zonk Wrote:

Ltmedic66,(time=1324853273) Wrote:

zonk,(time=1324837215) Wrote:

Ltmedic66,(time=1324832803) Wrote:Again, that's just like saying a VPAP can be set to VPAP, APAP, or CPAP modes, so we should just get everyone a VPAP and use it in the mode that they need.

Even with Boxing day hangover i can figure this one out by myself, it is exaggeration of the facts the price of VPAP is more than double of APAP while APAP is only $50 more CPAP.
Can i have another mince pie please :lick-lips:

zonk, not sure where you are getting your facts, but I can find brand new CPAPs for around 300-400 all day long. An S9 with humidifier is around $1100-1200. Seems a little more than $50 to me.

Sure, if you take a really expensive CPAP and compare it to an average APAP, the price difference is probablly modest...but that's kind of rigging the comparision, no?

Assured no rigging just compare apples with apples, not apples with oranges. Quick price check suuplier #1:
S9 Elite : $805
S9 AutoSet : $853
(price difference $48)

S9 VPAP BiLevel : $1959
(price difference $1154-$1106)
http://www.apneaboard.com/forums/Thread-CPAP-Supplier-List

For me if have to make decision of whether getting S9 Elite or S9 AutoSet knowing that it is only $48 price difference than i would definitely get S9 AutoSet (auto-titrating machine) as most CPAP users would do in the same situation.

Ltmedic66 Wrote:Indeed zonk- in the two isolated examples you provide, I agree. In fact, I'm not sure why a DME wouldn't allow you to pay to $50 difference in your example if you asked. Frankly, I also wonder why so many people end up with an elite rather than an S9 Auto without being given the option of paying the $50. I would suspect that with most insurance companies and Medicare, there are contractual restrictions to providing an APAP when the doc orders a CPAP, but I don't know for sure. However, I doubt that is the scenario that is generally at play.

What you are leaving out (and where I would say this analysis is incomplete) is that the humidifier, which most patients use, is another $200, so both of your examples would really go for over $1,000 retail to a real patient. I know insurance and medicare will get this price reduced, but we'll talk retail for comparison.

Now, consider that it is possible to get straight CPAP WITH humidification for less than $400 from the same supplier you mentioned. Price difference: at least $600-700, and many of these machines have some type of EPR and data recording. So, to demand an S9 when there are other options can be a $700 difference. And many of these machines have very high satisfaction ratings from the customers, so we're not talking about a piece of junk.

So, again, when you are talking about demanding an S9 Auto when the script is for a CPAP, you are really talking about price differences of well over $500 from standard CPAPs not $50. And it is in this context that we should be considering the question. When you are talking about the health care system as a whole, can I serve more patients by providing $400 machines or $1,100 machines? If I am a for-profit DME (remember, their job is to make as much money as possible), why would I accept less profit and give up the S9 Auto? To be objective, if most users of the $400 report that they are happy, what is the benefit to "the system" for providing the extra $700 of machine?

I acknowledge, we don't know what the DME actually pays for the devices, but I think it is safe to assume that the $400 machines are aquired for much less than an S9 Auto.

Don't get me wrong, I think that the whole DME system is, on average, corrupt and profit-centered rather than service-centered. And I am concerned when profits are more important than quality patient care, which is what a truly market-based system would provide. But that doesn't change the basic financial facts between machine choices.

zonk Wrote:

Ltmedic66,(time=1324902342) Wrote:Frankly, I also wonder why so many people end up with an elite rather than an S9 Auto without being given the option of paying the $50.

Few of our board members with insurance ended up with the S9 Escape which is basic entry level no data whatsoever just compliance to meet insurance requirement and it does not help the patient or their doctor not one iota. Mind you the doctor wrote the prescription he could have prescribe S9 AutoSet or at least S9 Elite which is data capable fixed pressure machine, i,m wondering as well why.

zonk Wrote:

Ltmedic66,(time=1324902342) Wrote:What you are leaving out (and where I would say this analysis is incomplete) is that the humidifier, which most patients use, is another $200, so both of your examples would really go for over $1,000 retail to a real patient.

It would not any difference to the price, just add the cost of the humidifier. The point is that nobody would go of their way and buy BiLevel machine just for the sake of it if they don,t need it and pay the extra thousand dollor and it does not add up.

HeadGear Wrote:

Ltmedic66,(time=1324902342) Wrote:Now, consider that it is possible to get straight CPAP WITH humidification for less than $400 from the same supplier you mentioned. Price difference: at least $600-700, and many of these machines have some type of EPR and data recording. So, to demand an S9 when there are other options can be a $700 difference. And many of these machines have very high satisfaction ratings from the customers, so we're not talking about a piece of junk.

The argument shifted, quite a few postings back, from whether equivalent models APAP is better than CPAP to a different proposition that a budget, low end, CPAP is best! I think any uninsured user is free to side-step the APAP vs. CPAP debate and get a machine they can afford. I would agree with you that a $400 budget CPAP, will do an adequate job of reducing apneas. Will overall therapeutic quality and user comfort be on par with that of a high end machine? That's doubtful, in my opinion.

zonk Wrote:Well judging from people who responded to this thread,
7 uses Auto including OP
4 uses CPAP (not) including 2 non data capable machines.
So majority goes Auto and data capable.

Ltmedic66 Wrote:

zonk,(time=1324929430) Wrote:

Ltmedic66,(time=1324902342) Wrote:What you are leaving out (and where I would say this analysis is incomplete) is that the humidifier, which most patients use, is another $200, so both of your examples would really go for over $1,000 retail to a real patient.

It would not any difference to the price, just add the cost of the humidifier. The point is that nobody would go of their way and buy BiLevel machine just for the sake of it if they don,t need it and pay the extra thousand dollor and it does not add up.

The point is that you have to consider the total price, my good friend zonk. In other words, an S9 Auto with humidifier vs other choices with humidifier, to compare.

Ltmedic66 Wrote:

HeadGear,(time=1324932539) Wrote:

Ltmedic66,(time=1324902342) Wrote:Now, consider that it is possible to get straight CPAP WITH humidification for less than $400 from the same supplier you mentioned. Price difference: at least $600-700, and many of these machines have some type of EPR and data recording. So, to demand an S9 when there are other options can be a $700 difference. And many of these machines have very high satisfaction ratings from the customers, so we're not talking about a piece of junk.

The argument shifted, quite a few postings back, from whether equivalent models APAP is better than CPAP to a different proposition that a budget, low end, CPAP is best! I think any uninsured user is free to side-step the APAP vs. CPAP debate and get a machine they can afford. I would agree with you that a $400 budget CPAP, will do an adequate job of reducing apneas. Will overall therapeutic quality and user comfort be on par with that of a high end machine? That's doubtful, in my opinion.

I think the original premise from our friend Zimlich was "is an APAP always better than a CPAP". It was also mentioned that a lot of CPAPs end up in the closet, and that we as a group (I think that mean society in general) end up paying the extra costs in on for or another for the increased costs associated with APAP- the feature of which may or may not be used.

I do not think we limited it to equivalent models. It's hard to say if the comfort and therapy would be any better with an APAP. The overall satisfaction ratings are very high on models such as the Intellipap, which is one of the lower cost units. Based on the user ratings, I would guess that both therapy and comfort are good.

zonk Wrote:

Ltmedic66,(time=1324945376) Wrote:

zonk,(time=1324929430) Wrote:

Ltmedic66,(time=1324902342) Wrote:

The point is that you have to consider the total price, my good friend zonk. In other words, an S9 Auto with humidifier vs other choices with humidifier, to compare.

Yep i can see your point but i think it is matter what works best for you.

archangle Wrote:

Ltmedic66,(time=1324902342) Wrote:I would suspect that with most insurance companies and Medicare, there are contractual restrictions to providing an APAP when the doc orders a CPAP, but I don't know for sure. However, I doubt that is the scenario that is generally at play.

There are no restrictions in general. The machine has to be set to the doctor's prescription. If the doctor specifies a single pressure, an APAP can be set to do manual CPAP at that pressure. If the doctor specifies a pressure range, only an APAP can fill that prescription.

zimlich Wrote:This thread is very interesting. The distressing thing to me is the amount of animosity shown when someone has a dfferent opinion in some cases. We all are entitled to an opinion and this was not a thread to bludgeon anyone into submission over the question, and I felt that ended up being the case. I felt personally attacked in some responses and feel very sad that some of you feel so strongly it wasn't enough to state your case, but you felt you had to denigrate mine.