AutoPAPs- a difference?- and some complaining!

IllinoisRRT · Post by **IllinoisRRT** » Sun Sep 18, 2005 6:57 pm

Have any of you used more than one kind of AutoPAP machine and been able to tell a difference?

I have a patient who has been on Auto-CPAP for many years. He's on a VirtuosoLX. He is having problems and refuses to have another sleep study done. His oximetry was fine through the night. I provided him with a Remstar Auto to test for a week so that I can download his events for him.

The problem is now, he feels that the Remstar is better. The Virtuoso he has had has been checked and has no malfunction that I can tell.

What really irks me about this whole situation is, and this is a side note if you will let me vent about a patient for a minute, he expects me to just give him the Remstar. And when I say "give him", I mean exactly that. Our store provided him with a CPAP years ago when his sleep study did not meet Medicare qualifications for CPAP. He is getting it for free. His masks are free. His oxygen, which he is also on, you guessed it, FREE. One reason I would like for him to get another sleep study (he hasnt been tested for almost 10 years) is to evaluate to see how his current regimen is working for him. The other reason, though, plain and simple, is so that if his condition is worse, we could at least get paid for it. The reason he does not want to get a sleep study done is because he would have to pay his 20%. I can understand if someone were living in absolute poverty, but he is not. I could go on and on about this guy, but I won't bore you with pointless complaining. I just don't like how he expects everything to be free.

However, I digress... is this guy legit when he says the Remstar is better than the Virtuoso, or is he just trying to wheedle me for more free stuff?

wading thru the muck! · Post by **wading thru the muck!** » Sun Sep 18, 2005 7:35 pm

Christine,

There are many on the list who have used auto's from multiple manufacturers. Some may have also used more than one auto from the same manufacturer as your patient now has. For me the REMstar auto and the PB420E works equally as well. I know that for some others that this is not the case.

Does the auto you provided him with have c-flex? If so, that may be why he likes it better.

As for providing him with a "free" machine, why don't you just give him a price if he wants the new machine? He does not "need" the machine and if medicare won't pay for it, you have no reason to provide him with one.

Getting back to one machine working better than the other, my guess is that the Virtuoso is still working as well as it always has, but he's gotten a task of driving a Cadillac and just doesn't want to get back in his Chevy and drive home.

neversleeps · Post by **neversleeps** » Sun Sep 18, 2005 7:52 pm

Well yeah, it's possible the algorithms of one manufacturer's machine could provide better treatment for someone's particular breathing patterns than another manufacturer's machine. But since both of the machines in question here are Respironics, that theory is out the window, isn't it? Or maybe since the Virtuoso is so old, it really does have a different set of algorithms... I don't know.

Does it provide the same data (via the software) as the REMstar Auto?

Maybe he's been reading this board and wants the best auto Respironics has to offer... (Wader's Cadillac vs. Chevy theory.)

Not sure why he expects a new machine for free if the Virtuoso is working properly. One would think he either must pay his 20% for the new REMstar or 20% for his new sleep study. But you can't blame him for asking; after all, he got a free one once before!

IllinoisRRT · Post by **IllinoisRRT** » Sun Sep 18, 2005 8:09 pm

Does it provide the same data (via the software) as the REMstar Auto?

No, which is why I am giving him the loaner Remstar... But I don't think he's computer savvy for THAT to be the reason why he wants it.

Does the auto you provided him with have c-flex? If so, that may be why he likes it better.

It has the capability for CFlex, but it's not set for CFlex.

As for providing him with a "free" machine, why don't you just give him a price if he wants the new machine? He does not "need" the machine and if medicare won't pay for it, you have no reason to provide him with one.

See, my manager would probably be more likely to work something out with him with this machine if he would at least agree to have another sleep study done. It would still be cheaper to pay the 20% of the sleep study I'm guessing than the cost of the machine (through us). I'm going to pick up the Remstar on Tuesday, I'll have to give you all an update. You've given me some great ideas though- I appreciate it!

Sleepless on LI · Post by **Sleepless on LI** » Sun Sep 18, 2005 8:19 pm

Christine,

Just wanted to sidetrack for a minute. You gave me some great advice when I told you my son was starting his new job after graduating from college and becoming a licensed RT. Well, he just passed his Registry last week, both parts, and is now officially an RRT, as well. Loves his job (is there tonight for his 12 1/2 hour shift). I even posted the other day how he has already saved someone's life. If you get a moment to read it, I'd love for you to. viewtopic.php?t=4606&highlight=crow

Thanks again for the wonderful advice. I printed it out and gave it to him. It was really kind of you to do that. Just thought you would get a kick out of how he's come so far already. We are proud of him. Have a great night.

PS: Figures it would be someone as kind as yourself to give this man the equipment he needed for free. You are a very compassionate person.

rested gal · Post by **rested gal** » Sun Sep 18, 2005 8:20 pm

Christine, I'm on your side on this one. It sounds like you and the DME you work for have gone the extra mile again and again for that gentleman. You're not out of line at all to want him to have another sleep study after TEN years. Given what you all have been providing to him free, he really should see that a sleep study at this point would be beneficial to him AND help you continue to help him.

I'd be inclined to just swap the machines back, giving him the Virtuoso again, since he's not willing to be reasonable. After this long getting everything free, he certainly should be willing (since you say he's financially able) to pony up the 20% to have the study that might help your office get at least some reimbursements on his equipment in the future.

Some people just are not reasonable people, though. Good luck.

The Virtuoso is outdated technology, but that doesn't mean it can't provide effective treatment for him. As Wader said, the man may simply like the idea of having a newer machine. And as neversleeps said, getting a free one worked once already for him. He may be a bit spoiled.

You need not feel any concern about having him go back to the Virtuoso. He's the one who should realize that you are asking him to do/pay very little (20% cost of a PSG study) compared to what the whole exercise has been costing you all. I'm afraid his attitude would make me not want to help him one bit more.

DaveMunson · Post by **DaveMunson** » Sun Sep 18, 2005 8:25 pm

IllinoisRRT wrote:Have any of you used more than one kind of AutoPAP machine and been able to tell a difference?

YES! how they work, how quickly they respond and what they do when they respond. How many steps up or down they change the pressure to your needs.

Yea. I used the Remstar and Autoset Spirit. The Spirit responded quicker and seemed to be smarter. Still consider it a more "intelligent" machine. On the other hand: I choose / have the Remstar. It has Cflex. It is slower to respond though. To me, Cflex is worth the difference.

Without cflex I would probably be back to the Spirit.

Guest · Post by **Guest** » Sun Sep 18, 2005 8:53 pm

The older Virtuoso uses a snore based sensor while the Remstar uses a flow based sensor. Different sensors means different algorithms. The new model probably does treat him much better than the outdated one.

But that doesn't mean he should get the newer model for free IMHO!

Guest · Post by **Guest** » Mon Sep 19, 2005 3:32 pm

If the man has been compliant 'for many years' and now has problems, be kind and give him the newer autopap....oops, forgot about the bottom line!

christinequilts · Post by **christinequilts** » Mon Sep 19, 2005 6:48 pm

Does his old prescription cover you to provide him a new cpap? Even mask & supplies, since technically they do technically require a prescription? I am thankful for my DME and all they have provided me when I didn't have insurance coverage for all my equipment- my insurance would pay for my enteral formula & bag sets but not the pump & other equipment, or disposible supplies. On the equipment they were able to recover the cost when I started Medicare and could bill for them until they reached capped rental. They still cover some small, disposible items Medicare doesn't feel are necessary. In my case I am pretty sure they end out ahead- especially since I ended up on BiPAP ST/NIPPV, which is rental for life at whatever Medicare allows (around $400-500 per month, if I remember correctly). I also have made it a point to recomend them to several people because of the great service they provide; and word of mouth recomendations are important for small, non-hospital based DME's to get new customers.

I guess since I've been in your customers situation I cannot imagine asking for new equipment without doing everything I could do to have it covered by insurance....and if I had the money I would defiantly pay for it myself, once I had a current prescription of course.

WillSucceed · Post by **WillSucceed** » Mon Sep 19, 2005 7:33 pm

IllinoisRRT wrote:

One reason I would like for him to get another sleep study (he hasnt been tested for almost 10 years) is to evaluate to see how his current regimen is working for him.

In all honesty, I think that you would be negligent to make a change in therapy WITHOUT appropriate testing to support the change. Treatment is an active thing that should not be taken lightly. While the auto machine does give data, it is not able to give you any information regarding the impact of oxygen -your patient really does need another sleep study.

I would refuse to make a change in therapy without the appropriate testing to substantiate it. In addition to this man wanting new equipment (who amongst us does not want new stuff?), his health warrents a new study and, your licence to practice may depend upon it.

I realize that this may sound harsh, but 10 years is a long time. I would not risk my patient's health, or my licence to practice, based on a 10 year-old study.

wading thru the muck! · Post by **wading thru the muck!** » Mon Sep 19, 2005 8:11 pm

This guy does not NEED a new sleep study, nor does he NEED a new machine. He just wants a new machine because he feels it is working better for him than his old one. Another sleep study will not tell him whether or not this new machine works better for him. Only he can tell you what works better no matter how many wires the sleep lab would hook up. IMO a sleep study really tells you very little about what is going to make you sleep better. If this guy wants a new machine, offer to sell him one. If you feel you need to give him some kind of deal, sell it to him at your cost. I sure don't see any reason to MAKE him waste anybodies money on another sleep study... the machine he has is working for him...correct?

IllinoisRRT · Post by **IllinoisRRT** » Mon Sep 19, 2005 9:20 pm

wading thru the muck! wrote:This guy does not NEED a new sleep study, nor does he NEED a new machine. He just wants a new machine because he feels it is working better for him than his old one. Another sleep study will not tell him whether or not this new machine works better for him. Only he can tell you what works better no matter how many wires the sleep lab would hook up. IMO a sleep study really tells you very little about what is going to make you sleep better. If this guy wants a new machine, offer to sell him one. If you feel you need to give him some kind of deal, sell it to him at your cost. I sure don't see any reason to MAKE him waste anybodies money on another sleep study... the machine he has is working for him...correct?

Well, he claims that with his "old" machine, he is not sleeping well. Which may be legit, but his overnight oximetry showed nary a desat (I know that isn't all that's involved, of course, but I thought it was a good sign that at least his O2 levels were up). With the "new" machine, which I am just using for the data only to maybe appease him (and as a free way temporarily to get some more information), all of a sudden he's better. Maybe he's fooling me to get a "new" machine, maybe not. I have checked his old machine and it seems to be working fine.

I wish he would get another sleep study to find out if there IS a change in his condition. The payment for the machine is not so much an issue for me because I get paid the same, regardless. It just irritates me, the very few patients I have who have come to expect sometehing free. Maybe there is something wrong with his machine, I don't know. It just that it isn't the first time something like this has happened with this particular patient. Maybe it's more of a complaint about him than anything!

My main reason for posting was to see if there is a legitimate difference in the two Respironics machines. I hate that this patient's behavior in the past makes me not trust him. I do put stock in the advice I receive here from other patients (my goodness, you would not believe how many Swifts and Activas I have put out lately!) and wondered if anyone had tried both. As much as some people would like to think that this is another case of "Evil DME" just watching the bottom line, we have had had this patient on service for a lot of years and haven't seen a dime from his CPAP. It is still a business, and unless cpap.com is giving CPAPs away for free, it's nice to get paid for services provided.

(Oh, and as a sidenote, my "financially challenged" patient, who I was supposed to pick up the Remstar and download it today, is now on a last minute "vacation" and can't have it picked up until later this week. So, we'll see what happens then).

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Sleepless on LI · Post by **Sleepless on LI** » Tue Sep 20, 2005 5:09 am

On vacation? Charge him.

IllinoisRRT · Post by **IllinoisRRT** » Tue Sep 20, 2005 6:03 am

Sleepless on LI wrote:On vacation? Charge him.

That's kind of what I was thinking. This is the kind of person I'm dealing with here, and why this is so aggravating!

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AutoPAPs- a difference?- and some complaining!

AutoPAPs- a difference?- and some complaining!

Re: AutoPAPs- a difference?- and some complaining!