Why is the industry like this?

[sifr]

The entire medical experience I'm having is nightmarish. The list of problems include:

1) 6 months from initial referral to beginning therapy
2) Byzantine internal communication process between HMO, Sleep Center (which is part of the HMO), and DME
3) Inability of sleep center to correctly communicate with me (like giving me my Rx, my sleep study, telling me to bring my smart card in, send faxes when they say they did, etc.)
4) DME charging me for the filter that came with the unit, the hose that came with the unit, the headgear that came with the mask, etc.
5) DME not following the directions set forth in the Rx re: settings and equipment to give me
6) Doctor having a degree from and job at Stanford, and not being able to spell or write clearly.

I mean, I accept a certain degree of incompetence and carelessness in most things, but not the medical industry.

[Wulfman]

The entire medical experience I'm having is nightmarish. The list of problems include:

1) 6 months from initial referral to beginning therapy
2) Byzantine internal communication process between HMO, Sleep Center (which is part of the HMO), and DME
3) Inability of sleep center to correctly communicate with me (like giving me my Rx, my sleep study, telling me to bring my smart card in, send faxes when they say they did, etc.)
4) DME charging me for the filter that came with the unit, the hose that came with the unit, the headgear that came with the mask, etc.
5) DME not following the directions set forth in the Rx re: settings and equipment to give me
6) Doctor having a degree from and job at Stanford, and not being able to spell or write clearly.

I mean, I accept a certain degree of incompetence and carelessness in most things, but not the medical industry.

Why not? They're in every other field. (Just look at what the "best and brightest" on Wall Street and the financial industries have done to us!!!)

Know what you call a doctor who graduated LAST in his/her medical school class?........Doctor!


Den

[sifr]

The entire medical experience I'm having is nightmarish. The list of problems include:

1) 6 months from initial referral to beginning therapy
2) Byzantine internal communication process between HMO, Sleep Center (which is part of the HMO), and DME
3) Inability of sleep center to correctly communicate with me (like giving me my Rx, my sleep study, telling me to bring my smart card in, send faxes when they say they did, etc.)
4) DME charging me for the filter that came with the unit, the hose that came with the unit, the headgear that came with the mask, etc.
5) DME not following the directions set forth in the Rx re: settings and equipment to give me
6) Doctor having a degree from and job at Stanford, and not being able to spell or write clearly.

I mean, I accept a certain degree of incompetence and carelessness in most things, but not the medical industry.

Why not? They're in every other field. (Just look at what the "best and brightest" on Wall Street and the financial industries have done to us!!!)

Know what you call a doctor who graduated LAST in his/her medical school class?........Doctor!

Den

Generally because most other industries don't outright kill you through incompetence. I mean, I don't expect an airline pilot to write like Hemingway, but I do expect them to be clean, sober, and able to fly a plane competently.

Similarly, I don't expect my doctor, or any medical professional, to be able to rebuild a carbeurator, but I damn well expect them to exhibit basic competence when it comes to every aspect of my healthcare.

Ask me about the time I was scheduled for gall bladder surgery and the nurse mailed me all the pertinent information -- about my wonderful upcoming gastric bypass. That got me the head of the department doing my surgery instead, and ultimately a registered letter from the hospital telling me to stop berating their employees.

[Muse-Inc]

...scheduled for gall bladder surgery and the nurse mailed me all the pertinent information -- about my wonderful upcoming gastric bypass. That got me the head of the department doing my surgery instead...

This would be hilarious if it weren't so damned annoying...maybe it's both.

...ultimately a registered letter from the hospital telling me to stop berating their employees.

Good for you!

[cinco777]

sifr wrote

1) 6 months from initial referral to beginning therapy
2) Byzantine internal communication process between HMO, Sleep Center (which is part of the HMO), and DME
3) Inability of sleep center to correctly communicate with me (like giving me my Rx, my sleep study, telling me to bring my smart card in, send faxes when they say they did, etc.)
4) DME charging me for the filter that came with the unit, the hose that came with the unit, the headgear that came with the mask, etc.
5) DME not following the directions set forth in the Rx re: settings and equipment to give me
6) Doctor having a degree from and job at Stanford, and not being able to spell or write clearly.

My initial "failed" try with CPAP 3 years ago experienced similar difficulties with only minor differences:
1) I began my CPAP therapy 2 1/2 months after my 1st sleep study (but 10 months after my initial meeting with the sleep doctor).
2) Communication between the Sleep Dr. and the DME was non-existent after an RX was faxed.
3) I was the go-between and problem solver for all three RXs that the DME screwed up (3 of 3). Please note that I didn't see any of my three RXs until the final Big screwup two months after ?starting? therapy when I demanded copies of my RXs - I had only "asked" for them previously. Each time that I "asked", I was told that "I didn't need them as they were very technical". I didn't get my Sleep Study results for 2005/2006 until I demanded them in writing in April 2009.
4) The DME charged (overcharged) for every piece of my two masks, etc., but my insurance paid for each @ 100%, no questions asked.
5) The DME, in a 2-month period, screwed up all three RXs. Since I tested with a FF mask, I should, based on RX#1, have received one at the very start. RX#3, one month after starting therapy, specified a FF mask. DME provided a "full face mask" one month later, one that completely covered the face. When I took it to the Sleep Clinic to show the Dr. and technician, they were astounded as they had never seen one before and the technician did a show&tell to inform his co-workers. The DME couldn't even provide a Respironics ComfortFull2 FF mask without screwing it up.
6) My Sleep Dr. had a prior affiliation with Stanford and had many professional credits. My Sleep Dr. was good at dictating but didn't participate in any problem solving afterwards.

Why is the Industry like this? Why? Because most Sleep Drs., Insurance Companies, and DMEs (brick and mortar) don't give a Damn about us, only about the money they get from us!

[Wulfman]

You just gave a good example of why the malpractice insurance is so damn high.
Just think of that one example multiplied thousands of times.......there's gotta be at least one in every hospital......

Sobering thought, isn't it? One reason I try to stay out of hospitals and doctors' offices. I could also give more examples of the some of the doctors I've encountered over the last 40 years or more.


Den

[sifr]

You just gave a good example of why the malpractice insurance is so damn high.
Just think of that one example multiplied thousands of times.......there's gotta be at least one in every hospital......

Sobering thought, isn't it? One reason I try to stay out of hospitals and doctors' offices. I could also give more examples of the some of the doctors I've encountered over the last 40 years or more.


Den

True. I avoid doctors as much as possible. Hell, it took me 6 months to finally go see a specialist about my rotator cuff injury...an injury I've been moving several thousand pounds of weight with, 4 days a week. Thankfully, I trust that doctor implicitly, as he's one of the best joint surgeons in the area, and possibly the country.

But I typically never go to a doctor. Hell, I had to argue with my ex-wife for an hour before letting her drive me to the hospital when my gall bladder attacked me. Of course, I was perfectly justified when, later, the ER screwed things up (I won't even go into the 3 people it took 15 minutes to figure out an EKG with just 4 buttons, each numbered in order of use, and with big pictures on them...) and tried to bill me for $8,000, rather than submitting it to my insurance.

I don't even take aspirin.


I do, however, take a carefully-selected set of OTC chemicals based on current research, and probably know a bit more about some physiological systems than the doctors I occasionally have to deal with. (I had to explain GABA and 5-HTP to my sleep doc, for instance. She, on the other hand, explained Ferretin to me, of which I was unaware.)

[unclematt]

I had been complaining of sleep problems for 17 years with 7 doctors before my new doctor decided a sleep study might help. The other docs just told me I was depressed.

[ScrappinMom]

I had been complaining of sleep problems for 17 years with 7 doctors before my new doctor decided a sleep study might help. The other docs just told me I was depressed.

I've been complaining of extreme fatigue for 30+ years, since I was about 9 or 10. Various doctors ordered various blood tests, of course all normal, they all told me it was just allergy related and I would have to deal with it. Not until my hubby told me a few months ago that I stop breathing in my sleep did it even occur to me that I might have sleep apnea. Well, nobody with an MD or DO after their name ever thought of it either! I think I've had it all these years, but for some reason he is now noticing it. Lucky for me I guess that I have an insomniac husband!

[Silver Pelt]

The industry is like this because the enormous costs and barriers to entry created by FDC hyper-regulation stifle competition.

No one would put up with this routinely terrible service and nasty attitude when shopping at Amazon, Best Buy, Wal Mart, or any other free market enterprise. Any grocery store operated with the ethics and attitude of the typical DME would go bankrupt in days. It is only because doctors and DMEs are protected from competition that they can get away with this outrageous behavior.

I was discussing this situation with my own doctor this morning, before I saw this post. I told him I would love to start a business serving customers requiring xPAP therapy. I would attempt to treat them with dignity and respect, and to save them as much money as possible. I refuse to do so because I will not subject myself to inspections, fines, and continual harassment by unaccountable bureaucrats. He agreed, and pointed out that Obamination of our health care system will certainly make the situation much, much worse.

Our dear sponsor, CPAP.com, was recently compelled to require prescriptions for small items such as mask purchases.

We now require prescriptions to be on file before any machine, mask, or humidifier may be shipped. This is because the Food and Drug Administration classifies masks and humidifiers along with machines as Class II Medical Devices, which require a prescription.

We at CPAP.com believe, like many of our customers, that this will deter some people from getting the treatment they need and deserve. While we disagree with the classification, we are a company incorporated in the United States of America that falls under the authority of the FDA. Therefore, we must abide by these regulations and have updated our prescription policy accordingly.

We fully recognize the inconvenience this policy places on many of our customers.

This does not benefit consumers, and it certainly does not benefit CPAP.com. They did it because they were forced to do so.
Who benefits? Doctors will get more office visits, because most prescriptions are valid for no more than 1 year. DMEs will get more business because they have harmed one of their most fierce and capable competitors, CPAP.com. Consumers are harmed by this policy; costs go up and the level of inconvenience in making what should be a simple purchase goes up along with them.

this will deter some people from getting the treatment they need and deserve.

This is why the industry as a whole simply stinks, with the rare exceptions such as CPAP.com. You are dealing with people who are willing and able to hurt some people as part of thier normal business policy. They raise consumer costs, even deny them treatment in order to increase their own profits. It is profoundly unethical and immoral. It would never be tolerated in a free market. It is possible only because government compulsion and coercion allows these creeps to avoid the wrath of consumers that they so richly deserve. We have no choice, when one appears via the internet or elsewhere, it is shut down.

I have no financial or personal interest in CPAP.com. I quoted them only to support my own point; they did not encourage me in any way or even know I was planning to write this response.

[cinco777]

I disagree with SilverPelt's premise. The lobbyists for the Medical & Drug Industry (Drug companies, Insurance companies, DMEs, etc.) have paid and paid (think almost all the politicians in Washington, the FDC, advisory boards such as the AHA, etc.) to get us to where we are today: a corrupt and broken system of health care and delivery. They are all making obscene amounts of money and we are getting sicker and sicker and poorer and poorer. The Medical Industry continues to deceive the American public - take a close look at the health care debate (death panels, socialism claims, etc.) now going on if you need proof.

Eighteen years ago, I read a book titled "The Parliament of Whores", and subtitled "A lone humorist attempts to explain the entire US Government". It was a good read then and a better, but still sickening, read today. We are worse off today than 18 years ago. Big Business and their lobbyists (last reported as 5X the number of congressman) and with millions, if not billions, to spend, have made a mockery of our government. However, knowing all this, I still prefer our government (there are still a few good guys and Obama is one of them) establishing a Public Insurance Option to compete with the entrenched and extremely rich and greedy private Insurance Industry. We have to start somewhere to take back our country from the greed that is enveloping it. I have children and want a better world for them, not the one that I see happening all around me.

Re DMEs, 15 years ago, there were numerous small DMEs here in the Bay Area, many of them who did their best to serve their customers, people like us, not the insurance companies. Today, there is one really big one, Apria, as they, over time, bought all the smaller ones. Apria, from my experiences and others, looks only at their bottom line and how to make it larger. That is why everyone gets a non-data capable (no AHI, Leak, etc. reporting) CPAP to start with and why they persist in confusing and lying to folks like us who question their selections, recommendations, etc. I agree with SilverPelt that they wouldn't last long (I like to think not more than a day) if they didn't have ironclad contracts with the Insurance Companies, HMOs, Sleep Labs, etc.

[sifr]

I disagree with SilverPelt's premise. The lobbyists for the Medical & Drug Industry (Drug companies, Insurance companies, DMEs, etc.) have paid and paid (think almost all the politicians in Washington, the FDC, advisory boards such as the AHA, etc.) to get us to where we are today: a corrupt and broken system of health care and delivery. They are all making obscene amounts of money and we are getting sicker and sicker and poorer and poorer. The Medical Industry continues to deceive the American public - take a close look at the health care debate (death panels, socialism claims, etc.) now going on if you need proof.

Eighteen years ago, I read a book titled "The Parliament of Whores", and subtitled "A lone humorist attempts to explain the entire US Government". It was a good read then and a better, but still sickening, read today. We are worse off today than 18 years ago. Big Business and their lobbyists (last reported as 5X the number of congressman) and with millions, if not billions, to spend, have made a mockery of our government. However, knowing all this, I still prefer our government (there are still a few good guys and Obama is one of them) establishing a Public Insurance Option to compete with the entrenched and extremely rich and greedy private Insurance Industry. We have to start somewhere to take back our country from the greed that is enveloping it. I have children and want a better world for them, not the one that I see happening all around me.

Re DMEs, 15 years ago, there were numerous small DMEs here in the Bay Area, many of them who did their best to serve their customers, people like us, not the insurance companies. Today, there is one really big one, Apria, as they, over time, bought all the smaller ones. Apria, from my experiences and others, looks only at their bottom line and how to make it larger. That is why everyone gets a non-data capable (no AHI, Leak, etc. reporting) CPAP to start with and why they persist in confusing and lying to folks like us who question their selections, recommendations, etc. I agree with SilverPelt that they wouldn't last long (I like to think not more than a day) if they didn't have ironclad contracts with the Insurance Companies, HMOs, Sleep Labs, etc.

Well, at least there are still two other options that I'm aware of in the SF Bay area: SleepMed (who is responsible for my original post), and Pacific Pulmonary. I'm going to call my insurance and see what it'd take to switch over to using PP instead of SleepMed.

[cinco777]

sifr wrote

Well, at least there are still two other options that I'm aware of in the SF Bay area: SleepMed (who is responsible for my original post), and Pacific Pulmonary. I'm going to call my insurance and see what it'd take to switch over to using PP instead of SleepMed.

I only have second-hand knowledge with PP (MIL used oxygen for 3 years prior to her passing). Her experience with PP was not positive. Give them a try re CPAP and report back. Other users here in the Bay area could benefit from a local DME that provides real customer service at a reasonable cost.

I received my primary machine and first F&P mask via Kaiser/Apria after some down and dirty street level fighting to get a data capable (AHI, Leak reporting) machine. I don't care to repeat that experience as it raised my BP for more than two weeks. Everything since then, backup machine (same model), mask (backup), seals (replacements), filters, longer hose, card reader, etc., have been purchased on-line. I have no need for a B&M DME.

[mattman]

This does not benefit consumers, and it certainly does not benefit CPAP.com. They did it because they were forced to do so.
Who benefits? Doctors will get more office visits, because most prescriptions are valid for no more than 1 year. DMEs will get more business because they have harmed one of their most fierce and capable competitors, CPAP.com. Consumers are harmed by this policy; costs go up and the level of inconvenience in making what should be a simple purchase goes up along with them.

Just to clarify that one point - the FDA classified masks and other items as medical devices from the get-go. They've been that way since day 1.

And to even further clarify - there isn't an equipment provider out there (That I've ever come across) that does NOT think it's inane, stupid and totally unncessary that they be treated as such.

Hell, FILTERS are only able to be sold with an Rx. A piece of cotton. Seriously.

The *only* thing is does is raise the burden and cost to whomever is proving the mask for no tangible benefit.

No DME company ever lobbied for it to be a medical device, they were created as such.

mattman

[cinco777]

Mattman wrote

No DME company ever lobbied for it to be a medical device, they were created as such.

With what many DMEs are doing today - deceiving, lying, confusing, overcharging, misinforming, etc. - I sincerely believe that they were lobbying yesterday. There may be a paper trail of lobbying $$$s for some investigative reporter to follow. However, no "insider" has come forward as happened for the Cigarette Industry, and recently, the Health Insurance Industry. However, just ask yourself the question "Who benefits most from making it more difficult to buy online?" The easy and most credible answer is the DMEs (so they can keep overcharging) and the Manufacturers (so they can keep their High Prices). I think my recent experience is quite common and supports my argument. My first mask, shipped to me by the DME, was billed at $320. My co-pay was 20%. My mask is available online for $110. I bought my backup mask, brand new in an unopened bag, for $45 including S&H, from CPAPAuction. The brick and mortar DMEs would love to shut down the online CPAP vendors but will, for the time being, be pleased with their lobbying efforts that have made buying online much more difficult (but not yet impossible for those of us that fought for and finally did get copies of our CPAP RXs). Everyone on CPAP should have a copy of their RX. However, to get an RX, you have to do more than ask, you have to demand, and I have read postings of forum members where they have asked, demanded, and finally threatened before getting their RX. Getting a copy of the detailed sleep study has often required the same progression: Ask, Demand, Threaten. The Threaten part, just to be clear, is stating that you will pursue your legal access to all your Medical Records.