Why Aren't All Machines Fully Data Capable?

[Thatgirl]

I'm so thankful for this forum! I would have never known what kind of machine I was looking for if I hadn't found this forum. Actually, if I hadn't found this forum I don't think I would have ever gotten my CPAP, period.

Because of this forum I was able to go to my DME and tell them exactly which machine I wanted. My script was for an APAP anyway- and it seems like they're all fully data capable anyway? They gave me no fights and I got my Autoset 10 for Her. I think being fascinated by the technology and loving the way it looks has really helped me stick with it.

My dad started CPAP therapy about 2 years ago. I remember when he got his machine him telling us that his DME told him he got the "Cadillac" machine. I looked at it last week. It's the S9 Escape.

All this rambling brings me to my question that started the thread. Why aren't all machines data capable? It seems a crime to leave some people unsuspectingly at such a disadvantage managing their therapy. Further, I don't understand why fully data capable machines cost more? Unless the sensors that obtain the data cost a ton, it seems like all machines have the SD card so memory isn't an issue. I would think the R&D would be the most expensive part. And that they're doing whether they give everyone access to it or only the people fighting for it.

I have type 1 diabetes and use an insulin pump also. There are about 5 models common on the market of insulin pumps. All of them record tons of data and are fully uploadable. Further, I could kill myself very easily if my insulin pump is misprogrammed. Not so much with the CPAP. My very first pump, and every upgrade from there on, was shipped to my house with the complete manual. I had training, but I had the device in my hands and could start without training. There's no such thing as settings being locked on insulin pumps. No clinical manuals or clinical menus. I was shown how to change all of the settings and even encouraged to look at my data and make adjustments as needed to my rates once I was more experienced.

Contrast that to my CPAP experience where I had to physically go to training to even get the machine and was told the settings aren't user adjustable and given a 10 page patient manual. I just don't "get" how different medical devices went such different routes.

Also, my insulin pump has an out of pocket cost of $8000. I had a $10 copay once to get it. My CPAP costs around $900 out of pocket. I'm paying $20 per month over 13 months for it.

[Julie]

Cpap technology is very new as technology goes... even 10 yrs ago using software, etc. was 'special'. There are only so many manufacturers (with the two biggies way ahead of the others, many of which are not even available in N. America) and only a few people who bothered or cared about software - don't you know the doctors are/were gods not long ago, who told you what to do (whether or not they had a clue themselves), so people were ignorant of possibilities til very recently. Cpap mfgrs are all about selling machines and didn't care much about end user (patient) wishes, just getting more buyers.

And some people with the type of insurance you have that makes you rent machines at a ridiculous price (by the time you've 'bought' it) have not gone through insurance but bought outright online when possible, because it's cheaper to do it that way, but I don't know if you personally could have done that (esp. being in Canada and not familiar with U.S. insce. co. rules).

[BlackSpinner]

Profit plain and simple.

Bricks are marginally cheaper but they get the same amount from insurance.
With no data you have to visit and get more studies. With data but no access you have to use their services.
Money money money.

[palerider]

All this rambling brings me to my question that started the thread. Why aren't all machines data capable? It seems a crime to leave some people unsuspectingly at such a disadvantage managing their therapy.

because the customers (the DMEs) want them, because they don't care if your treatment works, and they cost less, only if you use it, so they can get paid by the insurance companies, who also don't care if your treatment works.

the "system" is fucked.

Further, I don't understand why fully data capable machines cost more? Unless the sensors that obtain the data cost a ton,

*lol* the *only* difference between the cheapest no data brick and the most expensive (3500$ish) adaptive servo ventilator in the resmed s9 line is the software that runs it.

even the models that don't have an alarm have a beeper inside, because it's cheaper to produce *one* circuit board in quantity and just program it differently.

[Thatgirl]

See, that's what I don't get. If they're the same price to make, why is one model cheaper?

[tan]

See, that's what I don't get. If they're the same price to make, why is one model cheaper?

Let us say there are 5 people that are willing to pay $500 for a basic model, and there are another group of five willing to pay $1000 for an advanced model. Then, if the models were all the same, the ten people would only pay $5000 total versus $7500 for different models, despite having the same production cost.

[palerider]

there's also *some* recouping of the costs of development, there's a WHOLE lot more R&D work that's gone into making a non-invasive ventilator work effectively than the pretty braindeadness of the basic brick.

[Thatgirl]

Ah yes. It's all making sense now.

[chunkyfrog]

Texas Instruments made one of the first truly compact personal computers, at first a basic model.
When later models came out with additional features, hackers opened their
older models up and installed jump wires to activate features that were present all along!
Sure wish we could do that to an Escape! Whoever figures that out will be a HERO!

[palerider]

Texas Instruments made one of the first truly compact personal computers, at first a basic model.
When later models came out with additional features, hackers opened their
older models up and installed jump wires to activate features that were present all along!
Sure wish we could do that to an Escape! Whoever figures that out will be a HERO!

yeah.
there's a trend these days with mfgrs offering defeatured machines for lower prices.
rigol is infamous for that, of course, they're not the only ones doing it. (there was another recent article that I can't put my fingers on at the mo.

[Wulfman...]

Here's where the phrase "Follow the money" fits the circumstances.

The DMEs will put THEIR profits above YOUR therapy.

On the other hand, I've been noticing in recent times that more DMEs (and doctors) are prescribing and dispensing "Auto" and other fully data-capable machines. Unfortunately, not all are on that band wagon just yet, but we're starting to see a trend developing. The users need to investigate and become well informed on this technology and equipment before they sign on the dotted lines. In my opinion, NOT doing that is no excuse. Typically, people will research the Hell out of other technology devices (cell phones and other items they purchase), so not researching these therapy devices they're going to use every night for the rest of their lives is no excuse (I know, I'm repeating myself).


Den

.

[cathyf]

I don't understand the economics of this market, either. The hardware engineering is relatively cheap, it's the software that costs the money. And QA and testing is a good-sized chunk of those costs. If you already have a piece of hardware, and a full-function software to run on it, then if you have a choice between installing the full-function software you already have and already sell on the machine, and developing and testing a NEW and DIFFERENT crippled software before you install it, why would you spend the money on the crippleware development costs?

With the crippled S9 auto, at least, it looks very much like the crippled machine is the same hardware, same sensors, same card, same cpap algorithm, with the only difference being that the software on the crippled machine doesn't log the data that it is using to the card. It still collects all of the data (it has to in order to make the decisions of what to change the pressures to) it just doesn't run the line of code that writes the data to the card. It cost ResMed money -- thousands of dollars, maybe tens of thousands -- to run the tests to ensure that they didn't break anything else when they took out the data writing. Why would they spend money to make a less valuable machine, when they could just crank out another copy of the more valuable machine for no extra cost?

[Janknitz]

There are many reasons why there are bricks in this world, none of them benefit us.

In many cases, when sleep apnea is suspected, the patient is "referred out" to a sleep doctor who runs a sleep lab. That doctor may never see the patient, but the patient will go through a sleep analysis and titration in the doctor's sleep lab and then be referred back to the primary care doctor for ongoing care with a prescription for a CPAP machine and the applicable pressures.

The sleep doctor has no interest in prescribing a data capable machine because he or she has no interest in following up with the patient (very little money to be made in doing so). The primary care doctor knows NOTHING about sleep medicine or data, so he or she may not even want the patient to have access and then be asking questions he or she can't answer. And the DME wants to squeeze every penny of profit from the sale/rental of the machine (even the $30 or so difference in the wholesale price between a data capable machine and a brick) so therefore has no desire to provide a data capable machine and may pressure manufacturers to make bricks to increase the DME's profit margin.

Insurance companies don't care what is supplied--they pay one price. And they think compliance is important to prevent more expensive downstream illnesses, but they have no understanding that an engaged patient is a compliant patient who will most benefit from their treatment. So they don't care about anything but compliance.

It's up to US to insist that we get data capable machines, and we are often taken advantage of because we know so very little at the time of diagnosis, and the learning curve is steep. It's a deck stacked against us, every step of the way.

[BlackSpinner]

Another thing to remember is that YOU are not the customer. The insurance company is and the DME is the customer for the manufacturer. You don't figure anywhere in that equation. Your needs come a distant second.
Unlike with diabetic meters, where there is you deciding between this meter and that one and directly affecting the profits, here you are supposed to accept what is dispensed by the DME and the insurance pays. You are only an annoying step between two profit making entities. The sink does not decide which wrench the plumber uses.

[BlackSpinner]

It's up to US to insist that we get data capable machines, and we are often taken advantage of because we know so very little at the time of diagnosis, and the learning curve is steep. It's a deck stacked against us, every step of the way.

Plus the learning curve is made even steeper by sleep deprivation. When I first started reading the site it was just words, words words - things seemed so complex I was so tired just surviving nothing made much sense. Two weeks after starting therapy everything started to become magically simpler and clearer. And I am a technical person, I like reading documentation to see if I can make things jump through hoops, but sleep deprivation made this very difficult.