CPAPtalk.com

Laughable it may be but my doctor did say to me that once I was more experienced and learned more about equpiment that I should consider internet providers and working with my insurance to cover equipment purchased from them.

We will NEVER, again, NEVER reach the day where a newly-diagnosed CPAP patient will be told by his doctor to "go on the internet and order your supplies."

Never say "NEVER"..... You're probably correct, but it probably has more to do with their lack of knowledge about what's available on the Internet. Then, if the insurance providers ever catch on to how to save money......?

....many of you had a sub-standard experience at your DME you are ready to broad-brush them all as a bunch of money-hungry idiots.

The phrase that comes to my mind is "All politics is local". If hundreds or even thousands of users are given sub-standard service by their LOCAL DMEs, what are their alternatives?

What internet retailers do is simply buy and resell. They are clever and they will always find a market doing this---anyone would who gets the opportunity to erode a historically-proven distribution line.

And, the problem with this is what???? (see remarks to the previous quote)

I wonder how 'greedy' you'd call johnny if he rose his prices just to want to make more money. God knows, there's room to. Maybe the DMEs aren't as dumb as you think.

That's how a competitive market works......if the overprice their competition (and don't offer good service), people will go elsewhere.
And, maybe SOME of the DMEs ARE as dumb as we think.

P.S. Resmed's decision to raise prices has nothing to do with 'greed'--did you folks take Economics? The prices they charge the internet folks STAYS THE SAME!

Most of us figured that out quite some time ago. And, ResMed's reasoning for doing so seems to be like nailing Jell-O to a wall......their logic and reasoning for doing so seems to be changing as the feedback keeps hitting the fan.

Have a good day,

Den

P.S. Ya got any more weird logic to throw at us?

MandoJohnny wrote:

Look at the requirements to be JHACO certified. Look at the requirements to get a Respiratory Therapy Licsence.

Well, I'm sure they are impressive, but I don't think that's the root of the problem, so respectfully I have to say that argument is nearly irrelevant. My guess is that all the docs and all the DME RTs out there could technically do the job well. But if the whole medical community has learned anything in the last few decades, it is that attitude counts almost as much as technical qualifications.
...
I deal with this as a management consultant all the time, working with highly technical clients. Technical competence is a prerequisite, a "learner's permit" if you will. It is where the job starts, not where it ends.

As far as the technical competence goes, I couldn't agree with you more!! Knowing all thier is to know about the guts of an item is really about the last thing on the list of 'Stuff that should qualify you to deal with patients hands-on'.
However, I mentioned it only as a specific case of things that show that DME companies very often can provide an outstanding level of service. The JHACHO stuff I've seen really focuses more on quality of care and quality of service than anything else. Most of the requirements I've seen have to do with patient tracking, lack of errors in equipment/settings, followup care, patient comfort, patient satisfaction and other stuff like that.
And I can tell you from the DME companies I've dealt with so far, all were JHACO certified and all did provide exactly those things. Heck my current company sent an RT to my house, handed me copies of all my initial paperwork so I could double check them, called me the next day. Sent me a letter at 2 weeks and then called me again at 1 month.
The previous company did much the same, though just one follow up letter and 1 phone call.
I still think there absolutely is a place for both an internet company for patients who need little to no follow up, and a more traditional DME for those who either cannot or don't want to take care of everything themselves.
It's just the specifics of how to work it out that baffles me.

Well, I am really not trying to be argumentative here and I mean this respectfully, but if the number of visits and follow up are your definition of good service, then the issue is that we are comparing apples and oranges. My DME does all that stuff too.

My RT came out to the house with the machine and all the paperwork, fitted the mask, explained everything, ect. Big problem: He fitted the mask WRONG. Not even close. He just looked at my nose from across the table and chose the small pillow set. After months of experimenting, the large works the best for me. If I still had that small pillow set, I would have gotten rid of that mask by now or even quit CPAP. Then I visited the RT during office hours with a question about the humidifier. He waffled. He obviously didn't know the right answer, but tried to buffalo his way through the question. I got the real answer here on this site!

When I ask about discomfort/compliance issues, he just says, "You should discuss that with your doctor." But my doc made it clear: If I have health issues, I should call the doc. If it is an equipment issue, I should call the DME. But my DME throws it back to the doc. Again, I get my only useful answers online. I do not feel at all comfortable asking my RT questions, because he has no credibility with me.

Another time, when a part broke, the RT had one in stock and promised to mail it to me, but two weeks later, I didn't have it. I called him and he said he forgot! "CPAP compliance is critical" and he FORGOT? That is just complete BS. Also, he told me once, "You can call me on the weekends and leave a message, but I won't get back to you until Monday. I mean, if your CPAP is broken, it's not like it's life threatening or anything." Clinically, he may be right, but it was a BS thing for him to say to a patient he is supposedly trying to get compliant and it is a BS policy for a giant DME like mine to have.

The RT's supervisor calls me occasionally. But it is obvious he is reading from a script and I am just on some checklist he has. It is so transparent as to be laughable. It is also apparent when he asks if I have any questions or issues, that the only answer he wants is, "No, everything is fine." Anything else gets me into a useless loop with the RT again. So I get a lot of "quantity" customer service, it's just all poor quality, useless, incompetent customer service.

I would have preferred to have someone FedEx me the machine, but provide clear instructions on how to use it and have a help line that was truly helpful. Also, I think any DME should initiate the overnight shipping of a replacement for a broken part "24/7/365." I think an online outfit could actually do a better job than a bricks and mortar DME. For instance, I think CPAP.com does do a better job than my DME.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): humidifier, cpap.com, CPAP, DME

Oh hey no worries mate. I don't take you as being argumentative or anything. We're just havin a chat is all.

And I would also tell you that I really do agree with you. I wasn't specific in my post, but I am referring to QUALITY care when I talk about this stuff.
Certainly I could have someone calling me weekly and holding my hand on a daily basis, but if they weren't helpfull, knowledgeable and compassionate, then it's pointless.
Now I do think I tend to give people a lot more leeway than many. I take things like a bad mask fitting as no big deal at all. Stuff just happens and it can be hard to get something so tricky right the first time.
However, it definately sounds like your experience was basically a failure in all areas of care, and I would agree totally that that is less than acceptable!
The only thing I would disagree with is the weekend care. I don't feel it's our right to expect someone to be able to handle things for us after hours and on the weekends. They are right, it's not life threatening. Does it suck to go without it? Sure. It sucks to go without a car too but I can't get that serviced on the weekends either (usually).
I'm sorry you received bad care from that company. It's a shame. I wish everyone had the success I've had with both the DME companies and the doctors I've been involved with.
The bottom line is the only thing I disagreed on was the general principle that ResMed had no idea what they were doing. I believe they have data and information indicating otherwise. I can't imagine why they would act otherwise.

I think doctors should start doing surgery over the internet <EYE ROLL>

Anonymous wrote:I think doctors should start doing surgery over the internet <EYE ROLL>

It might improve their patients survival rates. Some of them don't know the difference between a knife and a fork. Jim

Guest wrote:The bottom line is the only thing I disagreed on was the general principle that ResMed had no idea what they were doing. I believe they have data and information indicating otherwise. I can't imagine why they would act otherwise.

I think you're right, Guest, that ResMed had/has a VERY clear idea of what they are trying to do. I also agree that they have data...data about who their biggest customers are -- the local DMEs. That's where most cpap equipment is sold anyway -- through local home health care stores. Internet sales of cpap equipment are a drop in the bucket compared to how many machines and masks ResMed can sell through local DMEs.

Make the local DMEs happy ("ResMed is on your side.") -- more sales for ResMed.

Make their own (ResMed) reps more productive by cutting down internet sales in their territory so that the DMEs the reps visit are ready to buy more -- more sales for ResMed.

To heck with the fact that their policy will hurt many uninsured sleep apnea sufferers who turn to the internet for more affordable prices.

I think ResMed probably expected other major manufacturers to immediately jump on the bandwagon and issue the same ultimatum to the internet dealers. But if they didn't, ResMed didn't really care. I think ResMed's real goal in all of their bluster about the internet has been to impress and woo the local DMEs.

I hope the other manufacturers continue to understand that there's a need for BOTH types of sales. I hope the mandatory minimum price for internet sales tactic backfires on ResMed if they ever finally implement it. Which I think they will.

Thank goodness there are other manufacturers with excellent machines and masks.

rested gal wrote: To heck with the fact that their policy will hurt many uninsured sleep apnea sufferers who turn to the internet for more affordable prices.

Now this specific point is something I find interesting. I wonder if ResMed even really considered that angle when formulating this new strategy? I know I hadn't even begun to consider it when I first read the release and throughout the first wave of discussion over it.
Further, at what point is it really not thier responsibility to cater to one particular segment. And lets face it, it's ultimately a segment that isn't that always that desirable to market to anyways? I don't mean anything against anyone personally, and in fact it has nothing to do with the person behind the label of 'uninsured'. Look at it this way - there are primarily going to be 2 types of consumer falling into the 'uninsured' catagory: One is a person whom you bend over backwards to help. That person is going to be your loyal fan for life now. They appreciate the chance they were given and will return the favor of bending over backwards to continue to buy products from you. The second type is going to be the person who will by neccessity go where they can get the lowst cost item that will fit thier needs. Brand doesn't enter into the equation because it can't - price drives the purchase.
My anectdotal evidence from dealing with charities and needy people for many years is that the vast majority fall into the 2nd catagory. Price will always be the driving force behind a decision. So if that's the case on a larger scale (As I think it is)- why would you base a business decision on that market segment?
The other issue is, at what point does a manufacturer have to step out of the equation? We don't look at Ford or GM to get us discount vehicles when we can't afford them. We don't villify Gerber because they don't send us baby food for our children when we can't afford it. So I do actually wonder why we feel that ResMed should base business decisions on the same criteria?
I have to honestly say that I really don't know how to answer these questions. Heck, part of me thinks this stuff should be provided free of charge to everyone anywhere no matter what. I really do.
Then the pragmatic side of me rears up and throws economics at me and I become very confused.
Wow did this become a ramble huh?

Anonymous wrote:
<snip>
The other issue is, at what point does a manufacturer have to step out of the equation? We don't look at Ford or GM to get us discount vehicles when we can't afford them. We don't villify Gerber because they don't send us baby food for our children when we can't afford it. So I do actually wonder why we feel that ResMed should base business decisions on the same criteria?
I have to honestly say that I really don't know how to answer these questions. Heck, part of me thinks this stuff should be provided free of charge to everyone anywhere no matter what. I really do.
Then the pragmatic side of me rears up and throws economics at me and I become very confused.
Wow did this become a ramble huh?

Anon,

I don't think your points are a 'ramble', you have put forward a very reasonable case.

I can also understand RG's frustration towards ResMed. As users of xPAP equipment we have a very personal interest in what they do.

The difficulty here is balancing our understanding about the interests of a business whose goal 1 is arguably to want to deliver the best and most useful technology to the users of it versus the requirements of running a business that can stay in business & fund the effort to achieve goal 1.

Sadly in our current capital driven economies, companies just can't operate like charities. Governments & secular organizations take on that role. Companies in global markets are forced to make pragmatic business decisions and they often don't coincide with the interests of us as seems to be happening in this instance.

From my perspective, I like what cpap.com has achieved. I believe it is quite clear that buyers of xPAP gear here get the best of service - we repeatedly hear anecdotal stories of RTs not knowing very much about xPAP machines that they are fitting people with.

Resmed as a market leader are going to come under fire if their 'pragmatic' decision doesn't fit with ours. I do believe there are a lot more issues though, than are being focussed on here.

DSM

Anonymous wrote:What internet retailers do is simply buy and resell. They are clever and they will always find a market doing this---anyone would who gets the opportunity to erode a historically-proven distribution line.

Cpap.com is an internet retailer and they do a whole lot more than simply buy and resell. They provide a priceless service with the education and follow-up care CPAP users need to stick with therapy. This service is sorely lacking from the brick and mortar DMEs.

To ensure that our customers continue to love dealing with CPAP.com, we've developed a number of absolutely free services for our customers to use including CPAP.com toll free telephone lines, email question submission, frequently asked question lists, CPAP chat rooms, CPAPtalk.com forums, streaming CPAP and sleep disorder related news, videos of every aspect of CPAP treatment, pictures and product descriptions of everything and anything CPAP, patient product reviews, consumer preference reports, manufacturer's product manager interviews, real time order status, mask fitting guide, machine size comparison guide, machine feature comparison guide, this newsletter and newsletter archives, and same day shipping on all stocked orders.

Many of these services are one of a kind. For all their resources, no other CPAP seller or manufacturer has a line up of services that are so accessible and easy to use.

Due to these unique tools, patients and industry professionals alike are flocking to CPAP.com and CPAPtalk.com in ever increasing numbers. CPAP forums are loaded with posts from experienced patients and industry experts helping others with encouragement and practical suggestions. CPAP Internet Retailers are providing great services to CPAP patients to any and all that visit, whether they buy or not.

What is said in industry publications does not mean much. In ever increasing numbers, CPAP patients are going online and voting with their wallets. Our company provides value and service to those seeking it. In the end, watching long term relationships with our customers grow and multiply because of the services CPAP.com offers is all the encouragement and motivation we need.

https://www.cpap.com/DisplayNewsletter/24

I'd like to believe Resmed's claim that the impetus for this price increase is their overwhelming concern for the OSA patient. I'd like to believe this really is all about education and follow-up care. I'll believe it when they make cpap.com customers exempt from the 40% price increase.

Now what I think will be interesting to watch is how the ResMed minimum price point for the Internet Retailers will fit in with cpap.com charging extra for the followup phone calls. ResMeds point to everything was primarily dealing with followup, correct? So how does all that fit in?

Anonymous wrote:When we first learned of this issue in the Investors.com article on 6/20/06, Resmed told the public they were implementing the 40% increase on internet prices to get them in line with reimbursement rates.

Then Resmed changed their tune. They must have decided it wasn't politically correct to admit they were bowing to the pressure of the Aprias and Lincares of the world. They must have decided it sounded bad to openly admit they were artificially inflating prices for internet equipment providers to appease their biggest (and angriest) clients. They must have decided it wasn't a good thing to reveal to the public they have no backbone. They must have figured it didn't do much for their image to be raising the prices paid primarily by those individuals who can't afford insurance.

So, Resmed reworked their public relations blunder and, in the July 2006 issue of HME News, claimed the REAL REASON the 40% price increase on internet prices was being implemented was to combat low compliance. That sounds A LOT better, doesn't it? Resmed cares deeply for the patient. They contend compliance is lower if the equipment is obtained via the internet than via a brick and mortar DME.

Two problems with this theory:
1) Resmed did not have the foresight to investigate whether or not this theory was actually true. Quite an oversight on their part. The very existence of this forum is testimony to the failure of the brick and mortar DMEs in dealing with OSA patients. We came here seeking answers, suggestions, education and support; none of which our DMEs provided. Resmed has absolutely no idea of the compliance rates of patients of the brick and mortar DMEs vs. the internet DMEs. It might have been wise to research that before using it as an excuse for raising prices.
2) Resmed has absolutely no standards set for follow-up care and education from ANY provider. It's too bad they don't. Cpap.com would meet and exceed all standards, and Aprias and Lincares, et al. would be shut down all over the country for failing to do so. (We could probably eliminate the majority of them right off the bat, just by requiring them to pass a test on how to properly set up the equipment per the prescription.)

So, now Resmed is going to have to come up with another reason behind the implementation of a 40% price increase for internet equipment providers. Maybe they should just be honest and be done with it. The real reason? Greed. Pure and simple greed.

Let's not forget there is yet a third reason Resmed has given at one time or another for the price increase. According to the owner of one internet retailer,
http://www.youneedsleep.com/resmed

They feel that we, the internet cpap sellers, need to sell their items at higher prices to protect the image of ResMed. They also are trying to force us to give them monthly reports on where our products are being sold, and they are introducing specific guidelines as to the minimum pricing for their products, and how we can display and advertise their products.

We have responded to many complaints by ResMed that we are selling their products for too low a price. They have "recommended" to us many times that we need to raise our prices.

We will not stand for intimidation and pricing games.

So Resmed has offered the following reasons (so far):

1) implementing the 40% increase on internet prices to get them in line with reimbursement rates... (Probably the truth. They are in bed with the DMEs and it behooves Resmed to keep them happy. Millions of dollars worth of "happy".)

2) increase on internet prices was being implemented to combat low compliance... (Not the truth, but sounds compassionate--unlike reason number 1.)

3) internet cpap sellers need to sell their items at higher prices to protect the image of ResMed... (Your products being offered at lower prices as the result of eliminating the middleman tarnishes your image? Or, is it that customers are suddenly aware of just how unnecessary the middleman is? See reason number 1.)
_______________________________________
I can hardly wait for the next REAL reason.

As far as Resmed's concern with protecting their image--- they've managed to chip away at that all on their own without any help from internet retailers. Credibility is tanking, but it's not too late. Resmed could permanently cancel the impending 40% price increase aimed at internet customers. Doing the right thing is always good for a company's image.

I think doctors should start doing surgery over the internet <EYE ROLL>

Well, interestingly enough, remote surgery is now very much a reality. Specialists can now do surgeries using networked video cameras and remote controlled robotics. So that idea doesn't turn out to be so far fetched.

Guess I was guested too.