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Re: What does a DME actually do? MY story

Posted: Thu Oct 29, 2009 4:52 pm
by mattman
Slinky wrote:However, I AM going to ask you since your clients "Patients are not allowed to adjust their CPAPs", just what you and your company would do when I DID take it upon myself to change my therapy setting(s)??
I know it wasn't me that you were asking, but I'll tell you what anyone I've been involved with would do, just for at least one perspective.

When we leave a patients home (Or a patient leaves our home) we are legally obligated to:

1) Make sure the patients equipment is in full operating order
2) Make sure that equipment settings match whatever is on the most recent prescription we have on file from a doctor. (So in your example, we would have to switch it back)
3) Make sure that if we are in your home, that your home can safely operate said equipment (IE, no obvious electrical problems)
4) Make sure there the patient does not have a mental or physical issue that would obviously keep them from being able to operate the equipment (IE, they have no hands and the
equipment has a small on/off switch)

That's about all that applies here that I can think of off the top of my head.

mattman

Re: What does a DME actually do? MY story

Posted: Thu Oct 29, 2009 6:06 pm
by JimIllinois
I'm curious on the question of "what the DME would do" as well.

If there were some reason for a DME visit for me - doubtful - I'm not sure what I'd do if the DME tried to change my settings. Would I arm-wrestle with him/her? Pretend to ignore it and change it back afterward?

My own situation had a very helpful RT deliver the machine, make sure the mask fit, offer to answer any questions, and that was it. I don't see the need for any future visit. Maybe some day my insurance would change, and I'd need a new machine and a new visit. Hypothetical. So, I can't imagine having to fight over my settings.

I do see a CNP at the doc's office twice a year to verify compliance and discuss results. At my last visit, we discussed the very different settings, but he said the results are excellent and why tamper with success. Of course, he had no financial interest in doing the settings for me.

Re: What does a DME actually do? MY story

Posted: Thu Oct 29, 2009 6:53 pm
by RN Ricky
DME's supply durable medical equipment and at least with the minimal contact that I have had with them they set the equipment and that is it. What in the world else do they do? Nothing. The doc tells them what settings to use. Why is this DME guy all over us? Lost some control

If we explode ourselves is it not our own doing?? Hopefully the pressure won't go that high!

Have any forum folk said that they are MD's?? Has anyone said those reading on this forum is are not "allowed" to check out the info on other sites? NO. Think... that's what cpaptalk forum folk do.

That is just my opinion.

Re: What does a DME actually do? MY story

Posted: Thu Oct 29, 2009 7:04 pm
by Muse-Inc
leejgbt wrote:...Medicare made accreditation mandatory Oct 1, 2009. This eliminated over 25,000 DME companies from Medicare provider status...If the DME you are looking for is not accredited go somewhere else.
Thanks! I didn't know this, a step in the right direction. Sound like your company's on the right path for patient success. While I understand your prohibiton against patient's managing their own therapy especially in light of many who chose to remain ignorant of the details, I choose to manage mine consulting with my sleep doc because it's my life and no one cares about that as much as I do.

Re: What does a DME actually do? MY story

Posted: Thu Oct 29, 2009 7:12 pm
by GaryG
mattman wrote:The only thing I will add to this is to try and look at it from the legal point of view of a DME company.

IF a DME company should give a patient instruction on how to adjust the pressure on the device and IF that patient raised the pressure too high and IF it was shown to cause Central Apneas and IF that patient died in their sleep.

Exactly how long do you think it would be before there was a long line of Lawyers salivating at the door of that patient's family?

I can tell you from very personal experience that the threat of litagation causes more hassle and strife, creates far higher obstacles and adds so much extra cost to the healthcare process it's not even funny.

Especially in the realm of healthcare the first response to anything negative is "Report them, bring charges, sue". Knowing that response is out there is the reason for a LOT more answers (Or lack thereof) than many people realize.

Again I come back to: Yeah, it sucks.
Matt, thanks for taking the time to explain. Makes sense that you need to be very sensitive on patient instruction, if you want to stay in business.

Re: What does a DME actually do? MY story

Posted: Thu Oct 29, 2009 7:14 pm
by Slinky
Actually, the DME providers' RRTs actually CAN change or adjust some settings WITHOUT a doctor's order (thank goodness in some cases). For instance, the better bi-levels, perhaps all, have some "comfort settings", i.e. Rise Time, Ti Maximum and Ti Minimum amongst a few others, that the good RRTs have more and better knowledge of than our sleep doctors. The not-so-good RRTs go w/the Default settings and let you struggle if the Default settings aren't w/in your comfort zone. Most sleep doctors haven't a clue about these "comfort settings".

Re: What does a DME actually do? MY story

Posted: Thu Oct 29, 2009 7:59 pm
by kteague
While I am one who has purchased machines my doctor wouldn't prescribe and adjusted my own pressure, I really do understand the liability issues involved with advising patients not to change their pressure settings. It's not good business to be liable for that which we have no control over. I do think OSA treatment should go the way of diabetes treatment. Training is provided so that diabetics can make adjustments within parameters as trained. An added dimension to OSA is that too often the patient is functioning at a substandard mental capacity. There have been a few times on here I have seen suggestions given and then the original poster's response shows that they totally misconstrued the info given. I do feel change needs to happen in regards to welcoming patient involvement, but I don't see a demon behind every DME/RT/Sleep Doctor bush. Just a need for progress in that direction.

Re: What does a DME actually do? MY story

Posted: Thu Oct 29, 2009 9:02 pm
by Scarlet834
On the side of the DME:

With the list of services described by leejgbt I suspect that many of us would honestly not have needed to adjust our own pressures. Surely such a DME/RT would have paid attention to anything we brought to the table and collaborated on a solution. Everyone who has had a lesser experience is very skeptical about the description, but if it were true, it would work. My husband has a collaborative give-and-take relationship of this sort with his physician.

The wording "not allowed to" is unfortunate and I don't agree with it. However, now that I have a working relationship with my RT I was asked, very pleasantly, not to adjust mine again without input. I have zero problem with this. If I found myself in an isolated situation, unable to reach appropriate (and reasonable) medical folks, and felt I needed to adjust my settings in order to function, I'd do it again and own up to it and why. However, under the given accessible and very positive relationship I don't expect to reach that point. For our next followup I'm just gathering my own data and FAXing.

My RT said he has also worked with DME(s) that are more the "drop-the-machine-off-and-vanish" sort. To me, all bets are off in that case. And the arrangement I described is only as good as the individual you partner with.

Not long ago we had a very scary fellow on the boards who bought a machine off Craigs list and was doing things like taping up the exhaust ports. In addition, my RT expressed that the majority of his patients have not been as self-educated on their condition as this board is. Worse, many do abdicate responsibility for their own health, not wanting to do more than receive and follow instructions, some to the point of not even communicating difficulties while continuing to suffer. Not everyone is as rational as I've found this board to be. I'm very, very glad we are here. I don't like to think we are in the minority.

Re: What does a DME actually do? MY story

Posted: Thu Oct 29, 2009 9:43 pm
by mars
To avoid further hijacking of this thread I have moved my reply to leejgbt to

viewtopic/t46255/A-Reply-To-Leejgbt.html

cheers

Mars

Re: What does a DME actually do? MY story

Posted: Thu Oct 29, 2009 10:15 pm
by Autopapdude
LinkC wrote:
Autopapdude wrote: the Cpap law that has never been shown?
Speaking of "never been shown", how are you coming with the federal law entitling a patient to his/her prescription?

" Your medical records are vitally important for a number of reasons. They obviously are the method by which our current doctors follow our health and our health care. They're also important to provide background if you need to see a specialist and to bring new doctors up-to-speed. Our medical records are the records of the people with whom we literally entrust our lives. Let's explore some of the issues regarding medical records. This applies not only to doctors who care for you for your headaches or Migraines, but for any doctor for any condition.


Your questions

Medical records are also the subject of many discussions on our forums and elsewhere and of many of the emails I receive. You have legitimately important questions, and you should. You ask:

May I see my chart at my doctor's office?
Do I have a right to and how do I obtain a copy of my records from my doctor?
My doctor says he can only give a copy of my records to another doctor, not directly to me. Is this true?
What do I do if I find an error in my medical records?
What do I do if I disagree with something my doctor said about me in my records?

Getting some answers

There are answers to these questions. It may seem strange, but the answers lie in the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA applies not only to health insurance, but privacy and medical records issues as well. So, let's answer those questions...

HIPAA gives you the right to see your medical records in your doctors' offices.
HIPAA not only allows your doctor to give a copy of your medical records directly to you, it requires it.
In most cases, the copy must be provided to you within 30 days. That time frame can be extended another 30 days, but it's required that you be given a reason for the delay.
You may not be able to get all of your information in a few special cases. For example, if your doctor decides something in your file might endanger you or someone else, the doctor may not have to give this information to you.
You may be charged for making and mailing copies. From a U.S. Health and Human Services FAQ:
Q. "If patients request copies of their medical records as permitted by the Privacy Rule, are they required to pay for the copies?"
A. "The Privacy Rule permits the covered entity to impose reasonable, cost-based fees. The fee may include only the cost of copying (including supplies and labor) and postage, if the patient requests that the copy be mailed. If the patient has agreed to receive a summary or explanation of his or her protected health information, the covered entity may also charge a fee for preparation of the summary or explanation. The fee may not include costs associated with searching for and retrieving the requested information. See 45 CFR 164.524."
If you find an error in your medical records, you can request that it be corrected or add information to your file if it is incomplete. For example, if you and your doctor agree that there's an error such as what medication was prescribed, he must change it. Even if your doctor doesn't agree that there's an error, you have the right to have your disagreement noted in your records. In most cases the file should be changed within 60 days, but it can take an additional 30 days if you're given a reason.

The bottom line

HIPAA, the same act that regulates how our health information is handled to protect our privacy, also gives us the right to see and obtain a copy of our records and to dispute anything we feel is erroneous or has been omitted. If you have difficulty with either of these issues, simply asking the office staff personnel involved to review HIPAA regulations will usually be enough to resolve the situation.

This is, however, one of those areas where it's sometimes best to "choose your battles" wisely. There may be times when demanding a copy of your records or insisting that you disagree with something in your records isn't worth the time or stress involved. Doctors will usually send a copy of your records to a new doctor at no charge, as a professional courtesy. This could be easier and far less stressful. If an error or omission in your records is minor, it might be not be worth pursuing and risking a problem in the relationship with your doctor and his or her staff. These are considerations, but only you can make the final decision.

HIPAA also regulates what medical information may be released to whom and for what purposes. For more information about HIPAA, visit the U.S. Department of Health and Human Services Office for Civil Rights - HIPAA Web site."

Quoted from a "Your rights and HIPAA site." Prescriptions fall legally under the category of medical records. Ask your lawyer if you doubt that.

Re: What does a DME actually do? MY story

Posted: Fri Oct 30, 2009 12:03 am
by Julie
Scarlet - you sound like a rational and moderate person, which is nice to see here, but you mentioned the man who tried to cover the vents on his Craig's list machine. Well, if we were not all here to have set him straight, what might have happened? We wouldn't be here to help such people if we were just knee jerkers going along with whatever providers (and I mean anyone from a surgeon to DME clerks) tell us to do, but it's our having taking the initiative in learning about the treatment that allowed us to help that man. As well, you mentioned that you're faxing your information in... you obviously think you're sending in important scientific data for the doctors to pore over and consider. Unfortunately, that data is strictly 'compliance' information to keep the insurance companies happy - it tells them that you've been using the machine for so many hours a day for so many days, and that's all, and no one apparently cares how you are actually doing otherwise (I'm not ultra knowledgable - the compliance faxes are standard procedure). However, if you were to participate in your treatment on another level, e.g. using the smart card, software and your computer, just the knowledge that you were 'on top of' your treatment alone would make you feel better, more in control, and more helpful to your doctors, DME's, etc. by your understanding of the issues, and also be in a position to intelligently agree to, or veto, certain medical equipment, etc. when it's presented to you, rather than being passive about it all, and possibly anxious if things don't go well (but having to wait for a doctor to 'fix' it). Well, maybe not everyone wants to be part of their own Cpap story, and there are obviously people who shouldn't, but I do think the majority of us would like the chance to understand what's happening to us, and to be involved in what to do about it.

Re: What does a DME actually do? MY story

Posted: Fri Oct 30, 2009 7:36 am
by LinkC
Autopapdude wrote: Prescriptions fall legally under the category of medical records.
Indeed they do. And HIPAA (as you quoted) requires you must be provided a COPY of those records, on request.

But a copy of a prescription and the prescription itself are two very different things. In most states a COPY of a prescription is not valid, for very good reasons. If your provider transmits the 'script directly to the DME/pharmacy THAT is considered the "original" and the best he can legally give the patient is a non-valid copy (which is what HIPAA requires).
Autopapdude wrote:I shall continue to stand by my advice to her that she may, under Federal and State laws, obtain her prescription.
You keep using "prescription" and "copy of prescription" as if they were the same. They are not. She was obviously looking for a prescription she could USE...not just a photocopy for her file. Under which Federal law may she demand that?

Re: What does a DME actually do? MY story

Posted: Fri Oct 30, 2009 7:37 am
by Slinky
Julie, how do you figure that Scarlet is only able to FAX compliance data to her local DME or sleep doctor? She has an M Series Pro which is fully data capable. It is unclear if she has the software and cable reader to print out the data to FAX or if she us just keeping a daily record of data off the LCD screen and FAXing that.

Re: What does a DME actually do? MY story

Posted: Fri Oct 30, 2009 7:57 am
by Slinky
Thank you, Mattman. That seems appropriate as regulations now stand. HOWEVER, what would you do if the patient's choice of settings provided better sleep and improved data? Would you TELL the patient you were changing the settings to the scripted settings and WHY? Would you contact the scripting physician to suggest changing the scripted settings and why or would you suggest to the patient that THEY contact their sleep physician for a scripted change to the settings the patient found worked best or would you just ignore the improved sleep and data and reset to the scripted settings w/o making any recommendations to patient or scripting doctor??
mattman wrote:
Slinky wrote:However, I AM going to ask you since your clients "Patients are not allowed to adjust their CPAPs", just what you and your company would do when I DID take it upon myself to change my therapy setting(s)??
I know it wasn't me that you were asking, but I'll tell you what anyone I've been involved with would do, just for at least one perspective.

When we leave a patients home (Or a patient leaves our home) we are legally obligated to:

1) Make sure the patients equipment is in full operating order
2) Make sure that equipment settings match whatever is on the most recent prescription we have on file from a doctor. (So in your example, we would have to switch it back)
3) Make sure that if we are in your home, that your home can safely operate said equipment (IE, no obvious electrical problems)
4) Make sure there the patient does not have a mental or physical issue that would obviously keep them from being able to operate the equipment (IE, they have no hands and the
equipment has a small on/off switch)

That's about all that applies here that I can think of off the top of my head.

mattman

Re: What does a DME actually do? MY story

Posted: Fri Oct 30, 2009 8:05 am
by Autopapdude
LinkC wrote:
Autopapdude wrote: Prescriptions fall legally under the category of medical records.
Indeed they do. And HIPAA (as you quoted) requires you must be provided a COPY of those records, on request.

But a copy of a prescription and the prescription itself are two very different things. In most states a COPY of a prescription is not valid, for very good reasons. If your provider transmits the 'script directly to the DME/pharmacy THAT is considered the "original" and the best he can legally give the patient is a non-valid copy (which is what HIPAA requires).
Autopapdude wrote:I shall continue to stand by my advice to her that she may, under Federal and State laws, obtain her prescription.
You keep using "prescription" and "copy of prescription" as if they were the same. They are not. She was obviously looking for a prescription she could USE...not just a photocopy for her file. Under which Federal law may she demand that?

You're having a pissing contest, which I shall not desire in which to participate. I showed you the law, and you can consult with your lawyer whether or not the "copy" of the prescription constitutes a request for a usable one. The prescription belongs to the patient, and when a duplicate is required to obtain services, they can be produced. I think it is rather clear. You're being gratuitously petty, despite an apology I made to you previously for my curtness. I think my apology was wasted on insensitive ears.