new thread on industry structure

[UTSleep]

DSM, I'm starting a new thread more directly related to the latest topic we were exploring (i.e., related to industry structure). also, this way we sort of put the Restraxx thread to bed, which was a poorly named thread to begin with.

Thanks,

Mike
sleepguide.com

[Guest]

this was the question I was wondering about, which DSM probably knows the answer to: why is it difficult for online DME like CPAP.com to check compliance. couldn't the insurance companies' breezy definition of "compliance" be verified by email?

Mike

[Slinky]

There immediately comes the expense, Mike. And the sheer numbers. Plus the rules are soon to change regarding compliance proof. Up until now, at least w/Medicare, the local DME suppliers could get away w/sending their patients a form letter which the patient filled out, signed and returned, verifying that they were using their CPAP, how many hours a night and how many nights a week. That is changing, now the local DME suppliers will HAVE to HAVE actual PROOF of compliance available for Medicare. No more just taking the patients' word for it - VERIFIED PROOF. Medicare makes up the bulk of the local DME suppliers' CPAP business.

[dsm]

In addition to what Slinky has said, there is the issue of compliance proof for people in the driving profession. They get to keep their license only if they can provide verifiable proof of compliance. At the moment I believe only a doctor or DME can provide that.

Internet sellers really don't have a mechanism for compliance checking but, I can't see why an Internet link - using a bluetooth or wifi link to a home pc on the net, can't be set up as the technology is developed.

DSM

[Wulfman]

this was the question I was wondering about, which DSM probably knows the answer to: why is it difficult for online DME like CPAP.com to check compliance. couldn't the insurance companies' breezy definition of "compliance" be verified by email?

Mike

To me, this is a non-question, because CPAP.COM and the other Internet sellers are "cash & carry" businesses. And, the main reason that "compliance" is checked is for reimbursement purposes.....allowing brick & mortar DMEs to collect payments from the insurance entities. If the person is paying for the machine out of their own pocket or if their insurance provider is reimbursing them (outright), then there is no need for the compliance checking. If I already own my machines prior to going on Medicare, they wouldn't even know I'm a CPAP user.

But, as far as any "liability" issues go, ie. "driving", then that is why I firmly believe that ALL of the machines being handed out to patients should be FULLY DATA-CAPABLE......and I don't just mean "compliance".


Den

[Slinky]

A-MEN, oh man, Den!!! You are dead on so right! I agree 1000%

[Guest]

Not trying to play the devil's advocate here.........but

Den and Slinky, are you both saying that you would be supportive of a law requiring the suspension of a persons drivers license until they can provide proof of atleast 30 days compliance? Lets say compliance defined by Medicare's standards.

Not trying to put words in either one of your mouths, just curious.

AKCPAPGUY

[roster]

....... a law requiring the suspension of a persons drivers license until they can provide proof of atleast 30 days compliance? Lets say compliance defined by Medicare's standards.

........

Of course such a law would mean more people avoiding screening, testing, diagnosis and treatment. The result would be greater danger on the highways.

[Wulfman]

Not trying to play the devil's advocate here.........but

Den and Slinky, are you both saying that you would be supportive of a law requiring the suspension of a persons drivers license until they can provide proof of atleast 30 days compliance? Lets say compliance defined by Medicare's standards.

Not trying to put words in either one of your mouths, just curious.

AKCPAPGUY

Not only NO.....but HELL NO!!!
But, in case the legal system migrates in that direction, people would be covered.
It's my understanding that in Canada the medical community CAN pull driver's licenses for non-compliance and I don't want to see us go down that road.

On the other hand, there are most assuredly lots of non-compliant and non-diagnosed people with apnea that are on the highways.

Den

[Slinky]

Not trying to play the devil's advocate here.........but

Den and Slinky, are you both saying that you would be supportive of a law requiring the suspension of a persons drivers license until they can provide proof of atleast 30 days compliance? Lets say compliance defined by Medicare's standards.

Not trying to put words in either one of your mouths, just curious.

AKCPAPGUY

My oldest daughter was killed by a drunk driver, AKCPAPGuy. What do you think? Do you see much difference between driving whilst drunk or continuing to drive when knowingly sleep deprived?

[dsm]

Re drivers licenses & the law. As I understand it it is only an issue for professional drivers.

In many US states & perhaps a growing number of countries, there are or will be laws that
say that when a professional driver (i.e. taxis, long haul trucking etc: ) is diagnosed with
OSA, unless the driver meets compliance the license will get pulled.

I haven't actually heard of citizen drivers having their licenses threatened if diagnosed OSA.

DSM

[Guest]

I apoligize if I offended you with the question Slinky, it wasn't meant as a challenge, just a question.

I wasn't aware of your daughter being killled by a drunk driver, i'm sorry if i drug up a bad topic, that was not my intent.

NO, I DO NOT see any difference between drunk driving and drowsey driving. Studies have proven time and time again that they are virtually the same.

There are some states where physicians are required to report to the state DMV when a patient is diagnosed with OSA.

For the record I WOULD support legislation suspending drivers license for atleast 30 days and requiring them to provide proof they are compliant.


AKCPAPGUY

[rested gal]

For the record I WOULD support legislation suspending drivers license for atleast 30 days and requiring them to provide proof they are compliant.


AKCPAPGUY

For the record, I would not support that. Mainly for the reason that rooster brought up:

Of course such a law would mean more people avoiding screening, testing, diagnosis and treatment. The result would be greater danger on the highways.

I'm very sorry about what happened to your daughter, slinky. I just don't think that telling people, "go get tested for sleep apnea" and then saying, "oh, by the way, when the test shows you've got sleep apnea, you cannot drive for an entire month while you use a CPAP machine" is the way to encourage people to get tested and get treatment.

There's nothing magical about 30 days of "compliance" to turn a sleepy driver into an alert, wide awake driver. Especially... ESPECIALLY... if the DMEs are not downloading data from the machines within the first few days of treatment and looking at the DETAILED OVERNIGHT DATA. Looking ESPECIALLY at the detailed leak data. It does little good for a person to be using machine and mask faithfully for 30 days if there are massive leaks from mask or mouth. The bedroom got treated, but the person sure didn't.

Instead of legislation that would scare people away from even finding out if they have sleep apnea, perhaps there should be legislation spelling out what DMEs have to do in the way of follow-up and actually helping people get real treatment from their machines.

If we're going to talk about suspending licenses, how about legislation to suspend the DME's business license for 30 days, if THEY can't prove -- via low leak and low AHI data downloaded from their customer's machines within 30 days -- that THEY are capable of really helping people use CPAP effectively. Bet they'd start downloading and studying the detailed data that first week.

Of course, to get those downloaded proofs, the DMEs would have to give out machines capable of generating that kind of data, wouldn't they? Not to mention, do a lot more to find the right mask and fit it right....

...Plus a million other helpful tips that people have to find out about here because most DMEs (not talking about you AKCPAPGUY ) don't even know about them.

[Slinky]

Thank you. I didn't take offense. It happened 28 years ago and I've come to terms w/her loss. But I have NO sympathy for drunks and those who knowingly drive when sleep deprived - or drug users either for that matter. NONE. Its playing Russian Roulette w/other people's lives.

RG, I LOVE your suggestion of legislation to enforce local DME suppliers do their job since too many haven't been willing to do so on their own initiative.

[sleepguide]

RG, that's an amazing idea. I'm ready to sign the letter to my congresswomen now and have enacted into law.