What a DME company can do to be better!

[kevincoop]

Hi,
I am a Respiratory Therapist for a DME company and have recently started coming on CPAPtalk to get some ideas on how to educate our customers better. I have been setting up CPAPs for over 10 years now and have realized that I have just started learning. I have been through a sleep study, I take the new masks home and try them out and try to give the best instruction I can. But after reading numerous posts about how bad DME companies are, I thought I would let CPAPtalk users give me some ideas on how I can make things better.
Please understand, I can't do anything about how insurances work and pay for supplies. I do take advantage of every offer the manufacturers give to us. We have a 30 day guarantee (and so do all other DME companies) on every mask that we give out. If the customer does not like it for any reason they can come back in and we will exchange it at no charge to you or your insurance company. If we open a mask and the customer does not like it at the store, I clean it and will use it to give to someone as a spare or an indigent customer.
We also follow up with our customers at 24 hours, 1 week, and every month after. Yes, this is partly because we can generate revenue from the supplies, but we also have very compliant customers compared to any other company that I have worked for in the past.
I know that there are several shortfalls that DME companies face compared to internet companies. We do have a greater overhead and feel we should get paid more for our services because we offer home delivery and setup, we have to keep a RT in house all the time in case someone comes in to be fitted for a new mask. If we could just ship out the CPAP's and answer phone calls and emails, we would be able to charge much less. I also think that small DME companies have a huge disadvantage because they do not get the pricing breaks from manufacturers that the larger internet companies get. I worked for one company that lost money on almost all "nicer" masks because they purchased them from a vendor and didn't have good pricing and also didn't have good insurance contracts.
So, give me your ideas on what a Respiratory Therapist or DME company can do better. I have started telling all of my customers to go to CPAPtalk to read the posts and get some good ideas, but I know I'm just at the tip of the iceburg.
I am posting another topic about our initial setup education. I would like the CPAPtalk users to see if there is anything I should add for new users. If you have a response that you would like for me to personally respond to, please send me a private message and I will get back to you as soon as possible.
Thanks for your input,
Kevin Cooper

[BleepingBeauty]

I think the concept of cloning is a very slippery slope, but in a case like this, I'm good.

If every DME operated like the one you describe, I have no doubt that xPAP compliance (and success) would increase greatly. It's a shame that so many of us don't have access to a good DME. (And thank goodness this forum exists for us.)

[kevincoop]

I'm definetely not saying we are perfect by any means. And customers do slip through the cracks unfortunately. I do want to do the best I can to educate our patients and give the best service available.

[Goofproof]

A DME company could do better by only putting equiptment out that can collect needed data on how treatment is going, (I'm talking using software). Another thing would be not to just throw out the cheapest nasal mask to everyong, and send them home to mouthbreath their treatment away. Setting the XPAP's up to the correct pressure or range of pressures for the patients needs. Getting the patient the equiptment they need in a more timely fashion. Being informed about the bussiness, and not trying to pull the wool over our "sheeps" eyes. This would be a good start. Jim

[LSAT]

Kevin...You said..."If we open a mask and the customer does not like it at the store, I clean it and will use it to give to someone as a spare or an indigent customer. "

This is unusual....Isn't it true that a DME's return opened masks to the vendor for a no charge replacement??

[kevincoop]

I just discard it into our indigent supply box.

[LinkC]

A DME company could do better by only putting equiptment out that can collect needed data on how treatment is going,

I disagree. Not everyone WANTS to track their therapy. The majority are happy to hose up and sleep...as long as they get some level of relief. They couldn't care less what their AHI is any given week. And, as long as they are getting treatment good enough to keep them happy, their doctors couldn't care less about the numbers, either. Data-capable machines are wasted on them. Give THEM "Plus" models.

They are the hundreds of thousands of patients you DON'T see here (or places like this). We are but the iceberg tip.

Kevin--if *I* were the ideal RT, I'd talk to each patient and determine how involved they want to be...and then tailor the equipment and education you give them to that.

[DreamOn]

Actually, we don't have to send them back. We just have to send them a paper as to why it didnt work and then "discard" it. I just discard it into our indigent supply box.

Bless you for donating to those in need!!!

When I had to return a mask because it wasn't working well for me, my DME told me that he doesn't need to send the masks back to the manufacturer. I asked him if he donates the returned masks to charity or customers in need. He said that he wasn't allowed to by law and has to throw them away. I think it's ridiculous to throw away a perfectly good mask, so I asked if I could have it. He gave it to me and also provided me with a replacement mask.

Organizations such as Awake In America are very happy to receive unneeded masks in good condition. What a waste it is to just throw them out!

[Jersey Girl]

Kevin,

I was completely new to cpap and on Jan 8 my DME came to my home. The machine pressure was already set and she had enabled the patient menu and furnished me with the Clinician manual so that I could check on my stats. I would have loved it had she also furnished me with software and a smart card reader, or given me the opportunity to purchase them at a discount. I like that she helped me fit the mask One mistake that she made in the beginning was just to fit me with a Swift LT for her and not hook it up, but fit me sitting in a chair in the kitchen. I think that all DME's should help fit the patient with the mask on and then have them try the mask out while hooked up to the machine with the machine on to see if they are liking the mask or not. I had her come back a few weeks later with masks that I had researched on cpap.com and this forum. Since I started on cpap on January 8 she has given me a total of 3 masks at no charge and a fourth they gave me as a courtesy 54 days into treatment - when the Swift FX came out. I agreed not to take another mask until June - skipping my April 1 new mask in favor of getting my Swift FX a little earlier.

Early on, I wish I could have gotten in touch with someone when I had questions about my mask or treatment, but I would have to leave a voicemail and then wait for my particular DME to call me back. Sometimes this took a couple of days. Thank goodness for this forum - I can post a question or concern, and have an answer within minutes!

She didn't really tell me it might take some time to adjust to cpap, or how to improve my treatment, or anything. I had the feeling that she had never worn a mask in her life. I think that all DME's should try on their product with the machine hooked up at least once to know what the client feels like the first time.

Also, she had no idea about this forum and was surprised that there was a forum for people just to talk about cpap. I think that it is very good that you recommend this site to your clients.

Thank you for asking the question. It shows that you really do care.

Best regards,

Jersey Girl

[jnk]

A DME company could do better by only putting equiptment out that can collect needed data on how treatment is going,

I disagree. Not everyone WANTS to track their therapy. The majority are happy to hose up and sleep...as long as they get some level of relief. They couldn't care less what their AHI is any given week. And, as long as they are getting treatment good enough to keep them happy, their doctors couldn't care less about the numbers, either. Data-capable machines are wasted on them. Give THEM "Plus" models.

They are the hundreds of thousands of patients you DON'T see here (or places like this). We are but the iceberg tip.

Kevin--if *I* were the ideal RT, I'd talk to each patient and determine how involved they want to be...and then tailor the equipment and education you give them to that.

I disagree with your disagreement, but in an agreeable way.

It is best to give full-data machines to everyone, even if the user doesn't need it AT THE MOMENT. Things change. The data machines are no longer much more expensive than the non-data ones. If a patient later has a complaint, the DOC can then have the DME check the data to troubleshoot instead of the doc having to require the spending of hundreds of dollars, if not more, on sleep studies and office visits. If all machines were full-data and they stopped making the others, everyone would save money in the long run, even if the patients never looked at the data who didn't feel they need to.

Just my opinion. Everybody's got one, I know.

jeff

[rested gal]

A DME company could do better by only putting equiptment out that can collect needed data on how treatment is going,

I agree with Jim (Goofproof) for this reason -- all machines "out there" should be capable of gathering LEAK data.

Not everyone WANTS to track their therapy. The majority are happy to hose up and sleep...as long as they get some level of relief. They couldn't care less what their AHI is any given week. And, as long as they are getting treatment good enough to keep them happy, their doctors couldn't care less about the numbers, either.

I agree with LinkC, too. I think most cpap users "out there" are not the least bit interested in checking their own therapy. All they want to know is how to turn the machine on and off.

Data-capable machines are wasted on them. Give THEM "Plus" models.

I agree that the vast majority of cpap users and their doctors are completely uninterested in seeing any treatment data from the machines.

I don't agree, however, that that means they should be given basic, non-data-recording machines.

I'd urge the DMEs to look for at least ONE important piece of data, and look for it VERY EARLY on during each person's first week on CPAP, even if the person is using a Full Face mask:

Leak rate.

http://chestjournal.chestpubs.org/conte ... /1248.full

They are the hundreds of thousands of patients you DON'T see here (or places like this). We are but the iceberg tip.

So true. Here on cpaptalk many of us are interested in seeing every iota of data we can know about our own treatment. As you correctly pointed out, most cpap users are not. Not interested in that at all.

Many out there are probably getting very poor treatment due to massive leak problems -- whether the leaks are from mouth, mask, or both. Checking the leak rate via a machine download should be a top priority duty (imho) of any DME who works with CPAP users.

DMEs probably assume any serious leak problems would be identified and dealt with at the sleep study. But what the sleep tech does about it for the scant few hours of a sleep study titration session is not necessarily going to work for controlling leaks when the person is sleeping at home. Not even if the same mask that was used in the study is used at home. And not even if a chin strap handled it "ok" during the few hours of the study.

My opinion:
DMEs should download the machines and check the leak rate during the first week of treatment, imho. They should look at the DETAILED data leak rate for the most recent nights... not just take a quick glance at the average leak rate. Don't assume the cpap-user will notice leaks. Many people can and do sleep through MASSIVE leaks -- I've seen it on my own downloaded data and that of others.

I can hear it now... "Download during the first week???? Just to look for leaks???? You've got to be kidding! Too time consuming, too much trouble. We're doing well if we have time to do a download at the end of a month or so, to comply with Medicare or insurance requirements."

Kevin--if *I* were the ideal RT, I'd talk to each patient and determine how involved they want to be...and then tailor the equipment and education you give them to that.

Good advice. But when tailoring the equipment to that, I'd still make sure it was a machine capable of recording LEAK data.

Whether the CPAP user was interested in it or not, I (the DME) would actually look at it.

I'd look at it by the end of the first week.

That is, if *I* were the ideal RT. (And if I had the time.)

[jnk]

Hi,
I am a Respiratory Therapist for a DME company and have recently started coming on CPAPtalk to get some ideas on how to educate our customers better. I have been setting up CPAPs for over 10 years now and have realized that I have just started learning. I have been through a sleep study, I take the new masks home and try them out and try to give the best instruction I can. But after reading numerous posts about how bad DME companies are, I thought I would let CPAPtalk users give me some ideas on how I can make things better.
Please understand, I can't do anything about how insurances work and pay for supplies. I do take advantage of every offer the manufacturers give to us. We have a 30 day guarantee (and so do all other DME companies) on every mask that we give out. If the customer does not like it for any reason they can come back in and we will exchange it at no charge to you or your insurance company. If we open a mask and the customer does not like it at the store, I clean it and will use it to give to someone as a spare or an indigent customer.
We also set up all of our customers on Auto CPAP's with modems and smart cards (unless the Doc writes for a specific machine). Even if the script is for a std CPAP pressure, we put everyone on the Auto so we have the capability in the future if the cusomer needs it. We have a lady at our office who screens this daily for anyone who may be having issues so we can have the RT call immediately.
We also follow up with our customers at 24 hours, 1 week, and every month after. Yes, this is partly because we can generate revenue from the supplies, but we also have very compliant customers compared to any other company that I have worked for in the past.
I know that there are several shortfalls that DME companies face compared to internet companies. We do have a greater overhead and feel we should get paid more for our services because we offer home delivery and setup, we have to keep a RT in house all the time in case someone comes in to be fitted for a new mask. If we could just ship out the CPAP's and answer phone calls and emails, we would be able to charge much less. I also think that small DME companies have a huge disadvantage because they do not get the pricing breaks from manufacturers that the larger internet companies get. I worked for one company that lost money on almost all "nicer" masks because they purchased them from a vendor and didn't have good pricing and also didn't have good insurance contracts.
So, give me your ideas on what a Respiratory Therapist or DME company can do better. I have started telling all of my customers to go to CPAPtalk to read the posts and get some good ideas, but I know I'm just at the tip of the iceburg.
I am posting another topic about our initial setup education. I would like the CPAPtalk users to see if there is anything I should add for new users. If you have a response that you would like for me to personally respond to, please send me a private message and I will get back to you as soon as possible.
Thanks for your input,
Kevin Cooper

AWESOME POST!

Thanks for being here.

You set the bar high, right where it should be. And you make good points.

Frankly, I would have been happy if my former DME had simply adopted one two-word policy. "Stop lying." They weren't exactly evil, or anything. Just not very bright. And in a way that made them deceitful.

The more you post in forums like this one about what should be done, the more educated we patients become, and the more ashamed the bad DMEs should be at how they compare. So please keep it up.

jeff

[Jersey Girl]

Kevin,

I definitely don't clean all of my equipment every day. I use Citrus Magic cpap wipes on my nasal pillows or nasal cushion every day. I empty out my dehumidifer water and only use distilled water in it.

Every week I wash my nasal pillows/or nasal cusions with hot soapy water - ivory dishwashing liquid and do the same with my hose. Then, I use vinegar and water to disinfect my dehumidifier.

I will also wash my mask straps (material) once a month.

I think that this is a more realistic regemin than telling people to fully wash all the equipment every week. It might be too overwhelming for a new cpap user to tell him/her to wash all the equipment each and every day.

Best regards,

Jersey Girl

[rested gal]

AWESOME POST!

Thanks for being here.

You set the bar high, right where it should be. And you make good points.

I agree, absolutely!

I've added Kevin to my little informal list of "good'un's" --
viewtopic.php?p=442957#p442957

Kevin's other excellent topic is at:

"New CPAP user Instruction Manual help."
March 24, 2010
viewtopic.php?p=465004#p465004

[Jersey Girl]

Kevin,

I respectfully disagree with LinkC on this one. When I was new to cpap - it was kind of overwhelming. But after a couple of weeks, I wanted to know more and to learn about how to use my machine to find out my stats, purchased a card reader, obtained software and now run my own reports. So, the new cpap user may not know how involved he/she would like to be at first...but once the first hurdles of sleeping with a mask are over, he/she may want to be very involved. I personally think that everyone should be given data capable machines.

Best regards,

Jersey Girl