Gilda,
What I was referring to was the people who CAN research, but just don't. Of course there is a number of people who, for whatever reason can't. And for them, I don't know what the answer is. I wish I did, but I don't. I wish life was a lot more fairer than what it is, and people were more honest and altruistic, but they aren't. But then again, not ALL DME's and RT's are the devil either, meaning, not everybody gets shafted and there are some good experiences.
Unfortunately, anytime that little concept called a "profit margin" is added into anything, there's gonna be people looking at how to maximize it.
As I've said before in this thread, an inexpensive XPAP would be most beneficial to someone without insurance for example who couldn't afford the Cadillac. Some therapy is better than no therapy right?
I DON'T think it should be used for DME's to maximize their profit margin any further than what it already is. I hope I've cleared that up before everyone that knows me thinks I've taken leave of my senses in this thread.
I feel like ALL of the DME corruption in this capacity stems from the fact that E0601 is a catch-all for ALL CPAPs. If this was ever changed, with extra HCPCS codes to diffrentiate basics from datas to autos, then you wouldn't see DME's trying to dump the most basic models left and right and practically outright refusing to give an Auto out unless the doc (or patient, if their knowledgeable) demanded it.
Willsucceed, let me start off by saying that, upon review, my phrasing was a bit inflammatory and let me humbly apologize. We all have bad days, though it seems mine almost stretched into half a week. The last thing I want to do is hop on the forum and let outside events influence the way I treat people. It's rare when I compromise my professional decorum so again, I am sorry that I didn't approach this thread with my usual tact.
Basically, I didn't understand why auto leak compensation was such an important factor to you. That's why I asked you to explain it. I personally don't look at it as a big deal because I don't believe in it. I've always thought this feature was "gimmicky" at best.
Now, in theory, it's a great concept. Automatically adjusts for leaks to make sure you still get your set pressure. I wish it was that simple. Here's the way I see it, when you have a mask leak, it's because of pressure, naturally. The pressure is like water, it tries to find the path of least resistance. When it finds a weak point in the mask seal, poof, you've got a leak. So the thinking is, (according to the..ahem...manufacturers....who have a vested interest in selling the priduct of course) the machine will increase the pressure to make up for this. In practical application, this is flawed because as you increase pressure, the leak rate isn't static, it's dynamic. The leak is simply going to increase as more pressure is applied to it. Now this isn't even factoring in the fact that intentional leak rates will increase also, so that, added to the unintentional leak rate, your total leak (intentional + unintentional) will increase.
Theoretically, if the machine increased pressure again, because now we have a larger leak, the same thing happens a little highwe up the pressure range. Now, I know this isn't the way these machine are set, or else everyone would top out at 20cmH2O. So then, where does the machine limit this increase? It would be at a minute amount at best and stop, else you WOULD top out the range of the machine.
So basically, that's why I'm not a big believer of auto leak compensation. Sure the reps come by our DME and tell us about all of these great and wonderful features, but I take it all with a grain of salt because I know where their interests lie (sell product, make $$)
But now, here's the kicker......a little leak is OK anyway. Yes, I'm talking about unintentional leak. By definition of unintentional, it's not to mean 'avoid leak at all costs', it means leak not related to the air that escapes out of the exhaust ports on all masks (intentional leak).
So let me go in detail why a little leak is ok. Obstructive apneic/hypopneic events are more prone to happen on inhalation. The reason being that when we breath in, a negative pressure situation is created throughout the airway, from the alveoli to the nares (or lips if your a mouth breather) this is draw air into the lungs. Think of it like a bellows if you will.
When your upper airway is predisposed to constriction for whatever the reason (large tongue, tonsils intact, extra tissue or just a narrow airway) this negative pressure on inspiration will draw the tissue together. In a true obstruction, the tissue, being moist from saliva and mucous will stay stuck together, making exhalation impossible.
This is where PAP comes in. We all know how it works, but the thing to keep in mind is that PAP works mostly during your inspiratory phase. The full set pressure is not that important on exhale because we generate our own positive pressure when we breath out. THIS is the principle that bipap operates on.
When we breath out, our exhaled pressure meets the incoming CPAP pressure (because it is constant) and creates a pressure spike in the mask. The pressure spike will be the one finding the path of least resistance so if a part of the mask isn't sealed up all that great, that's where it goes. But it's OK. It's on exhalation. It's about a 1-2cmH2O loss at best, which is nothing compared to the spread of most bilevels.
I suppose I've timed out with this lengthy reply, lol. Didn't mean to write a book (oh wait....I AM writing a book....I'll just cut and paste this then )
But all of this talk about leaks is making me have to go to the bathroom.
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CPAPopedia Keywords Contained In This Post (Click For Definition):
bipap,
CPAP,
DME,
seal,
auto