What a DME company can do to be better!

jnk wrote: It is best to give full-data machines to everyone, even if the user doesn't need it AT THE MOMENT. Things change.

I disagree with your disagreement with my disagreement, but in a very confused way...

Using your logic above, then, every kid who starts piano lessons should have a Steinway grand, just in case "things change" and he becomes a virtuoso. Never mind the thousands who lose interest after two lessons.

IF things change, the equipment can change. In both instances.

However, speaking of change, RG makes a good point regarding leak data. NO ONE gets good therapy with significant leaks, whether they care or not. I might just *change* my mind and agree with both of you. Let me sleep on it...

But I STILL think a great RT should feel out each patient to determine their interest level, and tailor the amount of detailed information they get.

> The majority are happy to hose up and sleep

The majority don't even know what questions to ask -- yet.

> They couldn't care less what their AHI is any given week.

See above.

> as long as they are getting treatment good enough to keep them happy

"Happy" isn't a universal constant, like pi.

It's entirely possible, indeed likely, that they may be happi_er_ than before they got sleep therapy. But if they had data, not just some _inexperienced_ feeling or belief, they could fine tune their sleep therapy and feel even better.

> Data-capable machines are wasted on them.

Predicting their future (that they will _never_ want a data capable machine) -- for some time in the future when they will then have the experience and knowledge to make an informed decision -- is, at the minimum, arrogant. Or worse.

A typical replacement period for machines is 5 years. Getting a data capable machine at the beginning is a smart strategy to cover whatever may happen in the next 5 years.

> I'd talk to each patient and determine how involved they want to be

Would that be the morning that they complete their sleep test -- the first time they got hooked up to a mask and machine, lol? And before they found this website?

Another thing you've missed is that spouses can get involved in patients' therapy. The spouse may be interested in using the data to improve sleep therapy. Including in the future.

> IF things change, the equipment can change. In both instances.

For _most_ people, that change will be in 5 years.

LinkC wrote: . . . Using your logic above, then, every kid who starts piano lessons should have a Steinway grand, just in case "things change" and he becomes a virtuoso. Never mind the thousands who lose interest after two lessons.

Steinways are expensive. Full-data blowers ain't.

New sleep studies are common. Becoming a virtuoso pianist ain't.

LinkC wrote:IF things change, the equipment can change. In both instances.

After 30 days, most are pretty much stuck with what they got for five years or so, according to many DME/insurance situations, even in the case of the 13-month (or whatever) rent-to-own, unless a doc plays advocate, as I understand it.

LinkC wrote: I might just *change* my mind and agree with both of you. Let me sleep on it...

I only make the points directly to you because I know you to be a reasonable, thinking man.

Kevin,

If all DMEs were like yours, most sleep deprived people would be much better off.

First -- although you are an equipment supplier, the way things go these days is that the DME is also where the xPAP user learns the most about his/her problem.

As a consequence, you need to have a program similar to what a good diabetics clinic might have.

My sister has just been diagnosed with severe apnea -- and she's concerned. Because although her husband has been a CPAPer for years, she knows NOTHING. Not what an apnea is, nor a hypopnea, nor an AI or an HI or an AHI. She doesn't know about leak rates. She knows she's a mouth-breather, and figures she'll need a full-face mask, but she looks at the varieties of masks, and doesn't know how to begin to choose. She doesn't know what questions to ask. (She is reading here, thank goodness.)

A new user needs to know the special terms which apply to his or her condition.

A new user needs to understand why having a data-capable machine is important.

A new user needs to know why their leak rate is important. (They need to know what the allowable leak rate in his/her mask at his/her pressures(s) is.)

It's necessary to understand that wearing the machine is a pain, but it can be adjusted to -- and that there are plenty of things the wearer can do for him/herself to make their therapy work, from a hose manager to a hose cover, to a chin strap. But the user shouldn't have to be on his/her own through all of this. If the DME employee does not know a specific mask, then they should know who to ask about that mask.

The new user needs to know that the right mask for him or her can be one of the keys to getting good therapy. They should know that the mask that works great for Uncle Joe may not work for them. And just because one mask does not work does not mean that no mask will work.

DMEs are busy. So are xPAP users. It makes sense for users to monitor their own data -- it saves them time in running to the DME, or in having to keep track of multiple cards because one or more is always in the mail to or from the DME. (It also protects him/her from having valuable data lost.) This also saves time for the DME: they don't have to worry about loss of valuable data, or of sending the wrong card to a specific patient. One of the things a DME can do is push the equipment manufacturers to make only fully data capable machines AND to provide end-user software without the run-around that we currently get.

I could think of quite a bit more, but I think I'm rambling. Nonetheless... it's sure nice to hear about a competent and caring DME. Wish mine was one.

I hate to just say "Me Too!", so let me cheerfully welcome you:



And let me offer a couple ideas.

First, while you are doing an exceptional job of providing use education, most of us are so overwhelmed we don't get it right away. So, in addition to your new user manual, I would suggest including ... at the front ... where to get support. That should include local A.W.A.K.E. meetings. It should include different online groups. It should include contact numbers for ResMed and/or Respironics. And of course it should include contact numbers for your company.

As someone in the business world, I can highly recommend that you make it easy for people to call you. Often that becomes a sales opportunity in the future. And yes, folks, the our DMEs do need to make money.

And don't forget the simple tricks. Such as, fridge magnets with your number. Calls to customers to see how they are doing. Mail to do the same. Mail on "anniversaries". Simple stuff that does not cost a lot, but says you "care". All too many people will not complain about problems if they do not have a "relationship" with the service provider. So, it does not get used. It gets shoved into the closet. And worse yet for you they will tend to discourage others from coming to your business. Sounds as if you "get it", but the following provides some facts, if you get any flack from within your company:

http://www.1000ventures.com/business_gu ... ntion.html
http://www.1000ventures.com/business_gu ... ction.html

Second, You might also develop a hints and tips section. You know the type of thing. Try to turn up the humidifier. Try to turn it down. How to clean and how often. Using distilled water to aovid buildup. Using a hose cover (if needed). Etc...

Third. You should always enable the data display for the patient. At a minmum it should show Leak, AHI and time. For many patients, that's all they want. No need to offer them more. For other patients who are interested, it would be really good if you offer the patient version of the software (if it is available). Mine did. I warned them that I was not like their average customer. After I had chatted with the sleep lab manager she laughingly (and only half way jokingly) told the RT that I could score my own sleep study. But as I told them, the more data I have, the less I will bother them. And the more I will come to them when it's time for new supplies. I *prefer* to be a low maintenance customer.

Anyway, I would be surprised if you had not already considered these ideas.

Holy crap. No joke the first DME I ever worked for was in Rome, GA where this person shows they are located.

Jeezus what a small world!!

mattman wrote:Holy crap. No joke the first DME I ever worked for was in Rome, GA where this person shows they are located.

Jeezus what a small world!!

Many roads start in Rome.

Well I don't want to speak for anybody but myself.

Five days after my sleep study I got a call from the RT from my DME (not that I knew she was an RT til I found this site and I didn't know what a DME was either). She was very nice but for me it was like she was a bull in a china shop. I thought I'd be talking to my doctor, but she said she wanted to come by. Then she waltzed in and whipped out a machine and talked a mile a minute. To say I was overwhelmed was an understatement. Since I didn't know what the appt would be like, my kids were home, they had friends coming in and out. We had no privacy. I was embarrassed. I was also in a fog. I didn't hear half of what she said and didn't understand half of that. That night I cried myself to sleep as I put on my mask and thought--oh my gosh I have to wear this for the rest of my life. My prescribed pressure was 20 and I tried on the mask with her there and the machine on ramp. So it wasn't until I was in bed that night that I realized that 20 was blowing my face off.

What would have helped is if my doc or the sleep tech would have told me what to expect next. Then if she would have come and just spent some time with me talking--not unwrapping the machine--not shoving paperwork at me. Just talking me through it. Telling me what was happening and what problems I might encounter.

She did a good job of follow-up. She did help me switch to a Bi-pap machine after I failed CPAP. So I can't fault her for any of that.

That's what would have helped me!

Good for you Kevin for wanting to do better for your customers!

> I would suggest including ... at the front ... where to get support.
> That should include local A.W.A.K.E. meetings.

Great idea.

> A new user needs to know the special terms which apply to his or her condition.

Yes, a list explaining all the jargon.

A replacement period list: all the parts and supplies, with their codes, part numbers, descriptions, and replacement periods.

A note telling them to get a copy of the part of their insurance coverage that details DME costs: annual deductable, co-pay, percent covered, annual limit, whatever.

Thank you everyone for your great feedback. I am trying to take everyone's opinions and make my setups better and help our company.
I agree with both points that some people want feedback and some don't. I'm glad we put machines that have either cards or modems on every customer. I do check out every person (not as often as I would like).
I hate that Insurances like United Healthcare or Cigna reimburse us so little that we have to put out machines that don't give the comfort or data capability that other customers get.
Yes, I'm probably supposed to trash masks. I won't keep them if they have left the store, but why trash a mask or give it back to someone who won't use it. I never have followed most rules, why start now.

I hate to say that some of my reason for doing what I do is for personal reason. Of course I want to see my customers get a great night sleep, but I also want to be the best at what I do. If Im going to set up CPAP's, I want to do it better than anyone else. If I'm cleaning toilets, I want them to shine better than the last person that did it.

Thanks again,
Kevin

I didn't read the second page of posts before posting my reply.

There is very little difference in the actual cost of a data recording machine (Remstar Pro vs Remstar Plus or S8 Elite vs S8 Compact etc) as well as there is very little difference in the cost of an Auto CPAP and a standard CPAP. Our company has implemented the policy to only put out auto CPAP machines (DS550's) with modems if the customer has a home phone and data cards if not. We use Encore Anywhere to track our patients on a daily basis. If they have a data card, we get a download monthly for the first 3 months and then whenever the ins, dr or patient ask. I let them know that if they are having any issues, let me know and I will download the report and send to their doctor. I will go over it with the customer, but most of our sleep docs don't want us to diagnose or treat their patients.
I think it is great that so many of CPAP users are taking the extra step to download their own data. I don't think that any of my customers have ever downloaded their data (or told me about it). I have to say that I would be proactive with my treatment and it is amazing at how many people just go with the flow.
I also go over the sleep study when I set a patient up (If available). I hate it when the sleep lab or doctor wants us to set up a CPAP before scoring the study. I like to go over the report and show the patient how they did in the CPAP study compared to the first PSG study. Sometimes it is a huge difference, but sometimes it is very little difference and it makes my job harder to convince them to use the machine. I think the docs don't like for me to do this because it steals their thunder when they get the patient to come in for their follow up.

Sounds to me like you are ALREADY doing things right! But kudos for your efforts toward continuous improvement!

(And if you ever have a need for CPAP data-tracking/analyzing software in addition to Encore Anywhere...we can hook you up! )

Thanks everyone for their comments. I guess the best thing I can do right now is keep reading the posts on this site for your tips. I consider the CPAP users as experts and I'm just the guy who gets you started. I need to just keep up with following up with my customers and not get behind like I have done in the past. Paperwork is not my strong suit and I get busy doing other things and forget to call the customer I set up a week or a month ago.
Thanks again everyone.
Kevin

Hi Kevin --

I'd like to join in and say thank you to you for taking the time to try to figure out exactly what patients need and try to help your organization provide better service. Good for you!

There are two main things I've run into that have frustrated the garbage out of me.

First, I think it's really important that patients be given accurate information. I think "most" people would be okay with an answer of "I'm really not sure. Let me check and get back to you" over being given the wrong answer. When I was switched to a bipap machine within a month after failing on cpap, I asked the woman if the bipap would kick in a breath if I stopped breathing (I didn't have the knowledge at the time to know the correct terminology, but she understood my question) and she answered immediately "Oh yes. Definitely." I found out about a month later that the bipap I had did NOT even have that capability. But she sent home with a sense of security that the machine would force me to breathe, when in fact, it wouldn't.

The second thing, for me anyway, is following up on promises that are made. My RT frequently will promise to do something and let me know, but then I never hear from her. Or, we'll have an agreement about something and I call (keeping up MY end of our agreement to call her) and I leave a message and she never calls back.

My situation is a little unusual and NOT typical for what most DME's run into. And my DME is new at this and there's a serious learning curve for them. There have been times that it was pretty obvious that my RT just didn't have any clue what to do, so she'd either do nothing (ie ignore me) or do something really stupid that didn't make any sense. That was obvious when I started having problems with the bipap not triggering to the inhale pressure. I spent over three weeks using the machine AFTER reporting that it was sometimes just staying at the exhale pressure because she made stupid changes to the settings, then kind of threw her hands up in frustration because she just didn't know what to do. After I finally convinced the OWNER of the DME to get involved, he started really looking into it (something the RT could have and should have done) to finally figure out that my breathing was too shallow to trip the bipaps, thus my being switched to a ventilator.

So, if you take an unusual case (me) with a new DME, it's a recipe for disaster IF there isn't a certain level of follow up.

If a case comes in that stumps you, you either need to refer to someone else that can provide better service OR make sure you keep the patient informed about what you're trying to do and never leave the patient hanging for days on end.

The fact that you are here asking is a fabulous thing. What I've described has simply been my experience with my DME and how frustrating it's been.

Read the topics that beotch about DMEs and do the opposite!