RESPIRONICS FISHER & PAYKEL MINIMUM INTERNET PRICING

[Snoozy Q]

DME Daddy, if I may add one more comment -- comfort issues loom large in making cpap a workable therapy. My experience has been that my DME did not adress comfort issues and did not seem approachable with comfort-related questions. I know that they didn't carry comfort-related products (like fleece hose covers or Pad-A-Cheek strap covers), and the hand-out they gave new patients had less-than-helpful advice on even the simplest things, like how to deal with rain-out ("run the hose under the blanket"). Meanwhile, internet providers (at least our host here) have provided information and a place to go to ask questions and get practical answers. And this service is provided free to all, whether you buy here or not. One more reason why, even if the prices were equal, I'd go with the internet provider.

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CPAPopedia Keywords Contained In This Post (Click For Definition): hose, CPAP, DME

[norm]

1. The brick and mortar folk cannot compete on price. They push Resmed and Respironics products. Resmed and Respironics thus need to protect them.

2. The Respironics policy may sound less draconian than Resmed's, but it will prevent comparison shopping on the internet. Respironics must have determined that the policy would be effective at hurting the internet sellers and at the same time would not look quite as bad to their customers (us). But I am all but certain that if it does not result in the anticipated end--steering business back to the DMEs--they will adopt a stricter policy.

3. It may be true that a wholesaler can purchase from Respironics and then resell to internet companies, but this will force up prices since the wholesalers have to make their profit too. So the internet companies will pay more for the machines they resell.

4. If the services the DME people are providing is worth the additional markup they charge (over the internet providers), let them just charge directly for the service. Why should there be a surcharge on each machine i purchase (I own three--one for travel and one for each of the two places I live) to help the DMEs provide services to new folks, services that at best I needed one time.

5. The "therapist" at my DME was helpful to me and seemed interested, but the 30 minutes or so he spent with me, and perhaps another 20 minutes of driving time and perhaps another 15 minutes of report writing, was not worth the extra $400 or so dollars they charged my insurance company over what the machine would have cost from an internet provider.

6. And I have found that cpap.com is extraordinarily helpful when I need help and a heck of a lot easier to get in touch with than my DME guy.

7. There is such a push these days for consumer driven health care, hoping that the patient who has "skin in the game" will make intelligent medical purchasing decisions. With sleep apnea, you have a pretty knowledgable group of patients, great on-line information (primarily but not exclusively from cpaptalk), and the results have been that we make good purchasing decisions. But the vendors and manufacturers don't want good consumer behavior--they want us to act the same way people act when they are fully insured and stupid purchasing decisions were made by others.

8. The real problem, I think, with Resmed and Repironics, is that if you want a machine with exhale relief, you have to go with them. They are, in effect, a duopoly. I have another machine I use for travel, and I like it, but it is not as comfortable to sleep with as my APAP with A-flex, or my Resmed CPAP, which has exhale relief. Resmed and Repironics can charge what they want for their machine, but if they charge too much the insurance companies won't pay for both the machine and the high DME markup.

[djtowle]

I really hate MAP policies. That said here is an internet example, I have no affiliation but I have bought from them before, of selling below the MAP.

http://www.surfremotecontrol.com/Mercha ... ode=MX-810

Click on the send an email to: link on the page and it sends you discount codes to get the 'real' price. Hopefully our internet CPAP providers will adopt a similar practice.

As to the DME Brick an mortars being paid for services rendered through built in high markups, I think it is just wrong. If they are providing a service it should be accounted for and paid for separately. A prescription for a drug doesn't include the doctor visit or tests done to determine if you need the drug (although one might think it would for the prices on some of those pills.) Installation labor isn't included (generally) on car parts. All this built in markup for 'service' breeds bad service. It is fully in the DME's interest to give you the equipment that costs them the least with the highest markup, and provide the least amount of service possible in order to maximize their profit margin. Ugh what a 'doomed for failure' system.

The current DME system seems outdated, outmoded, stale, impractical, expensive, and well just doesn't work. To see manufactures defending these policies is appalling. And speaking of service with very few exceptions I have generally received better, faster service from internet companies (not just cpap sales) then most of their Brick and Mortar counterparts.

[WNJ]

. . . All this built in markup for 'service' breeds bad service. It is fully in the DME's interest to give you the equipment that costs them the least with the highest markup, and provide the least amount of service possible in order to maximize their profit margin. . . .

Exactly!

These MAP manufacturers are providing an incentive to the brick-and-mortar DME's to provide minimal service by shielding them from competition.

Wayne

[NightHawkeye]

The first obvious unintended consequence of artificially high prices in a competitive marketplace is that it opens the door for competition.

The unintended consequence I'm enjoying the most, however, is that these actions clearly expose how artificial the prices are. As already noted by many, the manufacturers are desparately trying to rationalize the higher prices.

The big questions in my mind are what form the backlash will take and when. The thing about unintended consequences is they're sometimes hard to predict.


Regards,
Bill (who has disdain for ResMed and Respironics)

[tomkat]

Reading the letter from Respironics regarding pricing suggests a very easy solution to the MAP. CPAP.com and others in the interest of providing a reliable machine might "test" each unit for perhaps one hour or so and then list it as a "used" device. This allows posting a selling price on the web site and not violating any of the punitive restrictions that will go into effect on March 31, 2008.

[Guest]

tomkat: Manufacturers might just "revise" their policy to include both new and used (which they have every right to do) or they might just choose not to do business with someone (which is their right as well).

[Slinky]

Is the intent of these manufacturer policies to drive business back to the DMEs that was lost to the internet?

Why else? The local DMEs are the manufacturers' biggest customers.

Are internet retailers behaving badly towards patients or others, forcing the manufactures to take action?

I have Medicare and good secondary insurance, but those things that my insurance coverages don't cover (like xPAP software and reader, pulse oximeter, etc.) I buy online and I've been HAPPY w/the prompt service and willingness for returns from the online suppliers I've bought from. AND I get BETTER PRICES from online suppliers.

Readers who buy from the internet, will you move a greater percentage of your purchases to DMEs in the future?

To local DME suppliers? H*ll no!

Are these policies going to drive newbies back to DMEs?

Quite possibly if they haven't looked for and found the various apnea support forums. Those patients who haven't thought for themselves and rely too heavily on their doctors will go w/the local DMEs. As more and more patients realize the need to take an active part in their health care and to advocate for themselves they'll turn to the online DMEs. UNLESS they have GOOD insurance AND the local DMEs shape up and provide the service, products and education they use to justify their drastically higher prices.

Yes, I work in the industry and value your views. That is why I lurk here.

And that is why I've always appreciated your posts, DME Daddy. You've always been civil. You're interested enough in our opinions and experiences to spend time lurking or occasionally posting. You are welcome here anytime as far as I'm concerned.

[DME Daddy]

My thanks go out to all who addressed my questions. Brick and mortar CPAP companies seem to be more patient adversaries than patient advocates. Manufacturer's are attempting to level the field by knocking the internet down rather than raising the brick and mortars up. These new internet polices are going into effect early next week and will be most interesting to watch. This price fixing is going to change everything.

Two other brick and mortars I know are pleased with the internet policy changes and think it will wipe out the internet competition, which they blame for many of their problems. Both have already moved to the next issue, the low bids Medicare received for DME and are worried about staying in business.

Based on what you write, maybe websites have a chance, but it seems a long shot to me. I think most will die before the end of the year.

[Wulfman]

Well, I sent an e-mail to Mr. Pflueger, expressing my opinions (yes, I was polite) and pleaded with him not to implement these policies.....listing the reasons, such as people with little or no insurance coverage, etc. As expected, I haven't heard back from him.

We'll see what happens.

Den

[SleepyScot]

First of all I think there has been some great discussion here about the new MAP policies but, having read them all I would like to add a bit of something:

RESMED - First of all let's all remember that ResMed is the company that first jumped onto this bandwagon. Really the other companies are following them after, I'm sure, 18 months of hearing complaints from DMEs about ResMed doing all of this work for the DMEs and Respi/Fisher/etc doing nothing. ResMed's policy is laughable. They brand the companies that comply as "Preferred Internet Providers" and then treat them like dirt forcing the highest prices and the most limited product selection. Of course the funny thing is that CPAP.COM continues to sell ResMed products 2 years after being "cut off" and they obviously get their product from the same DMEs that complain about internet sellers!

RESPIRONICS - Mr Pflueger should be worshipped on these boards, not reviled. Okay, not worshipped but still... Read Respironics policy carefully. It is designed to cover ALL resellers, not just the internet, and it is designed to provide pricing flexibility. This is something that ResMed and Fisher are not doing. They are forcing prices to go up. Respironics is allowing prices to remain flexible at least, if not quite so open. While I do dislike the policy and everything it represents, in its present form it is the fairest one out there and the most flexible for internet resellers.

FISHER & PAYKEL - I really don't understand the F&P policy. It is a US only policy and an Internet only policy. It is very restrictive and is clearly aimed to shut down internet sales of F&P products in the US. From what I've read there is no way around it if it is enforced. F&P has done some great work in recent years to introduce innovation and flexibility and the sad thing is this policy will deny their work to many users. All in the name of "better serving our patients" as usual blah blah blah. (Remember when you boycott F&P to boycott all of their products, not just the sleep therapy division.)

OTHER VENDORS - The great news is that Puritan Bennett, DeVilbiss, AEIOMed and others all have great machines out there. The Sandman is down right sexy in my opinion. Sleep-Net, DeVilbiss, Somno have some great masks and I think over the next few years we'll see many other great masks come out of smaller companies who are willing to work for customers rather than for insurance companies and DMEs.

Quite a bit of bother just to get a good night's sleep isn't it!

[ozij]

Mr. Pflueger's response to Den - new thread

O.

[goose]

Broke down and ordered the HC150 HH from cpap.com before the price change....(could swear I had a promotion code, but sure couldn't find it!!!)

I hope public outcry will have some affect on these manufacturers policies, but my money wouldn't be on "we the people".....

Bottom line is, It is what it is........

cheers
goose