Manhattan A.W.A.K.E. 8-3-11 with Nicole Garrison RT, RPSGT

[jnk]

These meetings just keep getting better!

I almost didn't make it. My last appointment of the day in Brooklyn ended just in time for me to make it to the F train and up to the meeting. That's the good news. The bad news is that I had to leave before getting a chance to get some answers relating to the upcoming AutoIQ machine. I hope Rested Gal and Slinky find it in their hearts to forgive me.

Mike and Dr. Park weren't there, so I ended up playing host a bit--setting up chairs, welcoming people, watching the door, etc. Fortunately, people tend to listen to a guy my size, even in New York.

But enough about me.

The bottom line is that whatever Philips is paying Ms. Garrison, they should double her pay. She single-handedly put on one of the most amazingly fantastic PATIENT-ORIENTED A.W.A.K.E. meetings I can imagine! If someone had asked me beforehand if it was possible for someone employed by a machine manufacturer to do that good of a job in front of a room full of patients and professionals, I would not think it possible. She nailed it.

Without fanfare she simply walked to the front of the room and introduced herself and said she was there to be helpful with any questions anyone had relating to OSA and then started calling on people who raised their hands. That simple. In the past when doctors have done that, they have trouble maintaining order with a room full of New Yorkers. Not Ms. Garrison. She has a voice that easily and pleasantly reaches the back row (something others have had trouble with) and she never once spoke over our heads with convoluted medical terms and abbreviations (something ALL docs seem to have trouble with).

No question was too simple for her to address. She made no one feel stupid. When she didn't know an answer, she said so straight out. She didn't push her products, but appropriately referred to them when it was helpful to her audience for her to do so. I don't have one bad word about her manner of presentation or content. Even when a question was overly broad to the point of being virtually meaningless, she found a way to pass on helpful observations from her clinical experience as an RT and as a sleep tech.

Enough about the way she said things. The best thing was all of the practical things that she said.

Before I get into that, though, I thought it interesting that she kept correcting herself any time she spoke of "Philips Respironics." (She didn't correct others, just herself.) It seems they are now just "Philips." They leave the "Respironics" on some things, since that is their history, of course, in respiration products--but the branding is fully "Philips." I think that is a good thing, since the name will be less easily confused with ResMed.

Now to the meat:

She explained that some DMEs may not always understand the manufacturers' policy involving manufacturers' requiring only that a simple form be filled out by the DME whenever patients return masks within 30 days that didn't work for them. So we as patients, unfortunately, may need to inform our DMEs of that policy of the manufacturers in order for us to take advantage of it.

Along similar lines, she mentioned another Philips program that was especially interesting to me: The "Bi-level Rescue Program." (http://trilogy200.respironics.com/pdf/1 ... ograph.pdf) If I understood her correctly, Philips wants to support a patient's being able to get switched to bi-level any time that is needed, so they make it easy for the CPAP to be turned in and only the difference in price between the CPAP/APAP and the bi-level will then be charged to insurance--provided, of course, the doc does everything right with the Rx, and all. Something like that.

One DME guy was there, and he made a great point, I thought. He said, "If you are a patient having trouble, don't just complain to the DME, complain to your doctor. DMEs tend to jump when they get calls from doctors telling them to make a patient happy." Good point, well made.

One thing Ms. Garrison did when demonstrating the new Philips GoLife for Men and GoLife for Women nasal-pillows mask really touched my heart. She put the mask on herself while talking about it to us. Maybe a small thing. But it instantly removed a little stigma and made her one of us. I would say that it was a brilliant sales tactic, but it didn't come across that way at all. It was a sincere, matter-of-fact presentation. Nice touch.

I asked her NotMuffy's question about her position on off-label use of ASV. She said it was an expensive machine that is designed to treat something other than OSA/UARS, so she can understand why insurance will not pay for it unless it is needed for what it is designed to treat. I guess New Englanders are more strict on that sort of thing than New Mexicans.

I also asked Rested Gal's/Slinky's question about the AutoIQ. Ms. Garrison's jaw dropped a bit. She wondered how I knew about it. She invited me to ask more after the meeting, but I wasn't able to stick around. Her basic response was that the machine was designed only to provide 30 days of autotitration, but that those 30 days did not have to be consecutive. Sounds to me like someone will have to find a hack to get the machine to do another full 30 days. She herself doesn't get trained on the machine until next week, she said. Sorry that I wasn't able to get clarification on whether the range of pressures can be narrowed for that autotitrating. Hopefully one of us will get more information on that soon.

Most of the discussion was on things like cleaning the machine, stopping leaks, sleep positions, etc.--common everyday questions that patients care most about. Those kinds of questions don't get considered at every meeting, so I was glad someone as knowledgeable and caring and experienced as she is was there to be of help with those things. Her answers were in full harmony with what the experienced posters say here every day.

On a side note (and I have my wife's permission to say so), Ms. Garrison is not, as they say in Kentucky, hard on the eyes. She has the looks and presence of a professional actress, the education and mental sharpness of an experienced medical professional, and the kind, down-to-earth manner that puts people at ease in a way that makes information easy to swallow and sink in. She was a breath of fresh air in every way, and it was a pleasure hearing her do what she did in the way she did it.

The journalist side of me wishes that I had some criticism to balance out my report to the class here, but I ain't got none. I rate her, and the meeting as a whole, a 10 out of 10. And I'm not just saying that to make Carbonman jealous of the meeting. That's just bonus!!!

(edited to correct typos; my copy editor has been fired)

[FizzyWater]

Thanks for sharing your experience!

[Slinky]

Thanks, jnk. Since Ms Garrison wasn't familiar yet w/the AutoIQ herself you are forgiven that you weren't able to stay. But do be sure to drop her a note and explain WHY you couldn't take her up on your offer to talk to you after the meeting!!!! (Like you are not going to do that w/o my telling you to).

And, by the way, you've given a heck of a good rundown on her presentation yourself. Thanks again.

[dsm]

jnk

Thanks for the informative report - nice to get the opportunity to imagine being there

DSM

[rested gal]

I also asked Rested Gal's/Slinky's question about the AutoIQ. Ms. Garrison's jaw dropped a bit. She wondered how I knew about it.

Hope you replied, "Well, uh, Slinky announced it on cpaptalk."
Ms G might have needed a Philips chinstrap at that point, while she was processing the words "Slinky" and "cpaptalk."

Thanks for your good report, Jeff. Your A.W.A.K.E. meeting reports are always fun to read and very informative.

[Mike6977]

Sounds great, Jeff. I live in Manhattan, and wish I had known about this and attended.

EDIT: I see the post now. Damn, 134 West 26th Street, a two block walk for me. Well, there's the upcoming September 07th viewing of the "latest and greatest products available on the market today"

Nice reportage, btw, makes the reader feel like he's almost in the room.

One minor quibble:

I asked her NotMuffy's question about her position on off-label use of ASV. She said it was an expensive machine that is designed to treat something other than OSA/UARS, so she can understand why insurance will not pay for it unless it is needed for what it is designed to treat. I guess New Englanders are more strict on that sort of thing than New Mexicans.

Mike6977 appears to me to have a contract out on K

I don't have a contract out on K, but if I did, and my contract specified bullets, I summize your contract specified spitballs when he isn't looking.

[carbonman]

I rate her, and the meeting as a whole, a 10 out of 10. And I'm not just saying that to make Carbonman jealous of the meeting. That's just bonus!!!

.....BUT,
all that being said, mission accomplished.....

you sick,
twisted,
AWAKE meet'n go'er,
AWAKE meet'n reviewer,
mask wear'n,
guitar play'n,
freak.

[NotMuffy]

I asked her NotMuffy's question about her position on off-label use of ASV. She said it was an expensive machine that is designed to treat something other than OSA/UARS, so she can understand why insurance will not pay for it unless it is needed for what it is designed to treat. I guess New Englanders are more strict on that sort of thing than New Mexicans.

The reimbursement criteria for ASV are the same all over:

(1) An apnea–hypopnea index greater than five; and
(2) Central apneas/hypopneas greater than 50% of the total
apneas/hypopneas; and
(3) Central apneas or hypopneas greater than or equal to
five times per hour; and
(4) Symptoms of either excessive sleepiness or disrupted sleep.

Given these criteria, 15% of patients will qualify. If somebody is "qualifying" 70% of their patients, I would start to wonder.

[jnk]

As for the AutoIQ, I have been informed by sources close to the White House that "the pressure can be set at any range during the Auto Trial period… 4-20cmH20, or 8-15cmH20… etc… any range you like, as in our Auto CPAP device."

I guess some RR, oops, I mean, Philips, people do read this board.

[jnk]

. . . I summize your contract specified spitballs when he isn't looking. . . .

Just remember: "Gentlemen, you can't fight in here; this is the War Room!"
https://www.youtube.com/watch?v=UAeqVGP-GPM

[napstress]

Thanks for the summary, jnk.

Does anyone know how I might find out when future AWAKE meetings are held in the northeastern US? I'm a 2.5-hour train ride from NYC.

[Mike6977]

Given these criteria, 15% of patients will qualify. If somebody is "qualifying" 70% of their patients, I would start to wonder.

Simple explanation.

To arrive at that 15% number, you would need a fairly large and random group of patients.

But if there's a pre-qualification screening process (including previous PSG reports and data) to look for patients who will qualify, it's not such a mystery.

Surely, you're not implying that the screening is just a beard, and that any walk-in who can afford to enter the carnival, gets to walk away with the latest model teddy bear?

BTW, K is very specific on how he overcomes the insurance barriers for ASV.

"Gentlemen, you can't fight in here; this is the War Room!".

[robysue]

The reimbursement criteria for ASV are the same all over:

(1) An apnea–hypopnea index greater than five; and
(2) Central apneas/hypopneas greater than 50% of the total
apneas/hypopneas; and
(3) Central apneas or hypopneas greater than or equal to
five times per hour; and
(4) Symptoms of either excessive sleepiness or disrupted sleep.

Given these criteria, 15% of patients will qualify. If somebody is "qualifying" 70% of their patients, I would start to wonder.

Just asking out of curiosity's sake and for a bit of clarification here.

Do most sleep labs even make an effort to distinguish between central hypopneas and an obstructive hyponeas?

And how is the decision to score a hypopnea as a central one instead of an obstructive one made at a lab that does distinguish between them?

And if the lab doesn't distinguish between central and obstructive hypopneas, does that mean item #2 says 50% of the events have to be central apneas? And item #3 then says a CAI >= 5 is required?

[jnk]

Thanks for the summary, jnk.

Does anyone know how I might find out when future AWAKE meetings are held in the northeastern US? I'm a 2.5-hour train ride from NYC.

You are welcome.

I don't know how up-to-date the map is, but this might help:

http://www.sleepapnea.org/support/a.w.a ... k-map.html

[jnk]

The reimbursement criteria for ASV are the same all over:

(1) An apnea–hypopnea index greater than five; and
(2) Central apneas/hypopneas greater than 50% of the total
apneas/hypopneas; and
(3) Central apneas or hypopneas greater than or equal to
five times per hour; and
(4) Symptoms of either excessive sleepiness or disrupted sleep.

Given these criteria, 15% of patients will qualify. If somebody is "qualifying" 70% of their patients, I would start to wonder.

Just asking out of curiosity's sake and for a bit of clarification here.

Do most sleep labs even make an effort to distinguish between central hypopneas and an obstructive hyponeas?

And how is the decision to score a hypopnea as a central one instead of an obstructive one made at a lab that does distinguish between them?

And if the lab doesn't distinguish between central and obstructive hypopneas, does that mean item #2 says 50% of the events have to be central apneas? And item #3 then says a CAI >= 5 is required?

Good points and good questions, IMO.