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Ruminations on Home Testing's Emergence in the Market

excerpting from a private conversation i had with a friend (on a no-names basis to protect the identity of the innocent ;-)


"I support the HST as an additional tool. I also see it as an easier way to get more people diagnosed. If the insurance companies use it as a replacement to the PSG instead of an additional tool I see more problems on the horizon for sleep. You have to see that this system is about what is best for the insurance companies, and has very little to do with pt care. I support the HST, but I am not so sure about the Watermark program. If this program were to catch on I believe it would be a step backwards in pt care as far as sleep is concerned. Everything would be done remotely via the primary care physician and Watermark. Under their system not once in the process would the pt talk to an educated sleep anything. I believe that this system would give the DMEs more power while crushing all sleep labs other than hospital based. I understand that the HST may enable more people to get diagnosed. That is huge, but what will be the sacrifice? I wish I knew. What I do know is that it will not fall on Watermark, the physician, or the insurance company. That only leaves one player in this game to take the hit. The patient. 

The key to getting more people diagnosed and treated is lowering the price of the REQUIRED test. Not coming up with cheaper versions that only encompass one sleep disorder. I know that 85% of all sleep patients are inflcted with simple apnea. 40% of those have other underlying sleep problems. If the HST and auto titration become gold standard a huge number of people may never get the treatment they need.

It is all about the pts. If you take care of them emotionally, mentally, and physically then they will take care of you financially. There are no shortcuts when we are gambling with lives. "

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BTW Rock, do we have the same vision of those jobs reading HSTs?

What I imagine is a trained professional, sitting in a cubicle, opening up studies on the WEB of people he has never seen and will never see. He goes through one after the other all day, keys in the scores and goes home at night hardly having seen or spoken to a person all day. That is the kind of job that very few people in our wealthy society would find appealing.

Let it be done overseas at first and then quickly figure out how to automate it. Or maybe figure out how to automate it right up front. If the data is in a file and the definitions for scoring are known, that should not be hard to do. (The programming for this can be sent to India :))

Another point on a firmly help misconception that the U.S. is loosing its manufacturing power - that is just not true. Manufacturing is continuing to grow in the U.S. See chart http://investing.curiouscatblog.net/2009/10/13/data-on-the-largest-... .

There have been more "job losses" in the U.S. and the rest of the world due to automation than due to free trade. (In fact, free trade creates jobs.)

When a job is lost due to automation, would you not agree that is a good thing in general? It can certainly be tough on individuals involved but I assume you would not withhold the fruits of automation from the mass of people in order to maintain employment in certain industries.

The world moves forward and if we want to stand still, we better have a good strategy for ducking.
short sighted
this is why we have terrorism
99 said:
short sighted
this is why we have terrorism

Huh??? Because of international trade???

Well come to think of it, those terrorist groups, as fundamentalists and backward socially, probably are very upset about the wealth created by international trade!!
it not the wealth that upsets them
it the one way traffic of wealth that upsets them
when the west act as a vacuum cleaner sucking in wealth and giving crumbs in return
Automated Health Care! That just does not sound right. I like the personal touch myself. Call me weird but I could interpret sleep for days on end.

I am not against automation or progress. When either impedes on a persons right to provide food for their children then that is a problem. You talk of automation as it is the only choice to apease the masses. Automation pleases corporate bank accounts more than any convenience it provides to the masses. At what point is convienience to much? When do we say when? As a country we have already sold our souls to China. How harmful has the american way of "easy access" already affected us? Part of our health problem has to do with automation. That is my opinion anyways. I hope this one stays on the high side. ;)

I have been all over North, South, and Central America. My wife and I are talking about going to Europe for a year or 2 after we get are credentials. We have been looking at jobs over there for some time now.
99 said:
it not the wealth that upsets them
it the one way traffic of wealth that upsets them
when the west act as a vacuum cleaner sucking in wealth and giving crumbs in return

99, that is just so wrong. Are you taking the primitive view of the economy as a pie and if one person gets a big slice then that leaves less for the others? Unfortunately many people in the U.S. have this wrong understanding.

The economy is something that grows with activity and wealth building. There is no "sucking" of wealth by the West. Look at China and India as they have moved to international markets and capitalism in the last 30 years. In a mere 30 years, 500 million people in those two countries have moved up out of dire poverty as they increased trade with the West. Go tell those people we are going to put up walls to international trade to stop "sucking wealth" out of their countries.

When you mention terrorism, I think you are talking about some other countries that have not done well in either education or wealth building. This is because they have not joined the modern world with trade, capitalism and individual rights for their citizens. Their leaders are holding them in an eighth century oppressive society - that is a major problem for them and the rest of the world.

Capitalism and trade have been the driving force behind the creation of an energy and optimism in India and China that is accompanied by a fantastic improvement in living conditions, health and education for 500 million people. The same thing is also happening in other parts of Asia and parts of Africa that are moving toward capitalism and free trade. So get rid of your Western guilt and feel proud of the magnificent Western contributions to world history and world progress.
Rock Hinkle said:
Automated Health Care! .... I hope this one stays on the high side. ....

It will only fall off the high side if you get near my Apap with your sledge hammer. :):)




http://en.wikipedia.org/wiki/Luddites
i may be wrong, but that is not what the terrorist see

they see an unfairness, and retailiate the only way they know how

Banyon said:
99 said:
it not the wealth that upsets them
it the one way traffic of wealth that upsets them
when the west act as a vacuum cleaner sucking in wealth and giving crumbs in return

99, that is just so wrong. Are you taking the primitive view of the economy as a pie and if one person gets a big slice then that leaves less for the others? Unfortunately many people in the U.S. have this wrong understanding.

The economy is something that grows with activity and wealth building. There is no "sucking" of wealth by the West. Look at China and India as they have moved to international markets and capitalism in the last 30 years. In a mere 30 years, 500 million people in those two countries have moved up out of dire poverty as they increased trade with the West. Go tell those people we are going to put up walls to international trade to stop "sucking wealth" out of their countries.

When you mention terrorism, I think you are talking about some other countries that have not done well in either education or wealth building. This is because they have not joined the modern world with trade, capitalism and individual rights for their citizens. Their leaders are holding them in an eighth century oppressive society - that is a major problem for them and the rest of the world.

Capitalism and trade have been the driving force behind the creation of an energy and optimism in India and China that is accompanied by a fantastic improvement in living conditions, health and education for 500 million people. The same thing is also happening in other parts of Asia and parts of Africa that are moving toward capitalism and free trade. So get rid of your Western guilt and feel proud of the magnificent Western contributions to world history and world progress.
500 million educated people is just a drop in the bucket for China. Their human right's issues go unchecked. When China will alow education for anyone interested we can talk of their improvements. As of right now the Chinese government decides who gets an education and who does not.
Sorry Rock, but 500 million people is not a drop in the bucket. That is almost 20% of the combined population (2.5 bio) of India and China.

In China these people are becoming the driving force to change the oppressive government. They are very hungry for freedom and more connection to the Western world. They also are fervently searching for a spiritual awakening. It is very exciting and I am optimistic about their further transition from dire poverty and oppressive government.

Do you know that China has had alternating cycles of prosperity and decline over its thousand of years of existence? The periods of prospertiy coincide with periods of much international trade and its periods of decling coincide with isolationist policies. This is a lesson for other countries considering their international trade problems.

But above that, international trade is a moral issue. No man or group of men should be able to prevent others from trading in the places they choose.
99 said i may be wrong, but that is not what the terrorist see they see an unfairness, and retailiate the only way they know how


But we must not cringe in fear and forsake the good because of fear of dangerous evil people.
I agree with this statement. I do not agree with your others. I am happy that China is showing improvement, and hope that it continues to move forward. Unfortuanately we have problems in our own backyard. I believe that you and I going to have to agree to disagree on the issue of this post.

Banyon said:
99 said i may be wrong, but that is not what the terrorist see they see an unfairness, and retailiate the only way they know how


But we must not cringe in fear and forsake the good because of fear of dangerous evil people.

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