Comment

Comment by Judy on March 21, 2009 at 5:14pm

We all have our own opinions on this - but - my experience has been that the only consistent "heroes" in the America sleep apnea field are the MANUFACTURERS and the RPSGTs. The sleep doctors and local DME RTs are a mixed bag - and overall at the low end of the scale.

Comment by James Moriarty on February 9, 2009 at 10:01pm

quattromask1.jpgThe ResMed brand is what is selling. It is not the fact that these products are different or offer the patient improved results. Here is a quick example. Headgear made of a material called "breathe-o-pene", costs anywhere from 45.00 - 60.00 for this to apply to the Quattro. Yet, It is a known fact that this headgear causes the mask to ride up/down, slide side-to-side, leak, and give the patient neck & shoulder soreness. Another issue is oils interacting with neoprene that slacken the material. People will pay for the headgear, the mask, because of "branding". Since it costs more it must be better is a common conclusion.
That is the problem, the oliogopoly of a few companies, ResMed, Respironics, Fisher Paykel, dominating the market and squelching any innovative product that competes. In essence, they do not practice improving the product(s) for the patient. Observation: ResMed is more concerned with business than clinical improvement or evidenced based medicine. Tell me that Fisher Paykel did not provide Covidien (Puritan Bennett) money to include the heated humidication software on the PB 840. Tell me that Ventilator Associated Pneumonia is really prevented by using Hi-Lo evac tubes, if the patient should have had a sedation vacation and extubated 3 days ago. Conspiracy Theory? Increase the time on the vent so that additional charges can be made off the insured? Therefore, increase the product cost, above what CMS reimburses.
The patient or hospital will purchase the equipment based on the efficacy? Doubtful. The humor lies in the propaganda, not the truth.

Comment by Henning on February 6, 2009 at 3:18pm

That is what every company does.

They develop new models, and in many cases it is only a few changes from previous models.

If they don’t, they will lose market share. So here it is fine with for example DME's who can take a position on
whether the new models are worth the money.

Henning

Comment by The SleepGuide Crew on February 6, 2009 at 2:21pm

this is what my fear/ concern was --- that the manufacturers will bring new products to market willy nilly kind of like software makers who have committed to rolling out a so-called "upgrade" every year.... to get a sense of what i mean, do a search on the amazon.com reviews of Intuit's QuickBooks 2009 vs. 2008. it's a telling commentary on this phenomenon. . .

Comment by Daniel on February 6, 2009 at 2:14pm

Getting back to the original topic of this discussion, we must remember that ResMed, Respironics, F&P, Covidien, and the others are all in competition with each other for market share. Sometimes they put new products on the market because they have new innovations. Sometimes they have a new product because they need to have a new product. And sometimes, the new product doesn't represent any new innovation therapeurically, but is actually an innovation in manufacturing which produces a cost reduction for them and therefore a greater profit margin.

As the end users of this equipment, we have to be careful not to leap at the newest mask simply because it is new. Compare it to that company's prior mask of that type. For example, The ResMed Quattro Full Face Mask was called the Quattro because it was their fourth generation Full Face Mask. It has a tremendous number of improvements over their prior mask, the Ultra Mirage FFM.

On the other hand, if any of you out there remember, ResMed's first nasal pillow mask, the Swift, was replaced about 2 years later with the Swift II. The Swift was a very successful and innovative mask which dominated the market (and boosted ResMed's stock price significantly). In the next year, competitors came out with the Opus and the OptiLife, which are nasal pillow masks that started to eat into ResMed's market share. ResMed had to do something, so they came out with the Swift II. The only difference was moving from six exhalation holes to a bunch of tiny ones (now quieter!) and changing the color of the end cap from clear to blue so that you are less likely to lose it in the sink. No earthshattering changes, to say the least. The more recent Swift LT does make significant design changes, but the Swift II still has its fans.

Sometimes, I look at a new mask and I can see the only change is a reduction in the number of parts, or moving to parts that are identical to other mask parts in that manufacturers product line. These types of changes are simply to reduce their costs and maximize profits.

In summary, Caveat Emptor, Let the Buyer Beware.

Comment by Judy on February 6, 2009 at 1:52pm

Art Hyde, which CPAP machine do you have? It sounds like it offers the Ramp feature and that you no longer need or want the Ramp feature turned on. There aren't that many xPAPs capable of providing 22 cms of pressure for sustained periods so you much have a high end xPAP.

Comment by Judy on February 6, 2009 at 1:50pm

Henning, in the USA doctors now bill in time increments, and they insist on an extensive initial office call that entails a 45 minute or more billing. Plus they only "allow" so many of these time consuming "office calls" a month meaning a 3,3 or even 4 months or more wait for that "initial office call". "Doctor shopping" can be cost prohibitive. I know, I went thru it twice. I had two family doctors die on me. Specialists charge even more for office calls. The last one after they started this "time increment" billing. And I'd had some previous "doctor shopping" experience BEFORE they started the "time increment" billing to help me reduce a lot of needless initial visits. Doctors seldom take kindly to being "interviewed" preferring to be the ones to decide who will or won't be their patient.

Art Hyde, cpap.com sells mask cushions and parts if your mask if of a type that allows for cushion replacement but they don't take insurance altho they do provide the necessary HCPCS codes for each item on the invoice. You could check to see if your insurance will reimburse you for out of network necessary and covered purchases. My first DME supplier didn't carry replacement cushions and tried to tell me that you couldn't buy just the cushion. When I proved otherwise to them they fell back on your insurance (Medicare) won't pay for them. Until I provided proof of Medicare's reimbursement policy and frequency schedule. THEN it took them 3 weeks to order them for me to pick up. Needless to say I dumped them as my local DME supplier and found another more accomodating one as soon as was possible.

Comment by Art Hyde on February 6, 2009 at 12:27pm

I am brand spanking new to this forum, but I do appreciate some of the comments I have already read. I have had some good medical treatment and insurance coverage for my sleep apnea problem. I is very severe and my problem is often staying ahead of curbing the face mask leaks that I have. It has always shocked me how when my mask become torn from use that my insurance replaces the whole mask and not just the snap-in facial cushion. I have tried to find places where I can find these cushions at a reasonable price - eBay, etc. but haven't been able to do so. Perhaps someone can help me with this search. It is even more important now, since I have lost my job and no longer have this insurance. I am a disabled veteran and do know I can get help from the VA to get a new mask every 9 months vs the 6 months I had with my insurance. I have Ultra MIrage medium sized mask. My machine is set at 22 and takes at least 5 minutes before I find a comfortable breathing rhythm.

Comment by Henning on February 6, 2009 at 11:24am

Hi Judy,

You've apparently had some bad experiences with doctors and associated personnel.

I think that we as patients must recognize that we are customers, and therefore must learn to explore the doctors before we choose who we want to be treated by.

We do this in advance when we deal with private companies, and I do not really see the big difference. There are also many companies that provide a poor service.

If everyone did this it would also change the medical profession to look at patients as clients.

So in reality I think we as patients are the ones who must change the system.

Henning

Comment by Judy on February 6, 2009 at 10:54am

I see the day when the medical profession wises up and treats xPAP therapy like diabetes treatment and allow their patients access to their therapy data and accept a patient adjusting their therapy accordingly w/supervision and advice from the sleep doctor as needed.

On the other hand, I asked on cpaptalk what training and education about managing their diabetes those diabetics in the forum got and was AMAZED. It would appear that diabetes management education and training by the medical profession isn't one heck of a whole lot better than what apneans are getting for their xPAP therapy!!!! That absolutely boggled my mind!! THAT is SCAREY if you're diabetic!

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