accuracy, there is no guarantee that the same or similar results may be achieved in all environments. Technical inaccuracies may result from printing errors and/or new developments in the industry.
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How Science Is Backing HME
By Laurie Watanabe
It takes a village to raise a child, the proverb says. Can the same be said for creating and maintaining successful regimens for patients living with diabetes?
New research published in Clinical Diabetes, the journal of the American Diabetes Association, suggests the answer is yes.
The article — Impact of Continuous Glucose Monitoring [CGM] Sourcing on Real-World Adherence and Health Care Costs: A Comparative Analysis by Insurance Type — examined the outcomes for patients with diabetes receiving CGM supplies from durable medical equipment (DME) providers compared to patients receiving those supplies from pharmacies.
Researchers studied the data of patients enrolled in traditional Medicare, Medicare Advantage, and commercial insurance payers. What the study’s authors uncovered supports the premise that the CGM provision process has a significant impact on eventual patient outcomes.
What the study found
The study’s authors — Jason C. Allaire, Consuela Dennis, Eugene E. Wright Jr., Steven V. Edelman, and Arti Masturzo — found that
patients who received their CGM supplies from DME providers were more adherent to their physician-prescribed treatments than patients who received CGM supplies from pharmacies.
Better adherence when working with DME providers was consistent across insurance payers. By the 12-month mark, Medicare and Medicare Advantage patients had a 78% adherence rate with DME providers vs. a 64% adherence rate with pharmacies. At that same 12-month mark, patients with commercial insurance had a 60% adherence rate with DME providers and a 48% adherence rate with pharmacies.
Furthermore, health-care costs at the 12-month mark for Medicare and Medicare Advantage patients receiving CGM supplies from DME providers were 35% lower than the health-care costs for Medicare/Medicare Advantage patients receiving their supplies from pharmacies. Researchers reported that commercially insured patients who received supplies from DME providers had “significantly fewer emergency room and [hospital] inpatient days than those utilizing the pharmacy channel — eight days vs. 11 days,” according to a March 25 news announcement.
PHOTO CREDIT: ADOBE STOCK/PEOPLEIMAGES.COM
“Higher adherence rates with continuous glucose monitors are directly linked to improved glycemic control, reduced complications, and lower health-care costs,” said Steven Edelman, M.D, one of the study’s authors. “This latest research emphasizes the need for industrywide support of evidence-based decisions that optimize patient access to diabetes technology and improve clinical outcomes.”
In addition to supporting the efficacy of diabetes technology, the study’s results also demonstrated that who provides the diabetes supplies absolutely matters.
“This research presents an opportunity to align health-plan policies with provider preferences based on measurable outcomes,” said Arti Masturzo, M.D., MBA, one of the study’s authors and the chief medical officer at CCS, a provider of clinical solutions and homedelivered medical supplies for those living with chronic conditions. “The data shows patients utilizing DME providers experience higher adherence rates, reduced health-care costs, and fewer emergency interventions compared to pharmacy channels. By focusing on these evidence-based results, we can work toward building a health-care system where patients receive better diabetes management support while reducing costs for the entire system.”
The challenges of using CGMs
In a video interview with HME Business, Masturzo pointed out that the March 2025 study is not the first to deliver these kinds of findings. A March 2024 study — Exploring the Impact of Device Sourcing on Real-World Adherence and Cost Implications of Continuous Glucose Monitoring in Patients with Diabetes: Retrospective Claims Analysis, published by JMIRDiabetes — also compared adherence rates for patients receiving CGM supplies from DME providers vs. pharmacies. That research showed, as one example, six-month adherence of 65% for patients working with DME providers, and 52% adherence for patients who got their supplies from pharmacies.
“That’s how [you know] the data is solid: When you repeat the study and see the same trends,” Masturzo, an author for both studies, explained. She added that the first study found that 22% of patients who stopped their diabetes regimens, but had been working with DME providers, resumed treatment, compared to just 10% of pharmacy patients resuming treatment.
“So, twice as likely to resume therapy after stopping,” she noted of patients working with providers.
The next logical question is why patients in the study who received diabetes supplies
from DME providers had better outcomes than patients who also received diabetes supplies, but from pharmacies.
Masturzo tried a CGM herself because as a prescribing physician, “It’s important to know who’s getting these,” she said. In fact, when she first tried to apply the CGM sensor to her arm, “I bent the needle, and I kind of broke it. So I wasn’t able to use it.”
During the interview with HME Business, Masturzo held up a CGM sample. “This is a sensor,” she said. “It goes on your skin, and then your phone basically acts as a receiver and you can read it. It’ll tell you in real time what your glucose readings are. And the prescription version gives you an alert when your blood sugar’s too high or too low.”
She then held up a sizable CGM brochure printed in small type: “These are the instructions.” Masturzo pointed out that some patients trying to read the brochure would surely have diabetic retinopathy, which damages the retinas and can lead to vision loss. “If you think about the complexity of [CGMs] — it’s not like an EpiPen. With Ozempic and some of those drugs [for treatment of diabetes], patients can inject the drugs. But [CGMs] can be complicated.”
That’s one reason, Masturzo believes, that patients working with DME providers have had better outcomes according to the pair of studies.
How DME workflows can benefit CGM patients
“Medicare has specific regulations for devices like this in general durable medical equipment [policies],” Masturzo said. “To bill Medicare and ship these devices, you have to ensure that the equipment is being used, and that the patient is capable and trained to use the device to bill a claim. That is not the case on the pharmacy side.”
As a prescribing physician, Masturzo has personally seen the difference between working with DME providers and pharmacies. “I know what happens when I write an order through my DME [provider],” she said. “They come back in a week and say, ‘Hey, Mrs. Smith is doing this,’ or ‘She didn’t do this,’ or ‘She didn’t order this.’ I never hear from my pharmacist, ‘Hey, Mrs. Smith didn’t do this.’”
Providers are also more interactive with those prescribing physicians. “Unlike pharmacies and pharmacists, the DME rep is constantly in the physician’s office and talking to the clinicians, talking to the coordinators, care managers, and more,” Masturzo said. “They’re also directly talking to the people who make these supplies, the original manufacturers. You get this cross communication in the community, in the [physicians’] offices, and so you get more support for these patients.”
Medicare’s operational rules for providers also benefit CGM patients, Masturzo added: “DMEs have really robust reorder protocols so that people stay on therapy.”
Medicare has specific regulations for devices like this in general durable medical equipment [policies]. To bill Medicare and ship these devices, you have to ensure that the equipment is being used.
— Arti Masturzo, M.D.
How Science Is Backing HME
Masturzo said a lot of the claims analysis for the CGM studies understandably came from national providers, who “create divisions within the DME company itself: ‘Here’s my oxygen tank team, here’s my wheelchair team, here’s my CPAP and BiPAP team, and this is my diabetes team — all they do is diabetes.’
“What happens is you start hiring experts in diabetes, people who know diabetes. You get focused, and that just means a higher level of support and expertise for people who are supplying these [CGM provisions].”
Does this mean that Masturzo would prefer that pharmacies not be allowed to dispense CGM supplies, even in remote areas where pharmacies could be the most accessible type of health-care business?
“There are communities and environments where pharmacists and pharmacies play a pivotal role,” Masturzo said. “And so the purpose of this study is not ‘You should close down all pharmacy channels.’ The whole point is that we should let physicians decide which channel serves patient needs best, period.”
That is not what the industry is currently experiencing, Masturzo added.
Masturzo circled back to her first interaction with a CGM sensor. “I twisted it too much,” she said. “I broke it. Who am I going to call if I got this shipped to me? Most of [pharmacy CGM distribution] is mail order, so it’s not even going through a brick-and-mortar. It’s not like I can show up [at the brick-and-mortar] with my CGM and say, ‘Look what I did.’ Instead, I get a telephone tree of people.”
Many patients using CGMs do need the specialized and personalized support that providers offer, Masturzo said.
“When you think about the reasons why people have trouble with these, sometimes, especially in the elderly, the skin is really thin and fragile,” she explained. “How do you troubleshoot that? What about people who are super active and sweating all the time?
“What we’re seeing right now is, increasingly, a push to pharmacy for [CGM distribution],” she said. “And you can see from the claims data: It’s not only that people [who receive CGM supplies from pharmacies] are not as adherent. People use CGMs for a couple of months, and then they stop. If you think about it from a taxpayer [perspective], you got no benefit from it.”
How DME businesses provide more robust support Masturzo’s position as CCS’s chief medical officer is evidence of how differently DME providers view the CGM segment and its patients.
“People have just forgotten that our responsibility, as the smartest DME, is to maximize the impact that we have in every patient interaction. What we’ve developed is above and beyond coaching and education. Beyond monitoring your blood pressure, and giving you a scale, and developing clinical programs. Going above and beyond is really what patients with chronic conditions need and deserve.
“What gets me excited is that we just launched a predictive analytics platform that can predict with almost 90% accuracy if somebody’s going to stop using their CGM. And then we innovate technology to create personalized interventions with those patients to improve adherence and overall health and well-being.”
“That’s why I feel there’s a reason [CGM provision] was started in DME from the very beginning. I think we’ve forgotten why the regulations were developed the way they were. We have this mentality of speed and more access [via pharmacies]. And then we forget fundamentally that the CGM is only as good as the people who know how to use it.”
Undoubtedly, tech-savvy patients who are internally motivated to adhere to their CGM regimens could receive their supplies from pharmacies and do fine. But it’s a different story for many other patients who need more support to use CGMs properly and remain adherent.
Masturzo said that if “you’ve got a doctor that has a lot of bandwidth and resources,” patients receiving supplies from pharmacies could do well. But,“There’s a wait time of three to eight weeks for an endocrinologist. PCPs [primary care physicians] have 15 to 20 minutes [per patient]; they simply don’t have the resources.”
Therefore, she said, “I wouldn’t want my mom getting this through a mail-order pharmacy. I would want somebody to call her and say, ‘Hey, how are you doing?’ If you look at the data and the study, and you look at the number of people that drop off, I think
The purpose of this study is not ‘You should close down all pharmacy channels.’ We should let physicians decide on
which channel.
We should
let the needs of the patient decide which channel.
— Arti Masturzo, M.D.
PHOTO CREDIT: ADOBE STOCK/MEDIAPHOTOS
there are people who decide ‘I don’t even want to put this on, I’m too scared.’ And so the CGM just sits there.”
The good news is that research has shown a better, more costeffective way forward. DME providers can boost adherence rates, which reduces overall health-care costs as a result.
The fact is that many CGM patients need the proactive communication, education, training and personalized village of support that DME providers can offer.
“I believe fundamentally that there are spots in health care where you can still be profitable doing the right thing and everybody wins,” Masturzo said. “And this is one of those situations. If you do this right, and you’re following the [CGM] guidelines, and you’re doing the necessary education and making sure people know how to use CGMs — people are benefiting. You’re building a business on holistic, personalized and preventive patient care, not just shipping medical devices to get them from point A to point B as fast as possible.”
Read more on CGM provision and outcomes … Dive into the most recent (March 2025) study that shows better outcomes for CGM patients who received supplies from DME providers instead of from pharmacies. Scan this QR code for news on the study. HMEB
AASM Releases Position Statement on Clinical Significance of Sleepiness
The American Academy of Sleep Medicine’s (AASM) new position statement focuses on how chronic daytime sleepiness can negatively affect physical and mental health while impacting virtually every part of a person’s personal and professional life.
The position statement was published in AASM’s Journal of Clinical Sleep Medicine.
“The position states that sleepiness is a critical patient-reported outcome that is associated with an increased risk for adverse health effects and diminished quality of life,” the AASM said in an April 14 press release. “The statement urges health-care professionals, policymakers, and researchers to prioritize the evaluation, management and treatment of sleepiness to improve public health.”
More than just a nuisance
Sleepiness is more than just an annoyance, the AASM said, calling it “a marker of insufficient sleep and a major patient-reported symptom associated with sleep-wake disorders such as narcolepsy and obstructive sleep apnea.” Sleepiness can also be caused or exacerbated by certain medications and lifestyle factors.
One of the challenges in treating sleepiness is its many causes. A diverse range of medical conditions, from rheumatoid arthritis to brain injury, stroke, hypothyroidism, iron deficiencies, Parkinson’s disease and dementia can cause sleepiness. So can
mood disorders, including depression, bipolar disorder, and seasonal affective disorder. Sleep deprivation from chronic insomnia, restless legs syndrome, or disturbances to sleep timing can also result in daytime sleepiness.
Excessive sleepiness during the day has been linked “to increased risks of cognitive impairment, workplace accidents, drowsy-driving crashes, and mental health concerns, such as depression and suicidal ideation.” Sleepiness in children can cause difficulties in school, including inattentiveness, behavioral issues, and decreased performance.
AASM’s position statement noted that one-third of adults in the United States report being excessively sleepy, a condition that “can have a negative impact on performance, health, mood, safety and quality of life. In severe cases, sleepiness can lead to debilitation, injury or death.”
Building on the position statement
In addition to the AASM, 25 medical, scientific, patient, and safety organizations supported the position statement, including the American Academy of Cardiovascular Sleep Medicine, the American Academy of Neurology, the American College of Chest Physicians (CHEST), the American Society for Metabolic and Bariatric Surgery, the American Thoracic Society, the National Safety Council, and the Society for Behavioral Sleep Medicine.
How Science Is Backing HME
“Sleepiness is a serious health concern with wide-reaching consequences,” said Eric Olson, M.D., president of the AASM. “From drowsy driving crashes to workplace errors and long-term health risks, the effects of excessive daytime sleepiness impact individuals and society every day. With one-third of U.S. adults reporting they experience excessive sleepiness, the importance of identifying interventions that recognize, assess and treat it cannot be understated.”
Olson added that the problem of chronic sleepiness needs to be urgently addressed.
“We’ve reached a critical point where the health-care system must prioritize the evaluation and management of sleepiness to help patients achieve restorative sleep and maintain daytime alertness,” Olson said. “Further research and innovation are essential to advancing the treatment of sleep-wake disorders, including studies that drive the development of therapies for daytime sleepiness.”
getting your z zzs : 5 Takeaways from the Academy of Sleep Medicine’s Position Statement on Sleepiness
The all-important takeaways from the American Academy of Sleep Medicine’s position statement on sleepiness:
— A lot of us are sleepy. The position statement noted that one-third of adults in the United States report “excessive sleepiness,” defined as the inability to stay awake and alert during daytime periods.
The AASM’s position statement quotes the National Sleep Foundation and the American Thoracic Society as saying adults generally need seven to nine hours of good-quality sleep per night. Kids usually need more sleep than grownups do, but their sleep needs vary with age; younger kids tend to need more sleep than older ones.
— Sleepiness and tiredness/fatigue are not the same things. We might use those terms interchangeably in everyday conversations, but the AASM’s position statement defined fatigue/ tiredness as physical exhaustion. Sleepiness, meanwhile, is associated with chronic sleep apnea and narcolepsy, which the National Institute of Neurological Disorders and Stroke noted is a chronic neurological disorder that affects the brain’s ability to control sleep-wake cycles. Cleveland Clinic said narcolepsy “is a condition where your brain can’t control your ability to sleep or stay awake.”
So, the tiredness you feel because you have a newborn baby in the house or because you’ve just pulled an all-nighter for a work project is different than the sleepiness you’d feel that was caused by sleep apnea or narcolepsy.
— We think we’re doing OK when we’re sleepy. We’re not. Research shows that when we go several nights in a row without enough sleep, we’ll report feeling acutely sleepy at first. But in the following days, we’ll likely add that our sleepy feelings have leveled off or only worsened a bit.
In reality, “cognitive performance continues to deteriorate,” the AASM said. So when we think we’ve acclimated to getting far less sleep than recommended and are now doing all right … we’re wrong. We just don’t realize it.
— Many, many factors can cause sleepiness. In addition to sleep apnea and narcolepsy, medical conditions including infections (e.g., encephalitis, chronic viral infections), inflammation (e.g., rheumatoid arthritis, allergies), brain injury and stroke, and neurodegenerative diseases (Parkinson’s, dementia) can result in daytime sleepiness. So can psychiatric conditions, such as mood disorders (e.g., depression, bipolar disorder), substance abuse, and schizophrenia. Genetic disorders such as Prader-Willi syndrome and myotonic dystrophy resulting in muscle wasting and weakness can cause sleep difficulties. So can iron deficiencies.
Healthy sleep can also be disrupted by more mundane things, such as ingesting too much caffeine or alcohol, or trying to sleep in an environment that’s too noisy, hot, cold or bright. Over-thecounter and prescription medications can also interrupt sleep.
— But sleepiness needs to be confronted; just because it’s common doesn’t mean it’s acceptable. “Sleepiness is associated with cognitive and functional impairments that can have a negative impact on performance, health, mood, safety and quality of life,” the AASM position said.
In addition to obvious dangers such as driving while sleepy, children who are chronically sleepy may do poorly in school because they can’t focus, or they’ll exhibit behavioral problems that can make learning difficult. Performing certain jobs or tasks while sleepy could also result in unintentional, but devastating errors or accidents. Sleepiness can impact relationships at home and overall, lead to a poorer quality of life.
The bottom line of the AASM position statement is that sleep and circadian care is health care at its core. And we therefore need to do all we can to ensure a good night’s sleep for all. HMEB — L. Watanabe
HMEB
