DME's Moving Toward Auto-Titration Machines For All??

Went to Norco yesterday, mainly to try on masks and listen to the spiel, and was surprised to be presented with...wait for it...an AutoSet II. Without me asking for anything. This surprised me, since the doctor's script they had did not mention auto anything. The RT said (I think I heard it right, but am starting to doubt myself) "yes, we only give out auto-titrating cpaps now."

Is she crazy, or am I crazy, or are both or neither of us crazy?

I can imaging an insurance company running the numbers and deciding the APAPs from the start for all would save enough money by reducing later titration studies for those who don't do well on straight CPAP at their titrated pressure, to make this be the economical option. So I can see how this could be chosen by an insurance company as policy.

But why would a DME switch to a policy of APAPs only?

I'm leaning towards me being the crazy one. But I took the machine, the terms being not too bad.

I've read on here before that some DME's have switched... but then again... some haven't.

Just count yourself lucky... and take it gladly.

Ive long thought that this sort of CPAP would come and put all the sleep lab staff out of a job
several tests have shown that apnea sufferers, given a simple CPAP that they can adjust, usually get near enough to their required pressure

It's about time!

Thank goodness they are moving to autopaps, as the user can fine tune the sleep study results to work better in real life. Also, that gives the choice of working as a Cpap, or an autopap. Wise move for DME to do so.

brain_cloud wrote: But why would a DME switch to a policy of APAPs only?

Lower price in larger quantity.
Superior profecciency with less training.
It is a far better choice then "basic compliance reporting" CPAP for all.
They should be applauded..

I had a very similar experience. I have always used cpap only, and that's how my new prescription read. The only difference is that before I contacted the DME I signed up here, and read enough posts to know that I should request an Autoset II. When I did, the DME didn't hesitate. That's when she said that more and more doctors and DMEs are going with the "auto" machines (with the insurance company's approval). She said she believes that in a relatively short time, the apap machines will become the industry-wide standard.

Yes! When I went to meet with a local DME prior to finding this forum, he told me he offers only two machines because they are durable and meet the needs of almost everyone and he doesn't have to spend time, energy, and lose money constantly sending machines back. He said, "The autosets to my mind do the work of bi-level machines." At that time, we were hankering for an autoset, so I was thrilled. (Now we know my husband needs a machine with SV but I'm still thrilled for everybody else!) The DME showed me only one machine and it was an autoset. Congratulations on your new machine!

On 10 August 2009 I went to my DME: BayState Medical and got my machine and mask. The machine that they had for me was a REMStar Auto M with A-Flex (without asking) . It's set to straight CPAP but because it's auto I can use it in a range if needed. I believe that this is what they are doing because it is not just a straight CPAP where if they give one out they would need to order and pay again for one that is AUTO. Cheaper for them and cheaper/better for us in the long run.

DJ

As a DME manager who made the decision several years ago to use only "auto" CPAPs I was glad to read that other DMEs are figuring out that "auto" CPAP have several monetary advantages over having a mix of CPAP types:

1. It is common for a physician to swith the settings to auto after a few months with straight. Most insurances and Medicare have rent to own so you cannot start over with the new auto.
2. Most also require compliant data before a purchase is made. All indications are that auto CPAP compliance is much greater so the DME will receive greater reimbursement while the patient get imptoved therapy results.
3. In general the auto also have more "bells and whistles" for downloads that can be forwarded to the physician (our referral source).
4. By purchasing autos only I was able to negotiate a very good price that was not that much higher that straight CPAP.

I would say that if your DME does not follow this strategy I would wonder just how educated and up on the current methodologies these cpmpanies are. I would look elsewhere.

As a DME manager who made the decision several years ago to use only "auto" CPAPs I was glad to read that other DMEs are figuring out that "auto" CPAP have several monetary advantages over having a mix of CPAP types:

1. It is common for a physician to swith the settings to auto after a few months with straight. Most insurances and Medicare have rent to own so you cannot start over with the new auto.
2. Most also require compliant data before a purchase is made. All indications are that auto CPAP compliance is much greater so the DME will receive greater reimbursement while the patient get imptoved therapy results.
3. In general the auto also have more "bells and whistles" for downloads that can be forwarded to the physician (our referral source).
4. By purchasing autos only I was able to negotiate a very good price that was not that much higher that straight CPAP.

I would say that if your DME does not follow this strategy I would wonder just how educated and up on the current methodologies these cpmpanies are. I would look elsewhere.

That's great logic, on your part. I commend you for your decision to do so. Unfortunately, in my area, few DMES have the same enlightened attitude. They stick with the "one insurance code" philosophy, and give the patient the cheapest machine possible at an inflated price. That is why so many around me have chosen to go the "self pay" way, and get reimbursed by insurance (if so covered). I do the 80/20 with United Healthcare, and choose to make my own decisions.

MY one positive suggestion would be to offer the patient a variety of machine choices, if he/she expresses a desire for it. In addition, all DME providers must face the facts that most people with OSA are getting educated on their condition, and want to monitor their own treatment with software. Most doctors are coming around to the fact that "home fine tuning" is a positive thing, as long as the individual uses the machine in a responsible and educated way. Face it, Apnea is a changing condition--the sleep study is only one moment in time, and many people choose to monitor the condition themselves (in addition to having their doctor/DME making changes to their therapy).

bcab17 wrote:That's when she said that more and more doctors and DMEs are going with the "auto" machines (with the insurance company's approval).

I don't believe that is quite true. It seems some DME's can't tell the truth yet and others want you to believe there is some "Black Magic" when it comes to sleep medicine.

As I understand it - there is one billing code for cpap and/or autopap. So tell me why would ANY Insurance Co. want to approve the make and/or model of the script being dispensed? Either they will cover cpap equipment or they don't. The DME wants to get paid - thats what the approval is for NOT whether it is an auto.

So to me that would be a lie. Not the 1st time I saw that (auto approval) mentioned on this forum and I wanted to either clear it up or bring it out.

In fact, if I understand correctly (with most Ins.co) , if the DME dispenses a low end straight cpap and any time during the coming year the script changes then the DME has to provide the "upgrade machine" for the same price. This is likely the reason so many Ins. Co. do the rental for 13 months and why the trend is moving to dispensing an auto cpap to begin with.

I heard this auto story several months ago from an Apria Salesman but from reading here it seems not ALL of them are doing it this way. I am not even certain that the Apria which said that is in fact dispensing just autos. I know another thing that was mentioned is manpower required for Medicare compliance. So they were also looking forward to using Encore Anywhere via modem.

I would avoid the modem movement at ALL cost. Modems will only serve to bypass the patient, period.

GumbyCT wrote

I would avoid the modem movement at ALL cost. Modems will only serve to bypass the patient, period.

Yes, don't buy into the modem hype by the DME (and/or Sleep Clinic/Dr.) if you have a full data capable machine (records/reports AHI, system leak, ...) and currently, or ever, plan to monitor/track your sleep therapy/events. Owning and using your machine's card reader module in combination with a card reader and software allows you to take control of your own sleep therapy. Many members of this forum, me included, have found that this combination - card reading module, card reader, and software AND CPAPTALK - was instrumental to their success with their sleep therapy. I speak from experience as I failed without this combination three years ago.

Since, as I understand it, the modem module and the card reading module occupy the same slot in the machine, having the modem residing in the machine negates having the card reading module in the machine - one or the other at a time, but not both concurrently. The DME will get your sleep information via the modem and you won't! If that isn't what you want, then keep your card reading module in your machine and tell the DME to "take a hike" with their modem.

If you have a compliance-only machine, and you think that having a modem will lessen the hassles the DME puts you through re reporting your compliance for insurance reasons, then you may be a candidate for the DME's modem offer. However, as always, read the fine print - the DME may see you signing up to take the modem as another way to overcharge you for what you are getting.

I read alot about "taking control of your own therapy" and I would just like to comment about one aspect of this. Changing pressures on your CPAP or BiPAP equates to changing the prescription. Not even an RT is allowed to do this, only the physician. This includes setting the auto range as well. Would you change your blood pressure dosage, etc.? This is a dangerous area and I see many giving advise about pressures. Please verify with your physician before changing any pressures.

leejgbt wrote:I read alot about "taking control of your own therapy" and I would just like to comment about one aspect of this. Changing pressures on your CPAP or BiPAP equates to changing the prescription. Not even an RT is allowed to do this, only the physician. This includes setting the auto range as well. Would you change your blood pressure dosage, etc.? This is a dangerous area and I see many giving advise about pressures. Please verify with your physician before changing any pressures.

Damn, you just about suckered me in.

I was just about convinced that you were different...
but you're not.

....and the beat goes on....and on....and on....