APAPs -- are they becoming standard prescriptions from Docs?

I WAS thinking of 'non professional' reasons; and the fact that Big Pharma
may not want "alternative treatments" (XPAP) cutting into their bottom line.
To the extent of proffering "gifts".
I had a classmate who became a doctor; and I can't think of anything good to say about him.
Neither can a nurse I know who's had to work with him.
I would love the CPAP manufacturers sending doctors to training seminars--Heck send them to OZ!

I think the cost of APAP over CPAP has gone down over the years so some DMEs are looking at cost of exchanging equipment vs just reprogramming and it comes out pretty even. I would imagine if the DME has been around for a long time they may be stuck with the old price model in their head but given what I have found online for the F&P Icon Novo vs Premo vs Auto prices the cost difference isn't that much.

From an engineering point of view they both need a variable speed fan and sensors to make sure it reaches the right pressure. The Auto just needs a few more sensors to detect events and as we see with the iPhone and other such devices... sensors are not that expensive anymore. Come to think of it they just need the same pressure and flow sensor a CPAP needs, maybe just a bit more sensitive so they can monitor your inhale/exhale pattern.

The price difference is also big for the manufacturer, they have to stock the multiple SKUs for circuit boards as well as the PAP models and that cost money as well. I would imagine in the future, unless there is an insurance need for a separate SKU, the APAP will become the standard model. It will save money for both the manufacturer and the DME supplier.

I would love the CPAP manufacturers sending doctors to training seminars--Heck send them to OZ!

My doctor has sleep apnea, so he uses his own machine every night. I think that really helps him in this field since he knows what it is like to use a machine and can understand what bothers the patient and how to help fix those problems.

purple wrote:To approach this from another side. As I understand it, the diff between a Respironics CPAP, and its APAP, and its Bi-Pap machine is only plastic on the outside, and firmware. Likewise the diff in Resmed up to S 9 Auto VPAP is only a bit of plastic and firmware. Any one with specific knowledge please chime in?

If this is true. Why do manufacturers sell crippled machines for less than the best, which a customer may need. I am in big support that company is entitled to receive extra money for better things, including Firmware. After all, if the Firmware is not programmed correctly, then the machines not serve the needs of all of us, including some that got killed.

However. I do not feel that it is a fair market procedure to make the best machine, then cripple it, sell if for less to make insurance companies happy, and to create a price structure. Yes, this includes bricks as well.

What do we do next? Can we lobby that manufacturers not be allowed to sell crippled machines? How much more would it cost of all machines had Full data, auto, and bi-level capabilities? I suspect that a full-data, Auto, bi machine is over a thousand dollars more is just a fiction made up by profit hungry management team.

And why not make a plug in for a recording Pulse-Oximeter to be standard as well (with alarm) plus to send a decent Pulse Oximeter with the machine as standard.

Resmed appears to have two physical machines and I make that statement based on maximum pressures that their product line can cope with. It is not uncommon to cripple devices based so you can have more on the shelves at different price points. Decades I ago I was taking about Bel radar detectors and soldering in additional lights so they things worked like the unit that costs twice as much. When you have pulled apart enough electronics, you will see that most of the parts for the next product up are already installed, you just need a few extra bits and the connectors. The US list price on the S9 is currently about $47 between the different units. Its nearly $1000 in Australia where some of them are made.

The S9's O2 adapter is only a small circuit to adapt the signal from another company sensor to something that can be read by the S9. It also contains an isolation power supply so if you manage to cut the wire to the sensor while cutting the wire to the heated hose and manage to hit just the worst combinations of the right wires at the right time, there is no chance of getting zapped.

I expect if a large buyer starts to tell them "we only buy data recording APAP, no more CPAP", the problem will go away. Right now it looks like there are so many choices you need to get an expert to tell you want one to buy but it appears the traditional concept of using the sales people to up sell isn't working.

Why would I sell a unit that I get paid $500 for that costs me $100 when I call sell a similar unit that only costs me $50 and still get paid $500 for it???

I was given a "brick" by the equipment supplier. Didn't know the difference about machines, but I got educated in this forum! I called my doctor and said I was having problems breathing back against the pressure. They recommended an auto CPAP and I got one without any hassle. This one also has all the data recording, which my first machine lacked. Interestingly, the original prescription called for a CPAP machine with AHI recording -- so the first machine supplied didn't match the prescription!

When your DME provider got that new script from your doctor they probably figured "oh, oh! The doctor had their number"!

For me, the sleep doc prescribed an APAP because my apnea is highly positional. But I suspect that the pressure I would have been prescribed on a CPAP would not have been adequate. The recommendation from the titration study was a pressure of 6, but my APAP varies from a median between 6 and 7 up to the maximum setting of 10. (I presume the high pressures are when I am on my back.) I started out with an APAP range of 5-15, which the doctor later reduced to 5-10. I agree with others on this forum that the upper limit doesn't matter and, as Pugsy says, the machine won't go there if it doesn't need to. So I've been watching the data. Some nights I do max out at 10, but only for a few minutes and I don't have any Obstructive apneas associated with maxing out. So for now I'm leaving things as they are.

A few weeks (?) back, i read an excellent description on this forum of the difference between Respironics and Resmed algorithims for increasing apap pressure. It was the first time I had any idea how an apap works and the information was tremendous. Those interested in apap might search for it.

It's money at the end of the day, but this time with some beneficial twists.

My insurance company cleared this up for me in a letter denying benefits for a second 'titration' sleep study. At first I was livid, then the business major in me saw the brilliance and benefit to the patient and insurer...at the expense of the sleep clinics.

Their logic was that if the point of the second study was to titrate, then an auto-titrating machine would satisfy the requirement on an ongoing basis. The net for them is that almost certainly an APAP costs much less than a sleep study, so I get a better machine, and they save money. The sleep clinic, not so much.

In another interesting paragraph, they mentioned that it was in their opinion preferable to conduct in-home sleep studies, as they felt that the data was more valid, and as such they would encourage this by waiving co-pays for same. Very shrewd business. Untreated apnea costs major bux...and sleep studies are a major barrier to entry for the patient, insurer, and gate keeping primary care physicians that make the bulk of initial referrals. PCPs frequently are allied with insurers and HMOs and sending patients out for expensive tests cuts the group's profits...however, if the net is positive, you can expect to see a huge uptick in home-study referrals, treated apnea, and long term health benefit savings. If the cost/benefit ratio seems good to the insurers and PCPs, you'll see it take off. Fasten your seat belts.

If this trend continues, we can expect that docs will have to justify NOT using an APAP and conducting sleep studies anywhere but home. The business model for the sleep clinics is almost certainly going to have to shift to something like the radiologists, where the images (data collection) are done away, but they make their money by doing lots and lots of studies and presenting findings to the primaries and counterparts for treatment plans. Only if they find certain conditions would further 'sleep lab' studies be authorized. Is this the way it's going? I don't know, this is just one MBA's analysis of a denial letter and playing the next few moves out in my head.

If I had to make a bet, this market is about to explode. The barriers to entry are falling and a tipping point seems near at hand.

-tim wrote:Resmed appears to have two physical machines and I make that statement based on maximum pressures that their product line can cope with.

If you are referring to the fact that "CPAP" machines are only rated to go to 20 cmH2O, that's an artificial regulatory and insurance reimbursement number. If you go over 20, you have to have a "bilevel" machine, which is classified as "not a CPAP," and gets a higher reimbursement rate/requires more justification.

As of a few years ago, Philips Respironics had 2 hardware designs for their PRS1 machines. DS250/Plus and everything else, including bilevel. The difference was labels and firmware. I don't know how AutoIQ and Model 60 designs work in terms of hardware vs. model.