DME and Sleep Centers: Food for Thought

Many of you live in an area that makes this suggestion impractical.... but I offer it for those who may find it useful in the current Medicare-DME crunch.

First, some background: I live in Rochester MN which many of you know is home to Mayo Clinic - Rochester. We have some of the national DME chains here; Apria, Lincare, and American Home that I know of. There is an apnea supplies store within the Clinic that is run by the Clinic. Mayo is also home to the only sleep center in the county, so that is where I get all of my sleep center needs and most xpap supplies. As a not-for-profit entity, any profit the Clinic makes goes toward medical education and research, even in the medical supply stores. Mayo does accept many insurances, as well as Medicare. If it is not in-network, many insurances will cover if you are referred to them by your in-network doc.

I'm not suggesting that you all come here to Rochester (not today anyway, it's darn cold outside), but I do think that every state has at least one large clinic or university hospital with a sleep center. If you call any university or teaching clinic/hospital you could find out if they have an apnea supply store or if they provide their patients with a list of suppliers. Mayo gave me a list of suppliers in the area at the time xpap was recommended, but I chose to use theirs, knowing that if there was a profit from my business it would be going for education and research instead of as a kickback for somebody's pocket. Most of the time, I believe, the larger, well-known hospitals and clinics, especially the teaching hospitals.

I have a different take on it.

It's great that you have the convenience and that you obviously trust the clinic. And the non-profit aspect works for you in this case.

But we have seen too many people here who feel OBLIGATED to use the DME associated with their sleep clinic. Often they just think it's part of the package and don't realize that they have a right (in most cases) to go elsewhere, sometimes they simply appreciate the convenience. Rarely do they look beyond what they are told, UNLESS something goes wrong. . .

But IMHO, there's an inherent conflict of interest when a DME and sleep clinic are connected. EVEN in a non-profit venue, there's a duty to maximize dollars for the benefit of the organization. More so, of course, when there is a profit motive. Everyone has to be aware of the bottom line. But a sleep center that is not in business with the DME doesn't have to watch the DME's bottom line, too. The sleep center is motivated then to prescribe equipment that they thing will optimize your therapy and make them look good as having quality skills at titrating and prescribing the best equipment for you.

The DME wants to give you the least expensive equipment possible to maximize their profit margin (yes, even non-profit enterprises). When the sleep clinic is connected to the DME, then the sleep clinic's mission also becomes to give you the least expensive equipment for the good of their company. Efficacy data on board a standard CPAP reduces the profit margin. And the sleep clinic or the DME may be able to squeeze some additional profit by renting you an APAP or oximeter for occasional testing if you are having a problem, since your dataless brick can't help. An APAP over a CPAP further cuts into the profit margin. And a fully data capable APAP (ResMed Autoset vs. Auto Escape, for example) even more cuts to that profit margin. So if the sleep center is involved in writing the prescription, they are going to have extra motivation to prescribe for you the compliance data only CPAP rather than the fully data capable APAP. They may want you to have the cheaper, standard mask instead of a more expensive mask that makes you more comfortable. Their interest has become their bottom line, not your benefit.

Some people are lucky to stumble on to a good clinic, that puts the needs of its patients over profits, but from what we've seen posted here, I'd say that is the exception, rather than the rule. In some states, it's ILLEGAL for sleep clinics to be under the same ownership as a DME, and for good reason.

Sleep clinics get paid a lot of money to do the testing and prescribing. I don't want them to stand with their hands out throughout my treatment as well.

You make some good points, and I have seen here that there is a lot of dissatisfaction with the DMEs... and I can understand it, with the prices, the medicare restrictions, etc. In a large medical center setting such as Mayo Clinic, there is a collective group practice where every employee in every department is on salary, with no monetary incentives at any level to try to make a buck, and that is why I chose to use them. It's hard to feel obligated to use them just because they're on the campus... they give you a 1-page list of the DMEs in the area, give you the choice... I have some friends who use outside DMEs just avoid the hassle of going downtown and finding a place to park... they are both somewhat disgusted by the service they get from the place, however.

library lady wrote: In a large medical center setting such as Mayo Clinic, there is a collective group practice where every employee in every department is on salary, with no monetary incentives at any level to try to make a buck, and that is why I chose to use them.

Sorry, but I must disagree with this statement. I worked 15 years for a not-for-profit hospital conglomerate. I worked in several different departments and had money incentives in all but two. I would bet there is a sales 'incentive' in the disguise of a bonus, or an actual out right quota. Every employee where I worked was on salary (except volunteers and I won't get on that soapbox here) but incentives are used to increase sales, productivity and especially in fund raising. And that money you think is going back into the organization may be funding frivolous niceties such as ornamental fountains, sculptures, employee parties and physician activities. It always pays to ASK where money you spend at a not-for-profit goes. Ask for a copy of the organizations most recent annual report, its a bit heavy reading, but also enlightening.

Jen

I get my equipment and supplies from my sleep center. They sold me a full data machine and not a brick that would make them the most money. They also have about 30 different masks all hanging on the wall and seem willing to give patients any mask they want versus trying to give patients the one they make the most money on. They even ordered me a mask they didn't have in stock with no issues.

The sleep center is a private for profit operation, but the doctors who work there are part of a much larger non-profit medical organization. I have no idea if the doctors get a kickback on equipment sales or not.

You are right, Jen, Mayo Clinic's money is going back into the organization in many ways, and I cannot deny what you say, but I do know that the profit from the various medical supply stores goes directly into research and education, also that prices in those stores are sometimes higher than at Apria or the other DMEs in the city. They are also extremely fair in their treatment of the people who patronize the stores, at least from what I have observed. I have seen the financial reports, and my father and other relatives have worked there for many years.

I work in a grocery store at an hourly wage. I do not get any bonuses for better sales.

BUT! We do get mystery shoppers who check our service and also note whether we offer a selling suggestion or not. And we can get in trouble for not doing so. Also, hours are better when sales are better, and morale is down when sales and hours are down. Even if my own hours are safe, my job is easier when there is more help. So, good sales are always good for employees, even if they don't get more money out of it.

library lady wrote:You are right, Jen, Mayo Clinic's money is going back into the organization in many ways, and I cannot deny what you say, but I do know that the profit from the various medical supply stores goes directly into research and education, also that prices in those stores are sometimes higher than at Apria or the other DMEs in the city. They are also extremely fair in their treatment of the people who patronize the stores, at least from what I have observed. I have seen the financial reports, and my father and other relatives have worked there for many years.

If you read their financial report, then I stand corrected. I have learned something here, apparently not all not-for-profits operate as the one I worked for did. I do know Mayo Clinic is one of the premier healthcare centers in the US, so apparently they are fiscally responsible, more so than Norton, where I worked. Thanks for correcting my outlook.

Jen

It always pays to ASK where money you spend at a not-for-profit goes.

Yes, that "not-for-profit" label fools a lot of people.

In the two-county area where I live, the local press finally got to looking into the two major not-for-profit hospitals. What they are finding out is executive pay and pay for doctors heading departments is way higher than in comparable cities.

They are also finding repeated cases of outsourcing contractors with fat contracts who are relatives of board members.

The local county governments want to start charging them property taxes and local business taxes. Everybody wants all they can get.

People that go to work for not-for-profits want salaries as high as they can get. No different than the rest of us.