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napstress wrote:
I am truly surprised to learn that doctors are not expected to look at patients' numbers before annual appointments.

the thing that most newer patients don't realize is that up until not too many years ago data simply wasn't available. doctors diagnosed and made changes based on how do you feel questions. alot of doctors choose to still do it that way and it's their right to do it any way they want. remember, doctors don't design cpaps, manufactureres design them. manufacturers design machines with data. it's up to the doctors and patients to decide if they want to look at it or use it. if your doctor decides not to use your data, it's your right to find another doctor. he is not required to look at it and you are not required to be his patient.

We print out summary reports for our sleep doc.
We offered to bring more, but summary is all he cares about.
The common mindset around here is somewhat Luddite,
but unless we have problems, this guy is OK for our needs.
We are running a quiet campaign to inspire the pro's what technology can do.

napstress wrote:I am truly surprised to learn that doctors are not expected to look at patients' numbers before annual appointments.

I think that Doctors think they should not be expected to look at patients' numbers before annual appointments - because they generally get away with not doing so in the majority of cases.

"I" believe that they should be expected to do so.
I am not saying that they personally have to make sure the data is available, but it definitely is a responsibility of their office to make sure that data is there for your appointment.

Having said all of that though, I am afraid that the only way to make sure she has data to look at is for you to bring it yourself.

Then, if she does not look at that data before making decisions about your continuing treatment, it IS time to find someone who will do that.

I also see no need to continue to see a Sleep Doctor or have another Sleep Study unless one has very specific problems. But, I would continue to see a Sleep Doctor for at least a year or more.

Remember though, that you may someday need that Sleep Doctor for another machine prescription - so don't burn any bridges behind you.

We will need the doctor's support in getting our Medicare supplies with a minimum of hassle.

chunkyfrog wrote:We will need the doctor's support in getting our Medicare supplies with a minimum of hassle.

I have just joined the Medicare ranks & have not yet used it for anything - so I did not know that was a problem.

My old BC/BS plan (which has now become my secondary insurance) would give me supplies off of an 8 year old prescription for a machine & supplies. So, I went in to see my Sleep Doctor when "I" needed something - which was almost never.

I do need some supplies for my ResMed S9 AutoSet that I purchased in January 2012 using only BC/BS. What surprises can I expect from Medicare.
BC/BS will pay whatever Medicare does not pay, but I do still have to deal with Medicare first.

StuUnderPressure wrote:I do need some supplies for my ResMed S9 AutoSet that I purchased in January 2012 using only BC/BS. What surprises can I expect from Medicare.
BC/BS will pay whatever Medicare does not pay, but I do still have to deal with Medicare first.

Not really any huge surprises. Recently there has been a crack down on suppliers sending automatic shipment of supplies to Medicare patients. You know the stuff that Medicare allows per their replacement schedule that we don't always need..like a new hose or new humidifier tank every 6 months.
DMEs are supposed to ask you if you "need" an item and not just assume that you need 2 filters a month or whatever.
Pretty much you just say I need so and so because so and so is worn out or I need more filters as I used my last one the other day.

My insurance is a Medicare Advantage plan...pretty much Medicare. I just go to my DME and tell them what I need. They haven't ever asked me "do you have a spare" or anything like that. They have never sent automatic shipments...wasn't needed.
But a lot of DMEs did do the automatic shipment thing...it was a cash cow for them.
I don't have to show them a worn out mask part...mainly this is just a common sense thing and the new restrictions were aimed at DMEs milking Medicare by sending stuff out that probably wasn't needed.

THANKS Pugsy!
That relieves me of the "Medicare anxiety".

I never let my DME do the automatic re-supply thingy for 2 reasons.
First, they always wanted to send me stuff I did NOT need. Who needs 2 mask cushions every month?
Secondly, they charged me shipping to send supplies automatically.
I always went in when I needed something. The DME is only about 3 miles away.
Even then, I was always able to stay ahead with a small advance supply of everything I needed. Plus, I was able to make sure that I received EXACTLY what I needed.

old64mb wrote:

napstress wrote:Would it be appropriate to find another Sleep Specialist at this point?

Sorry, but I think you're being rather unfair to her, and given your concerns I'm not sure another MD is going to be better.

First and foremost, she gave you a full hour of time. If you are familiar with how doctors have to fight insurance, that is really a rather tremendous gift. Chances are for a followup, she will get paid for 30 minutes or more likely 15 minutes. (Being a specialist, she'll get paid well, but lousy doctors don't give you an hour.) She doesn't get paid for downloading data. That's Apria's job, and if Apria doesn't get it to her, it's not on her to followup - that's her assistant's job, but it's also yours.

An hour of time is worthless if it doesn't address the issues. As a software specialist I didn't get paid to sit and shoot the breeze with a client.

Third, as far as data analysis, it's on you to get your sleep MD a readable, and more importantly, succinct and accessible set of it. It is Apria's job too, but Apria has the reputation they deserve for customer 'service', and it's realistic that you shouldn't expect much from them and should act as your own liason.

A sleep specialist should be ready to do that (or have the assistant do it) I have never had to go and bring my blood test or x-ray info to my doctor. We do bring the blood meter in to the office for my mothers diabetes specialist and he is quite capable of downloading the data all by his little self.

Now, all that said...I'd be a little concerned that she was slightly dismissive of the machine data, although I do tend to think people here put way too much faith in numbers what is a fairly blunt instrument. (Individual numbers from machines aren't that helpful, but interpreting them to show trends are.) However, to fire someone over that when you didn't have numbers to present her? I think you're overreacting.

Cheers.

They should be up to date in their speciality, that is why they get paid more. If I had gone into a clients office and prepared a tacky old fashioned html website with no security just because that was what I learned in the 90's then I can not be expected to get paid or get a second gig. When you call "geeks anonymous" to fix your computer because it has a virus you expect them to know how to do it with the latest software and technology, you don't expect "we only do windows XP and you need to have the software"
Your doctor is no different then "Geeks Anonymous", your plumber or your mechanic, they work for you, you and your insurance company pay them. Either they are good and keep up to date or you fire them.

blackspinner wrote:he is quite capable of downloading the data all by his little self.

Your post and a statement like that makes me wonder if the courtesy and professionalism you demand so stridently is perhaps a little one sided.

napstress wrote:I am truly surprised to learn that doctors are not expected to look at patients' numbers before annual appointments

Yes and no. They are expected to look at tests. Numbers aren't tests.

Lab tests have this crazy quilt patchwork of law (HIPPA, CLIA, and literally 50 different state laws or lack thereof) on who gets your lab tests forwarded to them automatically, which medical providers are allowed access without your express permission, which tests (like HIV status) are subject to higher levels of restrictive access, and whether or not you have a right to see those tests without getting them from your doctor first.

The way the system for lab results is supposed to work is that the MD who orders your lab work should get it automatically, review your test results when they have time, and if something gets flagged as really being out of range, they should contact you immediately. Otherwise, they'll bring up when they sit down with you during your appointment.

There are all sorts of ways this system can break down, including if another MD who should get access to your lab results somehow doesn't get it or if there's an outlier result that requires urgent treatment and you don't get notified. However, there are such big legal and financial consequences to getting it right - like if you don't get notified that the lab tests have flagged protein levels that signify cancer but they don't tell you until 3 months too late, there's a malpractice suit ready to go against insurance, doctor and lab - that there's incentive to make it work.

Sleep data is different. Sleep lab tests are clearly protected and treated as tests under HIPAA, but machine data falls into a grey area as it's not a 'test'. Unlike a test, there's no real incentive for a DME to get it to the MD before your appointment or for the MD to review it - especially since so many machines can't record data at all, and no one blinks an eyelash at this.

Hence, many doctors don't bother looking at the data on the machines even if it's available and they have it. Neither the MD or the DME is going to get sued if they don't do so, and the only thing the insurance company cares about (which generally is the only thing many doctors end up caring about) is the compliance data. Even good doctors aren't going to look much at nightly data; most will just want to take a look at the summary sheet showing overall trends, add it to their interview and examination, and form a professional medical judgment based on all of the above data points.

In your case, Apria should have gotten the data to the doctor, but it's not surprising that they didn't. It's also not surprising that your doctor didn't notice or worry that they hadn't done so, since 90% of her patients probably either don't have data capable machines or have a clue as to how to read them. Moreover, neither your doctor nor the DME gets paid to deal with machine data (beyond compliance data for the DME), and neither has a stick hanging over their head if they don't.

The best way around this is for you to be your own advocate. Print your own data out, bring it to the doctor, and let them be the consultant and do their job in interpreting it. If there are a few nights that you think are worthy of notice, show them. If they can't explain their interpretation, or refuse to bother interpreting, that tends to be a good reason to fire a doctor.

When someone is gracious enough to spend an hour with you, explain how and why they weigh data (even if you disagree with it), and answer your questions, it doesn't feel like that's the case here. If you're unhappy with this doctor you should feel free to find another one, but based on what you've told us on how the situation developed it's unlikely a different doctor would treat things differently enough that you'd feel more comfortable.

Cheers.

archangle wrote:

JayR_1945 wrote:From a former computer Doctor.

<the Doctor will see you now>
$40.00 for an hour with the Physician. That's cheap. If I spent 8-12 years in expensive and grueling medical school to listen to sick people complain, my rates would be outrageous.

$40 for an hour? Nobody gets an hour of the doctors time for a regular visit. How about $80 per patient, and 4 or 5 patients an hour. Probably a lot more than $80 per visit if the doctor is a "specialist."

You're right. I was responding to napstress's statement:
.... And I paid $40.00 for pretty much no information. While I am grateful that she spent an hour with me....
and didn't consider the fact the $40.00 was probably only the "CoPay". And the Insurance company pays the rest.

I think there is a discrepancy between what we patients expect from a sleep doctor and what the patient gets. Their role is to diagnose "sleep apnea" and get the patient on a CPAP machine to get them out of the severe range. But they are really unprepared on an individual basis to deal with the "subtleties" like mask leaks, humidity, differences in patient supplied printout reports, and the fact that my dog treats my hose like a chew toy. These issues are best handled in a "consumer" discussion forum like this one. I love this site.

In the hospital, when the patient starts to get fussy about the lack of ambiance, it's time to kick them loose and send them home.

JayR_1945 wrote:
I think there is a discrepancy between what we patients expect from a sleep doctor and what the patient gets. Their role is to diagnose "sleep apnea" and get the patient on a CPAP machine to get them out of the severe range. But they are really unprepared on an individual basis to deal with the "subtleties" like mask leaks, humidity, differences in patient supplied printout reports, and the fact that my dog treats my hose like a chew toy. These issues are best handled in a "consumer" discussion forum like this one. I love this site.

In the hospital, when the patient starts to get fussy about the lack of ambiance, it's time to kick them loose and send them home.

So any diabetic who has issues is to be sent to a random internet site to get their answers? Really? Sleep specialist are specialized in sleep, not apnea. Sleep includes everything related to it. What you are suggesting can be programmed by computer and sent to a regular GP, it means there is no necessity for sleep specialist. A competent RT can do all of the above with so additional training too. so why are these guys getting big bucks if all the do is read a print out and write a prescription and they can't be expected to handle any issue a patient might have?

old64mb wrote:

blackspinner wrote:he is quite capable of downloading the data all by his little self.

Your post and a statement like that makes me wonder if the courtesy and professionalism you demand so stridently is perhaps a little one sided.

.

Since your only comment is about a bit of snark, I gather you agree with me on all the other points.

BlackSpinner wrote:

so why are these guys getting big bucks if all the do is read a print out and write a prescription and they can't be expected to handle any issue a patient might have?

Because they went to medical school and got the diploma that is hanging on the wall.

Always expect more; no profession attracts the lazy and incompetent like a well-paying one.

greatunclebill wrote:up until not too many years ago data simply wasn't available. doctors diagnosed and made changes based on how do you feel questions. alot of doctors choose to still do it that way

Thanks, greatunclebill. The picture is starting to become clearer to me. It explains my doctor's not being terribly concerned about the numbers—as well as her emphasis on how I'm feeling. I value the data because my only two states are "tired" and "exhausted." Because I never feel rested, I look to the numbers to find clues about the insomnia and sleep fragmentation.

BlackSpinner wrote:An hour of time is worthless if it doesn't address the issues. As a software specialist I didn't get paid to sit and shoot the breeze with a client.

BlackSpinner wrote:When you call "geeks anonymous" to fix your computer because it has a virus you expect them to know how to do it with the latest software and technology, you don't expect "we only do windows XP and you need to have the software"
Your doctor is no different then "Geeks Anonymous", your plumber or your mechanic, they work for you, you and your insurance company pay them. Either they are good and keep up to date or you fire them.

BlackSpinner wrote:I have never had to go and bring my blood test or x-ray info to my doctor.

BlackSpinner wrote:So any diabetic who has issues is to be sent to a random internet site to get their answers? Really? Sleep specialist are specialized in sleep, not apnea. Sleep includes everything related to it.

Exactly so, BlackSpinner: Thank you.

StuUnderPressure wrote:Remember though, that you may someday need that Sleep Doctor for another machine prescription - so don't burn any bridges behind you.

Great advice, Stu!

JayR_1945 wrote:the $40.00 was probably only the "CoPay". And the Insurance company pays the rest.

Correct; that is what I meant.