Medicare's Home Testing Proposal

[Slinky]

Well, as I remember it (its been several days since I read the proposal) Medicare would only pay for 12 weeks of therapy based on a home test. As I remember it, altho I was doing better, I wasn't doing all that great 12 weeks after starting therapy so I most likely would have been one of those who would have had to go in for an overnight sleep evaluation at the end of that 12 weeks anyway. Still it does sound like a less expensive way to at least find those few that DO respond quickly to mask and CPAP.

And it does make you wonder about how many poor souls will end up spending all 12 weeks (if they make it that long) at 4 cms to 20 cms of pressure!!

[Guest]

Medicare and most insurance companies already have the three month rent before purchase requirement. In common practice, someone from the Dr office or DME calls to say are you using it,is it helping and maybe does a QOL (quality of life) questionairre. The home testing isn't with autopap. The unattended sleep study data, would result in a prescription of cpap or bipap as a general rule.

The regulations just say that data from the cpap must show a specific level of compliance(X hours of use) to retain the cpap...so I guess at least the medicare beneficiary is assured of receving a fully data capable cpap.

The new part really is that the patient who has a prescription isn't forced to go to a sleep lab to have medicare equipment benefits.

[gregnga]

In Jan 05 I had a sleep study done. They gave me a CPAP machine (the usual DME rip-off game, I was too naive to know the difference). It was set at 8cm as prescribed. I didn't have much success with CPAP so I finally went to the sleep doctor about a year later and told him I was still tired all the time. He changed it to 10cm. That was a big improvement, although still not what I hoped for.

I found a new sleep doctor and several weeks ago. He told me I needed a new sleep study, which I had. When I went back, he told me very little about the sleep study results except to say "looks good" and I needed a new CPAP machine and hoses, which of course, he could supply. He didn't even give me a copy of the sleep study. I was wise to the game by now and declined. He set my CPAP machine at 7cm. I thought this was strange since I had terrible results at 8cm and better results at 10cm. I took the machine home and, with skepticism, used it at 7cm that night . I woke up the next morning and was so tired I could hardly make it to work. I was very irritated with the doctor. I suspect he set it low on purpose so I would have to come back 3 or 4 more times to have it increased.

I immediately went out and bought a new Remstar Auto C-Flex machine from CPAP.com that I just got last week. I saw the price list the doctor uses to bill the insurance company and the CPAP machine was $5000.

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[Slinky]

I beg to differ w/you. Medicare currently requires a 13 month capped rental, i.e. they rent for 13 months at which time, assuming the patient has been compliant, the xPAP becomes the property of the patient.

I was compliant. And I would have been absolutely DELIGHTED had I been able to convince Medicare to do the outright purchase of my CPAP at 3 months so I could have been rid of the sheister DME supplier who provided my Resmed S8 Elite!!! I am MUCH happier w/my new DME supplier I switched to as soon as my capped rental was completed.

And just because an xPAP can provide compliance data does NOT mean it is a fully data capable xPAP. Just because an xPAP has a data card or data card slot is in no way any indication that it is fully data capable.

Medicare recipients are no more likely to get a fully data capable xPAP than any other new or unsuspecting CPAP eligible patient.

[rested gal]

And just because an xPAP can provide compliance data does NOT mean it is a fully data capable xPAP. Just because an xPAP has a data card or data card slot is in no way any indication that it is fully data capable.

Slinky's right. A machine (the Respironics REMstar "Plus" machines, for example) can have a Smart Card stuck in it and all it will be recording is "hours of use" (compliance) -- not capable of recording "full data" at all. Full data being AHI and leak info, mainly.

Medicare recipients are no more likely to get a fully data capable xPAP than any other new or unsuspecting CPAP eligible patient.

Again, I think Slinky's right.

[lifeartist59]

I read several post about feeling better on therapy. How long does that take? I am 8 months in, still waiting to feel better. Actually several family members are noting less than positive changes. I am admittedly sleeping less, it takes a lot longer to go to sleep with the mask on my face and I wake up a lot more. Do I need to try something else, a new mask? I am a restless sleeper as it is, but really dont want to give up more of my sleep to this if there is an answer. Yes, doctors really don't have a clue at times either. I keep wondering, am I destined to be miserable with the therapy?

[Wulfman]

I read several post about feeling better on therapy. How long does that take? I am 8 months in, still waiting to feel better. Actually several family members are noting less than positive changes. I am admittedly sleeping less, it takes a lot longer to go to sleep with the mask on my face and I wake up a lot more. Do I need to try something else, a new mask? I am a restless sleeper as it is, but really dont want to give up more of my sleep to this if there is an answer. Yes, doctors really don't have a clue at times either. I keep wondering, am I destined to be miserable with the therapy?

Could be mouth leaking.....could be you need a different mask.....could be your pressure is too low. (among other possibilities)

Den

[sleepndeep]

This is a welcome change. Sleep Labs beware!

I own a sleep diagnostic company that specializes in in-home diagnostic testing. I also provide the treatment equipment to the patients as ordered. I will be offering type III (7 channel) at no cost if APAP is needed and only mark up equipment supply cost to 20% above wholesale, which includes follow up, billing, etc. . Total including type III (7 channel) test including board certified sleep physician interpretation, APAP, mask, humidifier, and all supplies will be under $1000.00 before insurance reimbursment. If Medicare or any other insurance reimbursing for in-home sleep diagnostic testing than total out of pocket will be under $800.00 after March decision. There will be an add in the local paper so if i am in your area you will see it. Cancel your in lab study and do it in your home "LESS HASSLE and LESS COST!"

[Slinky]

Thanks for your input, SleepNDeep, w/o identifying your area, etc. as it "could" have sounded like "advertising" if you had and we would have ignored your input.

[alv7722]

This discussion is right up my alley! Another earlier thread on this forum had a link to a study about just this subject. Inserted here is the finding of that study:

This study demonstrates that patients with OSA are capable of effective self-titration of CPAP treatment at home. The optimal CPAPs, defined by self-titration and by manual in-laboratory titration, were similar. Improvements in both subjective and objective outcome measures were fairly consistent and were similar in magnitude between self-titration at home and manual in-laboratory CPAP titration during overnight polysomnography. There was no clinically significant difference in any measured outcome between the two CPAP treatment modalities, and compliance with CPAP treatment was highly satisfactory on both study limbs.

My sleep quack was holding me up for another expensive sleep study for "titration". In the meantime, my OSA had becom markedly worse, to the point I feel I was in danger of actually dying from it, or at least having an auto accident. For sure I would have lost my job before he got to the "titration study". Other doctors and emergency would not help me because I was under his "care". The quack decided to "fire me" when I said I was going to seek an attorney's help in getting a prescription from my PCP. In the meantime, I found an ad on Craig's List, and got a brand new auto-m with heated humidifier. The price was even a little under cpap.com though I would have preferred buying from them!

I'm just thankful there was some avenue for me to do this, but it should not be that way. I am in the process of bringing a small claims suit against the sleep quack for what he charged me. I recieved no service or benefit from him for the $2,000 I paid him to that point. I am also going to ask for $3000 in punitive damages for the suffering, and risk to my life from his denying me needed treatment. He would not talk to me in 7 phone calls to his office and 3 to his answering service, now he can talk to a judge with me! Al V

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CPAPopedia Keywords Contained In This Post (Click For Definition): humidifier, cpap.com, Titration, CPAP, Prescription, auto

[GrizzlyBear]

Hooey, hot diggedy.

Go for the jugular - good luck. I only hope the outcome is worth the aggro.

These scumbags have got to be taught that we are paying for a medical service. This is not about whether or not the television they sell us works as they say or not. It is about a life saving treatment for a life threatening condition.

I've ranted heaps elsewhere about my view on this - treatment of life threatening diseases should not, in my opinion, be left to the fully private enterprise system. The life costs are far too high.

I know this is anathema to many in the US, as it is to at at least some in my country. But sometimes at least partially socialised medicine is necessary to protect the rights of disease sufferers - and in the case of my country, in regard to OSA (at least) it needs to be more socialised than it already is.

Otherwise we become economic victims as well as disease victims. And we simply should NOT have to put up with the garbage 'service' we are delivered by these people.

Regards,

GrizzlyBear