I have a couple questions for you guys that track data

[JeffH]

The industrys only worrying about compliance is stark raving proof that they are concerned with one thing and one thing only....GETTING PAID.

Compliance is real simple for me. If I'm not compliant, I'm awake.

I've learned from this forum to monitor my own sleep and make occasional changes to my settings. Thanks to James Skinner, a member here, I can take a look at my sleep over periods of time from one week to the start of the machine being used and compare different settings to each other. I really feel that due to this forum, I and most of the members know more about treating OSA than most of the professionals.

I currently have insurance and use them for supplies, but plan on buying machines on my own. I have to use the machine to sleep, so worrying about compliance is just worrying about payment.

Maybe you can get thru to them from reading what you learn on this board. My guess is that they won't want to hear it and if you push it you will get fired. That's been my experience with thinking outside the box in corporate America.

JeffH

[Mike@TibroMedical]

Mike, I have some questions for you...

The Respironics web site talks about the doctor being able to change a patient's pressure through EncoreAnywhere. Does that simply mean the doctor can enter the prescription change for the DME into the program rather than paper copy or fax? Or is there magic in that telephone line that allows machines to be be reprogrammed remotely? And can it download treatment data if it is a data capable machine? Surely you didn't think we're out here wasting time downloading our compliance data, did you? I mean, we already know how long we used the machine, so that info means nothing to us.

Seems a streamlined and more automated tracking of compliance has three advantages - 1} to let the physcian know at-a-glance when a patient is lying (accountablility) , 2) to not miss qualifying for insurance payment because of no verification, and 3) to prevent insurance companies from paying for equipment not being used.

What are the direct costs for the end user (us) to have EncoreAnywhere added and maintained on their home land phone line? Are those costs billable to insurance?
Are existing machines compatible or is this a feature available only in new machines? What about those who use two machines (one for napping)? Or those travel a lot? Or those who don't have a land line?

As the system currently stands, compliance verification is supposedly required but, in my experience, seldom followed through on. Guess this will help the DMEs with the reporting and payment process, but I'm afraid it may also cost them, as noncompliance will be evidenced much sooner. (Will this mean a boon in "barely used" machines on the auction sites and more room in closets?) I just hope this isn't a step towards a requirement.

Mike, I don't doubt you or your company's intentions to be a responsive and responsible DME, or that you may even hope to help in addition to the free exposure. But in all honesty, you could not have done much reading here or you would have known the difference between what those of us who download data do and compliance data. You'll likely have a hard sell here. But keep learning, you'll be even better at your job. And well informed staff at the DME level are a always appreciated.

Kathy

I am in no way trying to sell anything the offer is on the table and people can let me know if there interested simple as that. and your right I didn't do much digging on data tracking all I've noticed are allot of threads with that as the topic. It made me curious to weather or not the DME's out there are requiring you as patients to gather your own compliance info when that should be the DME's job. I feel as though it would have been smarter to come on here not mentioning I work for a DME company cause that has obviously been something allot of you are focusing on in a bad way. I have OSA and I do deal with the same hurtle's as all of you. My interest and question's have been nothing but curiousness from both a DME provider and a PAP user. Kathy I am going to come back and answer all the other questions you had about the modem's I want to finish reading all the reply's really quick but wanted to let you know I am not trying to sell anything

[LoneStar]

I was curious from a stand point of a provider that has never had a pt even mention the thought of learning and understanding what it all means and I was simply intrigued.

If you always assume the patient isn't interested in learning anything, then you'll never know when they are. And yes, there are some patients who could care less and don't want to be bothered. But if you don't try to educate anyone, then you'll never find the ones who DO want to be educated.

I always tried to assume that all my patients wanted to be educated and took the time to do so.

Lisa

[Mike@TibroMedical]

Another point to mention the encoreanywhere doesn't just do compliance. it gives a full detail report just like the SC. and the Dr can access the machine and remotely adjust the pressure or ramp or Flex's we can also pull trouble codes if there is an error on the screen. When I have Dr's requesting a detailed report I simply log onto the site and pull the full report and email it to the Dr & the patient both. So your assumptions that we try and keep the patient out of it is not correct. Dr's would just rather they make the call instead of a patient that may not understand everything fully. The Dr should take that as a point to possibly explain things more fully.

[yardbird]

Mike-

Don't get scared off or anything. You asked questions. You got answers. Maybe more than you bargained for but nobody here is on a witch hunt and everyone's input is welcome. Mentioning that you're a DME is being honest. Nobody here is going to fault you for being honest. As you can tell though we're a rather opinionated bunch. please take it in stride and know that we don't all always agree with each other. hehehe

[Mike@TibroMedical]

Take a little more then this to scare me off. I do love the response that I have gotten. I do feel that if i had made this thread as a joe blow "Bipap'r" that so many people wouldn't have jumped to the conclusion that I was only referring to compliance tracking side which I wasn't (even though thats the main use for encoreanywhere) also that we actively try to keep the patient in the dark which is just not true. I spend hours on the phone a day with pt's and I will answer/explain any question they have.

[jnk]

. . . compliance tracking . . . the main use for encoreanywhere . . . patient in the dark . . . .

Nothing personal. Strictly business.

We know from experience that compliance data is what brings the bucks in from insurance, and as in most things, money makes the world go 'round. So it isn't a personal accusation, just a recognition of the reality of how things work in the industry, when we vent about the differences in priorities that often occur between patient and provider, especially when it comes to data.

And also, we know that it is a matter of policy for most DME's to tell patients that it is illegal for them to adjust their own pressures and that they should not be trusted with the knowledge of how to do so. That, again, is not a personal accusation, just a recognition of how most patients are treated.

Everyone is welcome here. ESPECIALLY DME employees. After all, this site is sponsored by an online DME. And some DMEs are amazingly helpful. But brick-and-mortar DME employees posting here often do tend to get an earful from those of us who have had less-than-helpful DMEs who were less-than-cooperative with our efforts to be involved with our own therapy.

[BleepingBeauty]

I am reading through this and wanted to stop and clarify something, I was in no way trying to make you guys think you shouldn't be tracking your data in fact I think it's great that you guys take that into your own hands. I was curious from a stand point of a provider that has never had a pt even mention the thought of learning and understanding what it all means and I was simply intrigued.

Hi, Mike, and welcome.

That's probably because your company takes good care of its patients/clients. For many of us, unfortunately, that's nowhere near reality.

Compliance numbers are meaningless to me. As others have posted, we use our machines, and we don't need "data" to prove it. I've been on CPAP for almost 18 months now, and I'm still tired. Since I don't have a data-capable machine, I don't know what's going on when I'm asleep and can't determine what aspect of my therapy needs improvement. I don't know if I'm mouth-breathing (even with my chinstrap) or if my mask is leaking, nor what my AHI is. Having relied on my sleep doctor and DME to improve my therapy experience has gotten me nowhere.

Every single one of us should have data-capability, IMO, even if we choose not to monitor the data ourselves. At least we could bring the smart card to the doctor or DME on a regular basis, see what's happening a lot sooner, and make therapy alterations quickly. As it is, I've been at the mercy of my sleep doctor to take care of me, but he has no idea how I'm doing on a regular basis. Without data, I can only judge how well (or not) my therapy is going by how I feel, and that's a very inefficient process.

As someone posted upthread, people with diabetes must monitor their blood sugar numbers all day, every day, and adjust their treatment as needed. Why is there such a stigma against xPAP patients doing the exact same thing?

[momadams]

Lisa's post reminded me of a parallel situation I experienced.
We live in the middle of nowhere. We're lucky to have services (prosthetics, sleep labs, DMEs) not too far away, but they're overextended and very busy.

When I developed a footdrop due to a compressed spinal nerve, I had emergency microsurgery and was given a plastic appliance which extended from toes to knee with a fixed ankle angle. All I was told was that I would progress in mobility for a year.
As I gained ankle strength and mobility (thanks to the world's best physical therapist and being rigorous about doing the exerciese), I realized that I wanted to be able to flex my foot on my own as much as possible. Did my online research and found an appliance with a hinged ankle. Called the orthopedic appliance guy and asked about it - sure, he said, you have enough ankle stability.
A year down the road, I was stronger still and found a minimalist ankle wrap with an elastic strap which attaches to my shoe. Called the appliance guy. "Sure, we can get that. We'll order it".
Early on, I had realized that my altered gait was affecting the rest of my body and limiting my activity, so I explored massage, cranio-sacral therapy, acupuncture, and aggressively pursued more PT visits.
It was a wonderful day when the cranio-sacral therapist suggested that I might not need the ankle wrap anymore. I only use it now when I'm out of the house, on unfamiliar terrain.
My point is, if I had simply taken the original brace and the original 6 PT visits, I would be in the same place I was 3 years ago.
All of my providers meant well, but I had to take charge of my own life and progress. Once they saw that I wanted optimal results, they were more than happy to help (As my PT put it, she usually found that folks don't even do the minimal prescribed exercises)

Now, I was lucky with my OSA diagnosis - I was put in contact with Walgreens DME and a good RT. But I have yet to meet the sleep doc and the DME can't order the Headrest mask a,didn't offer the FP 150 Humidifier and would never have suggested Poligrip Strips. But I did find CPAPTalk, did learn about what is now my favorite mask, did get encouragement when problems cropped up, and learned how to set my machine to show leaks and AHI so that I'm confident about my treatment.

We need to empower ourselves - that's what life is all about.

I'm reminded of a chat list I check out from time to time - twenty-somethings in a major city, primarily. When that city had major snow (unusual), there were tons of angry posts from renters angry that the landlord hadn't cleared stairs and sidewalks. I desperately wanted to post "So get a shovel, a broom, a piece of cardboard, and CLEAR THOSE STEPS".

Shari

[Hawthorne]

BUT, from my experience and many others who have replied - you sound like the exception. People are reacting from their own experience with Providers (DMEs). For the most part they just want the money for the equipment. Proving compliance means, to most of them, that the patient's insurance company will give them the money and they seem to only care about that.

I'm from Canada but things are no better here. We deal with the same lack of patient care that the US forum members do. I didn't reply on this thread before because everything I would have said has been said.

You asked the questions and you got the answers! We track our data because we care about our therapy and our health and most of the professionals in this field don't care about our health. They care about money.

As I said, you sound like the exception. There are probably some others but they are few and far between. That's the reality for most of the forum members and that's why we are here and that's why many of us are monitoring our own therapy. Bottom line - our health is important to us and it does not seem that our health is important to many of the sleep medicine professionals. Our money is what's important to many of them.

[bjdare]

Hi Mike,

Welcome to the forum and thanks for your interest.

I'm relatively new to all this - started CPAP therapy in 12/08. My Sleep Doctor (Pulmologist at a sleep clinic) prescribed straight CPAP for me and Apria gave me the most basic of machines - not data capable. About 2 1/2 months into CPAP therapy I was still struggling - pulling my mask off in my sleep, waking up gasping, etc. I called Apria about upgrading to a data capable machine - the said ONLY with a letter of medical necessity from my Doctor. I called my Doctor and asked if he would rewrite my prescription for an APAP - got a flat no - then I asked for just a data capable machine - still got a no. Said we would discuss it at my visit in 3 weeks. I have been a member of this forum since I first found it and it has been my "survival" tool and learning center. After the phone conversation with my Doctor's office I ordered an APAP, software and card reader on line, out of my own pocket. At my Doctor's visit I was told "They don't like APAP" but could give no reason. When I told the Dr. of my recent problems he simply told me that I needed to figure it out and that he could do nothing until I could proved I was using PAP therapy at least 7.5 hrs a night. I asked him just how I could prove that since I didn't have a data capable machine. His reply was simply an icy stare.

Apria has NEVER called me - no one has EVER asked for compliance data. It's obvious my Sleep Doctor and Apria are only interested in my money.

The M-Series APAP, software & card reader have allowed me the opportunity to actually see what's going on with my therapy and correct issues. Without a data capable machine, I had no idea. I run and review my reports on a daily basis. I would have quit all this had it not been for this forum, the collective wisdom of the members and their encouragement. As a result, I have taken my therapy into my own hands and the ability to actually "see" and respond to my therapy issues has kept me on this journey.


“You must learn day by day, year by year to broaden your horizon. The more things you love, the more you are interested in, the more you enjoy, the more you are indignant about, the more you have left when anything happens.” - Ethel Barrymore

[roster]

Another point to mention the encoreanywhere doesn't just do compliance. it gives a full detail report just like the SC. and the Dr can access the machine and remotely adjust the pressure or ramp or Flex's .......

Mike,

Understand one thing clearly: A doctor can adjust my machine's pressure only when he can pry it from my cold dead hands.

I have been through that crap with three doctors and two sleep labs. They don't know how I sleep and breathe and they don't know how to prescribe an optimal pressure. I will do it myself.

We make an analogy to diabetes. The diabetic who has blood-glucose levels under control has educated himself, monitors his BG levels, and adjusts his diet, exercise, drugs and insulin injections to achieve good results.

IMO, that is the model for treating sleep apnea with a CPAP process. I feel sympathy for the millions of patients who don't know and do this. I believe the treatment of sleep apnea with CPAP will evolve toward the "diabetes model".

Take a little more then this to scare me off. ..........

I like that attitude and hope you hang around a lot.

Regards,

[Wulfman]

Take a little more then this to scare me off. I do love the response that I have gotten. I do feel that if i had made this thread as a joe blow "Bipap'r" that so many people wouldn't have jumped to the conclusion that I was only referring to compliance tracking side which I wasn't (even though thats the main use for encoreanywhere) also that we actively try to keep the patient in the dark which is just not true. I spend hours on the phone a day with pt's and I will answer/explain any question they have.

Good!
There are and have been numerous other DMEs, RTs and other sleep professionals who have shared their thoughts and experiences on this forum over the years. And, for the most part, we very much appreciate their input. Some exceptions are when they try to "preach" to us about how "dangerous" it is to monitor and tweak our therapy......YES, INDEED THEY HAVE!
I don't know WHY......but they don't seem to hang around too long after that......
You need to keep an open mind to the fact that we're trying to educate the users as much as possible to make their therapy successful. Since not everyone is the same, when someone comes on here with a problem, we try to offer as many thoughts from our own experiences and from the prior experiences of others we've read about on the forum to help them out. It's not saying that a certain specific solution will work, but to open them up to at least TRYING different things that MIGHT.

Overall, this therapy has a very miserable success/compliance record......somewhere around 50%......give or take about 10%. In my opinion, it's because the patients aren't being educated about it, told the benefits of it or the serious consequences of it if it's not successful. It's amazing how few users even know what makes or models of their machines, masks, pressures or other aspects of their therapy. They just know they have this box that they're hooked to every night that blows air at them. I've often mentioned that people probably spend more time investigating things like digital cameras and other electronics they're going to spend money on than on a machine that will help them live a better life and keep them alive alot longer. For all of this, I blame the "medical professionals" for trying to keep these people in the dark.


Den

[DreamStalker]

As my good friend rosster pointed out ... the key to OSA patient care is "EDUCATION" and the sleep doc/DME/RT patient care pros just are not providing that ... that is the underlying problem with current treatment of OSA. Hence we here have taken control and that is why we track our data ... we educated ourselves cuz the people that were suppose to did not.

[6PtStar]

Someone on this board is using Encoreanywhere but I can't remember who. They posted their data in a post and down on the bottom it said read by Encoreanywhere. I saw it and wondered what in the world Encoreanywhere was because I had never heard of it. Now I wonder how thew patient got the data. Did his doctor give it to him or is there some way it can send a copy to yourself. I may have to look at this especially if I have to go to Vista on my computer.

Mike, my first DME did not have the program or any interest in reading my data, I asked. All they wanted was the compliance numbers off the LCD. My doctor does not have the program to read my card either. I print the data and take it to him. I recently changed DME's and the present one does have Encore Pro. Thr RT did tell me if i needed it read I could bring it in and they would be glad to read it. I have been on the hose almost 3 years now. I told the RT I had the program which did raise an eyebrow (but she did not say anything), but if I need any help I would bring it in. Nothing more has ever been mentioned.

I hope you stay around and give us some help from your prospective.

Jerry