Let me first state that you all are my friends here, so this is in no way personal AT ALL, so please don't anyone take it that way. This is simply a friendly discussion
I'd like to challenge your thoughts on this LT (and maybe my friend Mary's thoughts also)... you could be absolutely correct... I'm not sure... but I do have some thoughts and questions:
Quote:First, I would venture to say that the vast majority of patients are not really interested in tinkering with their CPAP pressures and are likely to follow their doctor's advice as issued.
I would agree on this. However, should these patients in the future decide to take a more active role in their own therapy, they will be restricted as to options if all they have is a non-data capable, standard CPAP. I personally think (as most people here seem to think also) that patients will have a much better chance at CPAP success if they take a personal role in their therapy, rather than simply following doctor's orders (and then when they have problems, they may decide to quit CPAP).
There are many folks here who have had problems, come here to Apnea Board to seek out solutions, and as a result, taken a much more active role in their therapy. Some of these folks are frustrated that their DME gave them a low-end non-data capable CPAP... after they become educated, they become angry with the DME for not giving them a data-capable CPAP or an Auto-CPAP in the first place, especially when the cost to Medicare or the insurance company would have been the exact same.
Quote:Second, there can be down sides to APAP, so it is clearly not for everyone.
Can you list what those downsides are? Are these professionally-researched downsides or simply personal opinion?
Quote:Third, if someone is not going to use the data, then there is no need to pay for that capability.
Again, you're assuming that most patients aren't going to be interested in the data. But I contend that a good number of them, if they became truly educated and informed as to what their AHI and other numbers mean to their treatment, would become very interested in following the data to obtain the best possible treatment.
For folks who are ignorant when first prescribed CPAP, they might be given a non-data capable machine... and LATER, after reading more on forums like this, decide to take a more active role. They must then go out and purchase a data-capable CPAP or Auto-CPAP from their own funds. This is paying for two machines, when if the right one would have been prescribed first, the overall cost would have been greatly reduced.
Quote:Finally, not everyoneis sold of the accuracy of the data recorded by home CPAP machines.
Again, when it comes to AHI and other data recorded by home CPAP machines, it is not the accuracy of that data that is most important. For instance, one machine may record an AHI during the night of 1.5, while another machine may record that very same night's AHI as 2.8. This difference in AHI calibration is not really that
important when it comes to being useful to the patient. These numbers are used to show trends only
. For instance, on most machines, they will accurately record overall trends
(whether a particular adjustment caused the AHI to go up
As you know, on our page on How to Find the Optimum CPAP Pressure
, we always caution when making pressure adjustments that patients should make "small, incremental changes
", "give it time to work
", and "don't make additional changes for a week or two
". The fact that a patient's AHI went from 1.5 to 1.0 or from 2.8 to 2.0 is basically irrelevant... these numbers are not set in stone (not even at the sleep center) and should only be used for trend analysis (to show whether a change in pressure raised or lowered overall AHI).
Quote:The key point in my mind, however, is that getting a more expensive machine for someone who is not going to use the features is just wasteful.
Is it not also wasteful to give a patient a low-end, non-data capable, non-Auto CPAP and have them keep coming into the doctor, RT or sleep center way too often to answer questions about their treatment or make minor adjustments every time something changes in their lifestyle, overall health, etc.? That is going to cost money... this waste might have been avoided if they were given a data-capable Auto-CPAP and also informed as to make small changes themselves to improve their treatment.
Quote:The simplest CPAPs are just a few hundred dollars, while most fully loaded APAPs tip out at around $1,200.
Yes, but those are the extremes. Seldom does a DME give a patient a $300 CPAP, and seldom to they give out a $1200 machine. They are usually given one that is between $700-800 in cost, when the DME could have given them an Auto-CPAP that is about $90 more (the cost of an average doctor's office visit). Again, the DME is reimbursed the exact same amount by insurance/Medicare, whether or not the machine dispensed is a low-end standard CPAP or a data-capable Auto-CPAP.
Quote:It's inefficient for the health care system and wasteful for the patient to spend more than is needed or will be used.
I agree. It is totally inefficient for the health care system and wasteful to keep having to spend $90 for an office visit 2-3 times a year every time a pressure or setting needs to be adjusted. It would be much less expensive to spend the extra $80 and given them a shiny new data-capable Auto-CPAP right off the bat, along with a bit more initial patient instruction to help them take control of their own therapy. Far too often, patients are handed a machine and mask, given 10 minutes of instruction, and then they never hear from their health care professional again (unless they can create a billable event - $$).
Quote:Additionally, it is probably a little disingenuous to expect the DME to "eat" the difference in the price difference between what is required and what is desired. They're not a charity.
It's supposed to be a free market. We're talking about a DME making a few bucks less on the average CPAP sale. If they can't be profitable by handing out Auto-CPAPs to patients, then there is always going to be another DME down the street that will
find a way to distribute Autos and still remain profitable.
No one is "stealing money" from anyone here... DMEs are not being forced
to distribute Auto-CPAPs anywhere that I know of. If I had insurance, and I knew that my DME would get $1500 from the insurance company no matter what CPAP they gave me... I would always insist upon a data-recording Auto-CPAP. Why? Because I am an informed customer. Likewise, I want all CPAP users to be informed customers. If my DME can't see fit to give me what I want, I will go to one who will. Free market, 'ya know.
Quote:So, I'd say if CPAP is prescribed but you want APAP, it's fair to expect you to pay the difference, not the DME.
So it's "fair" for DMEs to screw with me, giving me a low-end, piece of junk non-data capable CPAP instead of a good quality, data-capable auto? All because they want to make more profit? If that's considered "fair", then why is it not also "fair" when I choose to walk out from that DME and go to another DME who is willing to provide me with what I want?
I don't pay any more money by going to another DME for an auto, the government pays no more money for that, neither does insurance pay more for that. The only one who doesn't make as much money is the DME that I left. In my opinion, if they can't provide a quality product for a competitive price, they deserve to lose my business.
Quote:Following the logic in this thread, we should all get $4,000 VPAPs and set them to CPAP or APAP mode, on the off chance that we might need VPAP some day.
Inaccurate analysis and comparison there, LT... We're not talking about VPAPs, we are talking about data-capable Auto-CPAPs vs. standard, non-data CPAPs
. The medical coding
for Medicare and insurance is the exact same
whether the patient gets an Auto-CPAP or standard CPAP. The cost to Medicare or insurance is the same.
VPAPs are not billed under the same code as standard CPAPs and Autos.
If, however, someone (like me) does not have Medicare coverage or any kind of health care insurance, I am free to purchase with my own cash whichever machine I can afford between the two (CPAP and Auto-CPAP). (or even VPAP if I have a prescription for it).
Mary's original thread title was "AUTO or not; is the auto machine inherently better than a CPAP
". To that I think the obvious answer is "yes, Auto is inherently better because it can be operated in both CPAP and Auto modes
As to cost when it comes to Medicare/Insurance, that isn't an issue since they both pay the DME the same amount for both types of machines. As for properly adjusted Auto-CPAPs being "harmful" to some patients, I'm not sure any professional studies have ever concluded anything like that, and even if they did, the machine (again) could be operated in straight CPAP mode, avoiding the "harm".
The DMEs have a vested financial interest in promoting the view that "Auto-CPAPs can be worse than than standard CPAP"... DMEs get richer at the expense of decreased patient options when they dispense a non-data capable standard CPAP.
Again, just my humble opinion on all this... and I'm willing to listen to differing views and change my mind if convincing enough evidence can be posted.