DME was PISSED.

[cinco777]

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.

Please note that the 90% AutoCPAP (Pressure) reported on the Respironics EncorePro (EP) Sleep Therapy Daily Details page is weighted by minutes at Pressure. To determine the 90th centile for pressure, the "minutes at Pressure" values are accumulated starting with the lowest pressure in the range until a pressure value is reached where the accumulated "minutes at Pressure" when divided by the total minutes at all reported pressures is 90% or greater. The data used by EP for this determination is shown in the Daily Events Per Hour table at the bottom of the Sleep Therapy Daily Details page.

A graphical representation of this 90% AutoCPAP determination is shown on the EP Summary of Daily Details page along with its data table (used to determine the 90th centile value).

Since I run my AutoCPAP with the same min & max pressure (of 8 cmH2O), I do not have the data to fully investigate the 7-day avg and 30-day avg LCD displayed values for 90% Pressure since, with a constant pressure of 8 cmH2O, my LCD always shows the 7 & 30-day avg 90% Pressure as 8.0 cmH2O.

However, based on circumstantial evidence including data residing in one of the EP SQL tables, I believe that the LCD displayed 90% Pressure numbers are weighted by minutes at Pressure and will, therefore, match those determined by EP.

In the quoted example above, if the minutes at pressure for pressure values of 1 & 2 total 90 minutes or more and the total minutes at all pressures (including the pressure values of 16 & 17) is 100 minutes, then the 90% AutoCPAP Pressure will be 2. Please note that if each value in the quoted set of numbers has the same duration, then the 90% AutoCPAP Pressure will be 16 (not about 16 but 16) since the last 16 value will correspond to 90% of the "minutes at Pressure" as it is 9th in a series of 10 values.

[JohnBFisher]

... Please note that the 90% AutoCPAP (Pressure) reported on the Respironics EncorePro (EP) Sleep Therapy Daily Details page is weighted by minutes at Pressure. To determine the 90th centile for pressure, the "minutes at Pressure" values are accumulated starting with the lowest pressure in the range until a pressure value is reached where the accumulated "minutes at Pressure" when divided by the total minutes at all reported pressures is 90% or greater. The data used by EP for this determination is shown in the Daily Events Per Hour table at the bottom of the Sleep Therapy Daily Details page. ...

cinco777, that's a great post with excellent detail. I didn't go too deep since my intent was only to explain why the user might want to track both the mean and 90th percentile. Think of it as manager speak. Since I my professional life requires me to provide detailed performance analysis, I can get deadly dull going into the detail of statistical analysis. I try to avoid that.

However, you did an excellent job of providing additional detail. It helps all of us better understand the different values that are presented to us. Thank you. I learned. And I'm certain others did as well. It's one of the reasons I enjoy reading and contributing to this forum.

[DreamOn]

You're lucky, my DME charges me $270 for ANY mask and headgear that goes out the door.

Wow!

[Cavallo]

cinco777, that's a great post with excellent detail.

Agreed. Awesome. Thanks.

[stacia123]

Cavallo, I had the same problem. I had to talk my DME into getting me the CPAP I wanted, they even tried to give me a cheaper kind hoping I wouldn't notice. Lots of accusations about how suspicious they were of the kind I wanted, and they also said "patients should be reading their own data". I suspect they were upset because they know doctors will order less sleep tests if there is data from the machine they can use instead, and I know they get a ton of profit from a sleep test.

And rjjayrt's comment about lack of profit on other products is ridiculous. See the other post I made tonight about how my DME charged me $58 for 2 replacement filters that I could have (and should have) gotten online for under $5.

[plr66]

You will hear about problems with DME's but remember no one really posts when they have a good experience and we should.
Gerry

Well that's not really true, Gerry. But the focus does often center here on helping folks troubleshoot the seemingly more predominant conflicts and problematic encounters with DME's.

[Gerryk]

I believe you did the right thing and it appeared they were really in the wrong unlike me.
I gave my dme another chance too in the beginning. Anyway, looking back the problem was caused by them and me. On my part because I was ignorant to everything sleep apnea and cpap. On their part for not taking ten or fifteen minutes more to explain things. Unfortunately I failed at cpap after trying for several months. I just gave up and packed it all away one night.
I didn't go back until about 4 years later when my doctor said I had to or I wouldn't see my son graduate from high school. When I went back the office manage was long gone, some of the better techs were now supervisors.

I am not on a first name basis with them and I never have a problem. I call for my supplies which are always waiting for me. I email my data to them and they are happy.


Just my two cents

Gerry

[DreamOn]

I believe you did the right thing and it appeared they were really in the wrong unlike me.
I gave my dme another chance too in the beginning. Anyway, looking back the problem was caused by them and me. On my part because I was ignorant to everything sleep apnea and cpap. On their part for not taking ten or fifteen minutes more to explain things. Unfortunately I failed at cpap after trying for several months. I just gave up and packed it all away one night.
I didn't go back until about 4 years later when my doctor said I had to or I wouldn't see my son graduate from high school. When I went back the office manage was long gone, some of the better techs were now supervisors.

I am not on a first name basis with them and I never have a problem. I call for my supplies which are always waiting for me. I email my data to them and they are happy.


Just my two cents

Gerry

Gerry,

I'm sure glad that you were willing to try CPAP again, after an absence of four years! I really feel for those people who struggle and just give up for good. It's so important to find a source of support and information, as we have here at this forum. If we had to rely soley on the doctors and DMEs to get us through successfully, there would be even more who give up.

My DME is also my sleep center/sleep doctor. I was shocked that the receptionist knew my name instantly when I showed up unexpectedly a few weeks after my first visit there. Maybe they have been talking about "that crazy lady" while I'm not there? They must not have many other patients who want to be intimately involved in their own therapy. When I insisted on having a fully data capable machine, the RT said he had supplied only one of those in the last seven months he's worked there! Unbelievable. I hope all those people who have no idea how they're really doing are still using their machines.

~ DreamOn

[rjjayrt]

I can't speak for other DME's but some of these costs don't sound right to me. For example a FP FlexiFix 431 FFM costs me 180.00. Medicare reimburses 150.92 with a patient co pay of 37.72, leaving me with a 8.64 profitt. As I said before, reimbursement for machines is much higher profit of approx 500.00 per machine. Profit on Hosp bed is approx 80.00, oxygen machines (concentrators) when all incidentals are figured in is about 300.00. What I was trying to say is that we have to replace inventory with profits made. Cpap and Oxygen concentrators are big ticket items, the profit from them essentially pays for the other equipment we rent/sell along with salarys, vehicle maintenance, building rentals, insurance, surety bonds, accredidation ect. Profit margins are different from item to item. Note: there are some masks that the profit margin is much higher, these are usually lower end masks. The bottom line is that reputable DME's are and should be cost conservative. Thats why I try to match the machine with what the client perceives his needs to be. Before ranting all over me please see my previous posts. Essentially there are good DME's and Bad DME's. The bad ones should not be let off the hook for the way they conduct themselves. When dealing with a bad DME please contact your state regulator, medicare and there accredidation source, they by law have to give you these numbers. By doing this we may be able to curb some of this.

[DreamOn]

I can't speak for other DME's but some of these costs don't sound right to me. For example a FP FlexiFix 431 FFM costs me 180.00.

And that same FlexiFit 431 FFM is sold for $101.00 at cpap.com (https://www.cpap.com/productpage/fisher ... -mask.html), $79 less than your cost. Interesting.

~ DreamOn

[rjjayrt]

costs are different for "private buyers" and businesses. If I'm correct and I think I am, I can't buy for my business from the site you noted. We purchase our equipment and supplies direct from the manufacturer.

[DoriC]

rjjay, I'll probably get a rant too, but I thank you for bringing us into your world for a better understanding of how the business end works. As far as the "perception" of what a new patient might think he/she needs at the time,I'm not sure how much time even a good RT would have been prepared to spend with me before I could understand different machines, data-capabilities,mask choices, pressure settings,etc. In our case, I had already begun my education here so when the RT(a young part-time per diem hospital RN who was trained on the job as an RT at the DME the year before) came and brought us the M Series Plus and only the Quattro as prescribed by the sleep center dr who we never even saw, we had a "discussion" , she took everything back, we contacted our Primary who wrote a new RX for what we wanted, and when she came back with the new equipment and a fairly nice selection of masks 2 days later (with an "attitude" , I might add!), she turned her back so I couldn't see when she was setting up the machine. When I gently asked her to allow me to watch, she said it was against company policy. He,He, , she didn't know that I already knew how to do that, thanks to this forum, although it was quite awhile before I had the knowledge and confidence to do it. I was given no instructions except the On/Off button, Flex , HH settting, and how to fill the tank. It's funny that I can always remember and repeat those early days of our journey and DME experiences but can't remember what I did yesterday.

[rjjayrt]

every client/patient is different. I try not to let any patient leave without knowing what there doing within reason. I've had patients come back to have there cards downloaded and I've explained to them what the numbers mean. I must confess that I refer them to there physician when they have questions about increasing or decreasing pressures, but I do tell them if there numbers suggest a pressure change might be useful and why the numbers suggest it.

[DreamOn]

If I'm correct and I think I am, I can't buy for my business from the site you noted. We purchase our equipment and supplies direct from the manufacturer.

Yes, I understand that. But I would assume that cpap.com is buying direct from the same manufacturers, just as you are. So it's amazing that they're selling the same mask for $79 less than you're buying it for. I know about "loss leaders" in business, but that's a huge discrepancy. Just sayin'.

~ DreamOn

[DreamOn]

rjjay, I'll probably get a rant too, but I thank you for bringing us into your world for a better understanding of how the business end works. As far as the "perception" of what a new patient might think he/she needs at the time,I'm not sure how much time even a good RT would have been prepared to spend with me before I could understand different machines, data-capabilities,mask choices, pressure settings,etc. In our case, I had already begun my education here so when the RT(a young part-time per diem hospital RN who was trained on the job as an RT at the DME the year before) came and brought us the M Series Plus and only the Quattro as prescribed by the sleep center dr who we never even saw, we had a "discussion" , she took everything back, we contacted our Primary who wrote a new RX for what we wanted, and when she came back with the new equipment and a fairly nice selection of masks 2 days later (with an "attitude" , I might add!), she turned her back so I couldn't see when she was setting up the machine. When I gently asked her to allow me to watch, she said it was against company policy. He,He, , she didn't know that I already knew how to do that, thanks to this forum, although it was quite awhile before I had the knowledge and confidence to do it. I was given no instructions except the On/Off button, Flex , HH settting, and how to fill the tank. It's funny that I can always remember and repeat those early days of our journey and DME experiences but can't remember what I did yesterday.

Hi Dori,

I appreciate the presence of the DMEs here too. I just wish there were more out there that put the patient's well-being first.

I think that you and I agree that we would never have learned everything there is to know about our machines and monitoring our therapy without all the generous people on this forum. And we both agree that having that knowledge before even picking up our machine is ideal! Personally, I think a well-informed patient makes a better, more successful patient. I just wish "the industry" in general believed the same.

When I got my machine, the RT slipped me the "forbidden" Clinical Guide on the sly. I had to promise I wouldn't tell a soul. I appreciated the gesture, but didn't let on that I'd already read (and practically memorized) the manual, which I found online through this forum!

~ DreamOn