Wise to tell the Doctor?

[greatunclebill]

Neither the DME or insurance company care about what pressure you use and they are not going to check it in order to compare it to the original prescription. They ONLY care about the number of hours per night you are using the machine. You will NOT be considered "out of compliance" if you tweak your pressures...compliance is just the average number of hours per night over a specific period of time..

i generally agree with what is being said and am not arguing. i know you mean well, but i just find it fascinating that you are trying to speak for every dme and every insurance company, without saying that there could indeed be problems. there are alot of dme's and alot of insurance companies in this world. i'm 100% sure you haven't spoken to every one of them. i would hate to think that somebody believes you and loses their coverage because of non-compliance over something they read here. remember the old saying about never say never. anything is possible.

[Suzjohnson]

Absolutely. If nothing else it will tell you something useful about your doctor. .

Amen!

Suz

[jnk]

Some sleep docs and primary docs encourage patients to take charge of the therapy. Other docs go into brain-lock, get scared and confused--or even angry, for some strange reason--when they hear about patients adjusting things on their own. Docs can get their feelings hurt, just like any humans, if they think the message being given them is "I don't need you; I'm doing it myself without you." The relationship is supposed to be cooperative, a partnership of sorts.

My primary doc asks me questions about what I do and why, and he says he does so in order to learn from me so he can be helpful to other patients. He does that even though he doesn't particularly believe in CPAP. I consider him to be supportive, but I think my relationship with my primary doc may be somewhat unique. It is a clinic/infirmary setting where neither I nor the doc have to worry about the financial aspects of who is paying for the time spent discussing the subject.

Only you can judge your relationship with your doc and what your particular doc seems to be able to handle knowing. Some things you NEVER want to hide from your doc. But with other stuff (even such things as minor, reasonable changes in pressure for simple OSA) it may be the course of wisdom not to give him information that he would only find shocking or disturbing. The question is a clear one of what you feel is in your own best interests with that specific doc, since, as has been said, the doc works for you, not you for him. But it is good to know that sometimes the ramifications can be far-reaching if it causes problems with other treatments or your coverage in other areas of health.

[Maxie]

I now see the RT in my doctor's office because I don't have any of the problems that require the doctor to see me. I email a printout of my machine readings and ask his opinion. (Although I already got what I needed on this forum.) I did tell him that I changed some of my settings but I've not changed the pressure because I figured that someone who knows more than I do made the decision on that one. I do think it is wise to tell the doctor or RT, whichever manages your care and I do think that my RT cares about more than compliance.

[akcpapguy]

If you are in the compliance stage for insurance, you should follow the prescriptions. Some DME or insurance might object if you changed things on your own. They may say you were non-compliant. Other than that, yes, let your doctor know. It helps the doctor to know what is going on.

Neither the DME or insurance company care about what pressure you use and they are not going to check it in order to compare it to the original prescription. They ONLY care about the number of hours per night you are using the machine. You will NOT be considered "out of compliance" if you tweak your pressures...compliance is just the average number of hours per night over a specific period of time.

As others have said, it's good to take control over your own treatment because nobody else cares about it as much as you do.

If your DME is Joint Commission certified they better be concerned about your compliance with the Physicians order for your PAP machine.
Every patient that I setup has either a modem attached to their machine or bring their card in for download every 3 months while the machine is still under a rental agreement. During the card download I check the pressure reported against the latest prescription on file. If their pressure is not the same I will ask the patient if they recieved a new prescription or if they changed it themselves. I also contact the Physician and notify them of the situation, sometimes they will write a new prescription on the spot and fax it and sometimes not. If the Physician does not send a new prescription I will reset the prescription on the patients card and notify them of the change back. This is our company policy which came into existance from our last Joint Commission inspection where we recieved a major finding for not changing a patients CPAP back to the current prescription on file when we downloaded the card.

[BlackSpinner]

If your DME is Joint Commission certified they better be concerned about your compliance with the Physicians order for your PAP machine.
Every patient that I setup has either a modem attached to their machine or bring their card in for download every 3 months while the machine is still under a rental agreement. During the card download I check the pressure reported against the latest prescription on file. If their pressure is not the same I will ask the patient if they recieved a new prescription or if they changed it themselves. I also contact the Physician and notify them of the situation, sometimes they will write a new prescription on the spot and fax it and sometimes not. If the Physician does not send a new prescription I will reset the prescription on the patients card and notify them of the change back. This is our company policy which came into existance from our last Joint Commission inspection where we recieved a major finding for not changing a patients CPAP back to the current prescription on file when we downloaded the card.

Obviously the best thing a patient can do is disconnect that Big Brother modem ASAP. Mail in the reports to the DME.

[xenablue]

Well, I guess my neuro and I will be getting into some hot water then! She is 100% confident that I understand my therapy, the data I see and am aggressive about taking care of my own health. She has given me full support and approval to change my machine settings within a certain range to have my therapy working at optimal levels.

If my DME disagrees with my neuro and changes my machine back to its original prescription, that's OK, I'll just change it back when I get home.

Cheers,
xena

[akcpapguy]

I certainly understand not wanting to have the modem attached to your CPAP, and yes I use it to verify compliance both in hours used and settings applied to the CPAP. However I can say honestly that in the last 5 years we have not removed a CPAP from a patient for either one of those compliance reasons. That’s not to say that patients have not turned in their CPAP’s for lack of compliance, mainly due to insurance refusing to pay due to non-compliance after a certain period of time. I would also add that since we started using modems we have not had a single patient that used one return their CPAP/BiLevel for non-compliance.

With all that said, compliance is just a small portion of the daily data that I look at from those patients, leak, flow, AHI etc. are all looked at as well. If I see that someone is having a large leak or a high AHI I will call them and discuss with them any problems they are experiencing. We pay a monthly fee for every modem we have active on a CPAP, most are only active for 6 months. We have patients who will often come back and pickup a modem for a month (at no charge to them), we review their data along with all the others every morning. I often times end up being and advocate for them in speaking with their physician about pressure changes, pulse oximeter monitoring etc. These services are a win/win for both of us, the patient gets an RT looking at their data daily and I get to interact with my patients and their physician. I know I (and the other RT’s that work with me) provide outstanding service to our patients, I have about a dozen or so patients who have even moved 1000’s of miles away and no longer receive supplies from us, but they still send their cards to me for download. I then call them, we discuss their therapy and many other things to include their grandkids, new vehicles they purchased, where they went for vacation this year. Bottom line I care and I make sure through my actions and interactions that they know I care.

Now I have been around here for some time and understand most of you heard “I wanna put this thing on your CPAP so I can make sure you are using it so I can get paid!”. Yes we want to get paid, however many measures were put into place in our business to help our patients attain successful and therapeutic treatment with their PAP equipment. We carry every (well every one that we know of to include masks from small companies like TAG and Circadiance) CPAP mask on the market, with the exception of the CPAP PRO mask. We also carry many of the “extra” CPAP items like hose hangers, pillows, hose covers which help SOME patients achieve success in obtaining adequate therapy.

I only mentioned setting the CPAP back to the current prescription because for some DME’s it is a requirement that they do in order to ensure that they keep their accreditation. I would never change someone’s CPAP without first talking to them and explaining to them my reasons for doing so. If they go home and change it back to another pressure that is out of my control, I have done my part to comply with the limitations of our accreditation guidelines. Also I will clarify that these guidelines only apply to equipment still on rent, not patient owned equipment.

[jnk]

I always enjoy your fine posts, akcpapguy.

Then again, that is generally true for me with everyone on rg's list of "good uns"!

viewtopic.php?p=442957#p442957

[akcpapguy]

LOL thanks jnk, I may fall off her list though for using the term "patient" too many times in the same post. Sorry just a habit.

[jnk]

LOL thanks jnk, I may fall off her list though for using the term "patient" too many times in the same post. Sorry just a habit.

Don't worry. We'll be patients with you. I mean, patient.

I have the same problem, and I ain't even in the bidness. So no worries. Say it however you want to.

I, for one, learn from you.

[Issac]

jnk, what do you mean "my doctor doesn't believe in cpap" ? What kind of doctor is he?

[Janknitz]

Clearly the many DMEs who think all we need are compliance only machines don't give a hoot about out compliance with prescribed pressure settings since they have absolutely NO way to check unless you physically bring the machine in so they can check the setting.

Are most DMEs JCAHO certified???

[jnk]

jnk, what do you mean "my doctor doesn't believe in cpap" ? What kind of doctor is he?

A good one, in my opinion. And I said "particularly believe in."

But like most docs of a certain age, ones who went to med school pre-1990's, he considers medicine to be mostly about surgical procedures to correct anatomical difficulties and prescriptions of medications and changes in lifestyle. Like most primary docs, he tends not to trust science funded by large corporations who want to sell gizmos marketed directly to, uh, as akcpapguy would say, patients. If a company wants to sell machines, few docs tend to take what that company claims seriously. It is even more insulting to docs than the drug companies who market heavily to sell their drugs. As a patient, I don't mind being marketed to, since, in my opinion, PAP therapy would never have gotten off the ground without it. But my doc doesn't like it.

I respect his stand, which is based solidly on his education. Docs can't be expected to understand things they have not been taught or have not seen for themselves. It is easy for us who have benefited so much from PAP therapy to forget how new it is, as far as a treatment for sleep-breathing difficulties. And the history of the development of the machines--and the sub-specialty of sleep medicine as a practice, for that matter--has been nonstandard, to put it mildly.

It is reflex for most primary docs to think first in terms of a surgery or a medicine over a machine that they associate with hospital-type life support measures. That is why we as successful patients do our fellow man a favor any time we can educate our doctors by helping them see the measurable improvements in our lives beyond quality-of-life stuff. When a primary doc sees the vitals change and the overall health change when his patient is on PAP therapy, then, and only then, does the doc start to become a true believer.

No primary doc can keep up with all the specialized developments in medicine. So it is not so strange, to me anyway, that many of them are unfamiliar with how far PAP therapy has come and how successful it is.

Let's teach them.

[BlackSpinner]

jnk, what do you mean "my doctor doesn't believe in cpap" ? What kind of doctor is he?

A good one, in my opinion.

But like most docs of a certain age, ones who went to med school pre-1990's, he considers medicine to be mostly about surgical procedures to correct anatomical difficulties and prescriptions of medications and changes in lifestyle. Like most primary docs, he tends not to trust science funded by large corporations who want to sell gizmos marketed directly to, uh, as akcpapguy would say, patients. If a company wants to sell machines, few docs tend to take what that company claims seriously. It is even more insulting to docs than the drug companies who market heavily to sell their drugs. As a patient, I don't mind being marketed to, since, in my opinion, PAP therapy would never have gotten off the ground without it. But my doc doesn't like it.

I respect his stand, which is based solidly on his education. Docs can't be expected to understand things they have not been taught or have not seen for themselves. It is easy for us who have benefited so much from PAP therapy to forget how new it is, as far as a treatment for sleep-breathing difficulties. And the history of the development of the machines--and the sub-specialty of sleep medicine as a practice, for that matter--has been nonstandard, to put it mildly.

It is reflex for most primary docs to think first in terms of a surgery or a medicine over a machine that they associate with hospital-type life support measures. That is why we as successful patients do our fellow man a favor any time we can educate our doctors by helping them see the measurable improvements in our lives beyond quality-of-life stuff. When a primary doc sees the vitals change and the overall health change when his patient is on PAP therapy, then, and only then, does the doc start to become a true believer.

No primary doc can keep with all the specialized developments in medicine. So it is not so strange, to me anyway, that many of them are unfamiliar with how far PAP therapy has come and how successful it is.

Let's teach them.

Not a good doctor. It is his duty to keep up with medical advancements. Nurses have to take course to stay up to date and employed. So do technical people. So do teachers (in Quebec anyway). Why shouldn't a doctor. They should, in order to keep their license, show that they take a certain number of course hours per year.
As a programmer I moved from cards to, eventually, web based development. There is absolutely no reason why a medical person should stay behind.
"learned this back in school and that is all there is to it" is not acceptable.