Has OSA become a cash cow.

Competitive Bidding, which is being implemented by CMS region by region is bad news for consumers. Essentially large regional companies will win the bids. They'll do most of there work through the mail, patient service will take days if not weeks due to there enormous service area. If you think its difficult getting something from a DME now, wait until this starts. This is probably best left to another thread....

This topic has come up a number of times.
I did a search on "cash AND cow" and here's the link to the previous discussions.

search.php?keywords=cash+AND+cow

With regard to reporting things to Medicare, there's a link in the "CPAP and Sleep Apnea News" ticker above which has an article "Battling the Medicare fraud 'epidemic' ". I found many of the comments below the article to be interesting.

http://fieldnotes.msnbc.msn.com/archive ... 70075.aspx

I guess it's a matter of perspective. It depends on which side of that "cash cow" you're on......feeding it or getting the milk.

When does "overcharging" become "fraud?
When does "milking the system for all it's worth" become "waste" or "abuse"?

I'd better stop now......


Den

jnk wrote:@Muffy, didn't cotech apologize for that?

Oh, right, sorry. I thought THAT apology was for not realizing that Guest Posts will list all associated screen names and anonymity will be lost.

My bad!

Muffy

rjjayrt wrote:Competitive Bidding, which is being implemented by CMS region by region is bad news for consumers. Essentially large regional companies will win the bids. They'll do most of there work through the mail, patient service will take days if not weeks due to there enormous service area. If you think its difficult getting something from a DME now, wait until this starts. This is probably best left to another thread....

A "good" example is this - When we moved to Nova Scotia we needed a day care asap so we interviewed some over the phone after getting recomendations. we found a nice one near by with very flexible hours. It was attached to a hospital. Three months later the contract came up for review , they lost the bid. The workers all quit or were laid off, the quality of care dropped like a brick, the food became french fries and kraft dinner. All the parents were furious but according to the rules "they" had to take the lowest bid. We tried pointing out that the service was no where near equal but that didn't count.
We found another daycare else where - same price as the first which was supposedly had extra funding - with much better and stable staff and food that met the Canadian Diabetic association standards.

I've must have been really lucky. I had a choice either to take my sleep study at V.A. hospital which is 45 minutes south of me or take my sleep study at home. Guess which one I took! So I just took the equipment home with me and sent it back by pre-paid fed-ex.

jnk wrote:

cotech50 wrote: . . . Sleep studies take far too long to get! . . .

Primary said he thougth I had OSA, took 2 months to get sleep doc appt, another month to split-study PSG (and I was on the cancellation list the entire time), then 10 days for insurance to approve CPAP...seems waaaay tooo long to me too! But my primary said this was the only sleep doc he recommended; good choice for me, I have as good a rapport with this sleep doc as I have respect...this seems to be a rarity.

cotech50 wrote: . . . It was not like the sleep study brochure . . . .

Gee, you got a brochure ...I didn't, just the appt and a set of instructions to do before the study and what to bring. During my pre-PSG appt, doc showed me how I would be wired up, pretty shocking but understandable after he explained very briefly all the things they'd be checking as I slept. The pic of someone wearing an xPAP mask was offputting but as my doc said, "maybe it'll just be for a few months as you lose weight" It worked, then when I had such good sleep in my PSG, I was sold regardless of my dis-ease at wearing a gas mask...thank goodness I ended up with minimal pillow mask!

jnk wrote:Some people get handed a machine, use it every night, feel better, and have no need for data or more help...

Describes my first 17 months to a "T"! Never needed help as I was feeling much better and making consistent if VERY SLOW progress. Then, with my wt loss, I started losng therapy air but I was so clueless about apnea that I didn't even realize that was what was happening...duh . Joining here just to see if a didgeridoo might help, I learned why I wasn't feeling good...I thought it was some other new bodily thing gone wrong. After doing some self-educating, I called my sleep doc and confirmed what was going on and got some help.

I think it is great that some people have the option to do it at home I was also told that if my numbers were "bad" enough that I would do a split night. Well, I don't know that you can get much worse than being a 97% on a scale where 25% is considered severe, and I did not get a split night My oxygen dropped below 50% too.

I was told that my insurance would not like it if I did not have a full night of data. And when they called me to give me the official results of night one, they scared the crap out of me and I was terrified to fall asleep Thankfully they got me in right away for the second night because someone cancelled.

BlackSpinner wrote:Fancy expensive sleep labs should be reserved for those that "fail" the home tests, who need more testing for other sleep abnormalities.

From a clinical Quality and Safety outcomes point of view that is very unsound reasoning.

The point of doing a PSG is to uncover as many as possible of the issues that may have created sleep disordered breathing and then perform a diagnosis based on that hard evidence, rather than rely, simplistically, on gross presentation symptoms.

Home tests may well indicate that there is potential benefit from xPAP treatment but are generally incapable of providing evidence of other concurrent conditions which may also need addressing. Under those circumstance the patinent gets an xPAP but their other SDB condition(s) remain untreated.... that is, they have not "failed" the home test in terms of xPAP but may still have non-trivial other sleep abnormalities.

There are numerous user war stories on this site about those who have discovered that xPAP is only the start of a journey in terms of their overall SDB conditions, so this not a very rare or very unusual occurance.

It is too easy to get caught up in the general weirdness of some aspects of the US healthcare delivery system, and lose sight of what is universally good clinical practice (whether or not it is actually employed at the point of care delivery, due to differences in national healthcare systems).

Cheers,

Bill

ISTM that "universally good clinical practice" sounds good in theory but as a practical matter may mean a whole lot of folks don't get even basic screening for OSA, due to the cost.

There's always a cost-benefit decision to be made, even if we don't want to acknowledge it (which is one reason health care costs in the US are spiraling). Why not do a simple at-home test as an initial step? If someone does that, gets on CPAP and feels great, symptoms abated, the expensive test was avoided. If they continue to have symptoms, then investigate further.

It seems sensible to me, especially if (as in my case) the home test can be done quickly and treatment started quickly, while the sleep center had a waiting list.

There are endless debates like this, of course ... stool screening tests vs. colonoscopy. The frequency of mammograms. And on and on. I don't want my money wasted (and it's always my money, whether insurance or taxes or out-of-pocket). Nor do I want unnecessary procedures. Not easy decisions, and hard to see how anything is "universally" the right answer.

My, I do ramble.

pmcall57 wrote:ISTM that "universally good clinical practice" sounds good in theory but as a practical matter may mean a whole lot of folks don't get even basic screening for OSA, due to the cost.

So you vote for indeterminate clinical Quality and Safety outcomes

Cheers,

Bill

What shocked me most was the billed charges for everything associated with my diagnosis and treatment so far. I have not had to utilize Healthcare to this extent until last year.

Also were the psg's performed in the $1000 - $2000 range a result of competition or were mine at the $3000 range better. Are all psg's read my a board certified Pulmonologist as was my case, or do sleep techs or docs read and prescribe therapy.

billbolton wrote:

BlackSpinner wrote:Fancy expensive sleep labs should be reserved for those that "fail" the home tests, who need more testing for other sleep abnormalities.

From a clinical Quality and Safety outcomes point of view that is very unsound reasoning.

The point of doing a PSG is to uncover as many as possible of the issues that may have created sleep disordered breathing and then perform a diagnosis based on that hard evidence, rather than rely, simplistically, on gross presentation symptoms.

But the majority of people have simple OSA which is detected by a cheap and simple home study. Here within 3 months you would have a full sleep study - all "free" to you, no hassles with insurance. So the reality is that a full sleep study for the majority of patients is a total waste of resources on an already over burdened system. OSA is rarely an emergency situation and as such I would really prefer my tax dollars to go to cancer and other big label issues. I am not greedy in wanting the biggest best and most pricey tests done immediately.
And if you really want to go for it then your private / work insurance will spring for a resort style sleep test experience at a private for profit testing centre.

cotech50 wrote:To date my insurance has been billed over $10,000 for all this

The amount that insurance agrees to pay (accepted by the hospital) is often a great deal less than what is billed. Or at least that's the way I understand it from what I've read frequently on this message board.

When the insurance company calculates you lifetime total capped at say $100,000., do they count the amount billed or the amount they paid?