Becoming VERY disillusioned with my DME (i.e. my employer)

BrianRT · Post by **BrianRT** » Mon Oct 08, 2007 1:25 pm

Well I had thought I worked for a pretty decent 'mom and pop' DME that did things a little different and went a little further for the patient than most of the others.

However, an order came from a doc's office to set a patient up on an auto w/ a-flex. Knowing this doc, the auto is 'to keep' instead of a loaner for a month or two to ascertain data and avg pressures like most cases in the past (with the patient ending up with a standard CPAP with the pressure set from the auto report or retitrating their old CPAP with the new info from the auto)

This doc is an awesome sleep doc who reads his own patients' cards so that's why I think it's to keep.

The owner has just implemented a new policy, brought about by this order that any patient who is ordered an APAP 'for keeps' will be charged a $200 upcharge fee. Of course, this is out of pocket. This is implemented to help protect the DME's bottom line from the reduced reimbursement that an AUTO costs them versus the base model (in our case a DS100H)

Oh, and that's not all, the owners just got back from Medtrade in FL. They ordered about 30 Fischer/Paykel HC230 CPAPs for patients who have insurance that doesn't reimburse very well (like United Healthcare)
Evidently the HC230 costs us less than the base model DS100H from Respironics.

All of this is very nauseating. One more DME finally succumbing to the Dark Side ($$ vs. patient care and satisfaction)

Kind of makes going back to critical care at the hospital look a little more appealing

Wulfman... · Post by **Wulfman...** » Mon Oct 08, 2007 1:36 pm

Sorry to hear that Brian.

BrianRT wrote:All of this is very nauseating. One more DME finally succumbing to the Dark Side ($$ vs. patient care and satisfaction)

Or, said other ways.....
$crew the patients and their insurance and take all the money you can get!
On the list of priorities, their health/therapy is far below our profits.

Bummer.

Den

Guest · Post by **Guest** » Mon Oct 08, 2007 1:40 pm

Could be in trouble charging extra if the patient has medicare.

Guest · Post by **Guest** » Mon Oct 08, 2007 1:52 pm

Hey Brian, I'm sorry to hear this from YOU, one of the best RT's on the planet!!!!!

Of course, being the Devil's Advocate, I'm thinking something else... Maybe they need to try to recoup the cost of keeping you on staff and paying your salary and medical benefits? A $200 OOP isn't that much for a big-ticket medical item. I'm paying nearly that for a stupid mouth guard from my dentist. That's ON TOP of what my insurance paid.

So... maybe talk to them about that? Everyone's costs are rising - my rent just got raised. Maybe their property taxes got raised, maybe their costs for other things got raised.

At least they aren't DENYING patients the ability to get APAPS!!!!!

Okay, enough Devil's Advocate work for one day.

GO GET SOME WAFFLES!!!!!!!!!!!!!!!!!!!!

Huggers,
Barbara

BrianRT · Post by **BrianRT** » Mon Oct 08, 2007 1:53 pm

That's a good point, guest. I'm also wondering if the private insurances wouldn't take issue with the fact that, in essence, the DME is not taking what the insurance considers "allowable" by charging the patient for more. For a provider that is 'in-network' with an ins. co, this is a no-no per their contract. (at least that's what I've heard, but I'm just an RT, not a bizness man)

Guest · Post by **Guest** » Mon Oct 08, 2007 1:59 pm

Sooner or later the insurance companies, and probably medicare too, will start listing apaps separately as is done with bipaps. Betch! When the DMEs and insurers holler enough.

Aged cynic.

Slinky · Post by **Slinky** » Mon Oct 08, 2007 2:08 pm

It is obvious how sick at heart you are w/this turn of events, BrianRT. Darn the xPAP manufacturers that turn out this trash for CPAPs. I fail to understand the cost savings per unit once the initial cost of building the unit is met to not add the full data capability. I wish just one manufacturer could look me straight in the eye and give me a straight, truthful answer of the additional cost of full data capability. "Ain't" a gonna happen but one can wish!!!

BrianRT · Post by **BrianRT** » Mon Oct 08, 2007 2:12 pm

Oh Babs, my little IHOP hottie.....hugs to you, I know it's been a while.

I understand about covering the costs as it seems everything is going up (esp our health benefits)

That would certainly be the reason they would give. I suppose in my view of it, they sure make enough jack off of all the others (base model PAP setups) to offset the occasional "APAP for keeps" that we see. What it does is paint us (them) as money grubbing, stick it to the patient people just so we can buy a boat and then pay cash for a Nissan Titan to pull it with (like the owner just did )

Guest · Post by **Guest** » Mon Oct 08, 2007 2:17 pm

Oh WELL! He drives an SUV? KILL HIM!

Okay, enough sympathy from ME! (To your boss, not to you) I say.... Uh, I got no good advice. You got a mortgage and kids to feed.

Well, I don't fault you for being the one good egg in a bad clutch. Any chance you can strike out on your own and start your own DME? I see that it requires no licensing, no education, and apparently no ethics to start one...

Maybe you could be the virtual RT for cpap.com?

BTW, sorta tangent-topic.... I just signed up another homeless family for services. My kid count since 09/05/07 is now 110 homeless kids. These three kids are the children of a single mother. Who lists her occupation as "CSR at Apria".

Don't be that woman, Brian! You keep your job and know in your heart you do good work!!!!!!

Huggers,
Babs

BrianRT · Post by **BrianRT** » Mon Oct 08, 2007 2:30 pm

Anonymous wrote:Don't be that woman, Brian!

Now THAT made me laugh out loud!

Yep, the mortgage and kids.....ever see "Thank You For Smoking"? with Aaron Eckhart?? It's a really cool movie and the line about "everybody has to pay their mortgage" is in it, several times

I like the idea of the virtual RT for CPAP.com, if it wasn't for the fact that so many of you guys do it better than I do

Oh well, just thought I'd add that story to the "just when you've thought you've heard it all about DMEs" pile (and it's a steaming pile too)

rested gal · Post by **rested gal** » Mon Oct 08, 2007 2:40 pm

Brian, you're a "good'un." Sorry to hear that the guy you work for is rolling the wrong way.

BrianRT wrote:ever see "Thank You For Smoking"? with Aaron Eckhart?? It's a really cool movie

I did. Loved it. Which is kind'a ironic.

oceanpearl · Post by **oceanpearl** » Mon Oct 08, 2007 3:05 pm

What you should do is quit! Go out tomorrow and open your own shop. You don't have to invest any money, rent a building, train people, buy equiptment, pay the utilities, ete, etc, etc......Then you can set around on your butt, get rich and not do anything for anybody.......and laugh all the qay to the bank or at least that's how some on this board would want you to believe it.

RosemaryB · Post by **RosemaryB** » Mon Oct 08, 2007 5:33 pm

This just makes me very sad .

I think it's a culture. They go to Medtrade and everyone there justifies this stuff. Since it's a way to afford the boat and the new car, they will then start doing things against their own moral judgments. It's a slippery slope.

I just hate to see patients with these cheapo machines. Very frustrating.

I think the MD's need to step in here and insist on the good treatment for their patients. I think it will just keep getting worse until they do.

BrianRT · Post by **BrianRT** » Mon Oct 08, 2007 5:45 pm

oceanpearl wrote:What you should do is quit! Go out tomorrow and open your own shop. You don't have to invest any money, rent a building, train people, buy equiptment, pay the utilities, ete, etc, etc......Then you can set around on your butt, get rich and not do anything for anybody.......and laugh all the qay to the bank or at least that's how some on this board would want you to believe it.

I'm not really sure how to take your post, oceanpearl, since the Net can make it hard to diffrentiate sarcasm from sincerity. I'm guessing though that you're saying that there's a lot to running a DME and that charging the $200 upcharge is part and parcel with 'business'

Just clarifying before I respond to the wrong intent

Sleepdeprived · Post by **Sleepdeprived** » Mon Oct 08, 2007 6:00 pm

[quote="BrianRT"]Well I had thought I worked for a pretty decent 'mom and pop' DME that did things a little different and went a little further for the patient than most of the others.

However, an order came from a doc's office to set a patient up on an auto w/ a-flex. Knowing this doc, the auto is 'to keep' instead of a loaner for a month or two to ascertain data and avg pressures like most cases in the past (with the patient ending up with a standard CPAP with the pressure set from the auto report or retitrating their old CPAP with the new info from the auto)

This doc is an awesome sleep doc who reads his own patients' cards so that's why I think it's to keep.

The owner has just implemented a new policy, brought about by this order that any patient who is ordered an APAP 'for keeps' will be charged a $200 upcharge fee. Of course, this is out of pocket. This is implemented to help protect the DME's bottom line from the reduced reimbursement that an AUTO costs them versus the base model (in our case a DS100H)

Oh, and that's not all, the owners just got back from Medtrade in FL. They ordered about 30 Fischer/Paykel HC230 CPAPs for patients who have insurance that doesn't reimburse very well (like United Healthcare)
Evidently the HC230 costs us less than the base model DS100H from Respironics.

All of this is very nauseating. One more DME finally succumbing to the Dark Side ($$ vs. patient care and satisfaction)

Kind of makes going back to critical care at the hospital look a little more appealing

Becoming VERY disillusioned with my DME (i.e. my employer)

Becoming VERY disillusioned with my DME (i.e. my employer)

Re: Becoming VERY disillusioned with my DME (i.e. my employe