DME was PISSED.

DreamOn wrote:

rjjayrt wrote:If I'm correct and I think I am, I can't buy for my business from the site you noted. We purchase our equipment and supplies direct from the manufacturer.

Yes, I understand that. But I would assume that cpap.com is buying direct from the same manufacturers, just as you are. So it's amazing that they're selling the same mask for $79 less than you're buying it for. I know about "loss leaders" in business, but that's a huge discrepancy. Just sayin'.

~ DreamOn

Not a "loss leader" effect or strategy at play. Many years ago I was considering starting a business based on the sales of voice, data, and more common hardware equipment. I discovered the same price discrepancies regarding my costs that rjjayrt described above. Bear in mind that was a different industry. However, it seemed entirely counter intuitive to me at the time that I could easily find lower costs from "bargain retailers" than wholesalers and manufacturers were willing to provide me at my initially-targeted low volumes.

Well, two possible factors come to mind. One is completely on the up-and-up: it's much more expensive (regarding overhead) for manufacturers/wholesalers to sell 100,000 widgets to 10,000 low-volume retailers than it is for them to arrange the sale and shipping of 100,000 widgets to say ten high-volume retailers. So high volume retailers are awarded for presenting manufacturers and wholesalers with much lower overhead costs per widget sale.

The other factor that comes to mind is that high-volume competitors can conceivably apply threatening negotiating or leverage tactics against manufacturers. They might informally but very aptly apply their own high-volume "alliance muscle" if you may, to keep potentially threatening upstart DME competition at a significant price disadvantage. That "business muscle" negotiating tactic---directly into the ears of manufacturers---essentially places effective market-entry barriers across the board. In other words, it cripples competition from the little guy...

-SWS wrote:In the meantime, the FDA is addressing this mess by cracking down on small things like humidifier and mask prescriptions. God forbid that a patient---who has already been granted a CPAP machine---should get their hands on a compliance-making humidifier or comfortable mask without going through a prescription gauntlet---one that clearly favors the status-quo brick-and-mortar DME business arrangements regarding traditional prescription hand offs.

I'm personally inclined to suspect brick-and-motor massive-volume DME corporations employ an entire variety of behind-the-scenes "marketing muscle" aimed at crippling competition rather than being primarily aimed at helping patients.

DreamOn wrote:

rjjayrt wrote:I can't speak for other DME's but some of these costs don't sound right to me. For example a FP FlexiFix 431 FFM costs me 180.00.

And that same FlexiFit 431 FFM is sold for $101.00 at cpap.com (https://www.cpap.com/productpage/fisher ... -mask.html), $79 less than your cost. Interesting.

~ DreamOn

rjjayrt:

With respect, your statement that your cost as a re-seller is $180 doesn't sound right to me, considering that the end-user can purchase that same mask online at retail for $101. Please explain to us what we're missing here, and how cpap.com can sell this mask (for a profit, I'm sure) at $79 less than you can purchase this mask at wholesale. I always assume that their price will be lower than a B&M store due to services offered (or at least claimed), but this disparity is pretty huge.

I'm not goading, taunting or mocking here - it's an honest question. If there is something I don't see, I'd love to know it. If your statement is true about your cost, how in the world can cpap.com purchase this mask for (apparently) less than 50% of what you can? If it is true, then specifically, what would prevent you from just ordering from them to stock your own inventory.

Thanks,
Tony

rjjayrt wrote:costs are different for "private buyers" and businesses. If I'm correct and I think I am, I can't buy for my business from the site you noted. We purchase our equipment and supplies direct from the manufacturer.

What has me puzzled about the situation is why you can't get a lower cost from the manufacturer. I'm sure they price based on volume, but the $80 difference(even without knowing cpap.com's cost) just shows how much of the pricing is on the manufacturer's end.

tonycog wrote:With respect, your statement that your cost as a re-seller is $180 doesn't sound right to me, considering that the end-user can purchase that same mask online at retail for $101. Please explain to us what we're missing here, and how cpap.com can sell this mask (for a profit, I'm sure) at $79 less than you can purchase this mask at wholesale.

2ndGenCPAPgal wrote:What has me puzzled about the situation is why you can't get a lower cost from the manufacturer.

Well, please see my post above, where I describe having personally encountered the same price-structuring problem in a different industry.

Your pair of reactions above are identical to my own reaction when I encountered that pricing "problem"...

Off topic briefly....

-SWS, your avatar is one of the most amusing around here! Every time I see it I almost laugh out loud! And when I read your posts I always pay attention. You are a well-respected and most appreciated contributor to this forum! I thank you.

Now, let's carry on with the discussion at hand....

sws said

The other factor that comes to mind is that high-volume competitors can conceivably apply threatening negotiating or leverage tactics against manufacturers. They might informally but very aptly apply their own high-volume "alliance muscle" if you may, to keep potentially threatening upstart DME competition at a significant price disadvantage. That "business muscle" negotiating tactic---directly into the ears of manufacturers---essentially places effective market-entry barriers across the board. In other words, it cripples competition from the little guy...

You are very correct. I have written lots of software for small manufacturers doing business with the likes of Sears and walmart. They call the shots. Not only do they dictate the prices but they get rebates. In other words manufacturer sells item at $10 to Walmart and at $11 to everyone else - all legal and documented, Walmart pays $10, at the end of the quarter Walmart gets $2 back. They also dictate who else you can sell to and at what price. Since often 70-90% of the manufacturers sales is to the big box they have no option but to lick boots.
Most retailers add 50% to their cost to cover brick & mortar, staff ect. An internet vendor has less over head so they can sell for less. But I doubt that cpap.com has the same clout that Walmart or Sears has, however the bigger DME chains are another story.
This is why I don't believe any of the patient education should come from the DME - it doesn't for diabetes and it shouldn't for this.

it doesn't for diabetes it shouldn't for this..... Your mixing apples and oranges. Patient Education for Diabetes comes from nurses or dieticians because its within there professional field. Patient education should come from an RT simply because its within there professional field. In some states Licensure laws prohibit anyone other that an RT or sleep qualified physician to educate patients with cpap/bipap. Granted some RT's who work for DME's, such as I, don't due a good job of educating patients for one reason or another. The focus should be to force the DME's to do a better job. This is best accomplished through there accredidation process. As I've said before not all DME's are bad, but there are enough bad ones that something should be done about it...

rjjayrt wrote:it doesn't for diabetes it shouldn't for this..... Your mixing apples and oranges. Patient Education for Diabetes comes from nurses or dieticians because its within there professional field. Patient education should come from an RT simply because its within there professional field. In some states Licensure laws prohibit anyone other that an RT or sleep qualified physician to educate patients with cpap/bipap. Granted some RT's who work for DME's, such as I, don't due a good job of educating patients for one reason or another. The focus should be to force the DME's to do a better job. This is best accomplished through there accredidation process. As I've said before not all DME's are bad, but there are enough bad ones that something should be done about it...

I don't think BlackSpinner is saying the education has to come from an RN, but that it should come from a professional, within the medical setting.

Certified Diabetes Patient Education is actually done by nurses or dieticians with additional, specialized training. They are deeply vested in their patients learning all they can to manage their disease. Better education = better outcomes. And they are either independent or connected to a hospital, dr's office, etc., not a retail establishment.

There is something inherently wrong, in my opinion, about receiving my "education" from someone whose paycheck depends on what machine I'm going to get. Also, it is quite evident that having an RT after your name doesn't mean that person has any particular knowledge about PAP equipment or how to use it. The CDE RN doesn't generally give a hoot about which monitor I purchase from Walgreens, as I am the one that has to live with it EVERY DAY...they want me to have the best one for me, not which one makes someone the most money.

When it comes right down to it, DMEs are in business to make money via furnishing supplies (not arguing the point if that's good or bad, but just a fact); they are a retail establishment, not a medical provider.

Some granted not all RT's are licensed professionals. Whether we work for a DME or in a hospital which I did for 20 years before going to a DME, we are bound by professional ethics, I know to some thats a load of crap, but to me and many other RTs I know in this field it means something. As I said before, the problem is that we'd rather complain about it rather that take steps to correct it. The RT at your DME is best positioned to educate you period. If he doesn't then he needs to be reported, maybe national standards should be adopted as it relates to cpap, I'm certainly not against it. Again the best way to affect change in the DME community is through there accredidation source. All DME's which do medicare patients are now required to be accredited, loss of there accredidation means loss of there job and business. My company is acredited through ACHC in North Carolina.

I don't think BlackSpinner is saying the education has to come from an RN, but that it should come from a professional, within the medical setting.

Yes this! Using the xpap machine, fitting the mask, reading the data is only a small part of adapting to the therapy. There is eye problems, swelling of face, aerophagia, life style changes, relationships and the psychological aspects of having a thing on your face all night. An RT can't handle this, a sleep doctor shouldn't either. Neither should I have to wait for a doctors appointment for 6 weeks in order to tweak my therapy. My pulmonary specialist has more important things to do then that anyway, its a waste of his time. An RT/RN/SW team should be able to handle all this in a walk in clinic setting and only referring people who have major issues to doctors. That would save a lot of people from tramping from specialist to specialist, trying to educate them on cpap therapy in order to get some simple issues resolved.

rjjayrt wrote: The RT at your DME is best positioned to educate you period.

I think you are missing our point. The RT should not be at the DME.

Whew, rjjayrt, many thanks for your patience w/us. You patience alone is remarkable given how tough and grumpy we can be from time to time.

The thing is just being an RRT isn't enough to educate, advise or monitor CPAP therapy for the sleep doctors. Being a PAP therapy RRT requires special, additional training and experience. Too many RRTs working for local DME providers wear two hats - for 02 therapy needs and for PAP therapy needs, and too many times the PAP therapy needs take a back seat to the 02 therapy needs. OSA is NOT a lung problem, it is NOT even a respiratory problem, really. Its an anatomical problem whether due to obesity, jaw anatomy, tongue anatomy, throat anatomy, etc.

Since people were referencing full face mask I only checked the pricing on them, our lowest cost was $148.00. As several people have stated here before, the difference is in your volume.

As an employee I can purchase a PAP machine at cost + $1 and even at that price it is still cheaper for me to purchase a PAP machine from an online store. Some of the cheaper CPAP machines were within $10-$15, but the more expensive the machine got the wider the gap, the highest being the new System 1 from PR at $260.

ScrappinMom wrote:There is something inherently wrong, in my opinion, about receiving my "education" from someone whose paycheck depends on what machine I'm going to get.

Far be it from me to defend DME's (mine happens to be one NOT like our friend here, rjjayrt, who seems very knowledgable and patient friendly), but heck, my doc's paycheck depends on tests ordered for me, and information provided to me. So how is this different? (I'll duck now, while I get clobbered.).

The diabetes education comments amuse me. My diabetes education came from a dietician and an instructor all assosciated with the edocrinologists office.

The training wasn't really very good and the doctor got paid $670.00 for it. And I never even saw him, only a nurse. Even worse, as a DME supplier for years handling diabetic patients I actually taught my patients far more about equipment, testing and what to do than was covered in this "education seminar". And the training I gave patients was 1-1. This class had 20 people in it. The only thing I learned about that I didn't already know was the segment on food but really that's all just common sense stuff anyways (Eat more protein, don't go nuts on carbs right before bed, cut down on sugar etc.)

As to the cost difference, my guess would be that the host here uses a fullfillment center like a lot of internet retailers do. I helped get one started up in Georgia for a while. Basically, the center buys H-U-G-E amounts of equipment at very low prices. I'm talking full containers/truckloads of things like CPAPs or nebulizers, etc. Houses it and then the internet retailer transmits an order to the center. The shipping label prints out with the selling companies information and goes out the door. The retailer gets to piggy back on my buying power and gets a HUGE benefit of no inventory and no overhead. I charge a small fee and make money by doing this for 50 different companies and turning inventory constantly. Everyone walks away with a nice happy feeling.

Except for the mom and pop who gets hammered since they have higher cost of goods AND higher overhead. A double whammy.

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