DME was PISSED.

[Cavallo]

I went to get my for-real machine this morning, and the RT was not at all happy about the fact that I had my doctor write a more specific prescription for the machine I wanted. She sounded as if she thought I'd betrayed some sort of unspoken trust. She used phrases like 'medical necessity' and 'doing me a favor.' She even explicitly stated that as a result, they wouldn't make as much money on the transaction! I explained politely but firmly that she was not, in fact, doing me any favors - she was providing me with a service for which I was paying. I went on to explain that she wanted to sell me a cheaper machine for the same price, and that as the consumer, if anyone had been 'betrayed' it was me. Finally, I explained that this was the machine I had intended to have before I even called her company, so it really had noting to do with her. This seemed to put her a little more at ease, and we began discussing my data. Eventually she calmed down, but JEEZ. Of all the freaking nerve!! If anything, I'm doing them a favor by allowing them to have my money. Sure, this doesn't entitle me to be a jackass, but at the very least, I would expect her to be appropriately servile.

Anyway, we looked at my data. It's the first I've seen it, since I haven't yet got a USB interface. While my 90th percentile as displayed on the LCD has indeed remained around 11, my median has stayed pretty solidly around 9 - my lab titrated value. Should I pay more attention to the median value than the 90%?

[Gerryk]

From what I understand the insurance companies and medicare will pay x amount for a cpap or auto it doesn't matter. So of course the DME wants to get that money and give you the cheapest machine they can it's pure profit. Once you step up to something like a bilevel or bipap then they insurance pays more.

And they are providing you with a service that you are paying for. Many people don't say anything and just get what they are given. At least she calmed down.

You may have just caught her on a real bad day. Seeing that she calmed down and was nice after that is a good sign. You will hear about problems with DME's but remember no one really posts when they have a good experience and we should.

Good luck with your treatment.

Gerry

[DreamOn]

I read so often about these DME intimidation tactics. It really irritates me! Like you said, YOU are doing THEM a favor by using their services at all. Would they rather you go elsewhere and not make any profit from you? I understand their motives, but if they were smart they'd have a better attitude so you'll continue to purchase from them in the future -- masks, supplies, another machine eventually. And refer your friends to them.

Sorry that I can't answer your specific question, but I know that someone else will. I just got a little riled up reading of your experience and had to vent!

Please let us know how you're doing. At least you got a great machine!!!

DreamOn

[desert rider]

I had a run in with my DME last week when I politely, but firmly, requested they swap out my entry level machine for a data capable one like I had asked when I initially met with them (I figured since the machine had a card in it, I'd figure out how to get the data out). They kept trying to blow me off, but I was firm. Finally the office manager came down and told me how crazy I was and that only professionals should view the data (except that even they didn't know how to view it--professionals).

I asked her if it was because of the money and offered her the chance to sell me the upgrade machine. I finally told her that it was clear to me that she wasn't there to listen--just to talk--and that I was surprised by her attitude towards customer service in this bad economy. I told her I'd be in touch with my doctor to see about taking my business someplace else.

I managed to get my doctor to write a prescription (not easy) and bought my new machine from cpap.com on Thursday. Yesterday I had the pleasure of returning my "dumb" machine to the DME. The woman who checked me in was stunned and asked me why. I told her to ask her office manager.

Your DME is lucky they managed to keep your business.

[Cavallo]

Your DME is lucky they managed to keep your business.

They are, but unbeknownst to them, I was motivated to keep them. I shopped around, and could have brought my rental down by almost $10/month, but that DME was considerably farther away. Proximity is key with gas this expensive. Fortunately, I have excellent people skills. I don't mean this to sound as sinister or self-aggrandizing as it doubtless will, but she calmed down because I wanted her to. If I felt the situation had warranted escalation to the point of me storming out of the office, I could easily have kept her riled up.

[DreamOn]

I don't mean this to sound as sinister or self-aggrandizing as it doubtless will, but she calmed down because I wanted her to. If I felt the situation had warranted escalation to the point of me storming out of the office, I could easily have kept her riled up.

You handled the situation very well. And you got what you wanted!

[carbonman]

Finally the office manager came down and told me how crazy I was and that only professionals should view the data (except that even they didn't know how to view it--professionals).

The woman who checked me in was stunned and asked me why. I told her to ask her office manager.

DR, I hope you have a feel for where I was coming from in my initial response to your first post.

It is just not right the way we are treated and what we have to do to get the best therapy we can.

[rjjayrt]

I certainly understand why you'd be upset over the treatment you received at your DME. Its only "good business" to provide the patient with what they want. There are certain factors that go into what machine your provided. #1 is your prescription. If your prescription is for a static pressure, your DME will almost always try to set you with a CPAP machine. Its my personal belief that all DME's should provide CPAP equipment that is fully data downloadable, regrettably some don't. Secondly is the cost factor. An Auto CPAP costs your DME more, therefore they receive less profit when setting one. Profit is not always a dirty word, consider this; your DME doesn't only do CPAP, they set all kinds of equipment from Oxygen to Hospital beds. The amount of profit gained from your machine is minimized somewhat by the lack of profit for your mask and tubing. The same gos for other equipment. When you consider the profits gained and the DME's outlays they don't make near as much as you'd think. My personal approach is to question the patient as to how involved they expect or want to be with there treatment. I explain what each piece of equipment will do and how it will affect them, and then we decide together which machine they should get. Also don't forget some sleep doctors order specific machines based on there ability to download and there personal preferences, some which may be legit, others not. Your DME's hands may be tied if this occurs. In all cases a DME should explain this to his client if theres a disagreement, and attempt to get a new prescription, if he can't then the problem would be with your physician not your DME...

[DreamOn]

I had a run in with my DME last week when I politely, but firmly, requested they swap out my entry level machine for a data capable one like I had asked when I initially met with them (I figured since the machine had a card in it, I'd figure out how to get the data out). They kept trying to blow me off, but I was firm. Finally the office manager came down and told me how crazy I was and that only professionals should view the data (except that even they didn't know how to view it--professionals).

I asked her if it was because of the money and offered her the chance to sell me the upgrade machine. I finally told her that it was clear to me that she wasn't there to listen--just to talk--and that I was surprised by her attitude towards customer service in this bad economy. I told her I'd be in touch with my doctor to see about taking my business someplace else.

I managed to get my doctor to write a prescription (not easy) and bought my new machine from cpap.com on Thursday. Yesterday I had the pleasure of returning my "dumb" machine to the DME. The woman who checked me in was stunned and asked me why. I told her to ask her office manager.

Your DME is lucky they managed to keep your business.

I keep reading similar stories over and over again. If I hadn't insisted on a machine capable of reporting full data, I would've come home with an Escape, and I would have NO idea how I'm really doing. If I had gone in without researching first, I wouldn't have known the difference.

It shouldn't be such a struggle! Not only do they not have the patient's best interest in mind, but it's like they want to keep us "dumb" about our own therapy too. Seems to me that an informed patient, with access to information to monitor their progress, is more motivated to continue with therapy. And they will come back to buy supplies and equipment in the future, and refer their friends. Argh!

I'm glad you have a good machine now, desert rider!

~ DreamOn

[JohnBFisher]

Anyway, we looked at my data. It's the first I've seen it, since I haven't yet got a USB interface. While my 90th percentile as displayed on the LCD has indeed remained around 11, my median has stayed pretty solidly around 9 - my lab titrated value. Should I pay more attention to the median value than the 90%?

'Nuf said about the attitude of the RT. Sure they don't make as much money. But if they help you, honestly answer your questions, then you will bring them continued business. The initial contact takes more time, but a new mask every six months should help. Oh, well.

About the numbers. If you don't mind, I'll jump in on this, because I do a lot of performance analysis and I think I can help explain why you need BOTH numbers.

Let's take two different sets of numbers. The first set is:

1, 2, 2, 2, 2, 16, 16, 16, 16, 17

Let's assume (unreallistically) that this is pressures. The total of these numbers is 90. The average (mean) value is 9. The 90th percentile is about 16. In other words, though the average is 9, to address most of the events, you need a pressure of 16.

Let's move onto the second set of numbers:

6, 7, 7, 7, 9, 9, 11, 11, 11, 12

This is much more like your case. In this case, the total of the numbers is still 90. But they are a completely different set. Though the average remains 9, the 90th percentile is around 11. So, though there is one event that is a little higher, most of the events are addressed by a pressure of 11.

So, your machine shows that it addresses most of your apnea and hypopnea events within a fairly narrow range of pressure. That is neither good, nor bad. It just shows the range is fairly limited.

On the other hand, during my last BiPAP sleep study they noted me snoring no matter how high they increased the pressure. So, in my instance, I would probably require a greater range to address my specific needs. It is neither good, nor bad. It just shows a broader range to achieve the same results - a good night of sleep.

Edit: Though that range can be used to help qualify the requirements for the proper machine. For example, my current BiPAP unit can only achieve a pressure of 20cm H2O. However, the AutoSV unit I tested recently can achieve a pressure of 30cm H2O. With my broader range, the AutoSV unit can better address my apneas and hypopneas.

Hope that helps explain why the machine manufacturer provides both the average and the 90th percentile number.

[DreamOn]

Its only "good business" to provide the patient with what they want....My personal approach is to question the patient as to how involved they expect or want to be with there treatment. I explain what each piece of equipment will do and how it will affect them, and then we decide together which machine they should get.

Well, then you seem to be the rare exception, rijayrt! I (and I would guess most people on this forum) were never asked these questions. Many (if not most) people were not given a "choice", even within the parameters of their doctor's prescription. And they were intimidated into feeling guilty for asking for more.

I fully understand the need to make a profit, but if an informed patient expresses an interest in monitoring their own therapy, then they should be provided with a machine that has that capability. We shouldn't have to feel like it's a fight to get what we feel we need. We're tired! And I can't tell you how many times people have been out-and-out lied to by their DME, who told them their Escape or Plus machine was "fully data capable". The number of hours used tells us nothing about how we're doing!

I'm obviously going through my "angry stage". I hope you understand my frustration.

~ DreamOn

[rjjayrt]

To be perfectly honest, if the machine is not fully data downloadable, its as useless for me as it is the client.

[carbonman]

Profit is not always a dirty word, consider this;

...HEY...consider this....it's my freak'n life.....

damn your profit margin.

I passed the anger stage long ago.

[Autopapdude]

rjjayrt wrote:
Profit is not always a dirty word, consider this;


...HEY...consider this....it's my freak'n life.....

damn your profit margin.

I passed the anger stage long ago.

AMEN--lest you think all DMes and RTs are altruists. They are business people--some good, some bad, some woefully ignorant. We put our trust in hands like that? Scary!

[Cavallo]

I certainly understand why you'd be upset over the treatment you received at your DME. Its only "good business" to provide the patient with what they want. There are certain factors that go into what machine your provided. #1 is your prescription. If your prescription is for a static pressure, your DME will almost always try to set you with a CPAP machine. Its my personal belief that all DME's should provide CPAP equipment that is fully data downloadable, regrettably some don't. Secondly is the cost factor. An Auto CPAP costs your DME more, therefore they receive less profit when setting one. Profit is not always a dirty word, consider this; your DME doesn't only do CPAP, they set all kinds of equipment from Oxygen to Hospital beds. The amount of profit gained from your machine is minimized somewhat by the lack of profit for your mask and tubing. The same gos for other equipment. When you consider the profits gained and the DME's outlays they don't make near as much as you'd think. My personal approach is to question the patient as to how involved they expect or want to be with there treatment. I explain what each piece of equipment will do and how it will affect them, and then we decide together which machine they should get. Also don't forget some sleep doctors order specific machines based on there ability to download and there personal preferences, some which may be legit, others not. Your DME's hands may be tied if this occurs. In all cases a DME should explain this to his client if theres a disagreement, and attempt to get a new prescription, if he can't then the problem would be with your physician not your DME...

I understand all of that, and I'm sure you personally conduct yourself as best you are able to balance the interests of your patients needs against the economic realities of your market segment. Unfortunately, not all DMEs are willing to involve the patient, preferring instead to pitch to the lowest common denominator. This is why I wrote a well reasoned letter to my doctor asking for a prescription for the machine I wanted, and explaining my rationale in detail. The doctor agreed readily. My DME reacted to the new prescription as if I had perpetrated some sort of personal attack, in an exchange that should be an impersonal business transaction. Further, I got a lecture about medical necessity. Sorry - but that's not up to her, or you. That's up to my doctor. If I explain my needs to my doctor, and s/he agrees with me, that's the end of it. Period. It then becomes the dispenser's job to dispense - not to tell me what my needs are.

What it boils down to is this - I honestly don't give a rodent's rectum what my DME's "needs" are. This is my body, and my money, and it's 100% about ME. In a matter like this one, where my health and even LIFE are in the balance, I will choose to spend my money as I see fit without any consideration whatsoever to corporate profit or shareholder value. I'm sure that for every patient like me, my DME has a dozen others who will passively swallow what they're told to, so I seriously doubt they are being materially harmed.