Don't blame RT/DME

rickskids wrote:Twenty-four of those forty-five years I have spent serving my country, giving all americans the right to express their opinions without fear of repercussions.

I would like the express my gratitude to you, Rickskids, and to others, both those who are still living, and those who have made the ultimate sacrifice.

We sometimes forget that freedom isn't free.

Rickskids, I'm grateful to you for your service to our country. My husband is a 100% totally disabled veteran and he is my hero!

SWS, You are always such a gentleman and you represent what this forum is really all about. And RG is the lady! I sometimes have to read both of your replies twice to really get that you might actually be disagreeing with a poster.

There's apparently a board there, as well.... although it is not an open board, like this one.

Annual Board memberships vary from $40 (Student w/o journals) to $400 (Industry Affiliate). Sleep Drs. pay $200/year (January to December). To access the online guides, you need to login in and you need membership to get a login ID.

CpapRRT wrote:

Uncle_Bob wrote:

CpapRRT wrote:
We set all the machine's to show AHI and Leak #'s with education on what those numbers mean and what range they should be within.

When you say all machines does that mean you initially give all your patients a data compatibile machine or do they have to request one?

The main problem with the majority of DMEs/RT is they hand out a bare bones dated machine and pocket the maximum amount of cash possible.

At our facility we only use machines that are fully data compatibile, the main machines we use as of today are the PR System One and the Resmed Autoset II. Sure, there are plenty of bare bones dated machines, but we have no use for them at our facility.

We do our own downloads at the 2 week mark, then the 1 month mark and every month for the first year, then on to a 6 month download schedule for lifetime. We do however work under a medical director with a standing pressure change protocol based on our download data and patient comfort, so we have plenty of wiggle room to help our patient's with their needs pressue change wise.

DMEs/RTs like you... I appreciate. There are others... that I don't. Just wish that there were more like you in the business. The difference between the bad ones and the good ones is quite a gap.

There will always be DIYers and those that prefer to use someone else's expertise.

IMO, anyone and I do mean anyone willing to learn and read this forum on a daily basis WILL become more of an expert on sleep apnea as it relates to their body over
ANY doctor or ANY DME. PERIOD.

So as I save $1400.00 on my machine and mask PLUS get the machine and mask I want (not what the DME wants to sell) I can say to all DMEs I simply do not need you.

Best,
Phil

Uncle_Bob wrote:

deadhead77 wrote:

Uncle_Bob wrote:

deadhead77 wrote: NO, for the vast majority I think that the whole delivery of information should be graduated into various levels of competence that is monitored and rubber stamped by professionals.

Kinda like a driving license for CPAP

Exactly, good analogy.

How long were you on cpap before you got confident enough to change settings etc.

After about 1 nights sleep, a couple of hours on the net (cpaptalk.com) and a chat with my RT

Wow! do you know, I have only just managed to get the mask to stop leaking, have my nose back to normal and feel the fog and exhaustion lifting a little after about four weeks!

I though it was all going well... I feel like a dickhead now...One nights sleep and two hours on the net and you got it all done and sorted out to the point you could.... Amazing, I envy that.



So, you do not think it would be a benefit to those less intelligent or clever as you to be given a clear path through all the steps to competent cpap use and understanding, you would rather leave it all to pot luck. At the moment it seems to me reading these boards that most new users have enough to contend with just getting themselves into routines and solving simple stuff. Out of respect for the seriousness of osa and the damage it can do to general health 'I' feel that a structured progression leading up to adjusting things yourself, is a far safer and manageable way than letting everyone do their own thing.

Why would Resmed not want patients to self monitor and 'fiddle'?? Could you explain why that is please.

You should also take a walk around a typical British hospital, there you will find people from all over the world being treated whether they have insurance or not. We turn no one away and it costs us what it costs.

Don't knock it till you have tried it.

rickskids wrote:Twenty-four of those forty-five years I have spent serving my country, giving all americans the right to express their opinions without fear of repercussions. Five of the last eight years of my life I spent in the mountians of Afgahnistan.

Thank you rickskids. It's a shame that so many of us take sacrifices like yours for granted.

My wife and I are in the process of helping our 17 yr old daughter jump through all of the hoops to secure a College Army ROTC scholarship. She wants to join the Army and become a nurse. It's her plan, not ours. She joined her high school's Jr. Air Force ROTC when she was a freshman. Now as a senior she is her school's commander and has promoted to Colonel (it's a big deal for her age--especially for a female).

Stories like yours scare the hell out of me.

I think you've earned the right to be blunt.

Hi All

So many interesting posts, so little time to respond.

I welcome Sleep Doctors, Rt's and DME consultants to this forum. We can all learn from the threads here. I, as a cpap user, do not get attacked straight away, I am given time to settle in (not much time I admit), and can start to get the hang of how things work.

Some forum members immediately attack any OSA treatment professional, and in this they are thowing out the baby with the bathwater. I, like most of us, have had bad experiences with my first sleep doctor, and my first 4 equipment suppliers. I now have a great sleep doctor, and a great equipment supplier (cpapauction). I have vented a few times early on about the problems I have had, but I need to move on, and have moved on.

Unfortunately some of us have not.

We do not get the chance to share our knowledge if we abuse OSA industry workers, and they decide they are not wanted here, and leave. They probably will not arrive at the Forum agreeing with our general philosophy, so if we live in the real world we need to accept that, not just mindlessly vent ad nauseum.

I do not agree with many of the people in the professions I have been a part of, and I learned that telling them they were wrong, were stupid, and idiots, did not help them to see my point of view (which, of course, was the correct one ).

It seems to me that the majority of forum members want to have a dialogue with the OSA workers who arrive at the Forum, and a few members want to deny that opportunity to the majority. Not to protect the majority, but to continue to vent their spleen. This is not helpful behaviour, it can only be called selfish behaviour.

Most things I disagree with I just let go, as I have said before. When I start a post I try to ask myself - will this post be helpful or is it just my anger or my ego taking over. I am getting better at not submitting those posts, or deleting them as soon as I have posted them.

One final question - which is relevant to all who (in whatever circumstances) are on the outer.

If you demonise someone, are they more likely to see that they are wrong and embrace your ideas: or are they more likely to get defensive, and continue their current behaviour.

cheers

Mars

deadhead77 wrote:

Uncle_Bob wrote:

deadhead77 wrote:

Uncle_Bob wrote:

deadhead77 wrote: NO, for the vast majority I think that the whole delivery of information should be graduated into various levels of competence that is monitored and rubber stamped by professionals.

So, you do not think it would be a benefit to those less intelligent or clever as you to be given a clear path through all the steps to competent cpap use and understanding, you would rather leave it all to pot luck. At the moment it seems to me reading these boards that most new users have enough to contend with just getting themselves into routines and solving simple stuff. Out of respect for the seriousness of osa and the damage it can do to general health 'I' feel that a structured progression leading up to adjusting things yourself, is a far safer and manageable way than letting everyone do their own thing.
.

You're missing the point! Nothing here is left to "pot luck". All the experts lead the newbies in a very "structured progression" towards taking their treatment into their own hands. All suggestions and recommendations by them are given with many years of experience behind them and given cautiously and with much thought. I've always felt safe here and never was "doing my own thing" until I felt confident enough. I still ask questions and probably always will, knowing I'll always get the right answers.

deadhead77 wrote:On the assumption that there is no user qualification requirement involved it would seem ridiculous to present someone with a diagnosis of sleep apnea, provide them with the equipment that will ease this affliction and then, allow them to fiddle with it!

Although I actually favor collaborating with medical professionals on treatment, the problem I have with the process I went through is that there was no apparent provision for checking up on me for the next two months to see how I was doing, and it was absolutely not clear who I was supposed to contact in the meantime if the answer to that question was not "better". This led directly to my tweaking my own settings. If I had not done so there is a strong possibility I would have remained largely non-functional for a lot longer than I did, if not for the entire two months. I don't think anyone but I was going to figure out anytime soon that my AHI was still in the 20s (under the initial settings). Not a good solution for someone needing to function every day and earn a living.

A few DMEs posting on this boards have referenced 1 week, 1 month, etc. follow-ups including a review of data. Without that type of close collaborative monitoring I'd say the individuals on this board have fared better under their own self-treatment. Even with the collaboration I describe I prefer to see my own data--I'd just be more likely to have discussion with my doctor prior to making changes.

I would say it is ridiculous to provide someone with the equipment that will ease this affliction and not make sure it's working as intended.

i appreciate/sympathize with anyone in the medical field that is sincerely trying his best to help people. we need more people like them.

but, as for how a patient uses his machine - i don't see how this is any different than when a doctor prescribes any other medicine/therapy. yes, it would be illegal for the pharmacist to provide anything other than what the prescription calls for. but as for how the patient uses it (if at all), seems to me that is entirely his choice/responsibility. it is not uncommon for an individual to decide to adjust the dosages from what was prescribed because they didn't like the way the meds were affecting them. and in the process, actually help his doctor find what does work, and in what amounts.

that being said, obviously, we are all responsible for the decisions we make regarding our health/treatments.

i just don't see how cpap is any different from any other treatment/therapy.

As this thread involves some of the exact reasons that as a CPAP user and also a manager of a DME company I looked for this type of site I thought I would add to the discussion from my perspective. When I entered this field it was not as a "profiteer" but I started with a company owned by nurses who wanted to give exceptional patient care they felt was lacking in this industry. The mentoring I received from these people opened my eyes to the difference between a job and a calling. These people tried to compete with regional companies and hospital owned companies with exceptional service and lower prices. It was quite an eye opener to learn there was no incentive to compete on pricing as Medicare set the prices (allowables) and insurances followed their lead. We then dedicated our company to having exceptional service and cutting edge technology. This worked very well for 20 years.

For over ten of those years I advocated for accreditation for our industry being mandatory as it was too easy to get in this business and no knowledge was necessary. Medicare made this mandatory October 2009. The irony was the primary intention was to eliminate over half of the DME companies as they had found it impossible to monitor the sheer number of companies in the business. In the years leading up to accreditation a tactic of making the DME responsible for the medical necessity of the item ORDERED BY A PHYSICIAN was implemented. It was also made the responsibility of the DME company to educate the prescribing physician as to the rules governing the item ordered. If the physician did not follow the Medicare guidelines then the DME did not get paid or had to refund the payment in an audit. If the physician did not have the documentation in their medical record then the DME was not paid AND the patient was not responsible for the charges. This is called a "CO" denial.

I have no doubt that the people of this website fall into the category of using a non-accredited DME or are the rare patient who takes it upon themselves to get educated about their condition. As a patient that is why I came to this site. In return for the info I believed my expertise could help those people with billing issues or navigating getting what they need from their DME.

Over 29,000 DME companies opted to not be accredited. I wish it were the case that this eliminated all the bad companies but some good companies were victims as well as reimbursement has been reduced over 50% since 1999. So many companies did not have the means to become accredited. Sadly, my old company was one of these casualties.

Sleep therapy is a relatively new field. New things are learned daily. I do not buy into the DME/Doctor/Manufacturer conspiracy. First we are not that cohesive. Their are two national associations, one that advocates for the "nationals" and of that advocates for the small business owners as defined by the SBA. We rarely agree on anything sadly even when it is our interest to do so. The manufacturers compete for our business and as an industry we demand good product, good pricing and good service.

It will be a sad day indeed if the conspiracy theorists are right. I am also a CPAP user, an insurance premium payor and a tax payor.

I feel pride for my industry when I hear cogent discussions regarding therapy by sincere professionals. I am fascinated by the level of education of the people on this site. Believe this, the more you know the more you comply. There are numerous studies that include patient involvement as a measure of compliance (success). The more you know the more we can spend on the more challenging patients to gain their compliance as well. My company only uses data/therapy capable auto units. We allow the patients to see AHI and mask leaks. We ask every patient if they want a copy of their download data and will explain the data as well.

We also abide by all laws, accreditation standards and manufacturer recommendations. This does seem to put us at odds with the majority opinion on this site but it does not make us your enemy. One thing I have been hammering my venders with is patient versions of the software that allows for all those things most asked for on this site short of the ability to change the settings (which you all have figured how to get anyway).

Excellent post there. I think so many of us experienced some form adversarial relationship with insurance, doctors or DMEs at some phase of trying to get the right equipment (i.e. APAP and/or data capable), we forget how many advocates are on that side of the fence as well. My personal experience is that after two years of being on the machine, I have never seen a technician or physician in person concerning my OSA. I have 100% coverage and every six months, Apria offers me a new mask and supplies. I suspect if I felt the need to go in for a consultation I could, The other side of that coin in my case is, no one has been interested in following up either except for the one appointment where the insurance company converted the machine from a rental to purchase.

leejgbt wrote: I feel pride for my industry when I hear cogent discussions regarding therapy by sincere professionals. I am fascinated by the level of education of the people on this site. Believe this, the more you know the more you comply. There are numerous studies that include patient involvement as a measure of compliance (success). The more you know the more we can spend on the more challenging patients to gain their compliance as well. My company only uses data/therapy capable auto units. We allow the patients to see AHI and mask leaks. We ask every patient if they want a copy of their download data and will explain the data as well.

We also abide by all laws, accreditation standards and manufacturer recommendations. This does seem to put us at odds with the majority opinion on this site but it does not make us your enemy. One thing I have been hammering my venders with is patient versions of the software that allows for all those things most asked for on this site short of the ability to change the settings (which you all have figured how to get anyway).

leejgbt wrote:As this thread involves some of the exact reasons that as a CPAP user and also a manager of a DME company I looked for this type of site I thought I would add to the discussion from my perspective. When I entered this field it was not as a "profiteer" but I started with a company owned by nurses who wanted to give exceptional patient care they felt was lacking in this industry. The mentoring I received from these people opened my eyes to the difference between a job and a calling. These people tried to compete with regional companies and hospital owned companies with exceptional service and lower prices. It was quite an eye opener to learn there was no incentive to compete on pricing as Medicare set the prices (allowables) and insurances followed their lead. We then dedicated our company to having exceptional service and cutting edge technology. This worked very well for 20 years.

For over ten of those years I advocated for accreditation for our industry being mandatory as it was too easy to get in this business and no knowledge was necessary. Medicare made this mandatory October 2009. The irony was the primary intention was to eliminate over half of the DME companies as they had found it impossible to monitor the sheer number of companies in the business. In the years leading up to accreditation a tactic of making the DME responsible for the medical necessity of the item ORDERED BY A PHYSICIAN was implemented. It was also made the responsibility of the DME company to educate the prescribing physician as to the rules governing the item ordered. If the physician did not follow the Medicare guidelines then the DME did not get paid or had to refund the payment in an audit. If the physician did not have the documentation in their medical record then the DME was not paid AND the patient was not responsible for the charges. This is called a "CO" denial.

I have no doubt that the people of this website fall into the category of using a non-accredited DME or are the rare patient who takes it upon themselves to get educated about their condition. As a patient that is why I came to this site. In return for the info I believed my expertise could help those people with billing issues or navigating getting what they need from their DME.

Over 29,000 DME companies opted to not be accredited. I wish it were the case that this eliminated all the bad companies but some good companies were victims as well as reimbursement has been reduced over 50% since 1999. So many companies did not have the means to become accredited. Sadly, my old company was one of these casualties.

Sleep therapy is a relatively new field. New things are learned daily. I do not buy into the DME/Doctor/Manufacturer conspiracy. First we are not that cohesive. Their are two national associations, one that advocates for the "nationals" and of that advocates for the small business owners as defined by the SBA. We rarely agree on anything sadly even when it is our interest to do so. The manufacturers compete for our business and as an industry we demand good product, good pricing and good service.

It will be a sad day indeed if the conspiracy theorists are right. I am also a CPAP user, an insurance premium payor and a tax payor.

I feel pride for my industry when I hear cogent discussions regarding therapy by sincere professionals. I am fascinated by the level of education of the people on this site. Believe this, the more you know the more you comply. There are numerous studies that include patient involvement as a measure of compliance (success). The more you know the more we can spend on the more challenging patients to gain their compliance as well. My company only uses data/therapy capable auto units. We allow the patients to see AHI and mask leaks. We ask every patient if they want a copy of their download data and will explain the data as well.

We also abide by all laws, accreditation standards and manufacturer recommendations. This does seem to put us at odds with the majority opinion on this site but it does not make us your enemy. One thing I have been hammering my venders with is patient versions of the software that allows for all those things most asked for on this site short of the ability to change the settings (which you all have figured how to get anyway).

You should sleep well at night Leejbgt, you obviously have a good heart and are passionate and knowledgeable about what you do. I for one will look out for your posts, I just hope you keep posting your perspectives, having a foot in both camps

Keep hammering those vendors mate, that last paragraph makes so much sense in whatever health system you have.

The problem I see with depending solely on an open forum for your education is the fairly substantial amount of misinformation available. Much of it gets repeated so often it's soon accepted as "fact".

You need to research elsewhere (and--dare I say it--run some of it by your competent professional!) before acting on it.

Don't take just anything (even what *I* post) as gospel...