True or False?

pj1016 · Post by **pj1016** » Fri Apr 28, 2006 11:41 am

The only difference between a RemStar Auto with C-Flex and a Pro2 with C-Flex is the operating software.

That is, Respironics builds the exact same machine for both models (in terms of hardware) and loads different software.

Do I have that right?

Thanks,

pj

Ric · Post by **Ric** » Fri Apr 28, 2006 11:57 am

Excellent question. And I don't know the answer about the firmware. I am reminded of some years back when Intel made 32K memory chips, then "zapped" one of the internal connectors to make them 16K chips (for less $$$), or zapped 2 connectors and sold them as 8K chips. (Not as dumb as it sounds, sometimes only half or less of the chip was functional, and they could choose which half to salvage). Or they would zap them just to fill orders based on market demand.

In the case of the RemStar, if your hunch is correct, it seems UNCONSCIONABLE! considering there are people out there who would be better served with an APAP, who can't afford the difference in price. And DMEs would have to stop playing the silly games about "insurance won't pay for an APAP", etc. But I better not get too far down this trail of thought before I know if what you're suggesting is correct. Seems plausible, not knowing.

NightHawkeye · Post by **NightHawkeye** » Fri Apr 28, 2006 12:08 pm

Ric wrote:In the case of the RemStar, if your hunch is correct, it seems UNCONSCIONABLE! considering there are people out there who would be better served with an APAP, who can't afford the difference in price. And DMEs would have to stop playing the silly games about "insurance won't pay for an APAP", etc.

Hey, I like free stuff, too. I still use Encore Pro 1.5i and I'm a big fan of open source software. However, I am compelled to point out that, since there is no material cost to software, the logical extension of your argument, Ric, would be that all software should be free.

Reality is that software is marketed by capability. Respironics spent some amount of money developing the APAP software. Shouldn't they be allowed to charge for that?

Regards,
Bill

ozij · Post by **ozij** » Fri Apr 28, 2006 2:55 pm

An APAP needs a mechanism that can change pressure frequently, on the spur of the moment so to speak. A CPAP doesn't. It also needs a mechanism to pick up the changes in your breathing. I think DSM's pictures of the machines disassembeled show the machines have different hardware as well as software.

http://www.internetage.com/cpapinfo/

O.

Brent Hutto · Post by **Brent Hutto** » Fri Apr 28, 2006 4:43 pm

I'm pretty sure DSM has shown that the two machines in question have different hardware. Either way, it doesn't matter. You buy the machine with the capability you need. The only person who cares what's inside is the guy who builds it and the guy who repairs it (and maybe DSM who is an incredibly curious creature by nature).

If they could build an APAP with no moving parts except one magic widget the size of a lima bean that would be no skin off our nose as long as it works as advertised.

[EDIT] And BTW...surely nobody believes that the selling price a mass-produced mechanical/electronic product is determined in any part by the cost of actually building each unit, right? The price is set by what the buyer is willing to pay and what the competition are charging for an equivalent unit. There's a reason all of the CPAP and APAP brands have their prices clustered together so closely.

dsm · Post by **dsm** » Fri Apr 28, 2006 5:33 pm

Re the diff.

To be honest I don't know because all I had to compare was a REmstar Plus.

The cflex feature does require the macine to have both a pressure sensor and a pair of flow sensor chips/tubes.

The plus has neither pressure sensor nor flow sensors.

It could well be right that the two are similar but my guess is that the AUTO has a much more sophisticated blower arrangement hence the much higher initial cost of the Pro with Cflex.

Anyone with a Remstar Pro game to undo the 4 screws & take a peek
I promise it is so easy - just don't drop it while taking the peek

DSM

## On rethinking this, it is quite possible Respironics implemented Cflex on the Remstar Pro without flow-sensors & possibly could have done so without a pressure sensor. An AUTO can't function as an AUTO without them but the flex can just be set as a motor speed adjustment set to several patterns.
_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): cflex, auto

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, cflex, auto

Handgunner45 · Post by **Handgunner45** » Fri Apr 28, 2006 6:32 pm

Well, this peaked my interest. I have been looking for a good reason to open my CPAP. I do have the RemStar Pro 2. I looked at the Service Manual and the only difference in replacement part #s is in the Main PC board. So to verify, I reviewed dsm,s pictures of the Auto, and opened up my Pro 2. Internally they are identical. I don't as of yet have a Auto to compare the layout of the PC boards but I hope to soon. We have 4 of the Auto's on order for the Hospital where I work. I will take the first opportunity to compare the two, and I will repost back here. From my experience with other Medical equipment, I have the feeling that all that is different is the embedded software.

Guest · Post by **Guest** » Fri Apr 28, 2006 6:43 pm

NightHawkeye wrote:...I am compelled to point out that, since there is no material cost to software, the logical extension of your argument, Ric, would be that all software should be free.

Reality is that software is marketed by capability. Respironics spent some amount of money developing the APAP software. Shouldn't they be allowed to charge for that?

I see your point, and I completely agree. I REPENT! I would edit my post to say "CONSCIONABLE", but then the rest of the paragraph wouldn't make sense. Must've been having a "liberal moment". Sorry. I'm breathing again. I'm over it. And I agree, an APAP is WORTH more than a CPAP, all else being equal. Let the market decide who gets what.

Ric · Post by **Ric** » Fri Apr 28, 2006 6:46 pm

that was me, got "guested"

grrrrrrrrrrrrrrrrrr

NightHawkeye · Post by **NightHawkeye** » Fri Apr 28, 2006 7:09 pm

Brent Hutto wrote: ...surely nobody believes that the selling price a mass-produced mechanical/electronic product is determined in any part by the cost of actually building each unit, right? The price is set by what the buyer is willing to pay and what the competition are charging for an equivalent unit.

Only in certain monopoly situations, such as medical practice and the airline industry does this logic work. Reality is that the cost of almost all mass-produced items, from mp3 players to automobiles, is very much determined by the cost of building each unit. That is one of the primary reasons that assembly for so many things has migrated to countries which can provide low cost, yet reliable labor.

Software pricing, the object of this thread, falls in between monopoly pricing and fixed cost pricing. The cost of producing usable software (or, more precisely in this case, firmware) is very high, because it is incredibly labor intensive. That cost is amortized over some minimum projected life of the product. While some software vendors practice monopoly pricing there are very few lucky enough to be in such a position.

Now, as for the airlines and the medical industries monopoly practices. Airlines had a good run for a number of years as a "de facto" monopoly, but that thankfully is now over, although not all the dominoes have yet fallen. I'm certain that most of those directly involved in the medical industry don't realize their run is just about over yet either, but neither did most involved in the stock market crash of '29 or the Nasdaq crash of '01. Nor did all the airline pilots who lost their massive pensions. Funny thing about reality though, when a system becomes unsustainable, the outcome is as predictable as it is inevitable.

Regards,
Bill

wading thru the muck! · Post by **wading thru the muck!** » Fri Apr 28, 2006 7:25 pm

Brent Hutto wrote: And BTW...surely nobody believes that the selling price a mass-produced mechanical/electronic product is determined in any part by the cost of actually building each unit, right? The price is set by what the buyer is willing to pay and what the competition are charging for an equivalent unit.

Good point! This is similarily and to a greater degree demontrated by the fact that they sell masks that contain pennies of plastic for $100 plus.

Brent Hutto · Post by **Brent Hutto** » Fri Apr 28, 2006 7:44 pm

Even in a monopoly, price is set by what someone is willing to pay. It will typically be higher than in a market with multiple sellers but a sale transaction still requires a buyer and a seller who agree on a price.

And Mucky is right about the masks. The marginal cost of production of pieces that make up my Swift can't be more than a dollar or so yet good luck trying to buy nasal pillows for ten bucks.

There's no monopoly in CPAP machines and masks, a quick Google search will turn up at least a dozen mail-order sources in addition to cpap.com and those are very low-overhead retailers. Yet a nasal pillow interface costs a hundred bucks and they sell tons of them. Obviously there are an awful lot of us out there willing to pay a hundred bucks for an item that can roll off the assembly line for 1/50 of that amount. Therefore they sell at what we're willing to pay.

Personally, I've spent on the order of $600-700 on CPAP-related stuff and it seems to be worth it so far (and that's not counting the costs of sleep lab tests, etc). I don't really care if all that stuff cost five bucks or five hundred to make, I just know what it cost and that I was willing to pay it. It doesn't take a conspiracy or a monopoly to explain prices of CPAP gear, just plain old freshman economics.

wading thru the muck! · Post by **wading thru the muck!** » Fri Apr 28, 2006 8:05 pm

Brent Hutto wrote: It doesn't take a conspiracy or a monopoly to explain prices of CPAP gear, just plain old freshman economics.

Brent is right... no conspiracy.

But there is a major flaw that prevents the free market from adjusting prices to a reasonable level.

That flaw? ...the health insurance industry. The direct chain between end user and payer is broken several times in the chain. In a perfect world we would buy medical care and pull out cash to pay for it. In reality, we earn our healthcare insurance which in turn paid for by our employers (break number one). The insurance then pays for our healthcare with little or no understanding on our part as to what amount was paid. (break number two). We receive the care and interact with our healthcare providers, but the payer (the insurance company) receives no feedback as to whether or not the care we received justifies the price paid (break number three).

If one supposes that the cost doubles as a result of each break, the end result is that we pay eight times what we should be paying... probably not far from reality.

Brent Hutto · Post by **Brent Hutto** » Fri Apr 28, 2006 8:21 pm

Exactly. The predominant payor is employer-prepaid medical coverage (not really insurance at all) and it is mostly the price that particular payor is willing to pay that gets set as the selling price. So their interest in making the price lower is not as great as it would be if the employer (funder) were buying directly and not nearly as great as if the consumer were shopping directly. Plus there are government subsidies and legislated risk aversion to consider. A very corrupted market (not "corrupt" as in evil and crooked but "corrupted" as in distorted from its ideal form) that has price distortions galore.

NightHawkeye · Post by **NightHawkeye** » Fri Apr 28, 2006 8:32 pm

wading thru the muck! wrote:Good point! This is similarily and to a greater degree demontrated by the fact that they sell masks that contain pennies of plastic for $100 plus.

Aw, come on now, Wader. Don't you think that's kinda like saying your computer contains just a little bit of sand. True as far as it goes, but many billions of dollars have been spent coaxing the sand to do quite useful and occasionally entertaining tricks.

Regards,
Bill