what benefits does a DME give?

Continued from previous page/post.

I'm going to have to do this in multiple posts because (apparently) the server won't let me post that many in one link.

Den


http://www.medicarenhic.com/dme/medical ... 006-01.pdf

"Accessories are separately reimbursable at the time of initial issue and when replaced."


http://www.medicare.gov/Fraudabuse/Tips.asp


http://respiratory-care-sleep-medicine. ... ?CC=162810


Continued in next post
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Hopefully this will work and be the last links.

Den


Please note the answer in #1 in the following document:

http://reimbursement.respironics.com/do ... Letter.pdf


Do a search on the word "separately" in this document (shows what is NOT allowed to be billed separately):

http://www.bcbsil.com/PDF/providermanua ... ipment.pdf

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mattman wrote

Speaking as a former DME guy who is a strong advocate of being able to both shop online AND use brick and mortar places as well, here is what I can tell you from a long personal experience (Both as a cpap user and a dme guy)

IF you are the sort to want to micromanage your healthcare and your cpap treatment in particular AND you are comfortable doing a lot of research and enjoy really studying up and becoming an expert on cpap treatment then a DME company will really not have a lot of benefits to you.

Basically, when using a local DME company you should be getting a local company who can work with you to get you setup and running without you having to be the expert. Obviously a LOT of people are coming here because they did not get effective treatment from a local DME so yes - there are a great deal of angry and hurt feelings from users here over the service they got at a local DME company. I firmly believe this is the exception and not the norm so if you want to give it a try don't be afraid to do so.

I, like many other users on this forum, have taken responsibility for my healthcare, including my CPAP enabled sleep therapy. In 2006, I failed with CPAP when I foolishly trusted a sleep Dr. and a DME to have some competence in treating Sleep Apnea and learned that all they really cared about was getting my money (no surprise to members of this forum). Three years later in March '09, motivated by the success stories and the helpful exchanges that I discovered here on CPAPTalk, I tried again. Since March, I've spent hours on this site learning as much as I can about CPAP therapy and how to be successful. I didn't become an expert but I'm happy to say that I've achieved my sleep goals and have moved on to other priorities. BTW, my DME ("A") screwed up everything possible including 3 of 3 RXs and provided no helpful service whatsoever so I wrote them off as the "incompetents" they are, and now buy online.

Remember," brick and mortar" DMEs have to pay the rent or the mortgage, utilities, phone, internet, water and sewer insurance, and employees, etc. There is considerable overhead, so their desire to bill is to meet their payroll. They don't have a commitment to their patients--their commitment is to stay in business. Most chain DME providers give as little service as possible, and bill as much as possible so as to maximize time/money relationships. They could care less if you are compliant. What I like about the online DME, and this one (Cpap.com) in particular, is that they really seem committed to giving good service to the customer. They want repeat business, plus referrals, and are extremely helpful, both online and on the phone. Even as an experienced (10 years plus "papper), I do have questions and want advice on purchases. They have always succeeded in giving me great service and are very patient, discussing therapy alternatives from the wide variety of brands they carry.

mattman wrote

IF you are the sort to want to micromanage your healthcare and your cpap treatment in particular AND you are comfortable doing a lot of research and enjoy really studying up and becoming an expert on cpap treatment then a DME company will really not have a lot of benefits to you.

If Mattman's post made any of you feel guilty or burdened or afraid regarding your decision to take control of your healthcare and your CPAP treatment in particular, I suggest that you consider the source and his choice of words: "you are the sort", "micromanage", "lot of research", "really studying up", and "becoming an expert". Forum members are not "you are the sort". We are people that have a sleep problem, some more serious than others. We do not micromanage (see the link below for definitions and examples of micromanagement). We monitor and track our nightly sleep events (AHI, leak, pressure) and make informed decisions. I believe most of us, me included (and I may be at the high end of the bell curve) have not done a "lot of research" or "really studying up". Instead, we found this forum, read, shared experiences on what worked and what didn't, contributed specialized knowledge when helpful, and learned from each other on our shared CPAP journey. Success stores occurred and we learned and were motivated by them. There are experts on this forum but most of us didn't or don't have to become experts to be successful as there is a "Shared Expertise" that is available here on CPAPTalk, available to all for the reading and asking.

The help that is available here on CPAPTalk 24 hours/day including weekends still astounds me. I wish there were forums like CPAPTalk available for some of my other ills. I'd be on Cloud 9 if there were!

http://en.wikipedia.org/wiki/Micromanage

Autopapdude wrote

Remember," brick and mortar" DMEs have to pay the rent or the mortgage, utilities, phone, internet, water and sewer insurance, and employees, etc. There is considerable overhead

My personal experiences with my local DME, 3 years ago and 6 months ago, suggest that they didn't and still don't have phones or internet access or, more likely, never use them for other than billing purposes. Hopefully, some have received a call from their DME that provided useful information and/or needed services. I never did.

Thanks for mentioning the "sewer" expense. It is very fitting for B&M DMEs to pay this expense.

cinco777 wrote:mattman wrote

IF you are the sort to want to micromanage your healthcare and your cpap treatment in particular AND you are comfortable doing a lot of research and enjoy really studying up and becoming an expert on cpap treatment then a DME company will really not have a lot of benefits to you.

If Mattman's post made any of you feel guilty or burdened or afraid regarding your decision to take control of your healthcare and your CPAP treatment in particular, I suggest that you consider the source and his choice of words: "you are the sort", "micromanage", "lot of research", "really studying up", and "becoming an expert". Forum members are not "you are the sort". We are people that have a sleep problem, some more serious than others.

You are really reading way too much into my comment! It wasn't derogatory or combative in any way at all. Really. I was just very very broadly describing two very different types of patients.

And remember to include me in the We are people that have a sleep problem, some more serious than others. I have quite a few extremely serious health issues, severe sleep apnea being only one of them.

But mostly yeah, I'm actually a decent guy and you are reading more into my choice of words than is there!

mattman

Mattman wrote

You are really reading way too much into my comment! It wasn't derogatory or combative in any way at all. Really. I was just very very broadly describing two very different types of patients.

Huh!

My words were an attempt to accurately characterize the members of CPAPTalk that I have "met" in my six months of membership. Most have taken control of their healthcare and their CPAP therapy in particular (maybe due to CarbonMan's repeated and heartfelt urging) which is why they visit, participate, contribute, and benefit from the ever increasing shared storehouse of "Expertise" here on CPAPTalk. My first impression on reading your posting, with your choice of words, was that you were falsely and derisively categorizing CPAPTalk members as "micromanagers, etc.". I still had/have the same impression on re-reading your post.

Your incorrect use of the term "micromanage" was just the first of many word choices that had negative connotations. The Wikipedia description for "Micromanagement" clearly lists all its minuses and summarizes these by stating "In business management, micromanagement is a management style where a manager closely observes or controls the work of his or her subordinates or employees. Micromanagement is generally used as a negative term.[1][2]"

You may not have *intended* to be derogetory......your word choices did venture into an area that understandably could be taken that way......."excessive" is part of the definition....and that is a pejorative judgement........


DMEs are supposed to be part of the "team".......and often drop the ball on the tasks that they are supposed to provide as part of the services. If my DME simply was reliable for the accuracy of the info they give and for sending the correct filters when ordered, then they would be a neutral factor in my health. Sadly, they are not in the neutral category, they cannot be trusted, and I must "micromanage" all aspects to make sure things CPAP related are done right..... Thank goodness for a great sleep doc and this board!! If I could find a local walk-in DME under my insurance (have to use insurance for now....can't yet afford to just order from CPAP.com) I would walk in, make sure I get the right stuff, and pay my co pay on the spot in cash rather than the nonsense system that is happening at the moment.....


My DME earned their own failing mark.... I take my health seriously, and have been marginalized and misdiagnosed for too many years for lack of ordering available tests or approaching all the issues together as a whole......... So, yes, I proudly am an information junkie and a micromanager of my health.........it is not a priority to anyone else on the "team"!!

J

Although it's early in the game for me -- still trying to achieve one compliant night -- my DME has been very helpful, initiating correspondence when they did not have to, meeting with me when I did not have an appointment, etc.

Mattman, I did not read any meanness in your remark.

Another way to say it that might be taken better? Howzabout: "If you are wanting to have an active involvement in your own diagnosis and treatment, skip the DME because they work with doctors. If you want an appliance, and want to leave the numbers to others to worry about, a good DME may be helpful."

In my case, I lean slightly toward the latter, although I am enough of a hacker / engineer / gearhead to be comfortable in the former category as well.

My DME was very helpful in fitting, exchanging masks, teaching me to avoid leaks, and helping me to take some of the advice on this forum (e.g., taping) with a grain -- or a box -- of salt. I am happy to have a good one. and though I am defending DME's here, I also consider myself mighty blessed to ohave found this forum!

See, that's the thing.....the DME sends me a card, I download, they send a report to my doc....perhaps in time for a scheduled appointment......usually not.....

Since I have software, I can download more frequently if detailed data is needed, if apneas are increasing, or fatigue is increasing.... I carry more info on my laptop to appointment than DME sends to my doc.....and it is far more easily "crunched" sitting there in his office.


So, DME adds nothing to the numbers part of the process...... at least in my case.

They never even debriefed me after night one/week one/month one on CPAP, nor gave me any kind of list of what a "problem" might be........ I learned all that by reading here. I learned about my machine here. I learned my settings (clock and mask) were wrong....luckily before my first night....by info I got HERE. Yes people make mistakes, that's why jobs especially where another person's health is involved(!!) should have a check list so you can make sure you are not missing or forgetting to do something.


Glad you have a good one.........glad good ones exist.....they are needed..........I'd like a good one....... even as I remain very involved in my own care.....just as I am with all my docs. I don't expect the DME to do everything.....I expect accuracy, integrety, working WITH me. I'm a lifer....I need supplies, and eventually another machine....I would love a reliable source. Do they not see that working with "us sort" is actually good business as we are pretty self contained in our needs and don't require hand holding.....just honesty.....?

J

One stat says it all:

60% compliance with DME companies versus 3% compliance with on-line.

The people on this website are a good demographic of the 40% who failed with a poor DME provider and decided to "take control" of their own therapy. They are successful because another factor of compliance is participating in a support group like this one. But, make no mistake, these people heere are the exception, not the rule.

DME providers, the good ones, will be part of the team of the sleep lab, sleep physician and patient to achieve good therapeutic outcomes. They will do a thorough mask fitting, have a mask replacement program for those who struggle with the mask. They will have an active followup process for the first 3 months as all studies indicate this is the critical time for compliance. They will educate the patient as to their responsibility in their own therapy and give them the tools to do so.

Why do the people here equate brick and mortar DMEs motivations any different than the online providers? Both want to have a continuing relationship with the patient as the supplies replacement portion is really where the money is, not the equipment as it is labor intensive and fraught with reasons to not get reimbursed.

My problem with this particular support group is that a certain number are advocating self dosing which by FDA regulation is the realm of the physician ONLY.

I would recommend one thing when it comes to DME providers, shop around. If you do not like what they are telling you, go to a different one. Find one that will meet your needs. If you cannot find one then look online.

leejgbt wrote:One stat says it all:

60% compliance with DME companies versus 3% compliance with on-line.

The people on this website are a good demographic of the 40% who failed with a poor DME provider and decided to "take control" of their own therapy. They are successful because another factor of compliance is participating in a support group like this one. But, make no mistake, these people heere are the exception, not the rule.

DME providers, the good ones, will be part of the team of the sleep lab, sleep physician and patient to achieve good therapeutic outcomes. They will do a thorough mask fitting, have a mask replacement program for those who struggle with the mask. They will have an active followup process for the first 3 months as all studies indicate this is the critical time for compliance. They will educate the patient as to their responsibility in their own therapy and give them the tools to do so.

Why do the people here equate brick and mortar DMEs motivations any different than the online providers? Both want to have a continuing relationship with the patient as the supplies replacement portion is really where the money is, not the equipment as it is labor intensive and fraught with reasons to not get reimbursed.

My problem with this particular support group is that a certain number are advocating self dosing which by FDA regulation is the realm of the physician ONLY.

I would recommend one thing when it comes to DME providers, shop around. If you do not like what they are telling you, go to a different one. Find one that will meet your needs. If you cannot find one then look online.

I'm still waiting for someone to provide the link to those statistics. In my opinion those are "made-up" numbers. Also, if someone is purchasing the equipment (mostly) out-of-pocket and from an online seller, they're closer to 100% compliant.

I'm not sure you could get away with saying that we all "failed" with a local DME. Some of us bypassed them altogether (for various reasons) and many here are still using local B&Ms.

Please provide that FDA regulation that applies to the patients not being able to "self-dose" (read - take control of our own therapy). Please include the statutes that provide the penalties for those who do it. I would also presume that (those statutes) would also apply to people with Diabetes who have to monitor their glucose levels and adjust their insulin dosages (if they use it) or other medications. When you find them, I want to provide the links to the Diabetes forums so those folks will know that they're breaking "the laws".


Den

leejgbt wrote

One stat says it all:
60% compliance with DME companies versus 3% compliance with on-line.

Wow. Here you go again leading with your "Golly Gee Whiz" statistic and this time you don't even attribute your statistic to anyone. In a previous posting to another thread
viewtopic.php?f=1&t=46050&st=0&sk=t&sd=a&start=15
you also began your posting with this same self-serving 60% vs 3% compliance statistic and attributed it to an AASM (American Academy of Sleep Medicine) survey. On reading your previous posting and, in particular, this statistic in "disbelief", I asked you to provide a URL and/or full name of the referenced survey so that I can find it on the AASM website. If the usual and standard scientific survey details are provided for this survey (assuming it exists), I will evaluate the survey methodology and, most importantly, how survey participants were selected, and post my findings to CPAPTalk.

by cinco777 on Sat Oct 24, 2009 11:47 am

leejgbt wrote

Whether the AASM study was statistically correct and accurate I suppose could be debated based on the methodology used.

Please provide a URL link or the full descriptive name of the AASM compliance study that you referenced. I searched the AASM site and was unable to find a CPAP Compliance Study that compared compliance of users when a B&M DME provided their CPAP machines to compliance of users when an online DME provided their CPAP machines. Thanks.

I'm still waiting for you to provide pointer(s) to your statistic so curious forum members can locate and review this ?AASM? compliance survey.

Please note that in a prior posting, leejgbt says "I am the manager of a DME".

Full Disclosure: Cinco777, me, is retired - the only jobs that I now have are those assigned me by my wife (who is not retired). I Do, however, have many hobbies and my newest one seems to be CPAPTalk.

When I started with cpap, my first contact was with an RT who played by the rules of cheap machine, lie to the patient, not answer questions properly, and so on. She was assigned to me for a month, and she was very happy to abandon me at month end. Somehow I was lucky enough next to snag the owner of the business who was much more responsive to my questions and needs. Since then I have been very happy with them for purchases I make using insurance. I found out early that if I buy from them I pay much more than when I buy online. It only took one lesson for me. The company is a small local firm that deals only in pulmonary and sleep apnea equipment. I believe that the owner quickly grasped that I had educated myself (here) and was not going to be misled easily. He has been very helpful to me in many ways. I sent him here but I doubt that he ever participated.
Maybe the secret to success with the DME is to be educated about the treatment enough so that you are assertive and unwilling to take the line they give patients who can be treated that way.

I do believe that a DME is handy to have for quick purchases in emergencies.