11-22-2014, 11:06 AM
(This post was last modified: 11-22-2014, 03:38 PM by surferdude2.)
Yep, that guy tells it like it is. We all know that down deep but there's little we can do about it since the medical mafia has absolute control of such things. The reality is that most people do not benefit from having medical insurance or for that matter any type of insurance. If they did the insurance companies would soon go broke. Insurance companies drive up the costs of everything they cover and as a reward they get deep discounts. The consumers all lose in the process.
When your doctor says he's going to prescribe some medication for you, ask him to be sure it's a generic for whatever condition you have or for the class of drug he's prescribing.
Getting back on topic, if he prescribes a sleep lab study, ask if you can get a home version instead.
ps. In spite of all that, I refuse to be cynical...jaded maybe but not cynical. I have had doctors complain about how bad the system is but they are forced to go with the flow or go under. I've always felt that the real culprits are the insurance companies and the their cohorts the drug companies.
(11-21-2014, 08:01 PM)Galactus Wrote: Whole industries get built around "things" then the "things" change, and the old industries become obsolete. This is the nature of things. At some point there was one guy left making riding crops for horses and buggies, I bet he made the best damn riding crops there were. then came the car, and as time went on there was less and less of a need for riding crops and people using horses for transportation. I bet there was also a bunch of people that were paid to shovel the horse poop, and with no horses, no more poop, time for a new job. Horse posts were replaced with parking spaces, and bike racks, and so goes life. New technology, new opportunity, out with the old in with the new. This is especially true when an industry or people in general realize they have been being taken advantage of for far too long.
This is really deep
*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.
"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
I'm reminded of my struggle two or three years ago to move up to a data capable machine. An employee I know at my DME mentioned back then that in his experience most docs around here would write for a brick but not for an APAP (he was referring to both regular primary care MDs as well as docs with a Sleep Specialist sub-specialty). He thought docs were reluctant to prescribe data-capable machines because pts. could change their settings with an APAP. In his opinion, if docs would write for APAPs, it would be better for his company because it would not have to continue stocking a variety of machine models.
Now, looking back, I wonder if there was another reason most docs didn't want to prescribe data capable machines. Perhaps they saw some writing on the wall about how doing so would be another step in bypassing the entrenched two-sleep lab-session system that was then firmly in place.
(11-22-2014, 01:27 AM)archangle Wrote: You could take a reasonably bright high school graduate, train him with a 2 week class to read the results of a home sleep study, dispense a good data capable CPAP, monitor the data through the wireless modem and SD card, work with some computer programs, take calls from the patients and answer questions and make changes.
Train him when to refer a patient to a real sleep doctor or therapist.
Have the doctor do real in-lab PSG sleep tests when needed.
While an actual doctor exam is a good idea, you could do most of this over the phone or internet.
You'd probably get better therapy than most of the current apnea patients are getting though our current high dollar medical system.
The medical mafia will fight really hard to keep something like this from happening, though.
This is a good example of an intermediate approach to therapy. It makes sense for some scenarios.
Another intermediate approach might be to take advantage of the ability of the modern XPAP machine to provide sophisticated data over the internet. Instead of using that capability to upload compliance data after the fact every 30 days, use it to stream data in real time over the internet to a center where a trained tech can monitor, modify, titrate, etc.
Instead of a single 6-hour test in a foreign environment, there could be multiple sessions over a period of days which would probably give better data in some regards (of course no EEG readings) and more complete data due to the ability to chain a number of sessions together over a week or two and aggregate that data.
There is no facility needed, and the interaction with the tech would be minimal; in fact a computer could do most of the work. That reduces the cost of a sleep study that only needs this particular available data, and also makes it more accurate.
Obviously it would not replace the full SS or the home "holter monitor"-style study (which is still a good starting point), but it could be a supplemental option, especially in the area of titrating pressures.
(11-22-2014, 11:06 AM)surferdude2 Wrote: ... In spite of all that, I refuse to be cynical...jaded maybe but not cynical. I have had doctors complain about how bad the system is but they are forced to go with the flow or go under. I've always felt that the real culprits are the insurance companies and the their cohorts the drug companies.
I think (here I go being cynical) it is just that opportunities abound that appeal to the darker nature of human behavior.
The established companies that comprise insurance, medical, and drug development are in themselves not where the problem lies. Where the problem lies is in human nature; in the tendency for some folks to try to get the most return out of their investment, which can also be seen as trying to provide the least quality, the least amount of goods, and to do the least amount of work possible, all while trying to get paid as much as possible for what they do.
It can also be seen as being squeezed, and even can be seen as a form of highway robbery. Unfortunately people will get away with, and try to get away with, whatever they can.
If you drop a 20 on the street by accident while at a hot dog stand, how many folks out of the 10 who noticed will pick it up and give it back to you?
I am one who had a home study. The insurance company would not allow a sleep center study because I was not an invalid. Initially I would have been better served by sleep center study but because it was not allowed I had to do much research on my own. The research lead me to the apenea board forum and I was able to get my AHI to under 1.0
Some people are not able to analyze data and need sleep study centers but I still believe that your parameters can't be fined tuned unless you take an active role in it.
Probably the most difficult thing initially was getting the correct mask. I had bloody and bruised nose bridge and many leaks. This is where my local sleep study center was beneficial. The Sleep Wellness Institute in Milwaukee operates a chain of supply stores called CPAP2Go. They have a policy that you can try any mask for 30 days and return it for another one. This lead me to my current mask which is a Resmed airfit f10. Cpap is difficult without a proper mask.
That is my story. I hope it helps someone.
Colin Sullivan (inventor of CPAP) is working on an in-home test which just might address a lot of the issues discussed here, if it can be managed appropriately. It's a development of the apnea monitor mats used for babies, but far more sophisticated. At the time of the attached report he was concentrating mainly on paediatric use, but I see he's recently published a comparison of the new device v polysomnography. This may be the way of the future.
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Having had two sleep lab tests, I for one would have preferred home testing, at least for initial diagnosis. The irony is that all of the sleep center patch leads etc. that undoubtedly give superior data end up affecting how you move in bed, affecting the study results. Couple that with having to schedule a night away from home, sleeping in a different bed, possibly with a strange pillow, different room temperatures etc...
Do we need sleep labs? Yes, but probably not as many as we have now. The inconvenience of a formal sleep study kept me from having testing done earlier, something I now REALLY regret.
With what I've learned here and elsewhere, I now understand why my initial settings as prescribed were off... I'm a side-to-back-to-side sleeper, and have been forever - during the sleep studies, I KNOW that the tugging of my leads prevented me from side-sleeping, and I slept on my back.
After I got my APAP, I realized after a while that my pressure range might be high, and after careful, staged changes, life (and sleep) were much improved.
Ultimately, health care has to serve the patient better than the medical industry... so if home testing ends up as a net positive, in terms of earlier diagnosis and treatment, count me in.
(11-25-2014, 08:19 AM)DeepBreathing Wrote: Colin Sullivan (inventor of CPAP) is working on an in-home test which just might address a lot of the issues discussed here, if it can be managed appropriately. It's a development of the apnea monitor mats used for babies, but far more sophisticated. At the time of the attached report he was concentrating mainly on paediatric use, but I see he's recently published a comparison of the new device v polysomnography. This may be the way of the future.
Great article and interview!
FWIW, here's what I found as a summary of Prof. Sullivan's recent publication on the Sonomat:
In the end I am doing a poor job of treating myself. I used the system as laid out there. It was a costly learning experience. I saw doctor billing for office visits come in at over four hundred dollars. My insurance plan is self funded through my union. So it is my money no matter which pocket it comes from. I saw my machine billed out at just under 6k. I saw my sleep study come around 4k. I saw physicians assistants getting billed out at specialised physician rates. I saw the Dme charge nearly double for accessories and purposely switch my machine and void my warrantee rather than repair it. I saw both the pa and the doctor misinterpret the most simplified of direct data for my machine prescription and later block my access to the sleep study results directly.
I was paying twenty five percent of this dog and pony show and in a state of pure suffering misery from severe sleep deprivation doing my best to be compliant. Eventually I lost my great job and lost my insurance while the pyahoos running my treatment still.refused to adjust the settings on my machine. I can go on more but why? We are all adults here. This is a cash register industry. I hope it improves. I am grateful to this forum for being here.
I have a cool resmed asv and am getting a little more sleep. There is still something out of whack. I wil eventually get it right or die. The one thing for sure is the triangle of death between the sleep clinc and the sleep doctor and the DME will not get another dime out of me.