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Steven B. Ronsen updated their profile
Sep 15

U.S. Medical Professionals to CPAPers: "Do You Know Why You're Being Punished?"

The plot thickens. I learned from one of the comments on yesterday's blog that there is "a clash of wills between the medical profession & the rights of US CPAPers to actively get involved in our own monitoring & regulation." Moreover, in the U.S. it is against the law for manufacturers of CPAP devices to explain to people how to change the settings on their machine.

So the powers that be have decided that we CPAPers are too stupid and inept to analyze compliance data from the CPAP machines, and to get insights into how we may improve our treatment based on that analysis? Funny, because that's how I'd characterize a lot of the doctors, DMEs and other clinicians charged with making those decisions for us.

At least we CPAPers have incentives to scrutinize the data -- our lives depend on it. There are no incentives in place, however, for doctors, DMEs and other clinicians to do the same: insurers don't reimburse them a dime more if they get our treatment right than if they get it wrong. As long as the machine is blowing for >4 hours a night most nights, their work is done.

How could this be? Why are CPAPers being punished?

The model needs to shift from a top down approach, where the doctor/clinician controls all the information, to a bottom up approach, where the patient has access to all the information about his/her therapy, and can work together with the doctor/clinician to improve therapy. Am I missing something? Why wouldn't that be good for everybody?

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Comment by Mike on September 8, 2009 at 2:02pm
Nice work!
Comment by Laura Hand on September 8, 2009 at 12:17pm
This is the exact reason I bypassed the insurance all together and purchased my machine out right. I took the advice from here about getting a script written fo a "machine and mask of the patients comfort" and asked for my data. My doctor looked at me like I was insane. (how dare I be an empowered patient) I looked at the script and set the machine up myself, and tucked the instruction manual (that says plainly on the front to remove before giving to patient) away for future reference. I had my machine in my house and set up and using it for four days before the DME even contacted me....much less started the process to actually get a machine.
If my life depends on this machine, you better believe I will be an expert on how to use it!!
Comment by Kelly Anne Weaver CRT/RCP on September 8, 2009 at 11:33am
I also feel patients should have better understanding of their settings, as a hospital therapist how many times do we get patients staying who do not have their home units, and have to use not know their settings, and at times even their Dr. does not know. Their statement is " the home care set it for me". settings would be a help so we can continue therapy as they are use to it.
Comment by Judy on March 21, 2009 at 5:27pm
Not to be argumentative, CPAPQueen, but WHY DO the local DME suppliers receive so much higher a price for the equipment they sell than the online DME suppliers.

Online DME suppliers have qualified RTs on staff, and RTs and sales staff that KNOW the products they are selling. The online DME suppliers have a building and/or warehouse to store the equipment they sell. Many do have an advantage of limiting the DME they sell to just respiratory products, etc. But why should respiratory products have to contribute to or support the sale of other equipment such as hospital beds, wheelchairs, etc? The online DME suppliers are NOT selling xPAPs at a loss or as a loss-leader. They are making a profit on them or they wouldn't be in business.

The ONLY reason I see for local DME suppliers' high prices is that they deal w/insurances and the excessive paperwork and staff required for dealing w/multiple insurances require. And claiming support, advice and education to clients than far too many actually provide.
Comment by sleepycarol on December 31, 2008 at 1:47pm
Hmm -- cpaps and apaps have the same billing code so insurance does cover the cost of these machines -- but means less inflated profit for the DME's. By providing the bare bones machines means that the DMEs make more money -- at the expense of YOUR treatment!!

If a patient is monitoring their treatment with the software (which I am) and are very proactive in their treatment why not make adjustments? I have made slight adjustments to my therapy and have increased my benefits from my treatment. Doctors or DMEs do not have a stake in your health -- YOU do have a stake in your own health.

If a person is not proactive and not monitoring their therapy then I can see why a doctor's visit is necessary. My doctor admits I know more about sleep apnea and machines than she does (she is my primary care physician and I have her blessing to tweak as I see fit -- but I always keep her abreast by providing detailed data for her and my file).
Comment by Mike on December 14, 2008 at 3:36pm
Good point, CPAPQueen. I do not advocate patients making adjustments themselves --- I do, however, advocate patients having full access to their data so that they can collaborate with their doctors on whether an adjustment is appropriate.
Comment by cpapqueen on December 14, 2008 at 3:26pm
You are absolutely correct! We don't get paid extra for going out of our way and analyzing data for the pts and the docs. We would love to get reimbursed for such activiities but insurance won't reimburse for it. Nor do they cover the cost of the elite or DS400 as well as the apap's.
I do not agree with pts being able to self adjust their pressures. In some cases this can harm the pt. Yeah your AHI may be lower at the higher pressure than you were titrated at, but what is your heart doing?? Are you having palpitations or perhpas have you induced a central or mixed apnea?

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