Home test machines

[Doug]

I am pretty new to this, hope I am not re-treading old ground but here goes.

I am still about 3 weeks away from surgery (AVR), and I am approximately 93.685%, sure I am going to choose a mechanical valve which will obviously put me on Warfarin for the rest of my life. My surgeon told me that there were home testing kits available, but that insurance doesn't cover them yet, but they probably will in a year. I see many of you seem to have them, is my surgeon's information outdated?

Al, got your book yesterday, my wife ordered it Wed or Thurs last week and we got it on Monday! (didn't know the mail could move so fast).

Thank you so much for getting it out so quickly we both greatly appreciate it.

 

[Guest]

Thanks. I hope that you find it useful.

 

[M&M]

Hi Doug, I know its hard to believe - but I still hear medical people who didn't know I could test myself at home.. and they work in the medical field everyday !!! They are amazed to hear me tell them. I guess its not well known - but my doc told me about it before my surgery - but totally forgot about it after my surgery. Luckily, my clinic has a coumadin clinic attached and they fixed me right up from day one. Coumadin Clinics are a great resource and they call me at home and see how its going. If I'm to high they go over what could cause that and if my INR is to low - we go over my weekly routine. Meds and exercise as well as food can change your INR - it sometimes doesn't take much. I highly recommend testin 'weekly' at home. I know sometimes the docs office will test once a month. I won't go that long - I'm just not that 'consistent' in my diet and its been almost 2 years. So many factors can change your INR. I recommend to anyone that testing once a week is the best way to go in the beginning.

I found my coumadin clinic to be very helpful in getting my insurance to approve it. I think Coumadin Clinics are better than regular doctors office as they have more time to explain what will effect your levels. I've been two years now on coumadin and I have to say - its gone relatively because of my affiliation with a coumadin clinic. They are very good at what they do.

Good Luck to you and please keep us posted on your surgery.
Best Wishes
M&M

 

[Ross]

Hi Doug, I know its hard to believe - but I still hear medical people who didn't know I could test myself at home.. and they work in the medical field everyday !!! They are amazed to hear me tell them. I guess its not well known M&M

Oh they know full well. They don't want to recognize it though because it cuts into their lab profits, so they deny knowledge of their existence.


Doug some hospitals are now sending patients home with machines. This is new!!! The machines aren't, but hospitals sending them home is. Insurance companies will cover it or I guess I should say some insurance companies will. It's going to get easier eventually, just give it time. You have to be on Coumadin a minimum of 3 months before they'll allow you to get one. Don't ask me why, I think that's stupid, but that's how it works unless your sent home with one.

 

[geebee]

Doug,
Talk to your insurance company. Find out what their restrictions are. Some companies will pay right away and some require waiting periods.

 

[Doug]

Al, Ross, M&M and Gee Bee,

Thank you very much for the information. I will get in touch with my insurance company and start the process.

I'm glad I asked as my wife and I were talking about buying one ourselves because we didn't think insurance would cover it yet. Thank goodness for VR.com and all the wonderful people here!

THANKS AGAIN!!!

 

[jeffp]

Oh they know full well. They don't want to recognize it though because it cuts into their lab profits, so they deny knowledge of their existence.

If it were only that simple. The remibursement for a PT/INR lab test in my area is $5.49. That includes the blood draw supplies as well as the test reagents, etc. It's the same if a home/POS tester is used rather than the lab. At about $4.00 per strip, there's not alot of margin for profit on INR testing. I've found it's more an issue of being uncomfortable/unfamiliar with the reliability of the home testing and concern about loss of control over the patient.
Not everyone can self test, let alone dose adjust. Many just don't want to. I think the fact that we're "net savvy", and as a group we are above average in desire to take part in our health and management, somewhat skews our view of home testing. My PCP didn't even know such things existed until I discussed it with him, now he has a Coaguchek in the office.

 

[Blanche]

Dr. Jeff's points are good ones. Now that Medicare is covering the use of home testers, more docs are becoming aware of them. Our doc did not know of them 5 years ago, now he's planning his own coumadin clinic in his office. Our cardio has testers in his two offices and was responsible for a point-of-care monitor in a local emergency room.

What concerns me very much is that people who want to home test sometimes do not have the necessary preparation to home test to begin with, and certainly do not have the expertise to adjust their own doses. When I hear of someone a month or so past surgery self dosing, it makes my blood run cold. It isn't rocket science, but there is both art and science involved in antcoagulation management.
Blanche

 

[Ross]

If it were only that simple. The remibursement for a PT/INR lab test in my area is $5.49. That includes the blood draw supplies as well as the test reagents, etc. It's the same if a home/POS tester is used rather than the lab. At about $4.00 per strip, there's not alot of margin for profit on INR testing. I've found it's more an issue of being uncomfortable/unfamiliar with the reliability of the home testing and concern about loss of control over the patient.
Not everyone can self test, let alone dose adjust. Many just don't want to. I think the fact that we're "net savvy", and as a group we are above average in desire to take part in our health and management, somewhat skews our view of home testing. My PCP didn't even know such things existed until I discussed it with him, now he has a Coaguchek in the office.

Oh O.K. Mr. Jeff, I'll give you that one, but I've caught some of these Doctors outright lying about not knowing they exist. If they've been reading their publications, it's pretty hard not to see what's going on in the world.

 

[Karlynn]

I've been home testing for almost 4 years. My insurance covered 100% of the machine when I first started. (My insurance was UHC.) Now I'm getting a new INRation machine and my insurance is covering 90% (Empire BC/BS). More and more insurance companies are covering machines.

 

[denverman1]

Raytel

Raytel

Am completing my first month of home testing on an INRatio machine furnished by Raytel. For the first two years since AVR surgery I was having a blood draw each month at my DR's office. Finally on my semi-annual visit to my cardio, the nurse mentioned that I could probably qualify to get a home testing machine. So far it has been great as I test each week and get the results instantly. I then call the INR into Raytel and they fax them to my DR. The home testing is covered 90% by United Health. I haven't seen a bill yet so I am not sure what the total cost will be for me.

 

[Granbonny]

Dr. Jeff

Dr. Jeff

Not to hijack..Doug's thread...but, you say, that the doctor's office only makes $5.49 from a lab draw, results, ect....How about the cost of office visit?Is that included in the $5.49 profit?...The last time I went down to my Cardio's office (Hubby's checkup)was noticing how many elderly were there for Protime check?( Not valve related)...Just wondering..if medicare paid for the office visit?...On a side note..I was very lucky 4 years ago..when I found VR.Com and read about home-testing. ..My Cardio (same office) approved mine over the phone. QAS handled everything for me..United health care paid 80% for machine and supplies.Ross, I think you are thinking of one of our members who posted that he would be sent home with home-testing..(Same member who has my Cardio group) Maybe it is just the script?..Not to pat myself on my back but, maybe I was the one that they saw ..that is successful in home-testing? He and I are young enough to handle it... I get a 6 month scrip for coumadin..Call in my INR every month to my Cardio's clinical nurse....After 4 years..she never bothers to call me back..always in range. Bonnie

 

[Guest]

I believe that the doctor's office gets about $5 to $7 depending on the state more than an office visit fee for doing a fingerstick INR test. The strip costs about $6.

 

[jeffp]

Playing strictly by the rules....an office visit would only be allowable if there was a problem present, such as needing a dose change or some other concurrent problem. If it was just a "3.0 - doing fine - keep up what you're doing" an office visit wouldn't be billable, by strict reading of the rules.
I've been working with the new programs director at my local heart hospital to look into the feasability of setting up an anticoagulation clinic and we're still looking for ways to use a pharmacist or a nurse to run the thing and come up with a way to get paid by insurers. It's too costly to have a physician manage the cases personally, and if there's no change, then there's no billing over and above the lab test. I'm starting to see why POS testing is not catching on as we would think it would. Ordering a lab test is covered as a visit, but interpetation of a normal test is not. Strange way to work things but bad stuff gets paid and good stuff doesn't. I always dealt with problem acute oriented care, never had much to do with the care of the healthy. Ya' live and ya' learn.

 

[Guest]

Maybe this is why so many people "get jerked around" and never get in range. If the doc has them hold a dose for an INR 0.1 units above the range, the doc gets paid and then gets paid again for the follow-up if the dose needs changing again.

 

[EVELYN]

Hi Doug

In response to your questions about who self-tests..... WE DO and love it. Matter of fact, we just got back from a two week vacation in our motor home and our Coaguchek went right along with us.

Tyce had his AVR done almost 4 years ago....June will be 4 years and we started testing about 6 months post op. Our first machine was a Protime....which we didn't like at all. Our next machine was the Coaguchek which we love big time. Much easier to read, I believe more accurate, less blood draws, and a great traveling case with it.

Our cardio absolutely agreed that self testing is the way to go, but also said that we were the ONLY one in his practice that does it.....and it's a huge, 7 dr. practice. Of course for the first few months we faxed in our results every week to his cardio clinic nurse who told us what to do and not do after she ran it by our cardio. Now, we do self adjust, and it's wonderful.

BTW, our insurances paid for BOTH machines in full.....Empire and Multiplan. They also pay fully for our strips, lancettes, cap refill tubes, etc.

My recommendation is GO FOR IT, but not for about 6 months post op till you're pretty stable.

Good luck.

Evelyn

 

[Ross]

Maybe this is why so many people "get jerked around" and never get in range. If the doc has them hold a dose for an INR 0.1 units above the range, the doc gets paid and then gets paid again for the follow-up if the dose needs changing again.

This sounds precisely right to me!