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By Tyler Decker
Lately, several conversations I have had with people working in durable medical equipment (DME) have converged on the same dilemma: manufacturer prices keep going up, reimbursement is not keeping pace, and products that once made financial sense are becoming harder to justify.
It is easy to understand why some providers are looking at less expensive alternatives. A DME is a business. Employees have to be paid, inventory purchased, claims processed, and there has to be enough margin to make the operation work.
A recent HME News Newspoll put some numbers behind that pressure. Nearly all respondents, 98%, said key manufacturers had raised prices during the year, while 52% said they were evaluating alternatives. Providers described weighing acquisition cost against reimbursement along with product quality, reliability, customer demand, shipping costs, and profit margin.1
Take a hypothetical DME performing 1,000 positive airway pressure setups a year. If changing machines saves $50 per setup, that is $50,000 a year. That is hard to ignore.
The harder question is what else belongs on the spreadsheet.
What the Invoice Doesn’t Show
In my CPAP work, I spent most of my time with the same make and model of equipment. After enough setups and troubleshooting calls, I knew those devices inside and out. That was not proof they were better than everything else on the market. It was familiarity built through repetition.
One machine I worked with frequently could develop a loud temporary leak even though the humidifier chamber appeared to be seated correctly. An inner seal could end up slightly oval instead of fully round. Reseating the chamber until the seal settled correctly usually fixed it. After seeing the problem enough times, I started warning patients about it during setup.
That kind of knowledge never appears in the purchase price. It builds through hundreds of interactions until troubleshooting becomes almost automatic.
By contrast, I remember helping someone with a machine from another manufacturer. Even though I knew what I wanted to change, I had to search online for something as basic as how to get into the clinical menu.
The same thing happens with monitoring software. When I knew a system well, I knew where to look and what I wanted to check next.
Move a CPAP department onto different equipment, and the staff will learn it. The question is what happens while they are learning. Setups and troubleshooting can take longer, and employees have to learn different menus, settings, reports, accessories, software, and the odd little problems that only become obvious after enough patients have called about them.
There probably is not a line item for “employee spent 15 minutes figuring out where they put that setting,” even though the employee was on the clock.
Devices Are Not Identical
The machines themselves should not be treated as interchangeable boxes either. Manufacturers use proprietary algorithms to determine how automatic devices respond. A 2023 bench study compared three APAP devices under simulated sleep-disordered breathing events with and without unintentional leak. The devices responded differently when leak was introduced, and their performance was affected differently.2
It was a bench study, not a clinical trial, and it looked at three specific devices. It cannot tell us that one machine will produce better outcomes for real patients. What it does show is that APAP devices should not automatically be assumed to behave the same simply because insurance reimburses them under the same code.
I have preferences in positive airway pressure equipment, as most people probably do after working with it long enough. But preference and familiarity are not evidence that one current machine consistently produces better adherence than another. I did not find enough head-to-head evidence to make that claim.
That uncertainty is exactly why I would want to measure what happens after a switch.
Downstream Costs
The financial pressure does not necessarily stop with the CPAP machine. If prices are rising across more of a manufacturer’s product line, the DME may eventually review how much of a line—machines, masks, accessories, and resupply—it still makes financial sense to carry.
Most patients I worked with did not ask for a particular machine. They wanted something that worked. Masks were different. Once patients found one they could sleep in, many became attached to it.
The clearest example I saw of hidden work created by a product change came from a slightly different situation. A commonly used mask was discontinued. While not the same as a DME deciding to stop carrying the mask, the practical problem was similar: established patients who were doing well suddenly needed another option.
Before long, my schedule started filling with refittings. Eventually, two managers pulled me into a meeting because I was doing so many refittings. Those patients were coming due for resupply, their old mask was no longer available, and they needed help finding something else. The workload became visible because my schedule was getting crowded. (Nobody had run a report showing a spike in refittings.) It was a simple example of a product change creating work somewhere else before anyone was measuring it.
That experience is why I would want the same downstream thinking applied when price pressure causes a DME to narrow the products it carries. If a mask a patient already uses successfully is no longer available through that provider, some patients will try the replacement. Others may buy their preferred mask online or take their resupply business somewhere else.
No DME can carry every mask made by every manufacturer, but changing the product mix does not happen in a vacuum. If lower purchasing costs also create more refittings, more staff time, or lost resupply business, some of those savings can disappear pretty quickly.
There is a patient-care side to this as well. In a study of older CPAP users, worse patient-reported usability was associated with lower nightly use. Among participants with objective usage data, a 10-point worsening in usability score corresponded to about 0.37 fewer hours of usage per night.3
The study was observational and did not compare manufacturers. The narrower point is enough: the patient has to live with this equipment every night.
The purchasing decision may happen in an office. The result ends up beside someone’s bed.
What Are We Measuring?
The acquisition-cost difference is easy to see. Someone can multiply it by annual setup volume and know the projected savings. The downstream effects are harder to spot because they show up in different places and at different times.
A fitter whose schedule suddenly fills with refittings will eventually attract attention, and machines coming back at an unusual rate probably will too. A little more time spent on each setup, a modest change in adherence, or a gradual loss of resupply business can be much easier to miss.
Insurance compliance already has to be tracked because reimbursement depends on it, but that does not necessarily tell a company how well its CPAP program is performing overall. A provider can know whether individual patients met their insurance requirements without knowing whether the percentage of patients succeeding changed after new equipment was introduced.
The monitoring system belongs in that conversation too. A 2020 meta-analysis of 19 randomized trials involving 2,464 patients found that telemonitoring was associated with about 0.68 more hours of CPAP use per night compared with usual care.4 Software does not create adherence on its own. Somebody has to look at the information and act on it.
Pilot New Options Before Full Rollout
Now go back to our hypothetical DME projecting $50,000 in annual savings. If I were sitting in the room, I would have questions. Have we actually used the machine? What is the monitoring system like? How are we going to train staff? What independent outcome data are available? Could masks, accessories, or resupply be affected too?
The most practical question might be: Are we piloting it first?
If the operation allows it, I would rather see new equipment introduced on a smaller scale before a full switch. A pilot gives the DME a chance to see what actually changes. Are setups taking longer? Are returns, mask changes, adherence, or troubleshooting time moving in the wrong direction?
If the product mix is changing more broadly, I would watch refittings and resupply too. A pilot will not answer every question, and contracts or inventory requirements may make a gradual transition difficult. When it is feasible, learning on a smaller scale makes more sense than discovering a problem after hundreds of patients have already been switched.
The company does not need to build a research department. Start with information it can already obtain reliably: 90-day adherence, returns or repossessions, mask-exchange rates, resupply activity, and, where it can be tracked reasonably well, setup or troubleshooting time.
The exact list matters less than having something meaningful to compare. Just use more than the invoice.
An internal pilot or before-and-after comparison is not a clinical study, and other variables can affect the results. It will not prove causation, but it can tell you whether something deserves a closer look.
Protecting Patients (and Margins)
None of this requires turning manufacturers into villains. DMEs cannot absorb price increases forever while reimbursement stays tight. More competition in CPAP can be a good thing. If another manufacturer can make a machine patients like, clinicians trust, employees can support, and DMEs can purchase at a better price, it deserves the opportunity to compete.
Protecting margin is part of keeping the doors open. The business still has to work financially.
My concern is that major equipment decisions affect more than purchasing, which means the people familiar with the day-to-day CPAP operation should have a voice in them. They are often going to see consequences that are difficult to spot on a quote sheet.
If our hypothetical company saves $50,000 and its meaningful patient and operational measures stay the same or improve, that is a good result. Keep buying the less expensive machine.
If some of those savings start disappearing through lost resupply, more returns, additional fittings, extra staff burden, or poorer patient outcomes, those costs belong in the calculation too.
Patient care and financial sustainability do not have to compete with each other. A DME needs both. If a company changes CPAP equipment because the numbers say it will save money, it should be willing to look far enough downstream to find out whether those numbers were actually right.
Until then, the company knows what it paid for the CPAP. What it actually cost them is a bigger question.
References
1. Beaulieu L. HME providers shop around as manufacturer price increases mount. HME News. 18 Sept 2026.
2. Fasquel L, Yazdani P, Zaugg C, et al. Impact of unintentional air leaks on automatic positive airway pressure device performance in simulated sleep apnea events. Respir Care. 2023;68(1):31-7.
3. Fung CH, Martin JL, Hays RD, et al. Patient-reported usability of positive airway pressure equipment is associated with adherence in older adults. Sleep. 2017;40(3):zsx007.
4. Chen C, Wang J, Pang L, et al. Telemonitor care helps CPAP compliance in patients with obstructive sleep apnea: a systemic review and meta-analysis of randomized controlled trials. Ther Adv Chronic Dis. 2020;11:2040622320901625.
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