Im just looking for opinions. I have a good idea of the answer already, but im curious to see your answers:

Why is it that the sleep reports are not given to the patients, without request? Why arent the reports given to the patient automatically?

Thanks for your input.

RAM_Sleep I would like to see your response first since you are in the field


_________________
White Beard with a White Beard
Resmed VPAP Adapt SV Enhanced, HumidAire 2i, ResLink with Model 8000 Flex sensor Pulse Oximeter, and ResScan 3.5 software. Respironic EverFlo OPI Oxygen Concentrator 3 lpm
EEP 9.0, min PS 6.0, max PS 16.0

White Beard wrote:

RAM_Sleep I would like to see your response first since you are in the field

Honestly, I think that (some) physicians do not want patients trying to interpret the results. Im not saying this is THE answer, but that is my guess.

There may be other theories, but I couldnt think of any.

There are a lot of intuitive users on the board, so I was fishing for opinions.

--

I always tell patients to request their study, but I am pushing for the office to get a copy to every patient, regardless of request.

I think it is just general practise to give test results to the dr first....just like with blood work, mri's, mammagrams, etc.  I agree that it is often a pain though.  I understand why they don't give it to the pataent ONLY, but it seems they could send the patient one at the same time as the dr.  I believe it has to do w/many patients not being able to interpret the info and possibly making incorrect assumptions---esp if there is info re: heart problems, desats, etc.

RAM_Sleep I think your probably right although or at least I would like to think that your are! I must admit I am a little more skeptical, having also worked in the medical field, and seeing some of the Doctors from the other side....... well I sometimes wonder?
      I do think patients should have full access to all their medical records and reports! I know when I worked in Onc, many patients requested their info, and my god you would have thought they were asking for a million dollars! The hoops they had to jump thru, get at their own information! It would not only make the patient mad but also mistrusting of all of us in the medical profession, they thought we were all trying to hide something from them! I didn't like it or agree with it then and I still don't!
     Have a question for you RAM_Sleep, in Jan07 I had my first study my O2 sats were down to 70% I was listed as severe O2 desaturation, I was put on CPAP and later  I had Pulse OX over night at home thing. They then put me on and Oxygen Concentrator at 2LPM only at night with XPAP, I have had numerous sleep studied since then  and went from CPAP to BiPAP and I am now on VPAP and they increased my O2 to 3LPM, I am on Medicare Disability, I have copies of all my sleep studies but not the O2 home one. What is the criteria that you have mentioned for insurance and medicare for home oxygen? I was just curious as I have seen the script putting me on O2 and increasing it but never the reason or criteria for it?


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White Beard with a White Beard
Resmed VPAP Adapt SV Enhanced, HumidAire 2i, ResLink with Model 8000 Flex sensor Pulse Oximeter, and ResScan 3.5 software. Respironic EverFlo OPI Oxygen Concentrator 3 lpm
EEP 9.0, min PS 6.0, max PS 16.0

i don't know if this is what you are looking for whitebeard or not but....

I was told this winter that in order for insur/medicare to pay for O2 the desat has to be below 88 for at least 5 min.

embryopathy wrote:

i don't know if this is what you are looking for whitebeard or not but....

I was told this winter that in order for insur/medicare to pay for O2 the desat has to be below 88 for at least 5 min.

Have you ever tried to find criteria (or eligibility) on the actual Medicare site? Ugh. Don't try it unless you want to be utterly confused and irritated.

Anyway, it appears that there are a million loopholes, however EMBRYO was close. It appears as though it is at 88% or lower for 5 minutes. Ill post the exact criteria below.

Just to add to what he/she said, the 5 minutes does not have to be continuous.

A few more items of interest, maybe:

For an item to be covered by Medicare, a written signed and dated order must be received by the supplier before a claim is submitted. If the supplier bills for an item addressed in this policy without first receiving the completed order, the item will be denied as not medically necessary.

Group II criteria include the presence of (a) an arterial PO 2 of 56-59 mm Hg or an arterial blood oxygen saturation of 89 percent at rest (awake), during sleep for at least 5 minutes, or during exercise (as described under Group I criteria) and (b) any of the following:

1. Dependent edema suggesting congestive heart failure, or

2. Pulmonary hypertension or cor pulmonale, determined by measurement of pulmonary artery pressure, gated blood pool scan, echocardiogram, or "P" pulmonale on EKG (P wave greater than 3 mm in standard leads II, III, or AVF), or

3. Erythrocythemia with a hematocrit greater than 56 percent.

Initial coverage for patients meeting Group II criteria is limited to 3 months or the physician specified length of need, whichever is shorter. (Refer to the Documentation section for information on recertification.)

Oxygen therapy will also be denied as not medically necessary if any of the following conditions are present:

1. Angina pectoris in the absence of hypoxemia. This condition is generally not the result of a low oxygen level in the blood and there are other preferred treatments.

2. Dyspnea without cor pulmonale or evidence of hypoxemia.

3. Severe peripheral vascular disease resulting in clinically evident desaturation in one or more extremities but in the absence of systemic hypoxemia. There is no evidence that increased PO 2 will improve the oxygenation of tissues with impaired circulation.

4. Terminal illnesses that do not affect the respiratory system.

For sleep oximetry studies, the oximeter provided to the patient must be tamper-proof and must have the capability to download data that allows documentation of the duration of oxygen desaturation below a specified value.

Home Sleep Oximetry Studies:

Beneficiaries may self-administer home based overnight oximetry tests under the direction of a Medicare-enrolled Independent Diagnostic Testing Facility (IDTF). A DME supplier or another shipping entity may deliver a pulse oximetry test unit and related technology to a beneficiary’s home under the following circumstances:

1. The beneficiary’s treating physician has ordered an overnight pulse oximetry test before the test is performed.

2. The test is performed under the direction and/or instruction of a Medicare-approved IDTF. Because it is the beneficiary who self-administers this test, the IDTF must provide clear written instructions to the beneficiary on proper operation of the test equipment and must include access to the IDTF in order to address other concerns that may arise. The DME supplier may not create this written instruction, provide verbal instructions, answer questions from the beneficiary, apply or demonstrate the application of the testing equipment to the beneficiary, or otherwise participate in the conduct of the test.

3. The test unit is sealed and tamper-proof such that test results cannot be accessed by anyone other than the IDTF who is responsible for transmitting a test report to the treating physician. The DME supplier may use related technology to download test results from the testing unit and transmit those results to the IDTF. In no cases may the DME supplier access or manipulate the test results in any form.

The IDTF must send the test results to the physician. The IDTF may send the test results to the supplier if the supplier is currently providing or has an order to provide oxygen or other respiratory services to the beneficiary or if the beneficiary has signed a release permitting the supplier to receive the report.

Oximetry test results obtained through a similar process while the beneficiary is awake, either at rest or with exercise, may not be used for purposes of qualifying the beneficiary for home oxygen therapy.

there is another thing....I used to work with people recieving ssi for various disabilities....soc sec office told me that they were prohibited from sending the med records to anyone but the dr who prescribed / conducted the eval.  They said it was a matter of the privacy laws...which of course i said didn't make sense that they excluded the patient, but they said regardless that was the law they are held to.   I think coz anybody could call and say they are the patient and they would not know if it was really an insurance co, lawyer, ex-spouse, employer, whomever.   (This was in the 1990's....I think that was before HIPPA, or whatever the current law's called, so it may have changed, dunno).

Thanks RAM_Sleep and embryopathy, I appreciate the info, it helped answer some questions I had!
         You know I was put on the supplemental O2 in late March or early April of 07 at 2 lpm, and then when I had my last titration study for the VPAP this past May, it was without the O2 and my new sleep doctor who this time is a Pulmonary Doc and Board Certified in Sleep Apnea, well besides putting me on VPAP he also increased my O2 to 3 lpm.  So I have been on the O2 for quite a while now!
       It's kind of  funny because I was only suppose to see this Pulmonary Doc temporarily because my normal sleep doc was sick, he was a neurologist and not board certified in Sleep stuff. I asked this new Doc what he thought about patients being active in their Sleep Apnea treatment, he said he thought it was great and the more involved the better. He is now my primary sleep Doc! I told him I wanted the extra stuff for my machine so I could monitor my progress, he told me to have the DME call him for what I needed and he would do what was needed to get it! I know that especially with my DME it helped that I was in the medical field, but that really shouldn't have made a difference, I think everyone should get that type treatment!    Anyway Thanks for the info and help!


_________________
White Beard with a White Beard
Resmed VPAP Adapt SV Enhanced, HumidAire 2i, ResLink with Model 8000 Flex sensor Pulse Oximeter, and ResScan 3.5 software. Respironic EverFlo OPI Oxygen Concentrator 3 lpm
EEP 9.0, min PS 6.0, max PS 16.0

Back to the original question: maybe it is my age and the era of health care I grew up in and had my kids during. I think it is because 1] doctors don't give their patients credit for having the intelligence to understand their results, 2] doctors don't have the time or want to take the time to answer any questions that might arise due to patient access to those reports and 3] no one wants to go to the time and expense of just automatically providing those reports.

Too many doctors still think of their patients as "borderline hypochondriacs" ready to panic at the first word in a report they don't understand. I DETEST that condescending attitude!!!

I've been told I ask too many "unnecessary questions"; that I should not be going to PubMed and reading medical journal abstracts and full articles becuase I "wouldn't understand them"; that it "isn't necessary for me to know WHY doctor has suggested a test, that it is sufficient that HE, the doctor, wants it done"; when facing open abdomen surgery at the height of HIV awareness and confusion, w/magazine and newspaper articles recommending banking your own blood for elective surgeries, I asked about the wisdom of my donating 1-2 pints of my own blood only to have the MALE doctor look past me to my husband and say "she's a worrier, isn't she?" (just 2 years before my husband had had back surgery and they had had him back 4 pts of blood prior - it almost wasn't enough!). There are still way too many educated idiots out there in the medical profession!!!

It doesn't bother me that they don't automatically give us such reports - BUT - IT INFURIATES ME when they obviously don't want to give them to you, make you jump thru hoops to get them, deliberately stall providing them, ask WHY you want them, etc. etc. etc. When I ask for them, I expect that they will be given to me. They don't even have to smile, just give me the darn things.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

CrohnieToo I think you have hit the nail  right square on the head! It is the condescending attitude that so many  Doctors have!!  I absolutely hate being Patronized that  really burns me up! So many Doctors are guilty of it, and I have seen them from the other side too and sometimes that really isn't pretty! So of them have Ego's so big that they really do think everyone else is stupid!


_________________
White Beard with a White Beard
Resmed VPAP Adapt SV Enhanced, HumidAire 2i, ResLink with Model 8000 Flex sensor Pulse Oximeter, and ResScan 3.5 software. Respironic EverFlo OPI Oxygen Concentrator 3 lpm
EEP 9.0, min PS 6.0, max PS 16.0

RAM_Sleep wrote:

Im just looking for opinions. I have a good idea of the answer already, but im curious to see your answers:

Why is it that the sleep reports are not given to the patients, without request? Why arent the reports given to the patient automatically?

Thanks for your input.

My eventual diagnosis and titration was carried out at Stanford.  I was mailed a copy of every one of my detailed sleep study reports, and at the same time as the doctor's copy went out.  

Unfortunately my doctor never received his copies, I gave him copies of mine.     Stanford administrative SNAFU.  My doctor's full name is identical to one already in Stanford's system, and they automatically assigned that doctor to me.  They didn't notice my doctor may have had the same name, but his street AND city were different.  I got that sorted out only AFTER the sleep studies were concluded.  My NEXT study's results should go to the right doctor now

Blessings,
--pseudonym

At the sleep lab where I currently work in the office, I'm not allowed to give patients copies of their sleep study report, but refer them to their doctor, the one who ordered the study -- the reports to to the referring doc.  

I've not checked to see how many of those docs comply with their patients' requests, but I estimate nearly all do.  I've not heard complaints from patients.... well, except one.  One patient stormed into our office demanding a copy, saying her doc would not give her a copy.  I didn't want to get fired, so I didn't do it.  I never heard why their office never gave her a copy, but I suspect it had something to do with her personally.  I do hope she got a copy, just to calm her down!!  

Others have requested copies and happily contacted their doctor for them, as we suggested.


.... But....

I do know one reason why our sleep lab doesn't WANT to give patients copies of their reports either before their doc gets it or before they can discuss it with a doc.  Sometimes those reports identify cardio problems, and that knowledge might scare a patient unnecessarily (in the opinion of my boss).  At the same time, we make sure the doc is made aware of any cardio abnormalities in case there is cause for concern or additional testing.  Most of the cardio problems seen during a sleep study are likely handled by the successful use of cpap, and may be identified as such during the titration.  Anyhow, that's one point of view.  I do agree, that maybe there might be some degree of concern by doctors that patients may interpret the data wrong.  But I don't really see that being a problem, and I think most of our referring physicians do comply and give patients copies of the reports, if requested.


Linda

Linda wrote:

At the sleep lab where I currently work in the office, I'm not allowed to give patients copies of their sleep study report, but refer them to their doctor, the one who ordered the study -- the reports to to the referring doc.  

I've not checked to see how many of those docs comply with their patients' requests, but I estimate nearly all do.  I've not heard complaints from patients.... well, except one.  One patient stormed into our office demanding a copy, saying her doc would not give her a copy.  I didn't want to get fired, so I didn't do it.  I never heard why their office never gave her a copy, but I suspect it had something to do with her personally.  I do hope she got a copy, just to calm her down!!  

Others have requested copies and happily contacted their doctor for them, as we suggested.


.... But....

I do know one reason why our sleep lab doesn't WANT to give patients copies of their reports either before their doc gets it or before they can discuss it with a doc.  Sometimes those reports identify cardio problems, and that knowledge might scare a patient unnecessarily (in the opinion of my boss).  At the same time, we make sure the doc is made aware of any cardio abnormalities in case there is cause for concern or additional testing.  Most of the cardio problems seen during a sleep study are likely handled by the successful use of cpap, and may be identified as such during the titration.  Anyhow, that's one point of view.  I do agree, that maybe there might be some degree of concern by doctors that patients may interpret the data wrong.  But I don't really see that being a problem, and I think most of our referring physicians do comply and give patients copies of the reports, if requested.


Linda

While I agree with most of what you wrote, it baffles me that it isnt automatically sent.

Another issue is ones hospital bill. Patients have to request the itemized bill, at least in my area. I guess hospitals do not want patients to be aware of the fact that they are being charge 70 dollars for an aspirin.  

Sorry to bring up, probably, an age old debate/topic.

Well, let's think about what diagnostic reports are automatically sent to the patient.

When I had blood work done for one doctor, the results were mailed to both me and my doctor.  But with my new doctor, I didn't receive the results via mail, I had a followup visit with my doctor who showed me the results and explained them.  Don't know why the difference, perhaps my first doctor checked some box authorizing a copy to come to me.

I had x-rays done and the diagnostic place in the hospital asked if I wanted to have them and deliver them to the doc, or they deliver them directly.  

So I don't know if things are done the same way everywhere.  I'm not sure if the hospital bill routine is the same everywhere.  

And, sleep apnea as a condition is relatively a new thing.  Sure it's been a few decades since it was first known, but I bet the medical business accompanying this condition has had growing pains.  

I guess our system of medicine thinks that if patients want to know bad enough, they should ask.  Dumb, I know.


Linda