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Kind of amazes me that you're having a 90-day followup visit with a DME? I wouldn't think of a DME as qualified to look at your data and help you in making adjustments to your therapy, or in giving useful answers to your questions about sleep problems. I'm not saying that only doctors can do this, but DME are essentially sales people in my experience. I really wouldn't expect this of even an HMO...With Medicare and Medicare Supplement insurance, I can get an HMO-oid experience here in River City by using the Santa Cruz Medical Clinic, which contains pretty much all the specialties that I might need. And the ones that they don't have, you can be referred to Stanford, etc. While I don't actually need to be referred to a specialist given my insurance, I treat it as a recommendation. When my PCP noticed that I might have sleep apnea, he referred me to a sleep doctor, and after that, all my sleep apnea stuff was done with the sleep doctor. I saw a DME to pick up equipment, and they were pretty much doing only that, distributing and demonstrating equipment. No therapy.

Sounds like what you're getting is really pretty backwards...can you ask for an appointment with the sleep doctor directly that your GP has been talking with? Pretty hokey to have to go through your GP to talk to a specialist, never hear of that being done around here. You go to the specialist after being referred, not to the guy that sells equipment.

I think that your instincts are good, and that you should pursue what you know is the right course.

Janknitz wrote:With Kaiser HMO I've never seen a sleep doc either. The sleep lab has Respiratory Therapists as techs, and they do all the testing, patient teaching, troubleshooting etc. Supposedly your testing data is run by the sleep doctor who puts his rubber stamp on things, but for run of the mill OSA, I'll bet a doughnut that the techs are the ones who decide on your settings and machine.

As a matter of fact, when I had difficulties and needed setting changes, I saw only the RT/techs and they made all the changes without stopping to ask anybody else's recommendations or permissions. It's probably illegal, but that's how it was done.

I'm not complaining because they do know what they are doing and did well enough by me. I don't have complex apnea, though. Kirasgram has a more complex issue and she's with Kaiser. I think she actually got to see the DOCTOR.

I'm not sure if it's within an RT's scope of practice in California to prescribe CPAP pressures and settings or not.

With my DME I only talk to the RT now. He's been great. I don't have a complex apnea (I think) and I pretty much let the machine and the RT do the work. I guess I could see a sleep specialist if I really wanted to but I haven't been so bad off that I have gone. If I had an HMO and really needed a sleep MD all you'd have to do is ask your primary care doctor for a referral slip to a sleep specialist and that's all. You just have to get a referral and the HMO should cover it. Not a big mystery. You just have to know how these things work in order to use them most effectively.

wow there appears to be a huge difference in DMEs the more I read and observe. With my DME, the rep is no more than a trained salesperson and has no certification as a respiratory tech of any kind. They wouldn't THINK of changing a patients pressure.With others, it seems like they are mini patient labs that do everything but diagnose. Is this a function of rural vs metro providers or what? I don't see that variation with other types of services. Its just crazy how different the DME's are.

Well...I feel that I made a little progress today!

I actually got to see an RT today who sat down with me and went over the past 92 days of my cpap therapy. I seems that I have improved. My average the first 30 days was around 5 and the past 60 days have been about 2.1. I mentioned that wasn't anything under 5 considered good? She said that she would prefer 1 or under. I must raise my bottom pressure to 8 for 2 weeks and then report my numbers. Then if any adjustments need to be made so be it. She also said this might help my afternoon tiredness as well

Overall, I felt pretty good about the visit! She gave me her email and promised she would answer it so as not to leave me hanging.

What are your thoughts? Is this correct about adjusting the bottom number higher?

As always...I am very appreciative of your thoughtful comments!

Well...the bottom pressure increase has certainly helped...Tuesday night ahi was 0.4. Last night was 0.5!

shhhhhh!! you'll jinx it!!

Great, much better. Glad that you finally connected with someone that could help you improve your therapy. Keep it up!

Just about all insurance companies now have, in some form, a medical policy that should explain the requirements needed by your Medical Doc.(PCP), Sleep lab, Sleep Doc., DME, then follow-ups. Each must maintain records showing COMPLIANCE with the CPAP. Private insurance companies, for the most part, use Medicare’s policy. These policies can be found on the insurance companies web site. From their web site look for medical policy on supplying CPAP. It’s a difficult process that the insurance companies can’t explain……..all because Medicare does it. Or call Ins Comp and ask for the policy number. This will tell you if a Doc has to see you, what the DME needs to do, etc..
OR, Google something like Medicare Policy for CPAP.

Medicare does not require a copy of your sleep test. They do require that the DME maintains in your file a copy of everything they state within the Medical Policy for CPAP.

oak wrote:shhhhhh!! you'll jinx it!!

Lol...I hope not...got lucky...last night was 0.3.

RogerSC wrote:Great, much better. Glad that you finally connected with someone that could help you improve your therapy. Keep it up!

Thanks, Roger! It is nice to feel that someone actually cares AND knows what they're talking about!

vic wrote:Medicare does not require a copy of your sleep test.

Medicare does in fact NOT require a copy of your Sleep Study (for them).

BUT, they do require that your Sleep Doctor have one (and if he is your Sleep Doctor, I am pretty sure he would have one anyway).

They also require that the DME have a copy of your Sleep Study.

That is because BOTH your Sleep Doctor AND the DME must confirm that your Sleep Study (no matter how old) meets the CURRENT requirements of Medicare for a Sleep Study.
That is a lot easier to do than it sounds.
I just helped someone go through that & their 15 year old Sleep Study met the CURRENT requirements of Medicare for a Sleep Study.
Of course, that Sleep Study was done by the Sleep Disorders department of a large regional Hospital.

Medicare does not require a copy of your sleep test. They do require that the DME maintains in your file a copy of everything they state within the Medical Policy for CPAP.

From my experience a handful of DMEs and sleep techs know more than some sleep doctors... on the other hand, some sleep doctors (and DMEs) seem to know a lot less than the more senior members of CPAPtalk. Just an observation and not one written in stone by any means. My so-so sleep doctor is fascinated by my Sleepyhead reports but just doesn't really take the time to understand them. He keeps asking how I know they are accurate, his standard reply. Guess I'll have to translate my SL reports into Encore or whatever so his brain doesn't explode.

OK...my 2 weeks of newly adjusted pressure has concluded...but there are some weird findings...

Since my bottom pressure was moved from 5 to 8, I decided to try the F&P Pilairo nasal pillows. Using the pillows my AHI numbers dropped from an average of 2.1ish to 0.5!!! I even had a night at 0.1!!! Here is the weird happening...I decided to use my nasal mask for 2 nights to try and mix it up so to speak and see what would happen. Those to nights I was at 4.0 and 3.8. I know the research would show that I need to use the nasal pillows...but what gives? Why is there such a difference? I will let you know what my RT says when I meet with her on Thursday to go over the data.

Well...just finished my visit with the RT. She is very please about the current numbers and wants me to continue for another 3 weeks to,see if I an get rid off the afternoon brick walls that I hit everyday.

I did complain to her that my Pilairo nasal pillows are awfully loud. And my wife complains of listening to me breath every night. She said that all pillows are loud. Is this true?