Are Clinician Manuals Illegal

sorry to say I work in a full service DME. I don't think it should matter if you specialize or not, each individual patient deserves the proper amount of attention, regardless of what modality of treatment they receive. Dept of health and human services in your state can direct you to the regulatory agency which regulates your DME. Here in Virginia its the Board of Pharmacy, its my understanding that most states do it the same. If your DME is accredited they SHOULD be giving you the number of there accredidation company, if not you can request the number from them. If by chance your with an unaccredited company (unlikely because they would not be able to supply to medicare patients) then you should consider switching companies (just my opinion). National DME companies are for the most part suspect. Its my opinion that a local company with local employees are more apt to provide better service, just because the community knows them. Any company who tells you that Insurance won't cover a particular machine is lying. Insurance companies work with codes, all cpap machines have the same code, it doesn't matter if its auto, fully data capable or not. Same with the Bipap family and SV family. There are 3 codes one for Cpap one for Bipap and one for SV. As far as hose and mask fees, thats nonsence. Insurance companies again work with codes, theres one for nasal masks, one for full Face masks and one for Pillows. Priceing is based on the code not the product. Have a Happy New Year

rjjayrt wrote:sorry to say I work in a full service DME. . . .

My guess is that the reason Slinky guessed otherwise is that the quality of service you described may generally be more common at specialized B&M DMEs. But if you are able to provide that level of service to every patient at a full-service DME, then that is particularly commendable, because it proves that what should be done can be done.

To my way of thinking, it would be nice if every sleep doc handed each patient a brochure explaining both (1) what the patient should expect and require from a B&M DME and (2) what a patient should expect and require from an online provider. That might promote some competition and empower patients by raising expectations and providing knowledge about options without the doc linking up with specific providers. That might be a start, anyway.

jnk

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secret agent girl wrote:

jnk wrote:a brochure explaining both (1) what the patient should expect and require from a B&M DME and (2) what a patient should expect and require from an online provider.

Excellent idea! Add what the patient should expect from (3) the sleep doc, (4) the sleep study (and personnel), and (5) the patient him/herself and I've got my first handout for the local support group I'm going to be starting.

Nice!

jnk wrote:My guess is that the reason Slinky guessed otherwise is that the quality of service you described may generally be more common at specialized B&M DMEs. But if you are able to provide that level of service to every patient at a full-service DME, then that is particularly commendable, because it proves that what should be done can be done.

To my way of thinking, it would be nice if every sleep doc handed each patient a brochure explaining both (1) what the patient should expect and require from a B&M DME and (2) what a patient should expect and require from an online provider. That might promote some competition and empower patients by raising expectations and providing knowledge about options without the doc linking up with specific providers. That might be a start, anyway.

jnk

RIGHT ON, jnk!!! You can be so doggone BRILLIANT at times! rjjayrt or even jnk, do either of you have the time to write up such a brochure?? Or at least prepare the text? I can make up the brochure easy enough. We need to be reasonable in our expectations. That is why YOU would be such a good candidate to write the text for such a brochure, rjjayrt. You understand the DME provider side of the equation as well. How about it? Would you do it for us? Pretty please w/sugar on it and I promise not to complain or make derogatory comments about DME providers and their RRTs in this forum for ..... a week? Boy! A week is a long time. It would take great self-restraint on my part .... but it would be worth it if you would write at least the text for such a brochure.

The following are my expectations of the DME/RT:

1. The RT should have a discussion with the patient concerning Diagnosis (make sure the patient understands what the diagnosis is), and treatment (explain what Cpap, bipap, fully data capable, auto titrating mean)
2. Discuss the available machine options. If the patient wants an auto titrating machine the RT should be agreeable to persue with the physician the ability to do so.
3. Once a machine is decided on discuss and demonstrate all functions of the machine. Show the patient a demo download and explain what each value means.
4. Discuss with the patient there sleep habits, if they sleep on there back or stomach, if there a mouth breather or nose breather. Find out if the patient is claustrophobic or not.
5. Based on #4 discuss the available mask possibilities, let the patient try the mask on while under pressure.
6. After a mask is decided upon, demonstrate proper donning and removal of mask.
7. Assuming you've discussed and demonstrated everything in a way the patient understands, you should be able to have the patient setup there machine, apply there mask, set there humidifier and start therapy. If the patient has problems or is hesitant repeat instruction until patient can complete the task from start to finish without error.
Before the patient leaves discuss known problems with cpap, discuss with them the problems they may have over the next few days or so and discuss with them ways to avoid the problems or ways in which to deal with the problems.
8. Ensure the patient understands accessory replacement schedule, cleaning procedures and most importantly has a way to get in touch with you if theres a problem.
9. Finally make a follow up schedule with the patient so downloads can be done to check progress. I suggest one at 1 week, at 1 month and again at 6 months.

As far as DME expectations go:

1. DME should explain to the patient what there insurance requirements will be.
2. Should discuss the cost schedule based on codeing, and what the patient will be responsible for.
3. Should provide the patient with dispute resolution options.

rjjayrt wrote:The following are my expectations of the DME/RT:

1. The RT should have a discussion with the patient concerning Diagnosis (make sure the patient understands what the diagnosis is), and treatment (explain what Cpap, bipap, fully data capable, auto titrating mean)
2. Discuss the available machine options. If the patient wants an auto titrating machine the RT should be agreeable to persue with the physician the ability to do so.
3. Once a machine is decided on discuss and demonstrate all functions of the machine. Show the patient a demo download and explain what each value means.
4. Discuss with the patient there sleep habits, if they sleep on there back or stomach, if there a mouth breather or nose breather. Find out if the patient is claustrophobic or not.
5. Based on #4 discuss the available mask possibilities, let the patient try the mask on while under pressure.
6. After a mask is decided upon, demonstrate proper donning and removal of mask.
7. Assuming you've discussed and demonstrated everything in a way the patient understands, you should be able to have the patient setup there machine, apply there mask, set there humidifier and start therapy. If the patient has problems or is hesitant repeat instruction until patient can complete the task from start to finish without error.
Before the patient leaves discuss known problems with cpap, discuss with them the problems they may have over the next few days or so and discuss with them ways to avoid the problems or ways in which to deal with the problems.
8. Ensure the patient understands accessory replacement schedule, cleaning procedures and most importantly has a way to get in touch with you if theres a problem.
9. Finally make a follow up schedule with the patient so downloads can be done to check progress. I suggest one at 1 week, at 1 month and again at 6 months.

I like your checklist, rjj. Wish my RT/DME was half as conscientious...

My $.02 on what I've bolded: In addition to a thorough discussion, this info should also be given to the new xPAP patient in writing. We're so sleep-deprived and muddled at that time that we're not likely to retain much of what's being said; being able to read (again and again, if necessary) that important info would be very helpful to the newly-diagnosed patient.

your right and it is here, sorry I did not mention it.

nice job rj

i like your list and can see you are a thinker and a caring provider.
this goes along with the patients bill of rights -maybe a bit further and more specific- that congress was working on in the 80"s
i wonder what ever happened to that? many practices have such a thing but you never see a brochure or pamphlet in the waiting rooms any more.

The posted provider manuals were a god send. I can now see my sleep dr. and if he wants to go up or down on my preasure I can adjust it my self without waiting taking the smartcard home and going the next day and waiting for him to get time to adjust it.

Thank you, rjjayrt!!!!! This is VERY MUCH appreciated!!!

Interesting comments. Apparently we have a significant number of people in this chat room (yes, it is a chat room) that think they are attorneys or at the minimum like to practice law without the necessary training. I always get a good laugh with people that like to quote law while knowing nothing about it. I doubt that many of you are attorneys - At most you may have done some quick scans via the internet. Just to quell all of the "experts" who expressed misguided opinions about the law, including contract law. I happen to be an attorney and economist by training. Needless to say I was quite amused in reading some of the comments. My initial thoughts (without checking) are that it is doubtful that there is a law prohibiting distribution of the clinician manuals. Could be a question of contract law, depending on the contract between the provider and supplier reads. Since I have not reviewed the contracts with various providers I have no opinion regarding the contracts. In the case mentioned (providing clinician manuals) the area of law that would apply is Tort Law. Use an example: A patient obtained a clinicians manual, then changed the setting on their machine. Assume further that later some sort of issue surfaced that may be related to using a pressure other than prescribed. I will not be providing the answer, but for the experts (at surfing the internet and treat what you find as gospel) where would the culpable negligence lie. The answer will take some thought rather than just surfing the internet for an answer because it is not as simple as one would think. Here is a hint - you will not find the answer in a comic book.

Interesting thing about this chat room. A few experts are allowed to express their opinions freely, which are taken as gospel. Others are quickly "slapped down" by the self proclaimed experts. I was also quite amused buy the comments about health care, as I was likely one of the few that expressed an original opinion rather that doing a quick search on the internet to come up with a few quick quotes. With a masters in Economics in addition to my law degree I'm quite certain i have a better grasp of the issues at hand with health care than the average clown in this chat room. I generally don't have time to spend a lot of time on the internet but I do occasionally check a couple of sites, this one being one of them, as I do sometimes have some questions about my CPAP therapy. Once in a great while I actually see a suggestion that is worth reading but still check with my Dr. before taking any of the suggestions that might be helpful.

We are unworthy of your further comments, Kilopy. They would probably just confuse us.

PST wrote:We are unworthy of your further comments, Kilopy. They would probably just confuse us.

Could not agree more. I doubted you would answer, as the question I posed requires knowledge and thought.

Perhaps you should stick with surfing the internet and reading comic books.