CPAPtalk.com

Let me start by saying that I think they should not sell bricks. Insurance companies should insist on decent machines.

That being said, as a person who develops and sells software for a living, I do understand the pricing model. The software for CPAP/APAP/BiPAP plus testing and regulatory compliance is a HUGE fixed cost that needs to be recouped. One way to do it is through feature differentiation. The more features you get, the more you pay, even if the hardware is the same. If they just sold basic CPAP using a hardware platform and did not need to develop, test, and get regulatory approval for the more advanced machines, their cost would be much lower. The fact that they use the same hardware is most likely lowering their cost rather than adding to it. One circuit board design, on bill of materials, etc.

No different than when I bought my last car. A navigation system was a $1000 upgrade. I will bet you that $1000 that the only difference between my car and the one with the nav system was software. I already had the screen.

palerider wrote:

chunkyfrog wrote: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.

A config file change turns a $US1000 FLIR E4 thermal imaging camera into its $US4000 model E8 big brother.

Sales of the E4 took off when that hack was discovered in 2013, so I don't think FLIR are complaining.

TechJungle wrote: A config file change turns a $US1000 FLIR E4 thermal imaging camera into its $US4000 model E8 big brother.

Sales of the E4 took off when that hack was discovered in 2013, so I don't think FLIR are complaining.

I think I saw a video on that

I really want a thermal imaging camera, flir or other, but haven't convinced myself to part with enough dough yet.

Let's not forget that the medical mafia loves in lab $leep te$t$. Why have a CPAP machine that can do a good job monitoring the patient's actual therapy results for free in the patient's home every single night when you can check it every few years and generate a bunch of extra profit for one of your fellow medical mafia members.

archangle wrote:Let's not forget that the medical mafia loves in lab $leep te$t$. Why have a CPAP machine that can do a good job monitoring the patient's actual therapy results for free in the patient's home every single night when you can check it every few years and generate a bunch of extra profit for one of your fellow medical mafia members.

Yeah, but that's at great disadvantage to the insurance company. If they can do a cheap at-home screening, followed by giving the patient an APAP set to 7-20 and telling them to figure it out, they spend about $850 -- $800 for the machine, $50 for the screening. (This is what Kaiser seems to do.) Compare that to paying $3000 for the sleep test, and another $3000 for a titration, and then they spend $800 for a brick. (Because the DME gets paid the same for a brick as for a data capable machine.)

The only way this works is if the medical mafia is raping the insurance companies...

. . . "Raping insurance companies".
As much as that thought makes me smile, the use of full data machines
could potentially benefit the insurance companies almost as much as patients.

cathyf wrote:

archangle wrote:Let's not forget that the medical mafia loves in lab $leep te$t$. Why have a CPAP machine that can do a good job monitoring the patient's actual therapy results for free in the patient's home every single night when you can check it every few years and generate a bunch of extra profit for one of your fellow medical mafia members.

Yeah, but that's at great disadvantage to the insurance company. If they can do a cheap at-home screening, followed by giving the patient an APAP set to 7-20 and telling them to figure it out, they spend about $850 -- $800 for the machine, $50 for the screening. (This is what Kaiser seems to do.) Compare that to paying $3000 for the sleep test, and another $3000 for a titration, and then they spend $800 for a brick. (Because the DME gets paid the same for a brick as for a data capable machine.)

The only way this works is if the medical mafia is raping the insurance companies...

The medical mafia fights real hard to keep the insurance companies from "interfering" with patient treatment. This is both good and bad. Lots of times, the things the insurance companies want are bad for the patient.

I agree that insurance companies should require all CPAP's be auto, have full data capability, and require monitoring. It wouldn't be at all hard to have a central service that collects the full data, does some minimal analysis and then sends the report to the patient's doctor.

archangle wrote:Let's not forget that the medical mafia loves in lab $leep te$t$. Why have a CPAP machine that can do a good job monitoring the patient's actual therapy results for free in the patient's home every single night when you can check it every few years and generate a bunch of extra profit for one of your fellow medical mafia members.

Really don't think the medical industry works the way you think it does. Neither the CPAP manufacturers or the physicians (unless they also run a sleep lap or read studies for one) make money off of sleep studies.

Thatgirl wrote:

archangle wrote:Let's not forget that the medical mafia loves in lab $leep te$t$. Why have a CPAP machine that can do a good job monitoring the patient's actual therapy results for free in the patient's home every single night when you can check it every few years and generate a bunch of extra profit for one of your fellow medical mafia members.

Really don't think the medical industry works the way you think it does. Neither the CPAP manufacturers or the physicians (unless they also run a sleep lap or read studies for one) make money off of sleep studies.

Among the doctors, it's a "good ole boy" system, in much the same way as lawyers, cops, politicians, gang members, big business, priests, etc. They tend to have a tribal mindset and protect each other and protect each others jobs and profit margins against outside interests.

Sometimes, they'll feud and fight with each other, but they're always very concerned with protecting their group's interests.

Doctors are very reluctant to do anything that hurts other doctors, and are very ready to prescribe tests of dubious value even if they don't get a cut of the profits. If one doctor starts cutting back on generating profits for other members of the tribe, others might do the same thing to him. They may not think they think that way, but it's the bias built into "the system."

archangle wrote:

Thatgirl wrote:

archangle wrote:Let's not forget that the medical mafia loves in lab $leep te$t$. Why have a CPAP machine that can do a good job monitoring the patient's actual therapy results for free in the patient's home every single night when you can check it every few years and generate a bunch of extra profit for one of your fellow medical mafia members.

Really don't think the medical industry works the way you think it does. Neither the CPAP manufacturers or the physicians (unless they also run a sleep lap or read studies for one) make money off of sleep studies.

Among the doctors, it's a "good ole boy" system, in much the same way as lawyers, cops, politicians, gang members, big business, priests, etc. They tend to have a tribal mindset and protect each other and protect each others jobs and profit margins against outside interests.

Sometimes, they'll feud and fight with each other, but they're always very concerned with protecting their group's interests.

Doctors are very reluctant to do anything that hurts other doctors, and are very ready to prescribe tests of dubious value even if they don't get a cut of the profits. If one doctor starts cutting back on generating profits for other members of the tribe, others might do the same thing to him. They may not think they think that way, but it's the bias built into "the system."

Yeah, maybe in the 70's. It's not really that way now. They try and be respectful of other physicians, and yes, they return favors to other providers that refer a lot of patients to them, but I promise they don't care about the DME companies or the sleep lab's bottom line. The tendency to prescribe tests of dubious value tends to come from one of two things: patients wanting lots of tests, or trying to "cover their butt" in a very litigious society.

Thatgirl wrote:Yeah, maybe in the 70's. It's not really that way now. They try and be respectful of other physicians, and yes, they return favors to other providers that refer a lot of patients to them, but I promise they don't care about the DME companies or the sleep lab's bottom line. The tendency to prescribe tests of dubious value tends to come from one of two things: patients wanting lots of tests, or trying to "cover their butt" in a very litigious society.

I disagree. I think it's part of "the system" and they don't even recognize the bias in many cases. It's a very common thing in many human organizations.

They may not ever sit down and think "I need to do this to pull more money into the brotherhood of medical providers," but the whole system favors things that protect the profit margins and fellow members of the fraternity. The idea of CYA tests has some value, but that's also part of the corrupt system. The doctors are all encouraged to think "If I don't run this test, I'll get sued." Funny how the mindset of things like this are things that tend to line the pockets of the other members of the medical mafia, isn't it?

How many of them are willing to testify against another doctor in a malpractice suit? I know one doctor friend who did that in a case where the defendant was clearly in the wrong, and it nearly killed my friend's career.

I guess we'll agree to disagree on that matter.

Well, the best secret conspiracy is one where even the conspirators don't know they're part of a conspiracy.

You sound like you're an insider. What do you do?

How many of them are willing to testify against another doctor in a malpractice suit? I know one doctor friend who did that in a case where the defendant was clearly in the wrong, and it nearly killed my friend's career.

That is exactly how a psychiatrist in my area was not reported for many years even though his colleagues knew he was engaging in horrific malpractice abuses. They greatly feared their careers would be harmed if they said anything.

49er

archangle wrote:Well, the best secret conspiracy is one where even the conspirators don't know they're part of a conspiracy.

You sound like you're an insider. What do you do?

I'm not a physician. I'm an NP. Definitely not part of any boys' clubs, conspired or otherwise.