supplies question

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
kcodeblue
Posts: 23
Joined: Fri Mar 20, 2015 10:31 pm

Re: supplies question

Post by kcodeblue » Thu Mar 26, 2015 2:31 am

rdfry wrote:Sorry, but it's not up to the DME provider to decide what equipment I need
.

I agree. It's something you and your Physician should discuss and decide together. Because he's the one sending in the request.
rdfry wrote:If you can't make money providing the equipment the patient wants that has been diagnosed with sleep apnea then you need to find another way to make a living
And stop providing BiPAP S/T's for COPD patient's? and AVAP's for ALS patients? and Home ventilators for all of our pediatric patients that have a variety of genetic disorders? I wasn't aware that the success of Respiratory Therapy was based soley on whether or not one could make money on CPAP's. How about we leave the deciding what to do with my life up to me. And please try and remember, I'm an RT who works for a DME, I'm not the DME. I am very much a patient advocate and try to help patient's get what they need by fighting the "powers that be" from the inside. Take that however you want.
rdfry wrote:I have been using xpap for 15 years and wouldn't settle for anything less than a top of the line Apap machine.
I think that's great! I would have no problem providing you with one as long as your doctor requested it

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Sharrykb
Posts: 156
Joined: Thu Apr 10, 2014 11:50 am
Location: Roseburg Oregon

Re: supplies question

Post by Sharrykb » Thu Mar 26, 2015 12:27 pm

kcodeblue wrote:
Sharrykb wrote:Okay, I've gone back and reread all of your posts (and I did finally find the one I quoted but on a different day and time than you said) and I think I finally get what you are saying. The DME you work for doesn't actually lose money on the sale (they are still collecting more money than the machine itself cost) but it is the LABOR involved that makes it work out to loss. Am I understanding correctly now?
Yes, that is correct. It's like any other business, you purchase a product at a wholesale price and sell it for retail (or in this case, whatever the insurance allowable will pay). The difference between the two should cover your operating expenses specific to the delivery of that product including labor and have some free cash flow left over.Your free cash flow is your profit. Unfortunately, the $200 plus dollars that we are left with (difference between wholesale price of device and allowable from Medicare) rarely covers the labor needed to jump through all of Medicare's hoops when pre-qualifying, delivering, and then qualifying again for continued coverage beyond the first 3 months as I outlined in my previous post you just read. The result is usually a financial loss. And it's all because of hours of mandated information gathering. Multiple calls to MD offices because we don't have ALL of the documents up front required by Medicare. Or they are sending them but they're not signed or they're signed but not by an MD who's qualified to sign them. Then once it's set up, we need to make sure the patient provides us with a compliant download from the device. This can take multiple attempts. Once we have that we need to make sure the patient goes in to see their MD and has him send us a signed and dated progress note that states the patient is clinically benefiting from the CPAP. Getting these progress notes can be like pulling teeth. We often times have to send someone out to the MD's office to pick it up. If we don't receive a compliant download and MD progress notes within the first 90 days of delivery, Medicare will deny coverage of the remaining 10 months as medically unnecessary. Unfortunately, 30% of our patients do not meet Medicare's compliance criteria within the first 90 days of delivery and we are forced to offer them a cash pay price or return the CPAP. Most return the CPAP. This means that for 30% of the Medicare CPAP orders we receive, we purchase a CPAP at wholesale (between $300-400) go through that entire process I just described ($200 plus in labor) and only get 3 months rental from Medicare ($126). That comes out to about a $450-$500 loss on 30% of our Medicare CPAP requests. That also needs to be considered when assessing the profitability of Medicare CPAP's in the region where I work .
Thank you for explaining this to me. I now have a better understanding of why DMEs want to pass out bricks to uneducated consumers. They have to make up for their losses somewhere.

Please don't take that personally. I know there are very good respiratory therapists out there that really want to help people. I am assuming you are one of them. I also know that sometimes an employee's hands are tied by company policy. And sometimes a company's hands are tied by insurance policies. It is a HUGE mess for which there is no simple answer.

I am very thankful that right now we seem to have good insurance and seem to have finally found a good DME with good respiratory therapists. I just hope it continues to go this well...

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chunkyfrog
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Joined: Mon Jul 12, 2010 5:10 pm
Location: Nebraska--I am sworn to keep the secret of this paradise.

Re: supplies question

Post by chunkyfrog » Fri Mar 27, 2015 10:32 am

My doctor was more than willing to write my prescription for exactly what I requested.
Of course, I got his attention with my comprehensive journal of my data, blood sugar, etc.

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