Things to come

[Vasily]

Well I had a 2 hour conversation with a friend of mine who works for one of the major CPAP (I'm sure by the end of my post you will figure out which one) suppliers. He filled me in on a few things that may be coming down the pipeline in the future which may not affect current CPAP users, but will definitely affect those in the future.


1. Insurance companies are on the push now for better, and more accurate compliance information. Many are asking for printed hard copy compliance reports that may be directly tied to the continued rental of a machine. I can confirm that currently some of the insurance companies I work with have moved to a 13 month capped rental and are asking for compliance numbers about every 2-3 months. I have only had requests from 2 of them for hard copy data from machines.

So what do I think this means for the future? Well the first impact I see is that people will be a little more hard pressed to change the pressure on their machines because "Big Brother" the insurance company will be watching. Ofcourse this really only affects those people who HAVE (for lack of personal funding or whatever) to use their insurance to get their machines. This also may affect those who do a self purchase and attempt to self bill to their insurance. There are other concerns ofcourse, but I'm sure those will surface in the insuing discussion.

2. There is no new ****** PRO software for patients coming! I asked him this direct question, and the answer was no. There will however be new software out for Clinicians which will be more secure and web based so the data can be viewed from multiple sites other than the download site, provided the person has the proper credentials. Each site will control access and credentials for it's database.

With those things said, I must say that while I don't agree with the intentions behind the push for more accurate compliance data. It is my opinion that the insurance companies are simply looking for an opportunity to not pay a claim. However with that said, I think that it will have an overall positive effect on patient compliance (Now everyone will atleast receive a machine with exhale relief) and overall patient comfort.

It is sad that it had to come down to the insurance companies trying to save a buck for changes like this to happen, but atleast it's progress, however small it is.

Oh and I should mention that he didn't have a time frame, but just that the pressure is on.

[Snoredog]

thanks for the info,

but I say screw the insurance companies, they are the very reason compliance is so poor to begin with. IF compliance was only 20% they would be even more happy, it means they pay out less, they will take their chances on if a patient ends up with a heart attack or stroke.

This compliance thing is so they can stop paying rentals.

I think insurance should rely on reimbursement only, allow the patient to purchase the machine of choice instead of that stripped down crap with no features.

[Slinky]

I fail to see where

... now everyone will at least receive a machine with exhale relief and overall patient comfort.

My sorry excuse for a DME supplier's only compliance data proof is a form letter from them telling me to sign that I have been compliant w/CPAP therapy and return it to them ASAP. And I've had my CPAP since October 2006. They've never done a download from my machine.

Sometime after their "compliance" letter my doctor did order a loaner autoPAP for 2 weeks and this DME supplier did do the download from that so they would have the compliance data proof from that auto. But that loaner was AFTER the time period they needed to establish compliance.

... 2. There is no new ****** PRO software for patients coming! I asked him this direct question, and the answer was no. There will however be new software out for Clinicians which will be more secure and web based so the data can be viewed from multiple sites other than the download site, provided the person has the proper credentials. Each site will control access and credentials for it's database.

Resmed has the jump on Respironics on the web based data site:

ResTraxx™ System

Web-based Patient Compliance Monitoring

The ResTraxx System is the first of its kind for wireless, remote monitoring. It is designed and developed by ResMed, global leaders in sleep and respiratory medicine.

Web-based monitoring in three easy steps
* Check on all your patients at a glance.
* Zoom in for more information.
* Quickly identify causes of non-compliance.
Exception reporting: the smart way to manage multiple patients
* Easily identify those patients who fall outside desired thresholds for usage or mask leak.
* Focus your efforts only on those patients who require intervention.
ResTraxx Wireless: unmatched benefits
* Simplify data capture—no need for phone lines, modems, cards and readers; less reliance on patients for data transfer.
* Improve staff efficiencies—reduced patient and physician phone calls; no need for reminder calls or home visits to retrieve data.

[DreamStalker]

I think the PAP manufacturers are between a hard place and another hard place. As SD noted, the insurance companies are looking for a way to increase their profits by having more options to turn down claims. The DME companies are looking for a way to increase their profits by making patients rely more on them for PAP treatment.

THe PAP manufacturers are trying to please both industries in order to maintain or increase their own profits ... to hell with patient health ... I still think corporate profits are an evil vice.

[Slinky]

Amen, DreamStalker!!

I wish I had cut it out and kept it but about 15-20 years ago Kiplinger's had a quote from one of the old "robber barons", J P Morgan, Rockefeller, I don't even remember who now, to the effect that any man who made more than 10% profit on his customers was screwing them.

[snoregirl]

Maybe this makes an opening for one of the lesser known companies to make a cpap that we, the user want and can use (with data). In the future if that happens, that company will have my attention and business.

[DawnTCB]

Well, I personally agree with the idea of insurance checking patient compliance before buying their machine... I am not sure why that is a bad thing? Without checking for compliance, one could get the machine paid for by insurance, sell it, and pocket the proceeds very easily.

My insurance requires me to rent and use the machine (4+ hours per night) for 90 days and then they will pay for it. Apparently, according to my DME, people who are going to quit using it will generally have quit by 90 days, so the insurance companies are pretty safe by that point.

Is the negative point that your DME or sleep doctor might see you have made some adjustments on your own? Or is it that patients should not have to prove they are using the machine before it is purchased? I don't understand...

On a slightly different but related topic, I was speaking to a pediatrician yesterday about sleep apnea, who said this:

Everyone and their uncle has a CPAP machine these days and almost no one is using them. They should never have gotten one in the first place if they aren't going to use it. It's just wrong. Giving out a CPAP machine is the "hip" thing to do these days but no one really pays attention to whether the treatment is working.

I am not sure what I think about that, as my experience has been so different. I am the only person I know IRL who has an xPAP, and I feel like my sleep doctor has been monitoring, even perhaps overmonitoring my treatment. But this doctor evidently has the impression that there are lots of dusty CPAPs out there which insurance paid for and they aren't being used at all.

Do you guys have an opinion about that?

Dawn

[Guest]

I fail to see where

... now everyone will at least receive a machine with exhale relief and overall patient comfort.

My sorry excuse for a DME supplier's only compliance data proof is a form letter from them telling me to sign that I have been compliant w/CPAP therapy and return it to them ASAP. And I've had my CPAP since October 2006. They've never done a download from my machine.

Sometime after their "compliance" letter my doctor did order a loaner autoPAP for 2 weeks and this DME supplier did do the download from that so they would have the compliance data proof from that auto. But that loaner was AFTER the time period they needed to establish compliance.

... 2. There is no new ****** PRO software for patients coming! I asked him this direct question, and the answer was no. There will however be new software out for Clinicians which will be more secure and web based so the data can be viewed from multiple sites other than the download site, provided the person has the proper credentials. Each site will control access and credentials for it's database.

Resmed has the jump on Respironics on the web based data site:

ResTraxx™ System

Web-based Patient Compliance Monitoring

The ResTraxx System is the first of its kind for wireless, remote monitoring. It is designed and developed by ResMed, global leaders in sleep and respiratory medicine.

Web-based monitoring in three easy steps
* Check on all your patients at a glance.
* Zoom in for more information.
* Quickly identify causes of non-compliance.
Exception reporting: the smart way to manage multiple patients
* Easily identify those patients who fall outside desired thresholds for usage or mask leak.
* Focus your efforts only on those patients who require intervention.
ResTraxx Wireless: unmatched benefits
* Simplify data capture—no need for phone lines, modems, cards and readers; less reliance on patients for data transfer.
* Improve staff efficiencies—reduced patient and physician phone calls; no need for reminder calls or home visits to retrieve data.

Well, the only Respironics machines that have any data capabilities ALSO have C-Flex, so if the insurance company requires hard copies of compliance reports the patient would have to recieve a machine with C-Flex. That was my point.

As far as the software goes, it was more of a myth busting statement, since there has been a rumor floating around about new user focused software from Respironics. It was at all a statement indicating they were making ground breaking strides in patient data software. I was simply reporting what I heard.

Like I said in my original post, I completely agree with you Snoredog. Insurance companies are not taking this angle in hopes of improving patient compliance, they are simply looking for another way to deny a claim.

[Slinky]

Ah, sorry, I understand now. I have no problem w/them insisting on JUST the compliance which would NOT require a fully data capable machine.

But, yeah, I would NOT like that they have/had access to my actual therapy data, AHIs, leak rates, etc. ESPECIALLY since patients receive so little follow up from DME or sleep lab/doctor for any problems they encounter. Too often the blame is squarely on the DMEs and doctors for the patient's non-compliance.

[DreamStalker]

Well, I personally agree with the idea of insurance checking patient compliance before buying their machine... I am not sure why that is a bad thing? Without checking for compliance, one could get the machine paid for by insurance, sell it, and pocket the proceeds very easily.

My insurance requires me to rent and use the machine (4+ hours per night) for 90 days and then they will pay for it. Apparently, according to my DME, people who are going to quit using it will generally have quit by 90 days, so the insurance companies are pretty safe by that point.

Is the negative point that your DME or sleep doctor might see you have made some adjustments on your own? Or is it that patients should not have to prove they are using the machine before it is purchased? I don't understand...

On a slightly different but related topic, I was speaking to a pediatrician yesterday about sleep apnea, who said this:

Everyone and their uncle has a CPAP machine these days and almost no one is using them. They should never have gotten one in the first place if they aren't going to use it. It's just wrong. Giving out a CPAP machine is the "hip" thing to do these days but no one really pays attention to whether the treatment is working.

I am not sure what I think about that, as my experience has been so different. I am the only person I know IRL who has an xPAP, and I feel like my sleep doctor has been monitoring, even perhaps overmonitoring my treatment. But this doctor evidently has the impression that there are lots of dusty CPAPs out there which insurance paid for and they aren't being used at all.

Do you guys have an opinion about that?

Dawn

When you look at the brochures and propaganda commercials of the health insurance companies, they claim to “be in business to provide you the best health possible” … which is an oxymoron (they are in the business to make as much money as possible … same as most corporate businesses). Rather than making sure you are compliant, health insurance companies should be checking to make sure you’re conditions are being treated properly.

Re: different but related topic … the reason that the machines are not being used is because not enough doctors are doing as yours is -- patient monitoring to make sure the treatment is working and not just monitoring to make sure the machines are being used so they can collect payments from the insurance (big difference).

[rested gal]

Like I said in my original post, I completely agree with you Snoredog. Insurance companies are not taking this angle in hopes of improving patient compliance, they are simply looking for another way to deny a claim.

I agree with both of you about that.

DawnTCB brings up a good point:

Well, I personally agree with the idea of insurance checking patient compliance before buying their machine.

It would be a waste of money for insurance to keep paying out monthly rentals on a machine that sits in a closet. And I think that is where MOST cpap machines end up -- after the hapless left-on-their-own users give "cpap" a try for a short time. I believe most end up not being used at all. Usually because of mask issues rather than machine issues, probably.

The lack of support for most new cpap users is all the way up and down the line, imho. Insurance companies, doctors, DMEs. Lucky is the new cpap user who finds a doctor or a DME who really helps him/her make it work.

On a slightly different but related topic, I was speaking to a pediatrician yesterday about sleep apnea, who said this:

Quote:
Everyone and their uncle has a CPAP machine these days and almost no one is using them. They should never have gotten one in the first place if they aren't going to use it. It's just wrong. Giving out a CPAP machine is the "hip" thing to do these days but no one really pays attention to whether the treatment is working.

I am not sure what I think about that

I think the pediatrician is absolutely right about this part: "almost no one is using them."

People on this message board are the rare exceptions, imho. We get tons of support via the click of a mouse. Support and helpful hints that the usual person prescribed "cpap" never gets. We also are perhaps more determined to make it work for us...a determination that sent us actively looking for information and help on the internet.

... the insurance companies, they are the very reason compliance is so poor to begin with. IF compliance was only 20% they would be even more happy, it means they pay out less, they will take their chances on if a patient ends up with a heart attack or stroke.

This compliance thing is so they can stop paying rentals.

Yep. I think the insurance companies are also banking on that heart attack or stroke costing them only a short ambulance trip... to have the person pronounced DOA.

[Guest]

Well I had a 2 hour conversation with a friend of mine who works for one of the major CPAP (I'm sure by the end of my post you will figure out which one) suppliers. He filled me in on a few things that may be coming down the pipeline in the future which may not affect current CPAP users, but will definitely affect those in the future.


1. Insurance companies are on the push now for better, and more accurate compliance information. Many are asking for printed hard copy compliance reports that may be directly tied to the continued rental of a machine. I can confirm that currently some of the insurance companies I work with have moved to a 13 month capped rental and are asking for compliance numbers about every 2-3 months. I have only had requests from 2 of them for hard copy data from machines.

So what do I think this means for the future? Well the first impact I see is that people will be a little more hard pressed to change the pressure on their machines because "Big Brother" the insurance company will be watching. Ofcourse this really only affects those people who HAVE (for lack of personal funding or whatever) to use their insurance to get their machines. This also may affect those who do a self purchase and attempt to self bill to their insurance. There are other concerns ofcourse, but I'm sure those will surface in the insuing discussion.

2. There is no new ****** PRO software for patients coming! I asked him this direct question, and the answer was no. There will however be new software out for Clinicians which will be more secure and web based so the data can be viewed from multiple sites other than the download site, provided the person has the proper credentials. Each site will control access and credentials for it's database.

With those things said, I must say that while I don't agree with the intentions behind the push for more accurate compliance data. It is my opinion that the insurance companies are simply looking for an opportunity to not pay a claim. However with that said, I think that it will have an overall positive effect on patient compliance (Now everyone will atleast receive a machine with exhale relief) and overall patient comfort.

It is sad that it had to come down to the insurance companies trying to save a buck for changes like this to happen, but atleast it's progress, however small it is.

Oh and I should mention that he didn't have a time frame, but just that the pressure is on.

Vasily,

By "supplier", do you mean "manufacturer"? (or someone like Apria?)

If your friend works for the MANUFACTURER that makes ****** (Encore) Pro, tell him to tell his company to get their collective heads out of their collective asses and start thinking more about the people who ACTUALLY use these machines.
Actually, if your friend works for someone like Apria......SAME message.

Ask him why they make sophisticated machines when nobody (except the actual "user") gives a damn about the patients' therapy.....just collecting the money from the insurance providers.

Without detailed data, the patients can still be compliant and still have lousy therapy. You can see it on the forums almost daily. DME gives patient cheapest machine and cheapest nasal mask (to maximize profits).....then they find their way to the forums and complain that their therapy isn't working.....that they don't feel any better than before therapy. The problem is almost ALWAYS mouth-leaking or mouth-breathing.

You talk about the INSURANCE COMPANIES trying to save a buck???.....It's mainly the manufacturers, DMEs and doctors who are to blame for the patients who give up on their therapy. The manufacturers should NOT make or sell machines which do not collect detailed data. They also should provide a software package to the patient (with the machine) that is easy to use and understand......and with which the patient can self-monitor.
After all.....patients move to different locations......doctors move on or die.....DMEs don't last forever, either (or in the same location). Also, insurance providers change contracts with DMEs.....so, nothing is carved in stone......and the patients still need GOOD therapy.

Without detailed data, I can envision people turning on their machines for 5 hours a night and NOT hosing up. Yep, they're "compliant" as far as the machine readings go, but not receiving any therapy.

What about the Medicare folks? It seems that most everything in this big joke follows Medicare guidelines. Are Medicare or the VA going to change their SOP? (Standard Operational Procedure)

IF the insurance companies are going to do what you say they are contemplating, I wouldn't blame them.......they've been getting fleeced by the medical professions and related providers for a long, long time.
That being said.....I'm not sure they're THAT smart.....to come up with these compliance changes.

I have never been asked to prove MY compliance......but I could have, since I started using Encore Pro from "Day One". (also, "compliance" had nothing to do with the other entities collecting their money)

Maybe, because I purchased all of my equipment and software and then submitted my invoice to my insurance provider, they probably thought I was going to be "serious" about my therapy. I AM!!!

What pisses me off is that everybody points their fingers at somebody else regarding the failures in this therapy......and it's always the patient who suffers.
"Keep 'em stupid and you can keep your hands in their wallets."
AAAARRRGGGGHHHHH!!!

Den (skeptic by nature.....been lied to, too many times)

[Guest]

I hear you Den, and my friend hears you too on the software issue. I didn't mention it my original post, but when I asked him about the "Patient Software", he said, "I can't talk about that other than to say, NO, due to active litigation issues I can't say anything more about patients using the software than that".

Later in the conversation I asked him if it would be worth it for me to upgrade my Encore software at home to the 1.8 version and his response was "I have to advise you not to use the Encore Pro software at home for your personal use, use of that software is limited to use by Medical professionals in a clinical setting" So I said, "Ok, what benefits would I see by upgrading our work system to 1.9 for patient downloads?" His reply was, "You won't see much of a difference in the reports, but if you have any patients on the M Series Auto with A-Flex, 1.8 is required"

He is going to his parents this weekend so I will call him there and find out why the evasive action when I asked about personal use of the Encore software.

Yup, sorry Den, I meant Manufacturer.

The current software can tell also if you just turn on the machine and don't hose up, the compliance lines are different color. Well atleast Encore does, I don't work with PB or Remed software.

The biggest reason DME's don't do proper followups with patients is woeful under staffing. I am 1 RT and I am suppose to follow 5000+ active CPAP/BiPAP files, plus schedule cpap setups, mask fittings, and follow 1000+ oxygen patients that require concentrator checks every 6 months? That's not even factoring in the Infant Apnea monitors and continue pulse-ox setups. Just the equipment setups alone every day could eat up my whole week. I do many of my follow ups and trouble shooting calls before or after work without pay. The simple answer is to hire more RT's, but the RT profession is already suffering a shortage, and then when they findout they will be making less money, they quickly run for the jobs in the Hospitals and Sleep Labs. And around and around it goes.


P.S. Den if you keep giving me a hostile tone on the boards I'm gonna fly to my sisters and come and put your CPAP on myself!!!!

[roster]

This is a good discussion and it is getting near the heart of the problems with treatment.

.......... The simple answer is to hire more RT's, but the RT profession is already suffering a shortage, and then when they findout they will be making less money, they quickly run for the jobs in the Hospitals and Sleep Labs. And around and around it goes.


........

Please permit me to take exception to the statement that the simple answer is to hire more RT's. Someone has to pay the RTs. Who will pay: insurance companies, doctors, medical practices, government? All of these entities get their money from us - so we will be paying.

You have already stated the better answer. Get machines with patient-friendly software in the hands of the patients. Educate the patients to monitor their own therapy.

Thanks for shedding some light on this discussion.

[Guest]

P.S. Den if you keep giving me a hostile tone on the boards I'm gonna fly to my sisters and come and put your CPAP on myself!!!!

Vasily,

Not hostile to YOU......just this whole, damn, ridiculous mess.
And, if you ever get out this way, please look me up.

Best wishes,

Den