DMEs Take a Swing at CPAP Internet Retailing - Please help!

MaskedMechanic · Post by **MaskedMechanic** » Sat Jun 17, 2006 1:47 pm

July 2006 HME News Poll

We're interested in your feedback. Please answer the following questions and add your comments and contact information if desired. Your response to these poll questions will remain confidential. Numerical results will appear in the July issue of HME News.

Are industry manufacturers doing enough to make sure Internet retailers of HME provide sufficient service and follow-up after an initial sale?

Yes
No

If Internet retailers of HME give adequate service and follow-up after a sale, should they be able to sell products at any price they choose?

Yes
No

Who should set the standards for Internet retailers: HME manufacturers or the free market?

HME manufacturers
free market

++++++++++++++++++++++++++++++++++++++++++++++

What I am saying is that this poll is the beginning of a push by DME powers to control our purchasing options. The questions, the source and the bias behind them says it all. BOTTOM LINE.... Pay more for HME including cpap..

Guest · Post by **Guest** » Sat Jun 17, 2006 1:56 pm

wading thru the muck wrote:The solution is the cpap.com/cpaptalk.com model... Superior service, Low prices and open forum feedback that is available to all to read and comment. This is a completely transparent process which leaves little or no room for corruption.

Excellent point. Corruption plays a huge part in the business of the Big Boys and no part in the business of cpap.com.

Anonymous wrote:Lincare just paid a $526,000 settlement for overbilling Medicare in Massachusetts. Not to mention the $10 million settlement they paid in May for giving kickbacks to physicians in exchange for referrals in Florida.

and that's just in the last two months.

(Corruption is apparently quite lucrative. Until you get caught.)

tooly125 · Post by **tooly125** » Sat Jun 17, 2006 2:23 pm

MaskedMechanic wrote: What I am saying is that this poll is the beginning of a push by DME powers to control our purchasing options. The questions, the source and the bias behind them says it all. BOTTOM LINE.... Pay more for HME including cpap..

Maybe it's time for internet based cpap providers to organize and push back?

Snoozin' Bluezzz · Post by **Snoozin' Bluezzz** » Sat Jun 17, 2006 2:36 pm

Anonymous wrote:
Lincare just paid a $526,000 settlement for overbilling Medicare in Massachusetts. Not to mention the $10 million settlement they paid in May for giving kickbacks to physicians in exchange for referrals in Florida.
and that's just in the last two months.

(Corruption is apparently quite lucrative. Until you get caught.)

What baffles me is how does this work? Do people actually sit around a table in an office or conference room and discuss providing kickbacks for referrals or other forms of corrupt behavior. I mean it just can't be one or two folks can it? How can they do this? I know I am sounding naive and disingenuous but, even as I apprehend that this is the way the world works I don't comprehend it. The mechanics baffle me. "Hey, here's some cash, give me some business." Or, "hey, here's a free trip!", yadayadayada. Somebody didn't raise them very well in my estimation but it sure seems to be pretty common.

David

Guest · Post by **Guest** » Sat Jun 17, 2006 3:06 pm

neversleeps wrote:How can the traditional DMEs compete if they don't lower their prices?

Simple. Attempt to mount a campaign which will result in forcing the online DMEs to raise theirs.

Wulfman · Post by **Wulfman** » Sat Jun 17, 2006 3:21 pm

Wulfman wrote:If you don't have the "service", you eventually won't have the sales, either.

And, if you gouge people long enough on prices, that'll come back to haunt you, too.

Those statements I made apply to ALL businesses.

Den

Guest · Post by **Guest** » Sat Jun 17, 2006 4:14 pm

Looks like the HMEs (DMEs) have more competition to worry about than just the online vendors. The following is from Home Health Care Dealer Provider. The question was asked of Ann Tisthammer, Vice President, Clinical Education and Training, ResMed Corp.

Q. What is your opinion concerning manufactures providing CPAP/BiPAP equipment and supplies to sleep facilities and competing with HMEs?
—John Galvin

A. This is an interesting question given that more and more labs are considering going (or have gone) to a vertically integrated model. To give some more insight into this, approximately 15% of sleep centers currently sell positive airway pressure (PAP) devices and masks directly to patients, while the remainder refer patients to an HME. Based on sleep center feedback, approximately 15% of sleep centers plan on dispensing product directly within the next year (Wachovia January 2006).
The overall goal manufacturers have is to market and sell their products and technology, which in turn results in more and more patients being treated. As you are probably aware, the vast majority of SDB (sleep-disordered breathing) individuals are yet to be diagnosed . . . let alone treated. Manufacturers are in a business to service and sellnot unlike HMEs, physician-owned labs, or hospital-owned HMEs. And the likelihood of manufacturers refusing to sell to a lab or to an HME is unrealistic, in my opinion.

Depending on which viewpoint you take, there are opportunities and challenges in both the HMEs and the integrated labs. Becoming the "best friend" of your sleep labs, building and maintaining a strong partnership, will continue to drive lab referrals to the HME.

The HME has the advantage of being more of a full-service center, being able to handle the many other home medical needs of patients (home oxygen, other DME vs just PAP devices). The HMEs also have the experienced clinical staff to educate and service these patients, whereas newly integrated labs will have to hire appropriate clinical and knowledgeable staff to educate, manage, and follow-up with the SDB patients.

The reality is that the face of the sleep market is changing and HMEs need to focus on being a serious player in this area of SDB and patient management. The biggest concern referring physicians have revolves around adequate patient education, follow-up, and management. They expect the dispensing entity (HME or lab) to be doing this. They simply don't have the time. This is likely one of the reasons why some labs are beginning to dispense.

For HMEs to continue to get "their fare share" in this face of change, they need to market their SDB programs and demonstrate a solid patient education and follow-up program. Change is inevitable in this area and whether manufacturers sell to HMEs, sleep labs, or hospital-owned HMEs, the number of patients undiagnosed and in need of treatment is only continuing to grow. Whether some labs become integrated or not, or whether manufacturers sell to labs should not be the issue. The issue is patient care and improved patient outcomes and therefore it really comes down to making sure you provide a quality and reliable SDB program. From that, HMEs will continue to get their "fare share."
-- Ann Tisthammer, Vice President, Clinical Education and Training, ResMed Corp

http://www.hhcdealer.com/experts.php?e=5

rested gal · Post by **rested gal** » Sun Jun 18, 2006 2:50 pm

For HMEs to continue to get "their fare share" in this face of change

----

From that, HMEs will continue to get their "fare share."
-- Ann Tisthammer, Vice President, Clinical Education and Training, ResMed Corp

(bold emphasis mine)

Wonder if it was a funny accident, or if Ms Tisthammer deliberately spelled "fair" that way...hmmm, thinking about the exorbitant "fares" so many HME (DME) bricks and mortar stores charge for some things.

Fair often does seem to get shoved aside by the fare when it comes to sharing the bounty.

I found this part of Ms Tisthammer's remarks particularly amusing in light of the poor mask fittings, erroneous settings on machines, and general misinformation that so many people on the message boards have reported receiving from the "experienced clinical staff" at the local DME level:

The HMEs also have the experienced clinical staff to educate and service these patients

neversleeps · Post by **neversleeps** » Sun Jun 18, 2006 6:59 pm

HA!!!! I didn't even notice it until you pointed it out! That's a freudian slip if I ever saw one!!!

GREgular going Incognito · Post by **GREgular going Incognito** » Sun Jun 18, 2006 7:42 pm

Snoozin' Bluezzz wrote:
Anonymous wrote:
Lincare just paid a $526,000 settlement for overbilling Medicare in Massachusetts. Not to mention the $10 million settlement they paid in May for giving kickbacks to physicians in exchange for referrals in Florida.
and that's just in the last two months.

(Corruption is apparently quite lucrative. Until you get caught.)
What baffles me is how does this work? Do people actually sit around a table in an office or conference room and discuss providing kickbacks for referrals or other forms of corrupt behavior. I mean it just can't be one or two folks can it? How can they do this? I know I am sounding naive and disingenuous but, even as I apprehend that this is the way the world works I don't comprehend it. The mechanics baffle me. "Hey, here's some cash, give me some business." Or, "hey, here's a free trip!", yadayadayada. Somebody didn't raise them very well in my estimation but it sure seems to be pretty common.

David

Snoozin' Bluezzz · Post by **Snoozin' Bluezzz** » Sun Jun 18, 2006 8:08 pm

I am such a square, I really, really am! I'm also a chicken I guess. Even if I desired the 'cash' I know I am not smart enough, or saavy enough to get away with it. There are powers that be in this country that are powerful enough to completely bury their skeletons, hide their tracks and call in favors to cover their misdeeds but many Tom, Dick's and Harry's just aren't that smart or powerful (even though they seem to think they are) and they do get caught. Not enough I'll bet though!!!!

Well, c'est la vie huh?

David

3islesnotguest · Post by **3islesnotguest** » Sun Jun 18, 2006 8:45 pm

Jumping back a page to where someone was talking about how DME's supply more than just XPAP. That is totally true, but even there we need to be the ones informed and exploring the best options. My daughter has CP and has needed a wheel chair from a very early age, the first chair I knew nothing and let the dme choose it was ok, not a great fit, and that DME company (not the one I have to use for my xpap...) is great, but even as great as they are, for the next several wheel chairs I did the research into what was available, and what would fit my kid best and best serve her needs. I told them what I wanted and they got it and it works

Thats what I had to do with xpap. the first mask the DME chose, and it was a total failure. After that I researched, read posts here and at other sites, and in the end I just had to try stuff till I found what works for me.

We need to be allowed the choice of what to buy and where to buy it. The doc can set the pressures, write the RX, do the medical followup, but we have to be comfortable enough to be able to use it.

Jere · Post by **Jere** » Sun Jun 18, 2006 8:46 pm

That survey is pretty pointless, and it was probably written to fill some space in that august publication by a part-time free-lance hack trying to make a few bucks writing vanilla stories for industry rags. HOWEVER, it was fun to write my personal views regarding where my DME can go and with who.

Guest · Post by **Guest** » Mon Jun 19, 2006 6:39 am

The biggest problem the local dmes face is the huge overhead they have to deal that the internet retailers don't. The traditional companies are regulated by state, local and industry agencies out the wazoo and back. They have to fight with doctors offices to try and get the right things ordered for the right patients.

They have to track equipment for years on end, track patients for years on end, get inspected regularly, maintain equipment for years etc etc. They have to send people out to patients homes, maintain 24hour a day service no matter what. They have to maintain licences both for the business itself and for the employees and all sorts of crap.

They have to provide equipment to patients and in many cases are not allowed by law to collect payment for that equipment if an insurance company denies the claim.

None of that excuses the aprias or any crappy companies. It does mean that the good companies out there are at a big disadvantage to the internet retailers who have zero overhead and dont face the same regulatory costs.

Its a hard question to answer - Should the intrnet companies be required to undergo the same requirements as the tradition companies. I know I can't think of any other industry where one side is required by law to carry all the extra costs that another side isn't.

snork1 · Post by **snork1** » Mon Jun 19, 2006 9:53 am

Anonymous wrote:The biggest problem the local dmes face is the huge overhead they have to deal that the internet retailers don't. The traditional companies are regulated by state, local and industry agencies out the wazoo and back. They have to fight with doctors offices to try and get the right things ordered for the right patients..

Seems like its the docs that have to fight the DME's to get the right things ordered according to most of the stories related here. An internet business is a business, and will have to operated under the same state and federal laws any other business is required to observe.

Anonymous wrote:They have to track equipment for years on end, track patients for years on end, get inspected regularly, maintain equipment for years etc etc. They have to send people out to patients homes, maintain 24hour a day service no matter what. They have to maintain licences both for the business itself and for the employees and all sorts of crap..

I can't even reach them at their office, certainly not on friday or weekends, much less get them to come to my home or get 24 hour service. I have spent more interaction time with GOOD on-line retailers than I have with DME's, unless you count the time the DME's keep me waiting in their offices. Tracking equipment? They seem to have no real clue as to what I have....and certainly no clue as to what I need. I never get reminders of being eligible for new masks or any extra services like that. The internet businesses have employees like anyone else and under the same laws.

Anonymous wrote:They have to provide equipment to patients and in many cases are not allowed by law to collect payment for that equipment if an insurance company denies the claim..

You mean all this time I have been paying that extra amount and don't have to? This should be really handy info, if its true, now that I have a high deductible.

Anonymous wrote: None of that excuses the aprias or any crappy companies. It does mean that the good companies out there are at a big disadvantage to the internet retailers who have zero overhead and dont face the same regulatory costs..

Seems like most of the legitimate internet businesses have to have a place to operate out of and hire employees and all that overhead stuff pretty much the same as any other business. The DME's certainly aren't paying extra for an advertising budget or anything. And I still can't figure out why the internet companies can manage to carry very adequate inventories of a variety of equipment but the local DME carries virtually ZERO inventory and takes weeks to get me the most basic item. That seems like the DME is trying to run it with a lot less overhead (i.e. inventory costs) than the internet retailer.

Anonymous wrote: Its a hard question to answer - Should the intrnet companies be required to undergo the same requirements as the tradition companies. I know I can't think of any other industry where one side is required by law to carry all the extra costs that another side isn't.

Or maybe the DME's should have to at least meet the same level of service and inventory as the internet retailers....