DME just remotely fiddled with my settings...grrrr!

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ShelaghDB
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Re: DME just remotely fiddled with my settings...grrrr!

Post by ShelaghDB » Thu Jul 24, 2014 7:21 pm

Of course, malice is possible, but "never attribute to malice that which is adequately explained by stupidity."
very well put

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Demerit

Re: DME just remotely fiddled with my settings...grrrr!

Post by Demerit » Thu Jul 24, 2014 8:46 pm

The modems do run on cell signal, however it is not connected to the users cell phone. Yes there are wired modems that can connect to a landline if need be, most dme's do not use these.
If a prescription was entered under your account, every time that modem uploads (usually in the afternoons after 2 pm), the prescription will reset to the machine. Dme's do not have to enter an rx, but can allow the feedback from the machine to control the prescription screen.

The reason for the modems is some insurance companies now want compliance downloads every 90 days for the first year and every year thereafter, some require first 90 days only. Dmes cannot depend on a pt to mail/ drop off a data card in time for an authorization. If you don't get the authorization in on time, insurance won't pay.

They are great tools for when a pt is having difficulty, no delay in waiting for a card.

Just the other sides perspective.

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Re: DME just remotely fiddled with my settings...grrrr!

Post by robysue » Fri Jul 25, 2014 1:58 am

Demerit wrote:If a prescription was entered under your account, every time that modem uploads (usually in the afternoons after 2 pm), the prescription will reset to the machine.
Changing the settings on the machine without informing the patient that it is being done is NEVER in the patient's best interests.

What if the receptionist/clerk made a typing error while entering the prescription?

What if the sleep doc has authorized a prescription change, but didn't bother to fax it over to the DME because the machine was changed in the office? Or the doc knew the patient could be trusted to change their own pressure settings?
They [modems] are great tools for when a pt is having difficulty, no delay in waiting for a card.
Not everyone who is having serious difficulties adjusting to therapy will have "bad compliance" data. Or even "bad efficacy data." I struggled mightily for the first 4-5 months on PAP, but my compliance numbers were PERFECT. As were my leak numbers and my AHI numbers. A DME relying solely on wireless data would never have suspected that I was in trouble.

So I just don't buy this idea that wireless data is going to magically "fix" the problems that so many of us run into when it comes to getting NO MEANINGFUL SUPPORT in making this crazy therapy work for us in our own beds each night: If a patient is having difficulty, s/he needs to SEE and TALK to a REAL PERSON in a face to face meeting about exactly what's going on in their bedroom night after night. I was lucky: I had both a PA in a sleep doc's office AND a DME who were willing to work closely with me in an effort to figure out just what the heck was wrong. But many people are NOT that lucky.

I just don't see how using a modem to gather compliance data is going to allow a DME to help a PAPer when s/he hits difficulties unless there's face-to-face support. And if there's genuine face-to-face support, there's no need to put a modem on my machine to spy on me. And that's really how I feel about modems on CPAPs---they're designed to spy on me in my own bedroom.

And if the DME gives you a brick with a modem? How the hell is a phone call telling you about your compliance numbers that were gathered wirelessly going to do diddly-squat to help you figure out that your real problem is a nasty combination of bad leaks and a treated AHI that is much too high? A brick won't gather that data in the first place, and so there's no way to identify the problem by wirelessly downloading the data from the brick. And if the compliance data "looks good", the DME is even less likely to call the PAPer in trouble and provide any kind of help.

You want to help your patients/customers who are genuinely struggling with CPAP? Here's how to do it:
  • Provide all the new PAPers with a full efficacy data machine and make sure they're aware the machine gathers data on how well it is treating their apnea instead of focusing in on how the machine gathers data on how much they use it. (We don't need to be reminded that our insurance company insists that you spy on us.)
  • Make sure every newbie can disassemble and reassemble their chosen mask correctly. Make sure they know how to properly fit the mask. And by the way, that means your staff needs to know how to properly fit the masks you sell. Don't just tell Newbies to keep tightening the straps in an effort to stop the leaks.
  • Have a generous mask exchange program and DON'T encourage a newbie to just keep trying to make the current mask "work out" when it's clear it's not going to work for them.
  • Provide a place to lie down while trying on masks and allow people to try the mask on at their full PAP pressure.
  • Develop a high quality patient education program and make sure that all your new patients attend. One 1-hour class is NOT enough. In that education program, educate your patients about what OSA is, how their PAP works, what the data gathered by their machine means, and how to access all the data. Be sure to talk about leak data as well as AHI data. Too many newbies just assume that there's no problem with leaks because they don't wake up to them.
  • Provide space and a meeting time for an OSA-CPAP patient support group run by patients. Have someone from the DME there to provide information about new masks and new machines, but make sure the group is run BY patients and FOR patients. Make sure any newbie who complains about any standard newbie problem knows about the patient support group.
  • Do regular calls to newbies during the first two months or so regardless of what the data says. Make sure you ask the new PAPer whether they're having problems and whether they have any questions. And listen to their whole description of the problem before chiming in with all the pat one-size-fits none answers we've all been told.
  • Treat your customers like they are competent human beings who can learn how to actively work with you and their sleep doc to properly manage their OSA instead of dummies who can't possibly understand anything about what's going on each night in their own bedroom.
I'll get off my soapbox now.

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Re: DME just remotely fiddled with my settings...grrrr!

Post by Tatooed Lady » Fri Jul 25, 2014 5:31 am

robysue, your soapbox makes more sense than many...and it's less "caveman" than mine.

archangle, I prefer to blame malice. By the time these people are working without someone looking over their shoulders, stupidity should not be an option. The modem sending info should be passive, in that it simply should send what's there...not allow some schmuck on the other end send back info to alter the current settings with no warning. But that's just MY thought. I CAN see, however...how this could be useful with a patient/driver who is on the road, having pressure issues (I talked to one like this awhile back) where the DME is able to remotely bump the pressure setting up or down for the patient's comfort. However, I suppose that he played nicer than I, or dealt with someone else, because when I heard of HIS success, I asked the DME to bump my pressure and got less than nowhere.

Shelagh, I don't know about being able to handle myself perfectly...but the people I deal with day to day can be a bit rougher crowd than those in the medical field, so I have a LOT of practice being b!tchy.

to those who offered suggestions and I didn't mention you by name, sorry. I'm on a short schedule this morning, and wanted to get at least SOME of this outta the way,

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Re: DME just remotely fiddled with my settings...grrrr!

Post by msla » Fri Jul 25, 2014 6:56 am

Tatooed Lady wrote:Shelagh, I don't know about being able to handle myself perfectly...but the people I deal with day to day can be a bit rougher crowd than those in the medical field, so I have a LOT of practice being b!tchy.
You're a Lady, I think of it as confidently self assured.

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Re: DME just remotely fiddled with my settings...grrrr!

Post by chunkyfrog » Fri Jul 25, 2014 8:14 am

I wonder how difficult it would be to place shielding around the device to block cell signals.
---"Yeah, the signal sucks here; I gotta go outside to use my phone. "
Then they would have to get the data off the card, and they couldn't fool around with your settings.

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Re: DME just remotely fiddled with my settings...grrrr!

Post by 49er » Fri Jul 25, 2014 8:20 am

chunkyfrog wrote:I wonder how difficult it would be to place shielding around the device to block cell signals.
---"Yeah, the signal sucks here; I gotta go outside to use my phone. "
Then they would have to get the data off the card, and they couldn't fool around with your settings.
I like the way you think CF.

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Re: DME just remotely fiddled with my settings...grrrr!

Post by Drowsy Dancer » Fri Jul 25, 2014 8:31 am

49er wrote:
chunkyfrog wrote:I wonder how difficult it would be to place shielding around the device to block cell signals.
---"Yeah, the signal sucks here; I gotta go outside to use my phone. "
Then they would have to get the data off the card, and they couldn't fool around with your settings.
I like the way you think CF.
+1

No one has asked for compliance data from me for years.I guess Aetna is different, or at least my husband's company's flavor of Aetna. I'm not even using the machine I bought through insurance that still has a "service contract" associated with it. I'm using a newer machine I bought privately. #modemfreeforlyfe

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Re: DME just remotely fiddled with my settings...grrrr!

Post by archangle » Fri Jul 25, 2014 9:49 am

Tatooed Lady wrote:archangle, I prefer to blame malice. By the time these people are working without someone looking over their shoulders, stupidity should not be an option.
Even if they are malicious people, there aren't enough of us informed CPAPers to matter. It's like politics. The well informed, intelligent voters are just a drop in the ocean of sheeple, so they only need to worry about soundbites, not well informed info.

As for stupidity, it shouldn't be an option, but these days, it seems to be the majority in the people I end up dealing with.

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Re: DME just remotely fiddled with my settings...grrrr!

Post by palerider » Fri Jul 25, 2014 11:23 am

msla wrote:
Tatooed Lady wrote:Shelagh, I don't know about being able to handle myself perfectly...but the people I deal with day to day can be a bit rougher crowd than those in the medical field, so I have a LOT of practice being b!tchy.
You're a Lady, I think of it a confidently self assured.
of course she is, it says so right there in her handle

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Re: DME just remotely fiddled with my settings...grrrr!

Post by palerider » Fri Jul 25, 2014 11:24 am

chunkyfrog wrote:I wonder how difficult it would be to place shielding around the device to block cell signals.
---"Yeah, the signal sucks here; I gotta go outside to use my phone. "
Then they would have to get the data off the card, and they couldn't fool around with your settings.
a little foil wrapped around it would probably work wonders

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Re: DME just remotely fiddled with my settings...grrrr!

Post by HoseCrusher » Fri Jul 25, 2014 11:36 am

Actually foil won't work. Foil will keep the machine from radiating EMF out but it won't stop cell signals.

To check this out wrap your cell phone in foil and then call it. If it rings the signal is still getting through.

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Re: DME just remotely fiddled with my settings...grrrr!

Post by palerider » Fri Jul 25, 2014 11:54 am

HoseCrusher wrote:Actually foil won't work. Foil will keep the machine from radiating EMF out but it won't stop cell signals.

To check this out wrap your cell phone in foil and then call it. If it rings the signal is still getting through.
I'll leave out the discusion about cell signals being emf and allow that they might be enough to get through a layer of ungrounded foil.

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Re: DME just remotely fiddled with my settings...grrrr!

Post by SuperChild » Fri Jul 25, 2014 12:26 pm

palerider wrote:
HoseCrusher wrote:Actually foil won't work. Foil will keep the machine from radiating EMF out but it won't stop cell signals.

To check this out wrap your cell phone in foil and then call it. If it rings the signal is still getting through.
I'll leave out the discusion about cell signals being emf and allow that they might be enough to get through a layer of ungrounded foil.
I'm thinking that a Faraday cage would work wonders. Got any spare copper foil?Image
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Re: DME just remotely fiddled with my settings...grrrr!

Post by palerider » Fri Jul 25, 2014 12:42 pm

[quote="SuperChild"
I'm thinking that a Faraday cage would work wonders. Got any spare copper foil?[/quote]
not since I quit building printed circuit boards at IBM.

aluminum foil should work, any conductive metal, pretty much. it's not like we're trying to block magnatism and need mumetal.

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