My visit to new sleep doctor

Hi, DO you have centrals that you've been made aware of (prior to this)? Your new doctor sounds like he's going to take the system for everything he can - either that, or he's not able to see (without more testing) that you've been managing well as things stand, or else he's a total stickler for perfection, but somehow I don't get that feeling (a kind of take-your-time confidence) but one of grab you as a patient while he can. Do you think you need a new study?

Along the lines of what Julie wrote......I think your new doctor smells the opportunity to make some more $$$$$.$$ (just by the fact that you're a new patient to him and that he CAN order a new sleep study).

We have no idea what your Encore reports look like, but YOU should be able to see if there's anything in them that indicates or warrants some suspicion on his part about Centrals.


Den

Patrick A wrote:...need to read my first sleep study and see what it says. Also the new doctor was livid that they never followed thru with and never and ordered another study 120 days after the original sleep study as written in the original sleep study request. Also he said that the original perscription for the machine was for a CPAP to see how I tollerated CPAP and then in 120 days for a Bi-Pap machine...

If I were in your situation, I'd get a copy of the original study and verify it does say switch to BiPAP in 120 days (maybe new doc's staff would give you a copy)...maybe you had centrals -- only seeing the study results will confirm this. I'm impressed with his efficiency...that so much was accomplished in so little time! Sounds like a keeper to me, esp calling APRIA and chewing them out.

Re the new study, if you did have centrals in the study, seems smart IMHO to collect current data and then determine the right therapy...our therapy requirement for treating sleep apnea change over time and maybe you really do need a servo ventilator (SV) machine now, maybe not, need sleep study data. My sleep doc wanted me to have another study (on unemployment I couldn't afford the co-pay) during my backsliding adventure last Spring & Summer. So, he loaned me an APAP set wide open (4-10) and a recording oximeter to see my numbers for 5 nights; afterwards, he wanted me on an APAP as my pressure needs varied quite a bit over those 5 nights but insurance denied his assesement of medical necessity, so we just set my CPAP to the a new lower pressure (losing wt opened my airways some). I ended up buying an APAP myself and love it. But my needs are simple compared to yours Patrick, I wish you good luck in finding effective treatment!

Wulfman wrote:Along the lines of what Julie wrote......I think your new doctor smells the opportunity to make some more $$$$$.$$ (just by the fact that you're a new patient to him and that he CAN order a new sleep study).

We have no idea what your Encore reports look like, but YOU should be able to see if there's anything in them that indicates or warrants some suspicion on his part about Centrals.
Den

Julie wrote:Hi, DO you have centrals that you've been made aware of (prior to this)? Your new doctor sounds like he's going to take the system for everything he can - either that, or he's not able to see (without more testing) that you've been managing well as things stand, or else he's a total stickler for perfection, but somehow I don't get that feeling (a kind of take-your-time confidence) but one of grab you as a patient while he can. Do you think you need a new study?

From reading the print out of the Encore report to me shows perfect compliance for a date range 12/20/2008 to 12/09/2009 Days of device useage 352 days. Days without Device useage 3 days.Percent days with Device Useage 99.2%, Cumlative Useage 2868 hrs. 38 mins. Maximum Useage (1day) 12hrs. 21 mins.Average useage (All Days) 8hrs. 5 mins. Average Useage (Days Used) 8hrs. 9mins. Minimum Useage (1Day) 5hrs. 29 mins.Percentage of days with useage >=4 hours 99.2% Percent of Days with Useage <4 hours 0.8% Total Blower Hours (During reported Period) 2868 hrs. 48 mins.
Maximum Titrated IPAP Pressure 23.0 cm H2O
Average Device IPAP Pressure <=90% of Time 18.3 cm H2O
Maximuum Titrated EPAP Pressure 20.0 cm H2O
Average Device EPAP Pressure <=90% of Time 15.1 cm H2O
Average Time in Apnea pre Day 40.8 secs.
Averag Time in Large Leak per day 6.6 mins.
Average AHI 1.8
So I guess he see's a way to make some money. But being as it's almost ttime to get a new machine from Medicare maybe he's right about the new study.

This just doesn't sit right. For one thing, true central, or even mixed apnea is RARE except for the normal few most people have on orig. studies. I can't see your first doctor not picking up on them or telling you about them at the start. What I do see reminds me of a urologist I know who, when I had a routine cystoscopy, proceeded to try and scare the daylights out of me saying I should come back every six months because I could get cancer (no medical reason to have said so though!). Well I haven't been back to him since (6 yrs at least) and everything is just fine. Having backed up, or felt loyal to so many doctors after working in hospitals forever, there are still those that deserve no loyalty and should be drummed out. But that's just my 2 c's worth .

Patrick A wrote:

Wulfman wrote:Along the lines of what Julie wrote......I think your new doctor smells the opportunity to make some more $$$$$.$$ (just by the fact that you're a new patient to him and that he CAN order a new sleep study).

We have no idea what your Encore reports look like, but YOU should be able to see if there's anything in them that indicates or warrants some suspicion on his part about Centrals.
Den

Julie wrote:Hi, DO you have centrals that you've been made aware of (prior to this)? Your new doctor sounds like he's going to take the system for everything he can - either that, or he's not able to see (without more testing) that you've been managing well as things stand, or else he's a total stickler for perfection, but somehow I don't get that feeling (a kind of take-your-time confidence) but one of grab you as a patient while he can. Do you think you need a new study?

From reading the print out of the Encore report to me shows perfect compliance for a date range 12/20/2008 to 12/09/2009 Days of device useage 352 days. Days without Device useage 3 days.Percent days with Device Useage 99.2%, Cumlative Useage 2868 hrs. 38 mins. Maximum Useage (1day) 12hrs. 21 mins.Average useage (All Days) 8hrs. 5 mins. Average Useage (Days Used) 8hrs. 9mins. Minimum Useage (1Day) 5hrs. 29 mins.Percentage of days with useage >=4 hours 99.2% Percent of Days with Useage <4 hours 0.8% Total Blower Hours (During reported Period) 2868 hrs. 48 mins.
Maximum Titrated IPAP Pressure 23.0 cm H2O
Average Device IPAP Pressure <=90% of Time 18.3 cm H2O
Maximuum Titrated EPAP Pressure 20.0 cm H2O
Average Device EPAP Pressure <=90% of Time 15.1 cm H2O
Average Time in Apnea pre Day 40.8 secs.
Averag Time in Large Leak per day 6.6 mins.
Average AHI 1.8
So I guess he see's a way to make some money. But being as it's almost ttime to get a new machine from Medicare maybe he's right about the new study.

The data you quoted is just "summary" data. The real "evidence" for possible Centrals would be in the "Daily Details" in your Encore reports......like NR events.....and then there would need to be "a number" of them to be of concern (a couple here and there shouldn't necessarily be of concern).

On the other hand, your AHI is pretty good and your "Average Time in Apnea" ain't too bad......maybe an average of 3 or 4 apneas per night (at 10 - 12 sec. per event.


Den

Patrick A wrote:Also what kind of pull does this doctor have with Medicare and BC/BS FEHB, to get this authorized in less than 2 hours. He also have his own sleep study lab onsite.

Bells should be going off in your head. Do you know what BOHICA means?

Do you think someone who owns his own sleep labs can and will be unbiased in your care and treatment??

Patrick A wrote: He also stated that after 5 years it was time to have a new sleep study.

Because insurance will pay again AFTER 5yrs. They all try to tell you after 5yrs you NEED another. Are you starting to see a pattern here?

BOHICA

Do YOU think you need to go again?

GumbyCT wrote:

Patrick A wrote:Also what kind of pull does this doctor have with Medicare and BC/BS FEHB, to get this authorized in less than 2 hours. He also have his own sleep study lab onsite.

Bells should be going off in your head. Do you know what BOHICA means?

Do you think someone who owns his own sleep labs can and will be unbiased in your care and treatment??

Patrick A wrote: He also stated that after 5 years it was time to have a new sleep study.

Because insurance will pay again AFTER 5yrs. They all try to tell you after 5yrs you NEED another. Are you starting to see a pattern here?

BOHICA

Do YOU think you need to go again?

I agree with Gumby. My ex-sleep doc did the same thing - ordered additional sleep studies for me (in his own lab, of course). Granted, my treatment was going very poorly (thanks to him!), so he could justify the "need" for additional studies. A data-capable machine would have allowed me to tweak my therapy, but he wouldn't make the effort to get me one, and I was a naive newbie who got saddled with a Plus machine (and crappy therapy) for 16 months.

It was far more lucrative for him to rack up the office visits, the APAP trials, and the sleep studies than to take an interest in actually solving any of my ongoing therapy problems. CHA-CHING!

My advice to you, Patrick: RUN!

we need someone with medicare knowledge to post - I thought that if you were on medicare then the doc you see can't send you to his own DME (one he makes money at) - might be similar statements about the lab ------ someone needs to get slinky or akcpapguy in on this thread for their expertise on these matters

Bells should be going off in your head. Do you know what BOHICA means?

Do you think someone who owns his own sleep labs can and will be unbiased in your care and treatment??

Patrick A wrote:
He also stated that after 5 years it was time to have a new sleep study.
Because insurance will pay again AFTER 5yrs. They all try to tell you after 5yrs you NEED another. Are you starting to see a pattern here?

BOHICA

Definite Bohica. Absolutely sounds like crap to me. So many alleged "sleep specialists" lack any common sense to sit down and TALK sensibly to OSA patients. My original Sleep MD was exactly like that, so I sought out doctors with more compassion and willingness to talk, as opposed to running tests. You don't necessarily need a sleep doctor to interpret OSA data--a lot of good IM doctors have sufficient expertise so as to make good advisers in matters of sleep therapy. Run from this dude---he sounds like bad news!
http://www.urbandictionary.com/define.p ... .O.H.I.C.A

jules wrote:we need someone with medicare knowledge to post - I thought that if you were on medicare then the doc you see can't send you to his own DME (one he makes money at) - might be similar statements about the lab ------ someone needs to get slinky or akcpapguy in on this thread for their expertise on these matters

They can not send you to any sleep lab or pharmacy they have a financial interest in . Acording to California law.

Patrick A wrote:

jules wrote:we need someone with medicare knowledge to post - I thought that if you were on medicare then the doc you see can't send you to his own DME (one he makes money at) - might be similar statements about the lab ------ someone needs to get slinky or akcpapguy in on this thread for their expertise on these matters

They can not send you to any sleep lab or pharmacy they have a financial interest in . Acording to California law.

If that's the case, how can this new doc order a sleep study for you in his own lab and have it covered? Maybe I missed something.