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What To Expect From Your Local Durable Medical Equipment Provider
These are compliments of rjjayrt, a DME RRT who has been gracing cpaptalk's forum w/his patience and presence:
What To Expect From Your Local Durable Medical Equipment Provider
1. DME should explain to the patient what their insurance requirements will be.
2. Should discuss the cost schedule based on coding, and what the patient will be responsible for.
3. Should provide the patient with dispute resolution options.
What To Expect From Your Local Durable Medical Equipment Provider's Registered Respiratory Therapist
1. The RT should have a discussion with the patient concerning Diagnosis (make sure the patient understands what the diagnosis is), and treatment (explain what Cpap, bipap, fully data capable, auto titrating mean)
2. Discuss the available machine options. If the patient wants an auto titrating machine the RT should be agreeable to pursue with the physician the ability to do so.
3. Once a machine is decided on discuss and demonstrate all functions of the machine. Show the patient a demo download and explain what each value means.
4. Discuss with the patient their sleep habits, if they sleep on their back or stomach, if they're a mouth breather or nose breather. Find out if the patient is claustrophobic or not.
5. Based on #4 discuss the available mask possibilities, let the patient try the mask on while under pressure.
6. After a mask is decided upon, demonstrate proper donning and removal of mask.
7. Assuming you've discussed and demonstrated everything in a way the patient understands, you should be able to have the patient setup their machine, apply their mask, set their humidifier and start therapy. If the patient has problems or is hesitant repeat instruction until patient can complete the task from start to finish without error.
Before the patient leaves discuss known problems with cpap, discuss with them the problems they may have over the next few days or so and discuss with them ways to avoid the problems or ways in which to deal with the problems.
8. Ensure the patient understands accessory replacement schedule, cleaning procedures and most importantly has a way to get in touch with you if there's a problem.
9. Finally make a follow up schedule with the patient so downloads can be done to check progress. I suggest one at 1 week, at 1 month and again at 6 months.
And I would suggest printing these out and taking them to your next local apnea support group meeting!
What To Expect From Your Local Durable Medical Equipment Provider
1. DME should explain to the patient what their insurance requirements will be.
2. Should discuss the cost schedule based on coding, and what the patient will be responsible for.
3. Should provide the patient with dispute resolution options.
What To Expect From Your Local Durable Medical Equipment Provider's Registered Respiratory Therapist
1. The RT should have a discussion with the patient concerning Diagnosis (make sure the patient understands what the diagnosis is), and treatment (explain what Cpap, bipap, fully data capable, auto titrating mean)
2. Discuss the available machine options. If the patient wants an auto titrating machine the RT should be agreeable to pursue with the physician the ability to do so.
3. Once a machine is decided on discuss and demonstrate all functions of the machine. Show the patient a demo download and explain what each value means.
4. Discuss with the patient their sleep habits, if they sleep on their back or stomach, if they're a mouth breather or nose breather. Find out if the patient is claustrophobic or not.
5. Based on #4 discuss the available mask possibilities, let the patient try the mask on while under pressure.
6. After a mask is decided upon, demonstrate proper donning and removal of mask.
7. Assuming you've discussed and demonstrated everything in a way the patient understands, you should be able to have the patient setup their machine, apply their mask, set their humidifier and start therapy. If the patient has problems or is hesitant repeat instruction until patient can complete the task from start to finish without error.
Before the patient leaves discuss known problems with cpap, discuss with them the problems they may have over the next few days or so and discuss with them ways to avoid the problems or ways in which to deal with the problems.
8. Ensure the patient understands accessory replacement schedule, cleaning procedures and most importantly has a way to get in touch with you if there's a problem.
9. Finally make a follow up schedule with the patient so downloads can be done to check progress. I suggest one at 1 week, at 1 month and again at 6 months.
And I would suggest printing these out and taking them to your next local apnea support group meeting!
Views: 269
Replies to This Discussion
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Permalink Reply by Teresa Hoehn on
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Teresa
What responsibility do you think the patient has? Its's the patient's money and the insurance company. They are paying fo rthe service you are suppose to provide. They need to know what they are getting and why. They also need to know why it is soooo improtant for them to use their therapy so thay do not quit.
This is why compliance is 60% nationwide.
I know for a fact that spending 45min. to an hour with a patient is worth it. Complaince can be in the 90's if the companies and therapist would slow down and be the healthcare professional the patients deserve.
Banyon said:Does the patient have any responsibility? I would like to see a post, "The Patient's Responsibilities."
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What a terrible way to think. There are people out there myself included that got into medicine because we love the patients and we want to improve lives. Do not go with the eveyone is in it for themselves. It's a load of crap that everyone is pushing at the next generatioin. You want them not to care keep it up. It would be good i you are able to enjoy what you do enough to make a difference.
Life can be so much better with enjoyment and job security if you care.
Dan Lyons said:Banyon said:Does the patient have any responsibility? I would like to see a post, "The Patient's Responsibilities."
Banyon,
We as patients and as human beings, through our upbringing, have been taught that "professionals" would not cheat, deceive or mislead a person intentionally. These “professionals” were supposed to be above questionability, and they made sure you knew it.
Our "responsibility" was to listen and pay attention to these "professionals" and to follow their directions and instructions.
The reality of the situation is, we now have to approach every situation we face in our life with total speculation and caution. That these "professionals", and every other person has but one goal in their life - THEMSELVES. If that involves cheating, lying or misleading, they will do it.
The desire for the almighty dollar has taken over their scruples. Not to stand on a soap box and preach, but this is clearing referenced in the Bible where greed is the sin.
We, as patients, don't realize the facts of the business world until after we have been victimized. What is even more revolting is the fact that we though of these folks as "professionals".
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Permalink Reply by Dan Lyons on
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Ms Hoehn,
It appears that you took offense to my statement. Well I am going to step on your toes some more to prove a point.
You say you "got into medicine because we love the patients and we want to improve lives." I really believe you think that. It is a shame that you and your goal cannot be said of the majority of your profession.
If you are a physician, I want you to take a look around your office. Take a close look. I want you to see everything to which your attorney has done to restrict you liability in your practice. That so caring attorney has restricted the patient's access to you, their files, and their ability to see you.
I understand why it is done. I also understand the monetary layer it imposes upon you and ultimately the patient.
Those same attorneys have also created a major medical industry with but one goal – MONEY. The physician is but one cog in that wheel.
You follow the directions of your attorney because you are afraid if you make a mistake someone will sue you, and they probably will. The reason why is another attorney who has preyed upon a medical victim as the result of the medical communities' many years of "high than thou" attitude.
Now if you want to say it is the patients fought, be careful of that mirror to which you are standing in front of. The "profession" brought it upon them selves. They have now started a PR campaign to change that and I hope they do. I also hope they remember that they are human also and not a step above everyone else.
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Permalink Reply by Banyon on
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Dan, There is a lot of truth in what you wrote because mankind has fallen and we all are sinners. However, I don't think we can take up sides and say the other side is totally bad. In Genesis 1:26 & 27 God says we are made in his image which means we are holy and in Genesis 1:31 God judged everything he made, including mankind, as good. That means every individual is a good creation of God.
I have personal experience with medical professionals who "work from their heart" with great enthusiasm and sacrifice for people with health problems. One friend and his wife live and work for weeks at time at their own expense in tents in the worse refugee camps in Africa. But even ones who don't do this type of charity work go about their business with great concern and empathy for their patients.
As far as professionals being greedy, some are, but I find most act in "enlightened self-interest". Enlightened self-interest means, among other things, they want to earn a living, be financially stable, support their families, and have money to use for charity. I like dealing with these kinds of people. If I go to a surgeon who is acting out of enlightened self-interest, I may know that he wants to make a good wage from dealing with me but he also wants to do a very good surgery for me and will take very good care of me.
I do believe that I have to look out for myself and be on the guard for people who would do harm to me either intentionally or by negligence. But I also have to guard that that I do not become cynical toward groups of people and fail to see all the good in them.
I enjoy reading many of your posts here.
Dan Lyons said:Banyon said:Does the patient have any responsibility? I would like to see a post, "The Patient's Responsibilities."
Banyon,
We as patients and as human beings, through our upbringing, have been taught that "professionals" would not cheat, deceive or mislead a person intentionally. These “professionals” were supposed to be above questionability, and they made sure you knew it.
Our "responsibility" was to listen and pay attention to these "professionals" and to follow their directions and instructions.
The reality of the situation is, we now have to approach every situation we face in our life with total speculation and caution. That these "professionals", and every other person has but one goal in their life - THEMSELVES. If that involves cheating, lying or misleading, they will do it.
The desire for the almighty dollar has taken over their scruples. Not to stand on a soap box and preach, but this is clearing referenced in the Bible where greed is the sin.
We, as patients, don't realize the facts of the business world until after we have been victimized. What is even more revolting is the fact that we though of these folks as "professionals".
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I am a Registered Respiratory Therapists who owns a dme company. We only do cpaps,bipaps, ASV, etc. We go to the pts. home do all the things on this thread except we do a phone follow-up in 3 days, 30, days, 60 days, and a letter every 90 days for supplies. We do either a 2 week or 30 day download depending on the physician. A week download really does not give you a fair chance to adjust to the therapy. But your provider should be available to help you adjust and help with mask issues.
Jan said:Wondering how many on have worked with a DME or RT who complies with the list that started out this thread? Not me.
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I am an RRTand RPSGT as wel. The answer is Yes, we do everything listed above. I set up this program in one location and also Managed a sleep lab and made it mandator that any company that provided service to one of our sleep patients must meet these guidlines.
Maybe other sleep labs should expect this from a provider so that the patients get the right services.
sheila Herring said:I am a Registered Respiratory Therapists who owns a dme company. We only do cpaps,bipaps, ASV, etc. We go to the pts. home do all the things on this thread except we do a phone follow-up in 3 days, 30, days, 60 days, and a letter every 90 days for supplies. We do either a 2 week or 30 day download depending on the physician. A week download really does not give you a fair chance to adjust to the therapy. But your provider should be available to help you adjust and help with mask issues.
Jan said:Wondering how many on have worked with a DME or RT who complies with the list that started out this thread? Not me.
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Hey Banyon,
I'm right with you on this. I know of medical providers that really in truly beleive in what they do. We have 4 doctors in my church that do missions 2 to 3 times a year. Their are people out there still trying to make a difference.
As for Dan's comment about lawyers and such making our country a mess to have to do healthcare, I totally agree to a point. I have never done anything in my extensive career that would warrant myself to have to worrry about someone coming after me. However, I have a physician friends that have only had the patient in mind have to defend themselves.
Point in case. A surgoen accidently nicks a persons bowl while performing an abdominal sergery. Lets think about this form any workers stand point. I go to work everyday for lets say 10 years and I have never ever made a mistake!! (yah right not!!) So do you think that it is possible to make a small mistake for a doctor who does this same procedure day in and day out. absolutely. Mistakes happen at work all the time. It's just for most it could be a paperwork mistake or dropping something. For a physician it is so much easier to make a mistake and we expect them to never make any. Lets me real. Mistakes happen. I do not know of any phsycian that would purposely hurt a patient.
So when I here someone complain about a physician I ask them if they have ever made a mistake at work. It usually makes them think differently.
Sorry, I got a bit caught up in that one.
Banyon said:Dan, There is a lot of truth in what you wrote because mankind has fallen and we all are sinners. However, I don't think we can take up sides and say the other side is totally bad. In Genesis 1:26 & 27 God says we are made in his image which means we are holy and in Genesis 1:31 God judged everything he made, including mankind, as good. That means every individual is a good creation of God.
I have personal experience with medical professionals who "work from their heart" with great enthusiasm and sacrifice for people with health problems. One friend and his wife live and work for weeks at time at their own expense in tents in the worse refugee camps in Africa. But even ones who don't do this type of charity work go about their business with great concern and empathy for their patients.
As far as professionals being greedy, some are, but I find most act in "enlightened self-interest". Enlightened self-interest means, among other things, they want to earn a living, be financially stable, support their families, and have money to use for charity. I like dealing with these kinds of people. If I go to a surgeon who is acting out of enlightened self-interest, I may know that he wants to make a good wage from dealing with me but he also wants to do a very good surgery for me and will take very good care of me.
I do believe that I have to look out for myself and be on the guard for people who would do harm to me either intentionally or by negligence. But I also have to guard that that I do not become cynical toward groups of people and fail to see all the good in them.
I enjoy reading many of your posts here.
Dan Lyons said:Banyon said:Does the patient have any responsibility? I would like to see a post, "The Patient's Responsibilities."
Banyon,
We as patients and as human beings, through our upbringing, have been taught that "professionals" would not cheat, deceive or mislead a person intentionally. These “professionals” were supposed to be above questionability, and they made sure you knew it.
Our "responsibility" was to listen and pay attention to these "professionals" and to follow their directions and instructions.
The reality of the situation is, we now have to approach every situation we face in our life with total speculation and caution. That these "professionals", and every other person has but one goal in their life - THEMSELVES. If that involves cheating, lying or misleading, they will do it.
The desire for the almighty dollar has taken over their scruples. Not to stand on a soap box and preach, but this is clearing referenced in the Bible where greed is the sin.
We, as patients, don't realize the facts of the business world until after we have been victimized. What is even more revolting is the fact that we though of these folks as "professionals".
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Permalink Reply by Carl Speas on
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this week i tried to contact my dme. it was like looking for a needle in a hay stack. when i finally reached her you could tell she could care less. i am less than 2 months on bipap had some questions. she was totally clueless. i went to see my doctor the same day, he told me from now on to contact him the dme was not knowledgeable enough to answer questions. she does well to sell equipment. he told my sleep apnea problem was so bad he did not want me to take advise from her. he also told me that if i cannot adjust to my machine and mask my only option from here on was a trach. sugrery nor dental appliance has worked so i must wear this machine. so far have not done the best, but i am going to keep at it awhile longer.
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I have a DME company and I am a respiratory therapists. Have you tried changing to another company for your supplies and help. A trach is pretty drastic. We have pt. all the time that got a machine from a company and have problems like yourself and we help them out. 2 months is not that long yet so be patient with yourself it can take months to adjust. I would be happy to try and answer any questions you might have and see if I can help you through this site.
Carl Speas said:this week i tried to contact my dme. it was like looking for a needle in a hay stack. when i finally reached her you could tell she could care less. i am less than 2 months on bipap had some questions. she was totally clueless. i went to see my doctor the same day, he told me from now on to contact him the dme was not knowledgeable enough to answer questions. she does well to sell equipment. he told my sleep apnea problem was so bad he did not want me to take advise from her. he also told me that if i cannot adjust to my machine and mask my only option from here on was a trach. sugrery nor dental appliance has worked so i must wear this machine. so far have not done the best, but i am going to keep at it awhile longer.
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thanks for your concern. my problem with the rt at the dme is her lack of concern. she does not seem willing to allow me other options as far as masks are concerned. she wanted me to wear a full face mask, i refused because we tried this 2 years ago and the mask ate my nose up from top to bottom my eyes swelled shut my whole face swelled up. it took six weeks for my nose to heal after getting off the mask. her attitude is no full face mask no service. must be her favorite mask . so i walked away from the machine and had very extensive surgery that did not work. then i had a dental appliance made that did not work either. so now i am on bipap this time because they discovered i have complex sleep apnea. i am sure there are good dme and rt out there but i have bad luck so far. as far as seeking a new one i do not know how the insurance company works that. i figured i probably could not change until the machine is paid off. 1 year.
i do have a question for you. is it normal procedure to give a client a used machine for the first month while yours is being ordered? it has been 7 weeks and i am still using a loner machine.
sheila Herring said:I have a DME company and I am a respiratory therapists. Have you tried changing to another company for your supplies and help. A trach is pretty drastic. We have pt. all the time that got a machine from a company and have problems like yourself and we help them out. 2 months is not that long yet so be patient with yourself it can take months to adjust. I would be happy to try and answer any questions you might have and see if I can help you through this site.
Carl Speas said:this week i tried to contact my dme. it was like looking for a needle in a hay stack. when i finally reached her you could tell she could care less. i am less than 2 months on bipap had some questions. she was totally clueless. i went to see my doctor the same day, he told me from now on to contact him the dme was not knowledgeable enough to answer questions. she does well to sell equipment. he told my sleep apnea problem was so bad he did not want me to take advise from her. he also told me that if i cannot adjust to my machine and mask my only option from here on was a trach. sugrery nor dental appliance has worked so i must wear this machine. so far have not done the best, but i am going to keep at it awhile longer.
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First off, Carl, you should call your insurance company and ask what local DME CPAP suppliers they are contracted with. Hopefully you will have the option of more than just this one.
Second if all you have is a loaner whilst "yours" is being ordered, you are NOT tied to this DME provider at all and can go elsewhere if you have other options thru your insurance.
Third, be aware that Resmed, Respironics and Fisher & Paykel will replace FREE to the local DME providers most all of their masks that patients have tried and been unsuccessful with if the DME provider will just fill out a form and return the mask and form to the manufacturer w/in 30 days. So there is absolutely NO EXCUSE for a local DME provider NOT to allow a lenient mask exchange policy (as long as you stick to masks by the above 3 manufacturers).
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my rt wants me to choose my mask in the first 30 days. i can only try so many with only 30 days to choose. i tried the opus and the oracle. my doctor told me this week i should try the hybrid but i do not think the rt will let me try another mask. she is pretty stubborn. she want me to use full face only. maybe she gets bulk pricing on them or is overstocked. i am currently using the opus having some mouth leakage.
Judy said:First off, Carl, you should call your insurance company and ask what local DME CPAP suppliers they are contracted with. Hopefully you will have the option of more than just this one.
Second if all you have is a loaner whilst "yours" is being ordered, you are NOT tied to this DME provider at all and can go elsewhere if you have other options thru your insurance.
Third, be aware that Resmed, Respironics and Fisher & Paykel will replace FREE to the local DME providers most all of their masks that patients have tried and been unsuccessful with if the DME provider will just fill out a form and return the mask and form to the manufacturer w/in 30 days. So there is absolutely NO EXCUSE for a local DME provider NOT to allow a lenient mask exchange policy (as long as you stick to masks by the above 3 manufacturers).
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