Damn DMEs

Well thats it.

We have Christine and MelMel on the good DME side. Any others want to join in being "Good DMEs".

Beware of the Evil DME.

Cheers,

Chris

Anonymous wrote:

wading thru the muck! wrote: wader says:

"...but only the cream of the crop DME's will give you the best money can buy."

Excuse me, but that is NOT TRUE with all DME's. I know several DME's here that work with the patient to select the machine and the patient has a CHOICE, within the guidelines of his/her insurance anyway, and within the selection of equipment carried by that DME, so that it is not an absolute decision by the vendor made purely to the vendor's benefit.

Clearly you missed Wader's last line. He did NOT issue a blanket condemnation of DME's. He said there was a cream of the crop. The problem is, MOST DME's, with regard to machines and the like, are skimmed milk. No cream to be found.

They do exist. My DME company is one of the money grubbing, price gouging ones, but my DME representative is WONDERFUL, spending as much time with me trying on masks as she can. She's limited by the number they have in stock, and the brands they carry, but she's also pointed out several to me that were not through her. She pointed me to nomask.com, in case I was one of those who would love that particular mask. She suggested the swift, even though she didn't have any in and didn't expect any for several weeks, and knew I'd go buy it on line.

But still, the pricing and the (lack of) choice on most of the equipment is pretty much par for the course.

Liam, who's pretty excited, he's never shot par before in his life!

Mikesus, I would love to let everyone know where a good dme is, but I don't want "All dme's are evil" squad to say I'm here to advertise. If you would like to message me individually I would be happy to give you some information.

Most of the cpaps I personally deal with are similar. ResMed, Respironics, Fisher Paykel...if you are talking just a straight no frills cpap they all do the same job. Besides they are all just overpriced air blowers anyway. The auto cpaps and other various machines are still great but I usually only recommend them if I feel the patient will have the need for it. Some patients come to the table knowing absolutely nothing about OSA and cpap, others have definite preferences and have done a lot of research. Each person has to be taken on a case by case basis. There is a fine line between educating a patient on their options (such as the numerous different masks) and between urging a patient to use an interface that I know will most likely have positive results. Am I cheating a patient by not showing them 15 different masks upon their initial set up or am I using my professional experience by guiding them to 3 or 4 different masks to choose from? It is a question even I have a hard time answering. The same goes with cpap machines. If I showed a patient 10 different machines and tried to explain cpap, auto cpap and bilevel most of their heads would be spinning. I guess it is a question of judgement combined with experience. Although should a person have a specific request I don't see why any dme could reasonably try to accomodate.

Another question.... How many of you actually ended up on the mask that was recommended by the sleep lab? I have noticed that sometimes what works well for one night in the lab is not always what is going to work in the home? What about the rest of you?

Thanks
Mel Mel

How can you make a ''recommendation'' unless you have tried every pc of equipment YOURSELF along with the doctor and RT's, you talk to. Everyone's sleeping habits, patterns, places, etc. are different.

Last I heard I didn't know a DME sleeps over and watches you sleep or attends the sleep study.....give us some credit WE KNOW WHAT WE WANT.

we can take a recommendation and file it away with other brain rattling comments, and still we have to decide for ourselves.

What the BIG problem is, as I see it, is that unless you--the DME--is pushing for an autopap, it does or does not get mentioned..

IF DME"ers were really smart, and pro consumer (and less profit driven) they'd ask a patient...HOW DID YOU FEEL AFTER YOUR STUDY????? DID YOU LIKE A RAMP, or would you like an auto feature that helps to aid yo and not blow air thru you whether you need or not.

You are in a tough business, and I admire you courage.....but just because an industry for now doesn't push a certain product, why do DME's, doc's and RT's negate the need.

Obviously --the big companies you mentioned, if they didn't see a need for autopap, it WOULD NOT BE OUT THERE FOR US TO BUY, huh?
$$$$$$$$$$$$$$

MelMel wrote:Mikesus, I would love to let everyone know where a good dme is, but I don't want "All dme's are evil" squad to say I'm here to advertise. If you would like to message me individually I would be happy to give you some information.

Most of the cpaps I personally deal with are similar. ResMed, Respironics, Fisher Paykel...if you are talking just a straight no frills cpap they all do the same job. Besides they are all just overpriced air blowers anyway. The auto cpaps and other various machines are still great but I usually only recommend them if I feel the patient will have the need for it. Some patients come to the table knowing absolutely nothing about OSA and cpap, others have definite preferences and have done a lot of research. Each person has to be taken on a case by case basis. There is a fine line between educating a patient on their options (such as the numerous different masks) and between urging a patient to use an interface that I know will most likely have positive results. Am I cheating a patient by not showing them 15 different masks upon their initial set up or am I using my professional experience by guiding them to 3 or 4 different masks to choose from? It is a question even I have a hard time answering. The same goes with cpap machines. If I showed a patient 10 different machines and tried to explain cpap, auto cpap and bilevel most of their heads would be spinning. I guess it is a question of judgement combined with experience. Although should a person have a specific request I don't see why any dme could reasonably try to accomodate.

Another question.... How many of you actually ended up on the mask that was recommended by the sleep lab? I have noticed that sometimes what works well for one night in the lab is not always what is going to work in the home? What about the rest of you?

Thanks
Mel Mel

I ended up with the same mask,the RT brought it to my home,I was not told that there were others available.Been using it since September,and haven't had any problems.
And I hadn't done research,because I didn't believe that I had OSA.
And I got the CPAP and all, two days after the sleep test.

I have since learned a lot because of this forum.
Had a nose cold,so went to the office here in town,and bought a full face mask so I could breathe through my mouth.I had called,and when the RT was in,he brought different sizes for me to try.

Happy dreams to all
Marie

gailzee wrote:Last I heard I didn't know a DME sleeps over and watches you sleep or attends the sleep study.....give us some credit WE KNOW WHAT WE WANT.

Yes, but MelMel's point is valid. *WE* know what we want. We here to take the time to sit on this site and discuss our options and learn about our condition and take an ACTIVE role in our care.

How many people go to the doctor expecting him (or her) to fix everything? I've known far too many people who felt it wasn't their JOB to be involved in their health care. "That's what I pay the doctor for", as if health were somehow similar to getting your car repaired.

Deal with enough of that sort of person, and I can easily see getting jaded. From the DME representative point of view, where it becomes a problem isn't making the recommendation (which I would argue the majority of patients probably WANT), it's when someone comes in and says "Hey, I know you recommend that, but talk to me about my options" or better yet "Yeah, I know, but I've been reading, and I really think I'd do better on this", and the DME rep is unwilling to give up on their recommendation.

Liam, proud to be among the intelligent, active (health-wise) people of CPAPTALK.COM.

Good point about about companies making autos. But let's not fool ourselves... Do you think ResMed (or any other manufacturer) is making autos only because it will help a patient? Or do you think they are making them because they know they can charge more for them?

The manufacturers go to sleep labs marketing such products to all the mds. Then the docs start to prescribe the machine and when we go to buy them the pricing from the vendor is sky high. This is the same thing that has happened with the "Swift". The reps go market the product and then guess what...when the dme orders it there is a three week backorder. Good planning on their part right??? I'm not here to cry the dme blues but there is always another side to every story.

I think auto is great. It is helpful in increasing compliance and it is also great in patients who are status post bariatric surgery. If us dme's could buy our product from cpap.com we would be doing great but in the meantime unless you are a company big enough to buy thousands of cpaps at a time then most manufacturers aren't willing to give us reasonable pricing. Please believe me when I tell you that from what I have seen at cpap.com they are selling some equipment cheaper then my company can buy it for from the manufacturer. Unfortunately the gouging begins way before the equipment hits the dme.

Now it is the job of the dme's to put enough pressure on the manufacturers to sell equipment at reasonable prices and to provide that equipment prior to them marketing it all over town. This is good for us which makes it even better for our patients.

I'm done with my rant...

MelMel

MELMEL- I was referring to the guest that stated that they knew of a good DME. As a DME I agree you shouldn't be telling folks unless they ask, but a consumer of a DME I think that should be allowed...

Liam, I couldn't agree more with you. You are right. If a patient comes in and they know what they want then there is no reason why a dme shouldn't be able to try and fulfill a reasonable request. At the minimum the dme should be able to educate each person on their options and the dme's ability to provide the patient with those options. If the dme is unable to reasonably provide what the patient wants then it is their professional responsibility to offer alternatives even if that means referring them to another dme company. However, I doubt that is what an evil dme would do. It takes a good company to have the intestinal fortitude to refer a patient to another company.

MM

MelMel wrote:Liam, I couldn't agree more with you. You are right. If a patient comes in and they know what they want then there is no reason why a dme shouldn't be able to try and fulfill a reasonable request. At the minimum the dme should be able to educate each person on their options and the dme's ability to provide the patient with those options. If the dme is unable to reasonably provide what the patient wants then it is their professional responsibility to offer alternatives even if that means referring them to another dme company. However, I doubt that is what an evil dme would do. It takes a good company to have the intestinal fortitude to refer a patient to another company.

MM

And it takes a really bad one to tell folks that there are no other options... Unfortunately there are a lot of folks that are lied to, ripped off and generally treated badly. I was told that my insurance would not cover a purchase unless they rented to me for 6 months. Meanwhile they had already gotten the approval for both the rental AND a purchase at the same time. My insurance company sends me statements and I already knew what they approved and what they wouldn't. Additionally the RT was telling me that an auto or cflex would not make a difference that straight cpap was fine. (she said this AFTER I indicated that it was difficult to breath against AND I have asthma) That was the point I said have a nice day and walked out. Went home and ordered from cpap.com If I had gone with the Fisher Roadkil err Paykil with the NASAL mask (because she didn't think that the sleep doc was right in requesting a Full Face) I HIGHLY doubt my compliance would be 80hrs (appx) in 8 days. If you are working for one of the honest ones, it must be very lonely...

Mikesus wrote:MELMEL- I was referring to the guest that stated that they knew of a good DME. As a DME I agree you shouldn't be telling folks unless they ask, but a consumer of a DME I think that should be allowed...

Sorry, that was me. I hadn't realized I wasn't logged in and it was a quick read and response before I went to a church event.

I'm in the Chicago area and the three companies I'm thinking of are all sleep only DME companies. Two are purely local and one is part of a regional chain.

I'm not saying that their pricing is all the same as cpap.com, and I've not personally bought from all of them, so I can't compare. Just that in terms of working with the client, I've known them to do that well, based on comments I've heard from folks at various A.W.A.K.E. group meetings in this area. Probably if I named names in this post, that might be something that the forum folks wouldn't like, but anyone in the Chicago area is free to PM me and I'll share the names.

Dave