Has OSA become a cash cow.

[cotech50]

Since starting my quest for OSA treatment I have some observations. Sleep studies take far too long to get! It was over a month before my first and had to be cancelled the day before but was able to get a cancellation a week later. Took place in a converted hospital room which still looked like a hospital room with a conventional bed shoved in the corner. It was not like the sleep study brochure of a motel looking room with TV, and looking like a bedroom at home. The private bathroom had 2 doors the other for the adjoining room. Now did this Hospital get into the business for need or money? I discovered that the staff used to come from a facility run by a scool of medicine but now is staffed with their own personnel. After a miserable experience I had to call the ENT I had been seeing when I mentioned my symptoms and they had received the report but the Dr. had not looked at it. I happened to see the RT that works at the local DME and she asked how my wife was doing and I told her about myself. She had me sign a release and got a copy of the report in which the Pulmonologist indicated I had a short night but my ahi was a 14 with no REM and suggested an apap and schedule a titration. Well here we go again the titration was no surprise showed just what the apap was showing but did not require another $3000 overnite stay. Called the RT about 2 weeks later about something and she had gotten my report 3 days prior. I am not sure if my ENT has washed his hands of me due to the machine and no surgery I would not know as I have not been asked to come in for a follow up with him. To date my insurance has been billed over $10,000 for all this and I wonder in looking at this if OSA diagnosis and treatment has become a cash cow to the medical field. I see threads with people left hanging by the people who have taken the money and left these people to fend for themselves, many times without the tools they need to effectively get good results. It looks to me that the sysyem has to change somewhat ie user software and working together with DME,RT,and Doctors. Seems here is a machine (overpriced ) now go home and use it as long as you are under 5ahi you are fine no need for tweaking lets not look at anything besides the summary data no looking at detail data to see if that number can become lower giving you a better quality of life.

Your Thoughts

[Tielman]

Your Thoughts

I have similar frustrations. My PCP told me I would be getting a "split-schedule" sleep study, but I ended up with two separate studies. It took just under a week to get my study results, and 24 hrs short of a week to get my equipment (why? because a Dr. has to review the data, and write up a summary/prescription, and there is no Dr. on duty during the sleep labs). I hate to say this, but if I was in the hospital, and had a Ox level of 78 I'd be receiving oxygen therapy, and multiple tests that would be done ASAP to resolve it, but because we are "outpatients" we have to wait, and live with a nightly Ox level in the upper 70's to low 80's (at least for me) for a week.

I'm still waiting on an Asthma test results that were taken in-between the sleep studies. The Tech gave me what I think is the clear part of a nebulizer (what they give you the Bronchial dilation with) with "in case your Dr needs to prescribe something". Tomorrow will be two weeks, and I think that's ridiculous for a simple "Asthma" test.

My DME basically told me that "nobody" gets the software (he had never heard of "client" software!!!!).

In my mind, there is a HUGE education issue here.

Did I say I'm frustrated

[Muffy]

Your Thoughts

I think you'll have a much more productive thread here pissing and moaning about the Sleep Industry than you did pissing and moaning about the forurm members:

I have seen some serious threads posted that got lost in much self serving banter and some serious posts by individuals go largely ignored. Is there a click that exists or some sort of initiation you have to go through. I do not see equal treatment here!!!

viewtopic/t48072/ignored.html

Muffy

[jnk]

. . . Sleep studies take far too long to get! . . .

Allowing sleep medicine to be a bit of a cash cow is the only way to get more labs/centers lured into existence so that the wait won't be so long in the future. That is how capitalism works.

. . . It was over a month before my first and had to be cancelled the day before but was able to get a cancellation a week later. . . .

I recommend always making oneself available to fill last-minute cancellations. Speak directly to the scheduler and let him/her know you can be there at a moment's notice.

. . . It was not like the sleep study brochure . . . .

Nothing is ever quite like the brochure. It is a rule of life. Kinda like "nobody dances as good as they think they can" and "everything tastes more or less like chicken."

. . . Now did this Hospital get into the business for need or money? . . . .

Yes. For need of money. It is, after all, a business.

. . . the titration was no surprise showed just what the apap was showing but did not require another $3000 overnite stay. . . .

A titration screens you for other sleep problems. Nobody likes to prescribe treatment based on old data.

. . . I am not sure if my ENT has washed his hands of me due to the machine and no surgery. I would not know as I have not been asked to come in for a follow up with him.. . . .

That is good. That means he is not milking you for money. If you have no need for him, washing his hands of you is the right thing to do, cow-wise. Right? After all, we can't have it both ways.

. . . To date my insurance has been billed over $10,000 for all this and I wonder in looking at this if OSA diagnosis and treatment has become a cash cow to the medical field. I see threads with people left hanging by the people who have taken the money and left these people to fend for themselves, many times without the tools they need to effectively get good results. It looks to me that the sysyem has to change somewhat ie user software and working together with DME,RT,and Doctors. Seems here is a machine (overpriced ) now go home and use it as long as you are under 5ahi you are fine no need for tweaking lets not look at anything besides the summary data no looking at detail data to see if that number can become lower giving you a better quality of life.

Your Thoughts

Some people get handed a machine, use it every night, feel better, and have no need for data or more help. We all need to remember that. It happens enough that the sleep doc and DME don't assume every patient is going to have a problem. That means those of us having trouble finding the right mask, the right pressure, and the right approach need to be very vocal in letting people know we need more help because our therapy isn't effective for us. Other than that, we have the forums and one another and have to keep trying things until we find what works for us.

Those are my thoughts. My views are not always mainstream, so they are what they are.

Hang in there cotech50. You'll make it work. Obviously the entire system is in need of some kind of overhaul. We can either wait for it to fix itself or do what we can to help ourselves and others. The more we understand about the system, the more we can work it for OUR advantage instead of "theirs." Posts like yours help spread the word.

jeff

@Muffy, didn't cotech apologize for that?

[Slinky]

Has OSA become a cash cow?? Snort! Where've you been? OSA has been a "cash cow" for quite some time now.

I think the minute it was determined that a reverse vacuum cleaner could reduce or eliminate OSA there were those in the medical profession who saw an easy "cash cow" in the making. And they are STILL jumping on board the easy "cash cow" bandwagon!

[rested gal]

@Muffy, didn't cotech apologize for that?

Apology II - by cotech50 - Jan 6 2010
viewtopic/viewtopic.php?p=437865#p437865

First one:
APPOLOGY- by cotech50 - Jan 5 2010
viewtopic.php?p=437399#p437399

[scrapper]

The really sad part of this cash cow, is that this forum provided way more to me than all of the dollars billed to the insurance company.........for free! Thank you to all!

[Slinky]

Ain't that the unvarnished, pure, truth, Scrapper???!!!! Hail to cpaptalk.com!!! And to our host, Johnny Goodman and cpap.com

[rjjayrt]

Sleep medicine as it relates to other specialities is basically still in its infancy. It changes everyday, sometimes for the better sometimes not. Sleep labs are popping up all over the place, problem is physicians are outpacing the ability of the exisiting sleep labs to do the tests in a timely manner. As far as education of DME/RT/Physicians go, I have no answer for that, The thing I do know is a DME will do whatever an Insurance Compant will let it get away with. Maybe the place to start is with the insurance companies, if they placed requirements on DME's to provide apap if a patient requested it or required minimum education for all patients and reduced there payment for the equipment and supplies and if they advocated patient management for there therapy then believe me it would get done. I'm not excusing physicians and DME/RT from the way some of them conduct themselves, just saying if the hand that feeds them stops feeding them then maybe things would change.

[drubin007]

I think the original post does say it all, and it is pretty much a cash cow...

I became involved quite by accident into the World of OSA. I snored. I come from a long history of men that snored (badly). I went to a Doctor (ENT) for an ear infection that would not go away. Casually mentioned I snored. That bought me 2 nights in sleep studies with and without cpap). In between I researched the hell out of OSA (this is before finding this site) and I went back to the doc and said no way in hell would he be cutting my throat. I would learn to love a hose to my head, but I would die fighting for air before I saw his knife collection. This got me a cpap machine.

Thru the good people in this site I learned lots about my machine and educated myself further. I then went back and showed my numbers to the dr and asked for an apap. Knowning more then he did, he obliged and wrote a new script.
Thats what I use today. I see him again next month I think, but not sure why. Should be a short visit. I have software, and once a month I review my data. I make changes to my pressure, humidity if needed. I order my own consumables as needed.

The sad part of it all: I never knew I had it, and feel the same as when I started. I was never one that had to go home and take naps, never fell asleep at traffic lights, the only noticable difference in my life now is that I do not snore (so my wife says). To sum it up... is it a cash cow? I think hell yea. The only reason I remain 100% compliant (have not missed a day in probably 8 months?) is because I know the effects of not using it, and do not want to be a burden to my family should
I have a stroke or some other horrible disease as a result of non compliance.

[BlackSpinner]

There is no reason for the excess of over priced sleep labs. Preliminary test for OSA can be done with a home sleep test and so can titration, as they do here in Quebec where it is an expense not an income for the medical system. Fancy expensive sleep labs should be reserved for those that "fail" the home tests, who need more testing for other sleep abnormalities.

It does not cost $2000-$5000 to send a patient home with some simple diagnostic equipment like an O2 meter, heart monitor and breathing monitor and to read the smart card and print the output.

Which is why US labs don't do home sleep tests.

[rjjayrt]

Home sleep testing was done alot in the USA until "fraud" reared its ugly head. As of January 2009, home testing again is allowed. There is quite an array of opinions as to if the home testing is as accurate. Theres also a question of how well the patient can manage the home test. But in answer to your post, it is available within the USA

[Slinky]

You make a very good point about the insurances, rjjayrt!!!

"... if the hand that feeds them stops feeding them then maybe things would change".

My primary is Medicare. Do you have any suggestions on how to reach them and educate them on this matter? Maybe CMS is the place to start?

I can try getting thru to my secondary insurance and maybe, in time, if enough of us preach this mantra to them, they will adopt this w/their primary insureds.

CMS has scared the hell outta me w/this bidding practice they've implemented in a couple of areas!!!! You know darn well that the likes of Apria and Lincare can outbid the locals and moms & pops and once they've driven them out of business start raising their rates to Medicare even higher and higher than now.

There is no way the politicians have the integrity, much less the intelligence, to outsmart the bloodsuckers and crooks of big business, much less the financial industry.

[pmcall57]

My health care provider (Group Health, Washington state, USA) does the home sleep test and titration as its standard practice, just as BlackSpinner described. They save the sleep lab for more difficult cases. Followup is mostly at the patient's initiative. It's a nonprofit consumer-owned coop, so their financial incentives are different than most of the US health care industry. The system has worked fine for me so far, but thank goodness for forums like this! Pam

[rjjayrt]

Medicare Hotline # is (800) 447-8477