Medicare CPAP reimbursement cut 47% for DMEs

DreamStalker wrote:I think Den linked to a different story, same topic on another thread.

The writing is clearly on the wall. Medicare and the whole healthcare system is collapsing under the fascist fraud that has sustained it up until now.

No politics. Especially for you guys that voted for Obama and Obamacare. Wait. It gets better.

They're going to distract you with the evil guns and budget matters until you are so sick that you can't complain or vote otherwise. Sic.

jnk wrote:

hyperlexis wrote: . . . My question was, and remains, please cite a peer-reviewed study or authoritative text that states providing elderly Medicare patients with prescribed, basic CPAP, vs more costly data-capable machines, is inherently dangerous or would have a statistically significant result in patients causing auto accidents.

Anything, something. Even hinting at it. Please.

Every study ever made of PAP therapy by OSA patients has found that discontinuing use is dangerous.

Have you found a study that suggests otherwise?

Rather than just making pronouncement after pronouncement based on conjecture or repetitive anectdotes relating to you, yourself, and my, you again, it's very simple. Show us a scientific study that proves that the base CPAP model sold and prescribed to hundreds of thousands of people across the country is inherently inferior when it comes to patient care and ultimate clinical outcome -- or that such patients have statistically higher rates of car accidents as one poster gravely warned above. Because if so, shouldnt all basic CPAP machines be outlawed or recalled? Hmmm?

Because face it. These people bitching on here are simply worried (most likely totally unwarrantedly) that Medicare is finally going to crack down on overutilization and they are no longer going to have the US taxpayers pony up for the fancier machines they have been currently getting from Medicare -- and are instead in coming years going to be eventually re-supplied only with cheaper, base model 'bricks.' -- And/or that they will then personally have to cough up the difference in price for the cadillac machines with heated tubes and fancy color displays. Worried over the plight of their poor, fellow apneacs? Please. Selfishness pure and simple. How many people under 65 on this site cant even get insurance at all. How many of them would kill for a basic machine, if anything.

Other parties with different vested interests (the DME people on here) are themselves worried their profit margins will be slashed because Medicare will demand competitive bids on DME equipment.

And FYI, believe it or not, CPAP is no more special than any other type of DME, be it crutches or beds in a hospital, regardless of it needing to be 'tailored' to each patient. The xPAP devices themselves are not unique at all regardles of what the manufacturers boast. There are different categories, such as BiPap and CPAP and APAP, humidified or non humidified, but aside from that, each machine within a sub-category does the same thing and can be adjusted in the field for each patient's prescription. So if Uncle Sam wants a contract bid out on 100,000 BiPaps for states A, B, and C, then why not open that for competitive bidding? Why shouldnt the cheapest, clincially effective FDA approved BiPap supplier get the contract for Medicare patients? As long as they do the job as designed at the least cost to the taxpayers, that's all that matters.

And if someone wants a cadillac machine let him pay the difference or prove that a more expensive machine is absolutely needed for proper treatment to get a waiver.

hyperlexis wrote: . . . CPAP is no more special than any other type of DME, be it crutches or beds in a hospital . . .

OK. Your opinion, I don't respect.

In fact I'm sure that even you don't really believe what you just said, if you think about it.

Not that you will.

If you were hungry, I would feed you, though.

To Mollete.

LSAT wrote:

mcdover wrote:

LSAT wrote:

mcdover wrote:

LSAT wrote:I check the new SPA reimbursements for my city against what my DME has been receiving for my purchases.....Under the new SPA they will be receiving a higher reimbursement for everything I normally purchase except for Tubing. I checked FF Mask, Headgear, Silicone Insert, Humidifier Cup, Filters and Tubing.

You are 100% wrong.

Well...I have my medicare EOBs that says I'm right. (Unless I'm reading the SPA chart wrong )

FF Mask A7030 My last EOB shows $80.15...my 20% 16.03.....New SPA 104.78
Headgear A7035 My last EOB shows $16.90...my 20% 3.38.... New SPA 20.00
Water Chamber A7046 My last EOB shows $8.30...my 20% 1.66 ..New SPA 14.37
Tubing A7037 My last EOB shows $17.45...my 20% 3.49 ... New SPA 11.19
Silicone A7031 My last EOB shows $29.65...my 20% 5.93... New SPA 40.00

No way that can be right. Here the fee schedule for non-CBA region B, which include Wisconsin:

http://www.ngsmedicare.com/wps/wcm/conn ... aultDesc=0

Right or wrong.... I have EOBs from the past 2 years...I should add that I am on a Medicare Advantage Plan, but I was told that they use the Medicare reimbursement schedules. The RT at my DME has always complained about the low reimbursements.

Makes sense now. Apples and oranges. You don't have Medicare, you have a Medicre Advantage plan. Whole different set of rules. You basically have private insurance, although than can follow Medicare's fee schedule, they are not required to.

jnk wrote:

hyperlexis wrote: . . . CPAP is no more special than any other type of DME, be it crutches or beds in a hospital . . .

OK. Your opinion, I don't respect.

In fact I'm sure that even you don't really believe what you just said, if you think about it.

Not that you will.

If you were hungry, I would feed you, though.

To Mollete.

Well, frankly, I could give two s---- about your opinions on my opinions or anything else for that matter. You are free to have your own, as wrong and illogical as they may be.

But the fact is that a CPAP machine like any other durable medical equipment has become a commoditized, generic item pure and simple. Want to make your's extra special? Put some fancy Dale Earnhardt stickers on it. Or Hello Kitty. (On mine I kept the little American flag that PR stuck on it to make me feel better about spending so much money on their product. Which, it kinda helps).

hyperlexis wrote: . . . frankly, I could give two s---- about your opinions on my opinions or anything else for that matter. . .

Then, welcome to the board.

jnk wrote:

hyperlexis wrote: . . . frankly, I could give two s---- about your opinions on my opinions or anything else for that matter. . .

Then, welcome to the board.

Thank you!

torontoCPAPguy wrote:

DreamStalker wrote:I think Den linked to a different story, same topic on another thread.

The writing is clearly on the wall. Medicare and the whole healthcare system is collapsing under the fascist fraud that has sustained it up until now.

No politics. Especially for you guys that voted for Obama and Obamacare. Wait. It gets better.

They're going to distract you with the evil guns and budget matters until you are so sick that you can't complain or vote otherwise. Sic.

I didn't vote for Obama. Nor have I ever supported the Patient Protection and Affordable Care Act or Obamacare or whatever you want to call it.

You are quite correct about the gun and budget diversions. However you left out the wars ... US troops now going to 35 African nations for puppet government installation duty but wait, that's not all -- let's not leave out the fuse to the Syria-Iran powder keg. All of this to hide the homeland police state plans and the destruction of the USD. These diversions are all going to cost a lot of money. Money that doesn't exist. Money that somebody has to borrow. Money that nobody can ever pay back.

hyperlexis wrote:
Because face it. These people bitching on here are simply worried (most likely totally unwarrantedly) that Medicare is finally going to crack down on overutilization and they are no longer going to have the US taxpayers pony up for the fancier machines they have been currently getting from Medicare -- and are instead in coming years going to be eventually re-supplied only with cheaper, base model 'bricks.' -- And/or that they will then personally have to cough up the difference in price for the cadillac machines with heated tubes and fancy color displays.
And if someone wants a cadillac machine let him pay the difference or prove that a more expensive machine is absolutely needed for proper treatment to get a waiver.

Cadillac? At cost there is probably $25 -$50 difference between a data capable cpap machine and one that is a brick. That is like saying windshield wipers and rear view mirrors make a car a Cadillac.

BS: +1
Or maybe a speedometer, tach, temperature and oil gauges instead of just the odometer!

BlackSpinner wrote:

hyperlexis wrote:
Because face it. These people bitching on here are simply worried (most likely totally unwarrantedly) that Medicare is finally going to crack down on overutilization and they are no longer going to have the US taxpayers pony up for the fancier machines they have been currently getting from Medicare -- and are instead in coming years going to be eventually re-supplied only with cheaper, base model 'bricks.' -- And/or that they will then personally have to cough up the difference in price for the cadillac machines with heated tubes and fancy color displays.
And if someone wants a cadillac machine let him pay the difference or prove that a more expensive machine is absolutely needed for proper treatment to get a waiver.

Cadillac? At cost there is probably $25 -$50 difference between a data capable cpap machine and one that is a brick. That is like saying windshield wipers and rear view mirrors make a car a Cadillac.

More like going to the DME and they give you crutches but axillary pads and hand grips cost extra -- and woe the patient who asks for adjustable center posts, patients are just not competent enough to make their own adjustments. Why they might adjust it too low, fall down, and break their noggin wide open, with all their stuff falling out and messing up the floor.

Contract with Medicare to supply crutches to people who need them. But then just nail a hunk of duct tape and rags onto the top of some broom sticks and call them the "standard crutches." And if anyone tries to demand a real crutch, make him pay extra out of pocket for a "deluxe" one. After all, no studies prove that a broomstick with duct tape doesn't work just as well! People should just be glad for what they get; people in some developing nations would be happy for that stick. And think of all the money we can save doing that!!!!! Cha-ching!!!!!

Then try to sleep at night and look at yourself in the mirror the next morning and call yourself human.

It's a recipe for evil.

In my opinion.

hyperlexis wrote: . . . Actually, to most Americans, a basic CPAP brick and a simple nasal mask is probably pretty darned acceptible. . . .

[/quote]

I walked around for months feeling terrible after I was given a brick by the sleep center, and had no idea they titrated me wrong or what my AHI was on the brick, or that the brick didn't have data! I thought once I took the brick to the sleep doctor he would be able to print out the data and tell me how it was controlling the apnea. When I was diagnosed I knew nothing about SA, nor did I know anyone who had it. In fact, at the time I could not work, and walked incessantly on the nearby bike trail because I thought it was just a matter of time until the "cpap therapy" would start "working," and walking was the only thing I could do to keep mentally sane because I was in so much pain. I've read similar stories on this forum. A brick cpap is terrible and it should be against the law to distribute them anymore. I suffered so unnecessarily and for so long, and losing that time was so detrimental to so many areas of my life.

Loreena wrote:

hyperlexis wrote: . . . Actually, to most Americans, a basic CPAP brick and a simple nasal mask is probably pretty darned acceptible. . . .

I walked around for months feeling terrible after I was given a brick by the sleep center, and had no idea they titrated me wrong or what my AHI was on the brick, or that the brick didn't have data! I thought once I took the brick to the sleep doctor he would be able to print out the data and tell me how it was controlling the apnea. When I was diagnosed I knew nothing about SA, nor did I know anyone who had it. In fact, at the time I could not work, and walked incessantly on the nearby bike trail because I thought it was just a matter of time until the "cpap therapy" would start "working," and walking was the only thing I could do to keep mentally sane because I was in so much pain. I've read similar stories on this forum. A brick cpap is terrible and it should be against the law to distribute them anymore. I suffered so unnecessarily and for so long, and losing that time was so detrimental to so many areas of my life.[/quote]

I hear you Loreena. Eight years ago, they titrated and prescribed me the wrong pressure, too. If I had had a "brick", I'd have been suffering with horrible therapy.
Fortunately, I had been reading this forum and had browsed the Internet and found out what machines had which features. Then, after I had my sleep study and got my prescription, Becky Polk at CPAP(dot)COM steered me to a good data-capable machine.

I have long said that the manufacturers would be way ahead if they would only make ONE CPAP machine (the APAP). Each of them have too many models and by eliminating the "bricks", they would save money in the long run. If some people don't want to read their data......fine......that's their prerogative. But, for those who do and for the doctors who WILL look at it, it would be there.

Den

.

Wulfman... wrote:

Loreena wrote:

hyperlexis wrote: . . . Actually, to most Americans, a basic CPAP brick and a simple nasal mask is probably pretty darned acceptible. . . .

I walked around for months feeling terrible after I was given a brick by the sleep center, and had no idea they titrated me wrong or what my AHI was on the brick, or that the brick didn't have data! I thought once I took the brick to the sleep doctor he would be able to print out the data and tell me how it was controlling the apnea. When I was diagnosed I knew nothing about SA, nor did I know anyone who had it. In fact, at the time I could not work, and walked incessantly on the nearby bike trail because I thought it was just a matter of time until the "cpap therapy" would start "working," and walking was the only thing I could do to keep mentally sane because I was in so much pain. I've read similar stories on this forum. A brick cpap is terrible and it should be against the law to distribute them anymore. I suffered so unnecessarily and for so long, and losing that time was so detrimental to so many areas of my life.

I hear you Loreena. Eight years ago, they titrated and prescribed me the wrong pressure, too. If I had had a "brick", I'd have been suffering with horrible therapy.
Fortunately, I had been reading this forum and had browsed the Internet and found out what machines had which features. Then, after I had my sleep study and got my prescription, Becky Polk at CPAP(dot)COM steered me to a good data-capable machine.

I have long said that the manufacturers would be way ahead if they would only make ONE CPAP machine (the APAP). Each of them have too many models and by eliminating the "bricks", they would save money in the long run. If some people don't want to read their data......fine......that's their prerogative. But, for those who do and for the doctors who WILL look at it, it would be there.

Den

.[/quote]


Same thing happened to me. I wonder what percentage of tested people this happens to. I didn't find out what the problem was until I got an APAP with full data and checked it myself.