You Can Sleep While I Thrive

Going through Sleep Review Magazine, and its business archives.

Sleep Doctors: Best Doctors of 2011

How they chose these 10 doctors, I can't say, but the interviews with each are interesting.

http://www.sleepreviewmag.com/issues/2011-TD.asp

The faces behind the 10 names, and their websites.

http://www.sleepreviewmag.com/issues/ar ... -TD_12.asp

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Spotting Unethical Practices

Any of these sound familiar?

http://www.sleepreviewmag.com/issues/ar ... siness.asp

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Unthinkable Acts: Sexual abuse in sleep centers

Just in case you have trouble falling asleep during your sleep study, this will put your mind at rest.

http://www.sleepreviewmag.com/issues/ar ... siness.asp

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Independent Means

Employing physicians in India to do all of the scoring. You get scored study and signed interpretation within 72 hours, and the average cost of scoring falls below $20!

http://www.sleepreviewmag.com/issues/ar ... siness.asp

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Finally, for those of you CPAPtalk members who want to cash in on your extensive knowledge:

How to Start a Sleep Lab

"A sure-to-prosper sleep lab suite with basic diagnostic services can be added to virtually any freestanding clinic anywhere in the US"

http://www.amazon.com/How-Start-Sleep-L ... B000X8OV5Y

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I'll buy you boots down in Texas, a hat from New Orleans
And in the morning you can tell me your dreams

You know I've seen it before
This mist that covers your eyes
You've been looking for something that's not in your life
My intentions are true, won't you take me with you
And baby you can sleep while I drive

Mike6977 wrote:Spotting Unethical Practices

Any of these sound familiar?

http://www.sleepreviewmag.com/issues/ar ... siness.asp

http://www.sleepreviewmag.com/issues/ar ... siness.asp

PRACTICE #1: SLOW TURNAROUND TIME FOR PSG INTERPRETATION
Many patients wait a month or longer to learn the results of their study. This backlog typically results from a shortage of scoring technologists or from insufficient time for technologists to score the data on a polysomnographic (PSG) record. In some centers, the backlog occurs because a sleep physician has insufficient time to review and interpret data—especially if the physician comes to a center only once a week or biweekly to review and interpret data scored by technologists.

A delay in scoring, reviewing, and interpreting data can create financial and treatment problems for a patient. A patient can be billed for a study for which they have no results; without results, the patient's insurance may not be willing to pay for the sleep study. A delay in getting results means delayed treatment for a sleep disorder. This can potentially be fatal if untreated symptoms (for example, excessive sleepiness) impair the patient while driving or doing any other activity that requires full alertness.

I don't know if the subject heading was insinuating something negative about folks profiting from sleep care, or if it was just matter-of-fact, however I don't have a problem with anyone profiting from my problem, so long as their performance is both ethical, professional, and of high quality. Regarding the above quote from the article about turnaround time, I guess maybe I feel a little better. I'm in the VA system, and from the first appointment with my provider when she got the ball rolling to the day I got my machine was 8 months.

I felt so bad sometimes that I really was afraid I would not make it through the process. Does it normally take that long in the private sector as well or is that more just an issue in the VA?

Ameriken
I took me some time too in the eveyday world.......9 months
July 2009 referred to sleep doc
Nov. saw sleep doc
Feb. had sleep test at clinic
April got my machine
By the time I got my gear in April I didn't think I would make it....but I did and I'm sssoooooo much better.

ameriken wrote:I'm in the VA system, and from the first appointment with my provider when she got the ball rolling to the day I got my machine was 8 months.

I felt so bad sometimes that I really was afraid I would not make it through the process. Does it normally take that long in the private sector as well or is that more just an issue in the VA?

Saw sleep doctor for first consult and order for sleep study 2nd week or so April 09. Sleep study done 2 weeks later which was not a split night with cpap. One more week for phone call from sleep doctor's nurse to tell me that I had to have the titration sleep study which was done 3rd week May 09. Had my machine within 3 days of the titration study.

So all total 6 to 7 weeks for me.

nanwilson wrote:By the time I got my gear in April I didn't think I would make it....but I did and I'm sssoooooo much better.

I just wrote those same words in my ASV thread...sitting through all that time, I didn't think I'd make it either. I'm glad we both did!

Mike6977 wrote: Spotting Unethical Practices

Any of these sound familiar?

http://www.sleepreviewmag.com/issues/ar ... siness.asp

#7 - why I changed my own pressure and my AHI dropped from 7+ to under 5

#10 - how the heck are you supposed to know what your tech did once you're asleep????? Psychic moments while sleeping?? No, no!! Electrode induced OBE!!!!

nanwilson wrote:Ameriken
I took me some time too in the eveyday world.......9 months
July 2009 referred to sleep doc
Nov. saw sleep doc
Feb. had sleep test at clinic
April got my machine
By the time I got my gear in April I didn't think I would make it....but I did and I'm sssoooooo much better.

Let's see - My doc prescribed the sleep study - got it within a couple of days - said it looked like I had mild sleep apnea (so much HE knew but he was a tech - still, after all those years of watching....oh well) - got the titration less than a week after that. Told it'd take about 2 months for the results - that tech said it looked like I had mild to moderate sleep apnea - called after 2 months when I didn't hear anything - was told the results were in and that I needed a cpap machine (why didn't anyone call me and tell me this??) Asked for a copy of my results. Was asked why. Excuse me?? They're my results! If I want a copy, I can frigging have a copy!! Anyway, I was going through a disability appeal and wanted them for that so that gave them a "good excuse" to give them to me so I got a copy. Found out I was moderate to severe OSA/CSA mix - techs really need to study up more but I guess I was stupid to ask even tho I acknowledged I knew he wasn't the doctor.

Never did speak to the sleep doctor who read my data. Have never had a visit with the sleep doctor. It'll be a year in September and have never had a call back to see how things are going, have never had a call back to see if I thought I needed a re-test in a year (insurance only covers a titration once a year except for medical necessity). Everything was up to me to do.

And while I'm glad I have the CPAP and am glad I did the test as I am now no longer waking up with monster headaches, it's still not doing for me what I was hoping. Still waking up lacking energy, yada yada yada. But I can't blame that on the machine - I have other medical problems which kick the butt of any good the CPAP would do if I was healthy so I don't get upset and stop using it because it's "not working like they said it should!" My headaches are gone and that makes me happy. I'm waking up less at night and that makes me happy. I'm not as restless and that makes me happy and ..... well, you get the picture. But yes, it does seem to be a trend that doctors/sleep labs don't seem to be in any hurry to do anything with their patients.....course, that's a disease that's affecting most doctors/clinics/hospitals around the world these days it seems......

From my initial request of my doctor to taking my first machine home: about 2 months or so.
Half that was waiting for results for two studies.
I guess I can quit complaining about that;
But I'm still irked that I did not meet the actual doctor until 11 months after the first study.
The sleep lab was also the DME (I had a choice, but --should have gone to someone else at the beginning --my fault?.)
That DME is also not Medicare--and I'm in my 60's-- Doc just tossed the dice, I guess.

I had my split night sleep study on a Friday or Saturday night ( I can't remember). Monday was a holiday. Tuesday morning the doctor called me with the diagnosis and that afternoon I picked up my machine. That was in September 2007 and I'm still waiting to feel better.

ameriken wrote:
I don't know if the subject heading was insinuating something negative about folks profiting from sleep care, .... I'm in the VA system, and from the first appointment with my provider when she got the ball rolling to the day I got my machine was 8 months.
... Does it normally take that long in the private sector as well or is that more just an issue in the VA?

Maybe just a side point, but if we believe doctors in the private sector take a long time from initial contact to CPAP startup, that would be evidence that something is at work besides the profit motive.

Every good businessman knows rapid throughput, along with customer satisfaction, is one of the keys to good profits.

I have seen many anecdotes about slow throughput in the private sector and a few about rapid throughput. Remember this industry is in its infancy and has experienced rapid growth in the last ten years. There has been a scramble to handle the demand.

If market forces are allowed to prevail, some firms will move quickly toward customer satisfaction (many already have moved in this direction). As the supply catches up with demand, firms that do not make the customer happy will fail and ones that achieve customer satisfaction will thrive. If one of the things the customer wants is rapid throughput, he will get rapid throughput.

Now about the public sector, the VA, what is the veteran's choice? Use the VA's services at no or nominal cost or use the private sector at actual cost?

The government entity is very much shielded from market competition. Progress toward customer satisfaction will be very slow if at all.

This is the way it is with government services. They have a captive customer base. They can do a horrible job and still stay in business. It is not that they don't have good intentions. It is that the market force of creative destruction does not force them to improve.

Husband carried me into sleep clinic as I had not slept in 4 days.
Did study and titration and had machine in two weeks. I'm so lucky to have a great sleep clinic and DME.

Son in California waited 3 weeks for home sleep study and machine was delivered by Fed X about 4 weeks later.
No follow up no phone call no nothing. In the package was the mask he used for the home study.
No wonder people fail at this.

So Well wrote:

ameriken wrote:
The government entity is very much shielded from market competition. Progress toward customer satisfaction will be very slow if at all.

This is the way it is with government services. They have a captive customer base. They can do a horrible job and still stay in business. It is not that they don't have good intentions. It is that the market force of creative destruction does not force them to improve.

I didn't expect the VA to be presto-speedo, but I am quite surprised when I hear of some in the private sector to be just as slow, if not worse. On the upside, despite their flaws, I think the VA did an outstanding job and I credit them with literally saving my life.

So Well wrote: If market forces are allowed to prevail, some firms will move quickly toward customer satisfaction (many already have moved in this direction).

As the supply catches up with demand, firms that do not make the customer happy will fail and ones that achieve customer satisfaction will thrive.

1) First catch: Only if the better "firms" (we'll lump sleep labs and DMEs together for now) take your insurance.

I live in NYC and I wanted a university-based sleep lab. None would take my GHI PPO. I was stuck with the low-rent private firms. Same with my DME.


2) Second catch: Only if discerning and satisfied customers talk to the uninitiated, and that's at the local level. I posted on a number of sleep apnea boards (not this one), looking for a NYC sleep lab and DME recommendation. No one had one. And that's in NYC, with a customer base in the millions.


3) Third catch: Litigation. My first sleep lab and its medical director were incompetent. If I post their names on this board, my guess is that they''l sue me.

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So customer satisfaction "market forces" may have a tough time prevailing in this field.

Mike6977 wrote:
I live in NYC and I wanted a university-based sleep lab. None would take my GHI PPO. I was stuck with the low-rent private firms. Same with my DME.

What are your specific complaints about the "low-rent" firms? Where did the one you chose fall short? Quite often consumers seek out low-cost ("low-rent") firms in order to save money or in order to get something they can afford. In other words the consumer demands low-cost firms and the market responds.

Why specifically did you want a university-based lab? Is there something you thought they could do that another provider could not do? Was something missed in your study that you think a university lab would have covered?

Mike6977 wrote:
2) Second catch: Only if discerning and satisfied customers talk to the uninitiated, and that's at the local level. I posted on a number of sleep apnea boards (not this one), looking for a NYC sleep lab and DME recommendation. No one had one. And that's in NYC, with a customer base in the millions.

Well of course! Would I dare go to a provider for the first time without a personal recommendation from a close and trusted friend or associate???

My family has relocated a few times and when we would land in a new city we would line up a new pediatrician, gynecologist, and GPs. I always had a good discussion with mature work associates and friends. My wife was especially good at discussing this with new neighbors and friends. These are not decisions to be taken lightly IMO. There are quacks and incompetents in every field.

I would not trust an internet forum for a recommendation unless I had been heavily involved in it for months and knew the members with good track records who could be trusted.

Mike6977 wrote:

3) Third catch: Litigation. My first sleep lab and its medical director were incompetent. If I post their names on this board, my guess is that they''l sue me.

If you post their names on this board and trash them, the forum administrators will remove your posts. But please do tell your real friends and associates about how your first provider fell short of your expectations.

Mike6977 wrote:
So customer satisfaction "market forces" may have a tough time prevailing in this field.

Market forces do have a very tough time prevailing in the medical field. This is due to heavy regulation and licensing throughout the field by federal and state governments. Brick-and-mortar DMEs, for example, have a primary focus on licensing requirements instead of customer satisfaction.

So much of what you see as "catches", I see as normal customer diligence in the market. I think you probably do this automatically with restaurants, that is, you seek out and make recommendations from personal contacts, compare prices, make judgements about the facility and the personnel, walk out if the restaurant doesn't meet your expectations, and in general act like a responsible consumer. Why should selecting a medical provider be any different?

BTW, time allowing, I could tell you some bad stories about top notch university hospitals.

My experience must be an anomaly. I self-referred to a sleep doc within the hospital/medical center where I had my last knee replacement (overall good customer service throughout system). Got an appointment quickly because someone else cancelled. Saw the doc, had an orientation with an RT letting me play with a machine, scheduled a sleep study for the next night. Saw the doc one day after the sleep study, got the results. Scheduled a titration study for the next night. Saw the sleep doc again same day as titration study and walked out of hospital with an S9 Autoset and climateline hose (and mask, of course). Total time was about a week, maybe a little more because I think there was a weekend in there.

Had several follow up appointments w/sleep doc until he was satisfied that I was doing OK.

BTW, to put in an attaboy for a good system: Virginia Mason in Seattle. I saw Dr. DePaso there, although I think the others are equally as good. The entire system seems to be very customer oriented.

Weezy