Resmed Price Increase

Wulfman wrote:. . . The whole thing stinks. . . .

Unless you are a stockholder, of course:

"Investors Wake Up to ResMed: Under the Radar
"By Jake Lynch 03/15/10 - 05:00 AM EDTAdd Comment

"BOSTON (TheStreet) -- ResMed(RMD), a maker of medical equipment for diagnosing and treating sleep and breathing disorders, is a recurring name on the 52-week high list. The company's shares have soared 77% in the past year. . . The company's fiscal second-quarter profit increased 36% to $46 million, or 60 cents a share, as revenue grew 23% to $275 million. . . . Sales in the Americas gained 20% to $148 million . . . During the past three years, ResMed has increased revenue 14% annually, on average, and boosted net income 19% a year. . . . ResMed derives 54% of its sales from the Americas, 38% from Europe and 8% from the Asia-Pacific region. Around 59% of revenue stems from flow generators and the remainder from masks and accessories. The sell-side is bullish on this mid-cap stock. Seven analysts advise purchasing shares while five advise holding them. UBS(UBS) expects ResMed to advance another 19% to $71.91. Our stock model rates ResMed "buy" and projects the stock will hit $78.99. . . . Major holders of ResMed, whose market value is $4.5 billion, include Bank of America(BAC), which owns 8.4% of shares outstanding, and Fidelity Investments, with an 8.2% stake. . . ."--http://www.thestreet.com/story/10701724 ... radar.html

pam933 wrote:In order to get an auto using a CPAP prescription does the prescription have to include a range for the auto?

(I just talked to my doctor and she doesn't even want me to have a machine that will give me data so there's no way she's going to rewrite my script for an auto or give me a range. I feel so defeated by this whole process that I just want to get a machine with the basic data and be done with it, but if I can get an auto I might as well.) I know I'll want to get a new doctor later on, but I just don't have the energy right now.

Is this your sleep doctor? If I would have had a data capable machine from the beginning, I would not have spent nine months in CPAP hell. I didn't know my CPAP wasn't working; I didn't know the pressure wasn't quite enough; I didn't know that the leaks were ruining even the good nights. I found this forum and I went to my PCP who wrote me a script for the machine I wanted. I have been 100% complaint since then and talk to my PCP about my therapy and problems every time I visit not just once a year.
I feel like without finding this forum and a wonderful Doctor who will work with me, my machine would be in the closet--or an estate sale.
My doctor didn't put a range on script and when I picked it up it was set 4-20. I changed it when I took it home. When I had to replace it the DME didn't want to give me the machine because there was no range on script, and I said, "Oh, it was set from 9 to 14." And like a good DME he set it 9-14.
Good luck with what you decide, but you are talking about your therapy and your life.

araminta wrote:

Wulfman wrote:Like Jim (Goofproof) said.......vote with your wallet/checkbook/credit card......
I made up my mind about 5 years ago that I would never own a ResMed machine. (and they won't get any more of my money for masks, either)

Den

Just curious, D.
As someone who's been involved with SA only for a year now, I don't have the history that you do. What made you come to that conclusion 5 years ago? What happened back then?

Here ya go, araminta. Very old threads, but interesting. Unfortunately Respironics eventually started doing the same kind of thing. But as Den said, ResMed started it:

LINKS to discussions about resmed's internet sales policy
viewtopic.php?p=98895

Good grief! Thanks for the link, RG.
Now I understand a lot of the chit chat on the forum that I didn't really grasp before. That's totally outrageous.

Does this occur in other areas of international business? Or just the medical industry?

Sorry - long post! It was my sleep doctor who didn't want me get a data capable machine. I left a message for her to ask her about getting the auto and apparently the DME had called her and talked to her first. They were mad becuase I insisted on returning the Escape. And the doctor seemed mad too.The doctor said that none of her patients had machines with data and that if I wanted one that I'd have to get it online because the DME's won't order them for me, and so insurance wouldn't cover it (because online is an out of network provider). I told her that I had found 3 local DME's that would order the data capable machine for me. She said well she wasn't sure whether insurance would pay for it or not and that she couldn't write me a prescription for a specific machine. And that the data machines are much more expensive. And that if I ordered an S9 that I might have problems with getting the machine repaired or getting a loaner if it broke because no one has experience with them. So, I asked her if didn't she think that it was a good idea to get a machine with data and she said that no she didn't - that the Escape had a card that the DME could pull the card from the machine and read the data from that. And that I didn't need the data on a daily basis. I asked her about the Climate Control with the S9 and she said that I should just talk with her about it at my follow-up which is in 6 weeks. And that she had 6 patients waiting for her and had to go. I didn't get a chance to talk with her about my compliance concerns or my concerns about money and the fact that the DME charged me one months rental for 3 days use of the Escape. And it was clear that there was no way she was going to write a script for an APAP if she didn't even want me to get more than the basic machine. She made me feel like I was being crazy and unreasonable. I wanted to ask her if she was getting a kick-back from the DME - I don't really think she is, but she sure seemed like she was on their side rather than mine.

So, one of the local DME's I found is ordering the S8 Elite II for me - I should get it next week. And insurance will cover it, and it looks like it will cost the same as the Escape. I asked the DME if I could get the Autoset with my script and she said no, I'd have to have a specific script for the Autoset (which I know people on this forum say isn't true, but I've gotten so stressed about this that I can't fight with them anymore).

So hopefully, I'll get my machine next week and will be able to find a new doctor for my follow-up. And get this -my first sleep study was at a private place and my insurance covered all of it, my second sleep study was at the hospital and because it was a hospital it fell under my deductible and cost me $320 - for the same exact service.

Thanks for giving me a place to vent. I almost wish I hadn't stumbled onto this site and just took the Escape without knowing any better. But really I'm glad I did because if I have any problems now I'll have my data to look at and a resource for asking questions.

Don't fight. If you think you could benefit from an auto, just tell the DME you are "going to call around to find out if any other DMEs will give me the Autoset II, since it is the same insurance code and does not require a specific prescription according to my insurance people." I bet they will agree to give you the AutoSet II right then instead of losing your business. If not, follow through. It is just a game of phone-shopping. No stress. As long as you are nice to everyone, there should be no extra pressure on you.

It is worth it to spend the emotional energy on this now. You will thank yourself later. It is your life and your therapy. You have to work the system a bit. But it is their job to make you happy, if they want your insurance money. And that is in your control. Enjoy the control. Find satisfaction in getting exactly what you want. Don't let them intimidate you. It is like dealing with used car salesmen, only used car salesman have a better track record as far as being worthy of trust.

Now that you have the knowledge to beat them at their own game, do it. Part of them will respect you for it. Get what you want. And try to have fun doing it.

pam933 wrote:Sorry - long post! It was my sleep doctor who didn't want me get a data capable machine. I left a message for her to ask her about getting the auto and apparently the DME had called her and talked to her first. They were mad becuase I insisted on returning the Escape. And the doctor seemed mad too.The doctor said that none of her patients had machines with data and that if I wanted one that I'd have to get it online because the DME's won't order them for me, and so insurance wouldn't cover it (because online is an out of network provider). I told her that I had found 3 local DME's that would order the data capable machine for me. She said well she wasn't sure whether insurance would pay for it or not and that she couldn't write me a prescription for a specific machine. And that the data machines are much more expensive. And that if I ordered an S9 that I might have problems with getting the machine repaired or getting a loaner if it broke because no one has experience with them. So, I asked her if didn't she think that it was a good idea to get a machine with data and she said that no she didn't - that the Escape had a card that the DME could pull the card from the machine and read the data from that. And that I didn't need the data on a daily basis. I asked her about the Climate Control with the S9 and she said that I should just talk with her about it at my follow-up which is in 6 weeks. And that she had 6 patients waiting for her and had to go. I didn't get a chance to talk with her about my compliance concerns or my concerns about money and the fact that the DME charged me one months rental for 3 days use of the Escape. And it was clear that there was no way she was going to write a script for an APAP if she didn't even want me to get more than the basic machine. She made me feel like I was being crazy and unreasonable. I wanted to ask her if she was getting a kick-back from the DME - I don't really think she is, but she sure seemed like she was on their side rather than mine.

So, one of the local DME's I found is ordering the S8 Elite II for me - I should get it next week. And insurance will cover it, and it looks like it will cost the same as the Escape. I asked the DME if I could get the Autoset with my script and she said no, I'd have to have a specific script for the Autoset (which I know people on this forum say isn't true, but I've gotten so stressed about this that I can't fight with them anymore).

So hopefully, I'll get my machine next week and will be able to find a new doctor for my follow-up. And get this -my first sleep study was at a private place and my insurance covered all of it, my second sleep study was at the hospital and because it was a hospital it fell under my deductible and cost me $320 - for the same exact service.

Thanks for giving me a place to vent. I almost wish I hadn't stumbled onto this site and just took the Escape without knowing any better. But really I'm glad I did because if I have any problems now I'll have my data to look at and a resource for asking questions.

As much as an auto would be nice (and don't accept the Escape Auto for example) I think Pam's decision to go with the Elite is a good one.

Just because we can use a CPAP script for an APAP at cpap.com doesn't mean a local DME has to issue one too. We don't know all the ins and outs of Pam's insurance coverage but we do understand her frustration and her need to get treatment ASAP.

I can't go to the local pharmacy with a script for ampicillin and expect to get brand name meds with a generic copay. I can't even get my insurance to do a brand name copay for it even if I have a specific rx for brand name. I get stuck with paying the difference because that is what insurance says.

Cpap.com is a "cash" business and not one that gives credit or takes insurance. They know what their profit will be on a machine and yes the same code is used for a bottom of the line cpap as well as an apap but each insurance pays differently and we don't know how much Pam's insurance had contracted to pay for a machine.

One thing that would concern me is "was this month's rental going against the purchase price for a machine and pam has to pay that month's rental OOP?"

jules wrote:As much as an auto would be nice (and don't accept the Escape Auto for example) I think Pam's decision to go with the Elite is a good one.

Just because we can use a CPAP script for an APAP at cpap.com doesn't mean a local DME has to issue one too. We don't know all the ins and outs of Pam's insurance coverage but we do understand her frustration and her need to get treatment ASAP.

I can't go to the local pharmacy with a script for ampicillin and expect to get brand name meds with a generic copay. I can't even get my insurance to do a brand name copay for it even if I have a specific rx for brand name. I get stuck with paying the difference because that is what insurance says.

Cpap.com is a "cash" business and not one that gives credit or takes insurance. They know what their profit will be on a machine and yes the same code is used for a bottom of the line cpap as well as an apap but each insurance pays differently and we don't know how much Pam's insurance had contracted to pay for a machine.

One thing that would concern me is "was this month's rental going against the purchase price for a machine and pam has to pay that month's rental OOP?"

Good points. Nothing wrong with an Elite II. That's for sure.

I am a shop-around kind of guy. But I realize that for many the stress isn't worth it if they can get a perfectly good full-data machine without having to make a bunch of phone calls and play all the DMEs against one another. I just find joy in fostering competition when I can. But hey, that's just me.

I thought you might be interested in a little exchange of e-mails I had with ResMed over this issue. I submitted a comment through their website, and received a reply.

Here's my first message to them:
I just wanted to say that I'm impressed with your new S9 machine, obviously a fine piece of engineering, and was ready to order one online, then was shocked when I called to order to find out that three days ago you have implemented an MIRP policy that raised the price of the package by about $400 (from $748 to $1123). This has caused me to cancel my planned order and rethink my purchase. I hope you will remove the MIRP restriction soon and let the internet providers determine their own profit margins rather than (as I suppose was the reason for this) supporting bloated profit margins for other providers. This is exactly the type of restriction on free markets that keeps health costs absurdly high in this country, and it should be illegal. Thanks for considering removing the MIRP restriction.

The response from ResMed:
Thank you for contacting ResMed and for sharing your comments about recent changes to ResMed’s Internet sales policies. The purpose of our internet policies is to promote and support a high level of patient service and care now and in the future. Sleep apnea treatment is complex and in order to be successful, patients need help and support from a trained professional. The price you pay for medical equipment includes not only the cost of the products, but also the cost of the medical care you receive. Your therapy is an important part of your life. It helps you to improve your health and feel better. For those times when you need help or support from medical professionals, we want to be sure you can get that from your provider.
As you may know, sleep apnea can be life-threatening. People with sleep apnea have higher chances of serious health problems like diabetes, high blood pressure, heart disease, stroke and obesity. In addition, sleep apnea causes symptoms like tiredness and headaches, to name a few. Treating sleep apnea can improve these dangerous health problems and help people get relief from their symptoms. However, people must use their therapy regularly in order to receive the benefits.
Helping people get used to their therapy and use their equipment properly is one of the biggest challenges for equipment providers. Studies have shown that the more education and help patients receive from their healthcare providers, the better they will do with therapy.1,2,3 Additionally, studies have also shown that when patients are successful with their therapy, their long-term healthcare costs are about 50% lower overall.4
Educating patients and helping them get used to therapy can be time-consuming and costly for medical equipment dealers. For dealers to care for their patients properly, they need to have sufficient resources. Charging a minimum price for the equipment they sell helps ensure they have enough resources to support their patients. By giving their patients quality care, dealers are ultimately helping patients save money on their healthcare costs in the long run.
At ResMed, we are aware that the quality of patient care varies from dealer to dealer. In the future, we are concerned that some dealers may sacrifice patient care in order to cut costs. The risks are especially high with internet dealers, as the internet can allow dealers to be anonymous and shield them from patient complaints. For example, we have already been contacted by patients who have ordered equipment online and received damaged products but had no one to call to correct the problem. We have also heard from patients who bought equipment online but were not told how to use it. We want to do what we can to protect patients from these situations, and our internet policies were designed for that purpose.
If you are not satisfied with the service and care you have received from your equipment dealer, we urge you to talk to your doctor and/or sleep lab. Your doctor and/or sleep lab can be an important check and balance on the service your dealer provides. In addition, if a dealer is giving poor patient service, your doctor should know in case they have other patients who might also be affected.
ResMed’s decision to impose stricter internet policies is a choice we made in order to help protect patients now and in the future. As we have often said, we are in the business of helping people and saving lives or, at least, preventing premature deaths. In the case of our internet sales policies, our goal is to promote and support high standards of patient care well into the future.

ResMed Reception - USA

Here's my answer:
Thanks for your message in response to my comments on the contact form. It has clarified my thinking.
I now know that Resmed is not a company I trust to do business with. In addition to trying to cheat me of $350 you are now dishing out a load of baloney (I used a stronger term, but can't post it here) as well. By your reasoning a box of bandaids should be $50. Your concern should be putting high-quality equipment into the hands of customers at reasonable prices, not patronizing justification of inflated prices. I will get my equipment from Respironics or another company in which I still have some trust. I hope you’re not able to come up with a price-fixing agreement with your competitors as well, or that if you do you will face the appropriate prosecution for it. In any case you have lost my sale, and many others, by this action.

jonboy's quote of ResMed wrote: . . . The price you pay for medical equipment includes not only the cost of the products, but also the cost of the medical care you receive. . . .

ResMed:

I find the supposed reason for the action more irritating than the action itself. Charge what you want for your product. You do it to make money, though. If you were to choose your prices based on the level of service given by DMEs, you should pay us to take your products, not the other way around. If you claim the prices you charge are because you are so in cahoots with insurance-based DMEs, that makes you as a company partly to blame for the lousy service from the DMEs, doesn't it? I can partially forgive that when you foster Internet sales, a way customers can circumvent the damage to our health done by insurance-based DMEs. But when you take away patient choice, you do us all a disservice.

I would ask that you please put patients first, not insurance-based DMEs. The best help with making my care a success has come from cpap.com, an Internet seller, and the forum it supports, cpaptalk.com. When you damage their business model, you damage me. And I take that personally.

Thank you for allowing me to pretend that you listen to me. If prices don't come down online, I will know you don't care about me or my fellow patients. Until such time as you change your policies that I disagree with, the only tool I have is my wallet and my word of mouth, which I will use appropriately, until such time as you start putting patients first.

jeff

Hmm, unless things change I can see that another Resmed in my future is becoming less likely.

My S8 Autoset II has 4,200 hours on it and I'd love to make it my backup machine and pickup a new S9... but that plan is now out and I'm rethinking all this.

jonboy wrote:I thought you might be interested in a little exchange of e-mails I had with ResMed over this issue. I submitted a comment through their website, and received a reply.

Their reply to you is just a cut and paste from the
"Statement to Patients" on their website.

You pay the higher price and
you do something about the poor support and service.

Lose/lose for you.

They know there are plenty of brain dead hosers
stumbling out of sleep labs everyday....

$$$$cha-ching$$$$

The S9 purchase has left the station for me, too.

If Resmed's explanation of their price fixing policy was TRUE, they wouldn't let online dealers sell their products at all.

The question is, do online suppliers get the equipment on consignment? Do they now have to pay $450 more? Or is it that much more profit in the resellers pocket whether they be a brick and mortar DME or an online seller? If Resmed is getting the same amount, why would they care how much profit the dealers make? That's the dealers concern.

They claim they want the users to have proper service and education from the supplier and, although cpap.com is a fine company and generously operates this forum, they don't hold your hand like a brick and mortar DME is supposed to ( they don't do it either ). Actually we get more info and support here than we do from most sleep doctors and DME'S.

I've never received any educational material from my DME. NONE.

The DME does not follow up and ask to see my card or ask me to email them copies of my data readings.
They came to the house when I got my first machine in 2006 and HANDED me the mask. They didn't really fit it to me. They did show me how to operate the straps. And I've changed masks several times since then and they didn't come show me how to use it or fit it. I just call and tell 'em I want to switch to a certain mask and UPS delivers it and I'm on my own. How is that different than online DME'S?

My sleep doctor does download the card ---- ONCE A YEAR.

Not much support going on there.

That's supposed to justify a $450 increase?

So far, I love my S9 and I'm gratefull to cpap.com for selling it to me. Especially happy that I jumped fast and got the good price.

They make good machines but someone needs to send their execs to a business ethics class.

It seems to me that imbedded in Resmed's justification to their minimum internet pricing policy is a key problem that needs to be fixed. If the prices of medical equipment are burdened with the additional cost of the supporting medical care associated with training, patient support, and periodically inspecting and maintaining the equipment, there is clearly great opportunity for fraud, waste, and abuse by the DMEs. The insurance industry should fix this problem by separating out the reimbursement for the cost of the actual equipment and the associated patient support services to provide transparency into the cost of each component. Bundling the two elements together (equipment and patient care) is a large part of what is driving the ridiculous cost of all DME.

The leopard hasn't changed its spots.

In October 2006 (yes, three and a half years ago) Mile High Sleeper got the same response from ResMed when she emailed them about their new (at that time) internet pricing policy:

viewtopic.php?p=120516#p120516
ResMed email on DMEs/price increase
posted by Mile High Sleeper Oct. 13, 2006