What does a DME actually do? MY story

[Autopapdude]

This is just my experience after over a decade on the hose, but I think appropriate for anybody. Back in late 1997, I had a sleep study that showed moderate to severe positional sleep apnea, and the lab titrated me at 11 Cm. The equipment was primitive by today's standards, but I hung in there, despite soreness, cherry red noses, "wind burn," and stiff necks due to the design of the masks for a side sleeper. My relationship with the DME lasted ONE session--they came to my house, gave me a mask, and a Cpap (the venerable Respironics solo), and left. I got maybe 5 minutes on setup lessons, and NO usage tips or anything else constructive. When I asked for a manual they said "we can't leave it with the patient." So, I figured that I had to go it alone, and read EVERY article published on sleep disorders. Repeated calls to the DME got recorded messages and nothing more. That was what my insurance provided, and that is what they gave me, according to them.

I stuck with my Solo, and finally moved to a Virtuoso autopap in 2001. They had the serial data link then, and that was extremely useful in monitoring my treatment. Also, slightly better masks came into being (the goldseal wasn't the "gold standard,") and my very helpful Internal med doctor, and a pulmonary medicine specialist were most helpful (sleep doctors sometimes help, and sometimes are only interested in evaluating sleep studies, as that doesn't require patient contact...lol). The Virtuoso lasted for 7 years, and when I needed a new machine, I got my script from the IM doctor (one of two I have seen in/re my treatment) and bought my new autopap on cpap.com. With United Healthcare, they reimburse durables at the rate of 80%--so my $470 purchase ( including filters) was reimbursed at $325.00. So, for a machine I expect to last several years (then I repeat the procedure as described above), it costs me approximately $100 out of pocket plus consumables, such as filters. My annual cost of therapy is probably $200 a year, and I feel great, and have felt so for over a decade.

I have had no special medical training, so if I can do so, anybody can do so. MY background in education constitutes Liberal Arts degrees, not in the Sciences. Self treatment, with the proper monitoring from doctors who are empathetic is extremely effective--some may choose to go another route, but frankly, it is easy, intuitive, and logical to take stock and take care of one's life and treatment.

Postscript--I have gotten better and more consistent advice from cpap.com, by talking to the very conscientious people online. Often, they will spend over a half hour, giving suggestions, advice, NOT medical treatment, but advice. I have gotten more from them with one or two phone calls than any "brick and mortar DME' in years.

[fuzzy96]

glad you did so well

this industry needs to pull its proverbial "head out of it's butt"
anyone diagnosed should be given classes to know what thier therapy will invole common questions problems etc. the docs won't do it . the dme's don't want to.
what happened to the hippocratic oath? was it replaced with some money grubbing oath?

my wife went for lap band surgery and had to attend classes, meet with nutritionalist,psychiatrist , a few others and attend a certain number of pre and post op support meetings. granted this was a elective procedure but everyone that this dr seen knew everything involved up front. his success rate is phenominal.

no reason the sleep med industry can't do the same . or at some future point they may be forced to. they should start now.

[Slinky]

Yup, yup, almost from the start I've put the "blame" for non-compliance on the so-called "sleep doctors". As I see it, THEY are the medical "professional" (snort) so it is THEIR responsibility to provide a knowledgeable staff person to educate, advise and support their patients if they aren't willing or able to do so themselves.

I can understand the constraints on a doctor's time and need for someone else w/more time and more intimate knowledge of the xPAPs and their features to provide the education, advice and support. BUT that does NOT relieve them of their responsibility to see to it that their patients' needs are met.

[Autopapdude]

Yup, yup, almost from the start I've put the "blame" for non-compliance on the so-called "sleep doctors". As I see it, THEY are the medical "professional" (snort) so it is THEIR responsibility to provide a knowledgeable staff person to educate, advise and support their patients if they aren't willing or able to do so themselves.

I can understand the constraints on a doctor's time and need for someone else w/more time and more intimate knowledge of the xPAPs and their features to provide the education, advice and support. BUT that does NOT relieve them of their responsibility to see to it that their patients' needs are met.

Don't get me wrong. There are many very conscientious and caring doctors. The ENT who first referred me to the sleep lab was very supportive, and was not a 'surgery cowboy.' He wanted to see me treated, and his staff not only gave me the referral to the sleep lab, they followed up several times to expedite it, as that hospital was booked for a long time. MY IM doctors have been super supportive in helping me over the years, and have written different scripts whenever my needs for equipment have changed. They are also very interested in my sleep data, and for my 6 month medical checkups, we discuss it, and take some time doing so. I find that sleep doctors in general are not wild about patient contact (at least in my experience). They get well-paid for their services in interpreting sleep studies, and don't have to maintain a "good bedside manner." DMEs have been worthless for me, so I tend to be rather caustic regarding them. I do think it is a case of with whom you deal--some in each category can be great--others can be callous, uncaring and indifferent. This is purely my experience, combined with some anecdotes from friends who have OSA.

[leejgbt]

The DME company I run does this for patients:

We have an RT fit the mask. This RT has had several years of training and a high success rate (over 90%) on first time mask fittings. If there are issues other masks are tried. We have access to almost every mask being manufactured today so we find the one that works. We have a mask replacement program that will replace a mask free of charge as long as it is a different kind than the original. The thinking here is that the fitting failed so it is our fault not the patient.

In conjunction with the sleep lab and the sleep physician we have education sessions every Tuesday with the patients (some not even with our company).

All patient are required to have a manual about the CPAP/BiPAP they were given. All our units are "autos" and are data capable.

We do one week, one month and three month follow up. We help schedule any physician follow up visits that are required by Medicare and Medicaid. After this the patient can bring or send their card in and we will read it and give them a copy of the results along with an interpretation from one of our RTs. If deemed necessary a copy is sent to the physician.

Patients are not allowed to adjust their CPAPs. Our policy states "the Rx is set by a heath care professional on the order of a physician. The thought being a patient doesn't have the ability to assess their own medical condition (i.e., why they see the Dr. in the first place) and changing their Rx could result in them affecting their health, thus the reason why we prevent the patient from changing the Rx (benefit doesn't outweigh the risk)".

We have also started a CPAP support group as users know all the tricks and have overcome all the roadblocks to compliance.

We have advocated for the last five years for MANDATORY accreditation for DME companies to increase the quality of care and to standardize care. Medicare made accreditation mandatory Oct 1, 2009. This eliminated over 25,000 DME companies from Medicare provider status.

If the DME you are looking for is not accredited go somewhere else.

[Autopapdude]

The DME company I run does this for patients:

We have an RT fit the mask. This RT has had several years of training and a high success rate (over 90%) on first time mask fittings. If there are issues other masks are tried. We have access to almost every mask being manufactured today so we find the one that works. We have a mask replacement program that will replace a mask free of charge as long as it is a different kind than the original. The thinking here is that the fitting failed so it is our fault not the patient.

In conjunction with the sleep lab and the sleep physician we have education sessions every Tuesday with the patients (some not even with our company).

All patient are required to have a manual about the CPAP/BiPAP they were given. All our units are "autos" and are data capable.

We do one week, one month and three month follow up. We help schedule any physician follow up visits that are required by Medicare and Medicaid. After this the patient can bring or send their card in and we will read it and give them a copy of the results along with an interpretation from one of our RTs. If deemed necessary a copy is sent to the physician.

Patients are not allowed to adjust their CPAPs. Our policy states "the Rx is set by a heath care professional on the order of a physician. The thought being a patient doesn't have the ability to assess their own medical condition (i.e., why they see the Dr. in the first place) and changing their Rx could result in them affecting their health, thus the reason why we prevent the patient from changing the Rx (benefit doesn't outweigh the risk)".

We have also started a CPAP support group as users know all the tricks and have overcome all the roadblocks to compliance.

We have advocated for the last five years for MANDATORY accreditation for DME companies to increase the quality of care and to standardize care. Medicare made accreditation mandatory Oct 1, 2009. This eliminated over 25,000 DME companies from Medicare provider status.

If the DME you are looking for is not accredited go somewhere else.

Spare me the crap. You're the one who has us being "dragged away in handcuffs for changing our own pressure." We are still waiting for you to produce the law that says it is illegal to do so (especially under the supervision of a doctor). It is a free country, and barring seditious speech, anyone can say whatever they wish. However, I'd prefer that you don't post on my thread, as I have no regard for your opinion. So, be so kind as to avoid responding to me, or posting on MY personal story thread. I will regard any such posting as repetitive spamming.
Thank you

If the DME you are looking for is not accredited go somewhere else.

DON"T YOU GET THE MESSAGE--I am not looking for a DME. I have one--it is called CPAP.COM

Patients are not allowed to adjust their CPAPs. Our policy states "the Rx is set by a heath care professional on the order of a physician. The thought being a patient doesn't have the ability to assess their own medical condition (i.e., why they see the Dr. in the first place) and changing their Rx could result in them affecting their health, thus the reason why we prevent the patient from changing the Rx (benefit doesn't outweigh the risk)".

Ahh, this must be the "law about which you spoke." it isn't a law--it is your own friggin' policy. You think patients are too stupid and ill-informed to participate in their own medical condition, so you want to protect them from your own stupidity? Or do you want them to follow you as the guru, and take your word as gospel? Sounds like you're doing some A&& covering to avoid any possible liability there.

Please be gone from my thread---you're a poseur.

[ScrappinMom]

Patients are not allowed

To me, this sums up the entire problem with the entire sleep medicine industry. NO ONE, since I moved out of my parent's house, has had the nerve to tell me what I am allowed or not allowed to do, not even (or maybe, especially) my husband. He has too much respect for me to even consider it. Those people have absolutely no respect for their patients. That's the problem.

[Pugsy]

NO ONE, since I moved out of my parent's house, has had the nerve to tell me what I am allowed or not allowed to do, not even (or maybe, especially) my husband. He has too much respect for me to even consider it

[/quote]

Same here. I am a fairly intelligent person and if my input is not valued, then .... them. I worked with doctors in the medical field for nearly 30 years. I know full well that many of them are far less than perfect despite what their egos tell them.

[Pugsy]

Patients are not allowed to adjust their CPAPs. Our policy states "the Rx is set by a heath care professional on the order of a physician. The thought being a patient doesn't have the ability to assess their own medical condition

Say what? Someone have a serious God complex issue? Insult someone's intelligence. Good way to get business.
I was almost to the point of saying you had some valid comments till this came up. It invalidates anything you might be trying to say.

[Autopapdude]

Mr. Dme who doesn't even advertise his company is trying to say we're a bunch of dumb s&%ts, who have no right to have input in our own treatment. Sounds like" Sieg Heil" to me?

[Babette]

EDITTED - Clearly I need more coffee this AM. I missed some of the evil thrown into the good on that DME's post.

CPAP.com and cpaptalk.com have been great and a life saver for me. But it sure would have been nice to have live in-person support that was trained and knowledgeable. Having to lay down on the dirty floor of my DME's office to test drive the "sleepability" of a mask was really not a high point for me. Being told by my "RT" that she was an intern from the local voc tech college was also not a high point. Being billed multiple times in error was the last straw. I told them to shove it and called my insurance company's fraud line.

Sigh... Someday. Someday there will be good brick and mortar DME's. Someday....
B.

[cinco777]

Pugsy, I love your KneelSuckers GIF. I just saved a copy. Sums up what many (most in my experience) DMEs and Sleep Drs. expect us to do in their presence. Thanks.

[Autopapdude]

Pugsy, I love your KneelSuckers GIF. I just saved a copy. Sums up what many (most in my experience) DMEs and Sleep Drs. expect us to do in their presence. Thanks.

Yepp. They want us to assume the position, bow and apply our lips to their buttocks. Not gonna happen.

[RN Ricky]

I am sorry but the Docs, RTs and DMEs put their pants on just like WE do..one leg at a time.

No one should be made to feel that they must be put lower just to treated for a medical condition. Hey it is MY medical condition!
For years it is drilled in that the entire medical staff works as a team.. even down to the housekeepers, but of course some docs and nurses want the "pride chip" on their shoulders to get as large as possible. We do have an option to go to another provider and let the ins. co. know why.

I am privileged to have found cpaptalk and all of the help I have received.

[Slinky]

Thank you, leejgbt, for your information. Would that there were more local DME providers and provider RRTs such as yours. You even managed to say that I/we don't "have the ability to assess their own medical condition" w/o my seeing red and losing my cool!

However, I AM going to ask you since your clients/"Patients are not allowed to adjust their CPAPs", just what you and your company would do when I DID take it upon myself to change my therapy setting(s)??

Given the level of service and support your company provides I quite likely might never have to take it upon myself to alter my therapy settings - but just suppose I did, what would your response be? What would your company's response be?