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Mary Z posted a discussion

Sleep apnea increases risk of osteoporosis

Sleep apnea/osteoporosis study finds “increased” health riskA recently published study may have found a connection between obstructive sleep apnea (OSA) and osteoporosis, marking yet another health…See More
Saturday
Mary Z replied to ZolliStar's discussion Non-invasion approach that can relieve mild sleep apnea
"Hi ZolliStar, I've heard before that speech therapy, or singing lessons can help sleep apnea.  The problem at that time was there was no way to determine which exercises help.  Getting research done, rather than anecdotal would be…"
Jul 28
ZolliStar posted a discussion

Non-invasion approach that can relieve mild sleep apnea

Some people report that singing -- singing! -- really helps their sleep apnea. Dr. Stephen Park said that myology (which are exercises to strengthen muscles around the inside of one's mouth area) helps some. I think singing would be better.  If you read all the FAQs on this (click below), I think you'll agree that it makes sense for some. Maybe you.http://www.singingforsnorers.com/index.htmSee More
Jul 28
ZolliStar posted a discussion
Jul 20
liz4cps commented on liz4cps's group Prince William Co, VA support group
"I talked to Kimberlie at the Novant Sleep lab last week (at Prince William Hospital) and she said they would not be holding any meetings this year but are planning to start holding meetings again next year.  I'll let you know when we have…"
Jul 14
richard graham posted a status
"I just have mask called the Wisp. Hope it works. Anybody have experience with it. I have an ultra mirage nasal mask and get leaks at brid"
Jul 9
Andy posted a discussion

Resmed S8 AutoSet II - No Longer Collecting Data??

Hi All,First off, my apologies for not checking in for a long time.I've been using my Resmed S8 AutoSet II for almost 3 years! I feel great, have lost almost 30 lbs, am no longer sleepy during the day, sleep through the night, and have my short-term memory back.Yay!I've told my doctors that I'm the "poster child" for Sleep Apnea and CPAPs! It's been, and continues to be, such an amazing experience that I want everyone to know!Everything has been going well in CPAP-land, but in the last few…See More
Jul 7
hifay replied to richard graham's discussion mouth breathing
"What type of chin straps?"
Jul 6
Ginny Edmundson replied to Ginny Edmundson's discussion Scheduled for evaluation and possible procedure next day
"No real improvement in sleep study.  Just not having to use cervical neck color.  What a bummer. Surgeon wants another sleep study in about a month or so (home one) Not sure if will do or not. "
Jun 22
Mary Z replied to Ginny Edmundson's discussion Scheduled for evaluation and possible procedure next day
"Ginny, how are you doing after the tongue procedure?"
Jun 22
Mary Z posted a discussion

AHI finally under five.

I have been on CPAP since March 2008 and had a good AHI when I started therapy (under 5).Then my AHI started getting worse- for a while it stayed in the 20's, then we got it to the high teens.  Nothing we did would help.  My doctor said it was due to the meds I take.  For a couple of years I just tolerated the high AHI.  I did another sleep study and changed to an ASV machine.  For two years I still had a AHI around 11-13.  Then all of a sudden - a month ago I noticed my AHI was running five or…See More
Jun 22
ZolliStar replied to richard graham's discussion mouth breathing
"FWIW, I've been alternating between my mouth device and my APAP. I haven't used humidity at all when I use the APAP -- and don't miss it, either. "
Jun 14
richard graham replied to richard graham's discussion mouth breathing
"I still use humidity but less of it. It seems to be working OK.."
Jun 14
ZolliStar replied to richard graham's discussion mouth breathing
"I rarely use the humidifier. I think it's less necessary during the summer when there is humidity.   I also switch between my mouth device and the APAP.  I like each for different reasons. Not sure with which I sleep better, though.…"
May 21
Mary Z replied to richard graham's discussion sick again
"I've been doing well.  I think you were going to try the cpap without humidity- did that help at all?  I haven't had a cold for a couple of years."
May 14
Ginny Edmundson replied to richard graham's discussion sick again
"CPAP seems to cause stuffiness in many of us.  ANother reason I hate it so much!Do you rinse your nose with saline once a day…maybe before you go to bed for the night? "
May 5
richard graham replied to richard graham's discussion sick again
"I do wake up stuffed up most days"
May 5
richard graham replied to richard graham's discussion sick again
"I do have non allergic rhinitis. Now I'm thinking that's probably it because I only feel that way for a day or 2. Thank you"
May 4
Ginny Edmundson replied to richard graham's discussion sick again
"I have been lucky.  Not one cold past three years. Could some of your problem be allergies?"
May 4
richard graham posted a discussion

sick again

It seems like I am sick with colds more often when I'm on the CPAP. Anybody experience that.
Apr 30
unsolicited correspondence sent to SleepGuide:

Please see the attached correspondence which I sent to ResMed corporate and internet enforcement employees.

"I would also like to get your opinion on ResMed's tactic of having employees pose as customers in an attempt to entrap us into a violation. I am leaning towards simply refusing to issue a refund to anyone who we identify as a ResMed employee or contractor who places an order on my website.

They are using a service known as "NetEnforcer" to police the various websites, with a significant amount of success. As of last Friday, I know of six websites which have had their accounts suspended by ResMed for infractions such as violating the prescription requirement for interfaces. 

If I am able to enlist [other internet retailers], do you think we would have the financial means to face a multi-billion dollar corporation?

I understand that ResMed is not acting illegally per se, but this entire issue goes much deeper than selective enforcement of a prescription policy. 


I have reams of data I have saved from corresponding with Respironics while implementing their MAP policy. There are so many violations that I would need a full day just to piece it all together. The most flagrant, and most frequent, legal issue is multiple "warning" emails; from my understanding, a manufacturer may implement a MAP policy, but cannot legally coach a distributor when a violation of said MAP policy occurs. Cut them off, with no second chances.


There is also collusion between the manufacturers. Of course, no record exists to prove this, but at a large national meeting in 2006 all of the players (ResMed, Respironics, PB, Fisher & Paykel) met, and the next thing you know, MAP policies were born. ResMed implemented an extremely aggressive policy, and attempted to publicly humiliate the other manufacturers into getting on board when they realized they were alone in their stance. Shortly thereafter, Respironics and F & P implemented very aggressive policies as well.


Respironics and F & P have softened somewhat, allowing websites to use coupon codes for discounts. ResMed actually did a 180, allowing us to use the 2-click method to convey lower pricing. Then in March of this year, ResMed implemented their current policy. The current policy, as you know, disallows any discount of any type if the transaction was initiated via the internet. No telephone discounts are allowed, even if the transaction is consummated by running the customer's credit card through my DME.


The most irksome part of this policy is that it only applies to internet retailers. I am free to sell their product at any price I choose through my bricks and mortar location. This is not a MAP policy, it is selective targeting of a distribution channel of which ResMed does not approve. I am certain that their legal team researched this thoroughly, and am not under the illusion that any internet reseller is willing to face them in court.


The irony is that ResMed has created a massive gray market, as the vendors they cut off simply turn to alternate channels to acquire their products.


> Good morning,

>

> I operate a HME, as well as a website on which we

> sell ResMed products.

>

> During the past one to two week period, we have identified numerous ResMed

> employees posing as potential customers in an attempt to entrap us into

> violating your company's MIRP policy. Specifically, attempts to purchase

> interfaces without a valid prescription.

>

> Please cease these attempts, as it is a tremendous waste of my employee's

> time. We will not sell your products without a prescription, as should be

> evident at this point.

>

> Selective enforcement of a "Prescription Required" policy is an extremely

> poor business model. Without exception, every local HME provider I

> questioned regarding a prescription stated that they do not require a

> prescription from a customer in which Medicare or a third party insurance is

> not involved.

>

> While I understand your corporate policy requiring a prescription, the

> complete lack of oversight from ResMed regarding traditional HME operations

> is unquestionably "selective enforcement".

>

> Your corporate policies related to internet retailers is disturbing,

> especially when you consider that the majority of internet retailers are

> backed by extremely large HME operations which purchase a tremendous volume

> of your products.

>

> We are your customer, we do not need you to police our business.

>

> Again, please cease and desist your attempts to entrap my company in a

> violation of the MIRP.

>

> I do not have the time or resources to continue interacting with "customers"

> who have no intention of actually making a purchase from my company.

>

> Thank you."

Tags: ResMed, allegations, collusion

Views: 364

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Replies to This Discussion

What is this about, exactly? Being sure a customer has a prescription, or the discounted prices available on some items from Internet Retailers. It seems ResMed should make better use of their time. They no longer answer my emails when I make a request that they upgrade or improve on a mask, or when I told them they really missed the boat in not offering a Total Face Mask. They didn't even answer my email when I enquired about them not answering emails. It seems this energy spent on entrapment could be put to better use- first in responding to and second in meeting all their customers needs whether end users or Equipment providers. I think I'll email them yet again.
I have to say it is so refreshing to read what i have just read. They have tried the same thing with my business. "They are so obvious and so bad at it." I just mess with them so anything they thing they have found is nothing because we knew it was them...... What is so frustrating is I love ResMed's products if I didn't things would be differen't. I'll tell you one thing with their MIRP pricing. They legally cannot tell you that you cannot sell their product for whatever you feel like. If someone asks you for a special price on the phone or they email you. They have absolute no legal ground and my understanding is some of the big dawgs out there are battleing them in court right now. It is not much of a free market when you have a vendor dictating the price you can sell their product for. I understand the MAP but to say that you can't in conversation provide your customer with a discount is completly wrong and unconstitutional! Sorry it makes me mad.
I encourage you to file a complaint with Department of Justice, Antitrust Division, http://www.justice.gov/atr/contact/newcase.htm#document . The link is for the Citizen Complaint Center and they have a history of accepting complaints from small businesses. If they refuse your complaint, make a consultation with a local lawyer who handles Federal and State cases. You can likely find a lawyer who will conduct an initial consultation with no fee. If you decide to mover forward with a lawyer, make sure you have an exact understanding of his fee structure.

You should file the same complaint with your State Attorney General's office. Some state AGs have been very aggressive and successful in defending the rights of small businesses in their states.

CPAP patients can protect their interests by choosing to vote with their dollars - don't buy products from manufacturers who are trying to crush the internet market.

Mike, Thank you for posting this information.
Greetings to all of you on SleepGuide.

This is my first post, and it is simply to step up and take the, umm, blame for the above post by Mike.

I contacted Mike yesterday, in an attempt to bring to light the myriad issues currently swirling around the world of sleep equipment and treatment of OSA.
Mary Z, Mark, and Rooster, I agree completely with your comments. Mark actually inspired me to use my real name when I registered. I am not doing anything wrong, so why fear reprisal from ResMed?
To answer the question posed by Mary Z, this is about money. Period. Claims of quality patient care being the core issue are simply false. As I am sure Mark can tell you, the vast majority of people who purchase OSA treatment devices online either have no insurance, or have deductibles which are astronomical. Or they get lousy service from their local HME providers.
ResMed actually operates a drop-ship program for HME companies. Same as ordering from the internet, right? Not to their way of thinking. It has more to do with control of the supply chain. This is a legitimate concern, as product that is intended for the U.S. market occasionally ends up in Singapore or China, or elsewhere in the world. I do not take issue with this section of their policy, as all of the manufacturers have such policies in place. The issue at hand is pricing; ResMed wishes to position themselves as the premium manufacturer of sleep equipment. Insurance reimbursement is another factor, as insurers have lowered the amount they are willing to pay for equipment due to the transparency of internet pricing.
I like Rooster's position of voting with your dollars. Patients (customers, clients, whatever your preferred term) have every right to utilize their healthcare dollars to get the maximum benefit at the lowest cost.
Mark is dead-on with his assessment of the quality of ResMed's products. The interfaces they produce are the best available. Luckily, in my city, Respironics' machines dominate the market thoroughly.
My wish is simply to conduct my business as I see fit, without interference from the manufacturers. Once I purchase an item, I own it; I should be able to sell it at any price I choose.
Online retailers of sleep products are doing a great service to the people who need it most, the uninsured or under-insured.
Sorry for the long post, this issue should not even be an issue.
This is price fixing, pure and simple. America used to pride herself on being a free market economy and we had laws with teeth against this type of criminal activity. Oooops. Not criminal any longer since the big oil companies decided that fixing prices at the pumps was a good idea for lining pockets.

Frankly, I would take the whole business underground, but then they can find you the first time a machine comes in for repair with a receipt, by serial number.

What we did in the cellphone industry was simple. We picked a manufacturer that was doing this and simply boycotted them to hell and back for a month. The message got through REAL fast when their shareholders started asking questions and their bottom lines started plummeting.

Remember too that the best defense is a good offense and a few well-placed calls to people like The Wall Street Journal and others, especially those that do not take revenue from ResMed, can generate a pile of bad PR.

I, for one, would have no problem boycotting ResMed for six months to make a point. They should not be concerned about where their revenue is coming from and should keep their noses out of a free market economy. And Obama, instead of ratchet-jawing about everything he is going to do and screw up, needs to get the hell off his keester and get those laws against price fixing back on the books. There's no work to be done... all they have to do is dig them up and run them through congress. Oooops. I almost forgot. They're on the payroll too. Geez. What did my family fight and die for all these years? Oh. Now I remember. The right to have BP oil screw up our economy and the world in general while the boss goes sailing. Yeh. That's the ticket.

I have seen this happen in the retail music equipment industry.  I asked a guy who has a really great product that he sells both direct and to music stores, why he wasn't in Guitar Center.  He simply stated that there are a lot of rules you have to abide by when you sell to a giant and one of them is to allow Guitar Center to blow out your product at below cost to clear it. He tells me that it causes problems for the dealers and his direct sales markets. He told me that he had a good solution to this by taking some of the designs that were sound but did not make it into the main product catalog and branding them for sale in the big box stores. Making them just different enough to differentiate. He could satisfy all sectors of his business with this model.  He has not implemented it yet to see just how well it would work, but I found it to be an interesting solution to his situation. Perhaps something like that would work with the Internet and allow the online dealers to do what they please with the gear they buy from Resmed or who ever they buy from. To fix these issues other than just changing their policy, they could be innovative and actually profit from the online sector in a way that would make everyone happy. That is the outcome they should be looking at, not to put all the Internet dealers out of business for having to compete with others in the free markets. I feel that Resmed's policies are are not solving anything, they are just making everyone angry at them and not wanting to buy or sell their products because of this. Why not turn this into an opportunity to become well established on the Internet and look like a good guy, instead of looking like the #2 heads that they now appear to be?

 

TJ Nugent

Lowly Sleep Tech

Guitars do not have to go through the nasty, innovation-killing, price-increasing, FDA approval process.

This may be true, but I still think these companies would grow sales by embarrassing Internet sales. My idea is just a brainstorm, and not the entire solution. But, It has to start somewhere. 

 

TJ

Banyon and TJ both make interesting points. It is somewhat apples to oranges, but just in the sense that the products are worlds apart in terms of necessity vs. an enjoyable pastime. 

I may be a simpleton, and I do acknowledge the gray areas which the manufacturers face, but I stand by my original statements from June of 2010. It is a financial issue for the manufacturers, whether it be guitars, medical equipment, Bose electronics (or Apple for you Cupertino fans). The manufacturers feel a strong sense of responsibility to their primary vendors, and MUST support them. Or at least pretend to support them, haha! In reality, when the internet is generating 20-30% of their sales, they will change course. The traditional HME providers are being squeezed from every angle. 

Many of you have likely experienced a local provider who tries to dump a low-end CPAP or BiLevel on you. An uninformed consumer (which is most of them), does not know to demand a full data capable unit when they receive their equipment. Insurance companies do not care if it is a low end unit (think ZzzPAP - a fine unit BTW), or a ResMed S9 Auto with Climate Control, a Philips DS550, a Fisher & Paykel ICON Auto, or anything in between.

As an advocate for patients/clients/customers, I feel it is incumbent on me to provide the client with the interface and PAP unit which will give them the greatest opportunity to successfully treat their OSA and keep them compliant. 

That was a bit off-topic, but I'm not fully awake yet.

 

Back to ResMed: they have become much more helpful with respect to internet providers, in such ways as providing high-res images prior to a new product release. It appears they have also stopped using Net Enforcer to dupe websites into selling below MIRP or selling a piece of silicone without a prescription. They are using a different approach to track sales, which is to serialize nearly every mask they sell. If you have purchased a ResMed mask in the last six months, look on the package insert. See that third UPC code? That code is specific to each interface, essentially allowing them to trace the original purchaser of said interface.

Seems to be a lot of trouble to catch the felonious violators, but hey, this is ResMed. Best interfaces out there, and they know it. Blowers, maybe, maybe not. Plenty of great choices in blowers. A quick look at CPAPdotcom's Consumer Preference trends tell the story. All of the big dogs are getting their butts waxed by DeVilbiss and ProBasics in the standard CPAP and Auto CPAP categories. I'm no psychic, but I did predict exactly this scenario about three years ago. But I'm sure Johnny Goodman, et al knew exactly the same thing would occur, just took some time for consumers to grow weary of jumping through coupon codes just to get to the actual selling price.

You guys are great, thanks for reading another tirade!

Best,

Frank

Our business has grown so much starting last spring that neither my brother nor I have kept up with the forums and what is going on with the CPAP market, new machines, masks, etc.

But this is music to my ears:

All of the big dogs are getting their butts waxed by DeVilbiss and ProBasics in the standard CPAP and Auto CPAP categories.

Nothing like competition to drive down the prices, drive up the quality, and increase the selection.

I also found this comment interesting:

Without exception, every local HME provider I

> questioned regarding a prescription stated that they do not require a

> prescription from a customer in which Medicare or a third party insurance is

> not involved.

A few of us (hopefully many of us?) have been saying for a long time that the FDA needs to declare machines OTC. That would drive the prices down and also allow a robust used market to develop in places like eBay.

 

I know the market for good machines is there -- yet, due to the FDA, many have to jump through hoops to get their machines -- especially if they do not have insurance and can't afford retail prices.  It is nuts that one can go into a pharmacy such as Wal-Mart and buy asprin or other OTC drugs in large quantities that can do more harm to you than a machine that blows air.  I can buy a bottle of 300 generic Zyrtec from Walgreens that if I swallow the whole bottle is going to play havoc with my body -- or a bottle of 500 aspirin or other OTC pain killer that can lead to overdose and possibly death --

Yet have to jump through all the legal mumbo jumbo to get a cpap mask.

SleepyCarol.  Very good point you make. Political correctness is ruining our country. It is all about control.  A good friend of mine has been on bipap for years and his mask broke.  He called his local DME to get replacement and they told him he needed an Rx to even buy one for cash. He then calls his sleep doctor and tells them that his only mask has broken and that he needs and Rx to get a new one. They tell him that he needs to see the doctor and that the doctor is on vacation and will be back in 2 weeks. They tell him, that since he hasn't seen the doctor that he has see him before he can get a prescription and then tells him the first available appointment is 1 month away.  They leave him no options. Luckily he called me while I was working at CPAP.com because I sold him a mask.  This is before the manufacturers started cracking down on prescriptions.  The manufacturers are trying to stroke the doctors by driving business back to them to run up fees. The say it is all about improving the level of patient care. What they are really doing is cow-towing to doctors to get their brands pushed.  It is a I'll scratch your back if you scratch mine. It becomes the standard because of political correctness. People making decisions for themselves is no longer good. I made sure my friend got a mask.  I wasn't about to make him wait a month without his machine. In that situation money corrupts the system. It isn't about the patient, it is about the dollars. It is enough to make people hate this type of therapy and make it so complicated that it lowers compliance.  We should be helping people. If we do that, we will be rewarded. That is the American way. I am sorry, but this just steams me. 

 

TJ

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