Portable Oxygen Provides Independence for Users and Flexibility for Dealers

For HME providers, freedom and independence mean the chance to migrate away from expensive delivery modalities, whether by embracing POCs or by finding new ways to serve customers using cylinder-filling technologies and oxygen conservers. POC cash sale opportunities and new efficiencies when serving Medicare and private-pay patients may just provide dealers the freedom and independence to keep their businesses afloat. The current HCPCS coding system and fee schedules are well known. As a result of competitive bidding, reimbursement is down significantly, although demand for oxygen services remains steady. Operating within the current system requires home oxygen providers to be innovative, highly efficient and low-cost operators.

Product developments include better oxygen output in smaller, quieter and lighter packages, improved durability and reliability with limited service and maintenance needs.

Lightweight and Maneuverable

Continuously driving the portable oxygen market is a need to provide greater oxygen capacity with lighter weights while maintaining and increasing battery life to meet patients’ clinical and personal lifestyle needs, says Brett Townsend, sales and marketing director, Caire Medical, a Chart Industries company. For non-
delivery modalities, POCs are lightweight, provide extended battery life, offer better recharging times and can recharge from AC and DC power while operating at prescription capacities. Caire’s technologies such as UltraSense and AutoSAT increase a POC’s ability to detect and adjust to the respiratory rate of the patient, ensuring the patient receives the prescribed pulse whether breathing shallow, such as during sleep, or inhaling deeply due to exercise. Carrying POCs that are powerful enough to provide and adapt to varied oxygen prescriptions—whether pulse or continuous flow—allows the HME/DME provider to treat the entire range of oxygen therapy requirements. Caire provides both POCs and liquid oxygen systems. Patients want small, lightweight devices that afford them travel and lifestyle flexibility—even patients who are difficult to treat clinically. Providers need the ability to adapt to changes in their referral bases and patient progression through the disease state continuum. Caire offers lightweight concentrators with advanced pulse setting options, needed clinical technology and extended battery life options. To make the most educated POC choices, providers should consider how to best meet the needs of their patients with their inventory, says Townsend. Choosing POCs that offer the ability to move from pulse to continuous flow broadens the number of patients who can be treated, while limiting the initial investment in stock. POC limitations due to battery duration and flow ability need to be discussed and explored while creating inventory and also with patients prior to unit deliveries. Discussion also should include considerations for weight of the unit and how it will be worn or pulled so patients can retain or increase their mobility. Caire Inc.’s research and development team harnesses technological advancements to decrease battery and POC size, while increasing flow rate capacities to continually improve the product line. An example is the eQuinox smaller transportable concentrator offering 3 liters/minute (lpm). Features include an advanced voice module interface, continuous flow options and nine pulse settings up to 192 mL. A multilanguage voice interface alerts patients of setting changes, alarms and remaining battery time. The screen intermittently displays the remaining battery time. The eQuinox is fully functional on AC, DC and battery power with pulse settings 1-9 and continuous flow up to 3 lpm, and has 12-cell and 24-cell battery options. The 14-pound weight and easy-to-maneuver frame ensure mobility, and it operates quietly at 45 dB for 2 lpm continuous flow. All five of Caire’s POCs are approved for both E1390 and E1392 ambulatory and stationary reimbursement codes and can stand alone or be paired with a stationary concentrator. They are also FAA-approved for in-flight use. Providers can offer either sale or rental options.

HomeFill Changed the Game

The most common clinical limitation for portable oxygen is managing higher flow and higher respiratory need patients. Patients with very high minute volumes, such as those with pulmonary fibrosis, often have high flow needs as well. This combination often presents difficulty when trying to use a small, pulse-only device, or devices with flows less than 2 lpm. On a technical level, most limitation discussions focus on long-term 
durability and reliability of many portable oxygen concentrators. Invacare has three key products in the portable oxygen space. The Invacare HomeFill Oxygen System is a cylinder-filling technology that uses oxygen from the concentrator to fill various sizes of portable oxygen cylinders. The HomeFill system is HCPCS coded K0738 and covered by most insurance plans. Invacare also has two portable oxygen concentrators—the Invacare XPO2 lightweight 6-pound pulse-dose-only portable concentrator and the Invacare SOLO2 portable concentrator for 3 lpm continuous flow and pulse-dose. Both the XPO2 and the SOLO2 operate from AC, DC and lithium ion battery power sources, are cleared by the FAA for use on commercial aircraft, are HCPCS coded as both E1390 and E1392 and are covered by Medicare and most insurance. The introduction of the HomeFill System changed the home oxygen paradigm, says Joe Lewarski, Invacare’s vice president of clinical affairs. As the first non-delivery oxygen system, the HomeFill system addressed two critical issues facing home oxygen providers—the high cost of providing portable oxygen therapy and the need to serve the clinical needs of highly active and ambulatory oxygen patients who spend considerable time out of their homes. The HomeFill System successfully overcame both challenges. It concurrently improves operational 
efficiencies and drives out non-value-
added costs for the provider while 
delivering portable and clinically 
efficacious oxygen therapy to the patient, says Lewarski. The HomeFill system 
continues to experience strong growth as the leading non-delivery system. With a range of cylinder sizes and the ability to use continuous flow and most conserving devices, it covers the largest range of clinical applications of any non-delivery, portable oxygen system on the market, Lewarski says. Many of today’s home oxygen users are highly active and spend considerable time away from their homes. This group 
is more consumer than patient, and is often educated and informed. Often they are seeking a technology that best fits 
their lifestyles, and many are willing to pay to have a choice, Lewarski says. Direct-to-consumer marketing is now a standard in health care. Informing the consumer about a dealer’s home oxygen program and technology options will have an impact on referrals, as well as help stimulate cash sales. Portable oxygen concentrators are a popular cash sales item; however, patients also purchase stationary concentrators and HomeFill systems. Although there is significant growth in the use of non-delivery, portable oxygen technologies, in many markets patients 
are still relying on deliveries and 
traditional cylinders (often E size) for portability. Many physicians and referral personnel, as well as many oxygen patients, are simply unaware of the many modern, lightweight non-delivery portable oxygen systems that are available. For those providers invested in portable oxygen technologies, a strong and effective marketing campaign can gain market share, says Lewarski.

Go Around the World

O2 Concepts supplies a portable oxygen concentrator providing continuous flow up to 3 lpm. The Oxlife Independence seeks to satisfy every foreseeable patient and dealer need, striving to be a low-cost, non-delivery solution that provides a great patient experience. For dealers, the Oxlife Independence is a 3 lpm machine made of lightweight metal and backed by a standard five-year warranty. For non-delivery, the provider can set up a patient at the hospital when discharged and keep a few units on every truck for flexibility. The approach eliminates the need to fill half a truck with elaborate equipment and to train a patient on stationaries, regulators, homefill, etc Late-day setups can be handled in 15 minutes, or a POC can be dropped off as a temporary solution if a stationary machine goes down for maintenance. “Maintenance costs are negligible as it’s very cost-effective to swap out a unit and take advantage of the warranty for repairs,” says Rob Kent, president and COO of O2 Concepts. Travel accommodations are not needed—the patient can merely unplug and go. For patients, the unit’s Energy Smart Absorption (ESA) technology extends battery life. The unit runs on a consistent current rather than a consistent RPM—air is mechanically redirected to keep constant pressure with a variable RPM. No current spikes extend battery life. The dual battery system allows users to hot-swap smaller batteries and easily carry spares. Desktop chargers allow a seemingly endless tether. Kent says several 
patients are using the Oxlife Independence as a single solution 24/7 (no stationary). The cap is 3 lpm continuous. “If you manage a continuous flow POC correctly, you can effectively go around the world,” says Kent. We find weight and battery life to be the biggest decision factors. As those performance factors improve, you will find patients able to do more with oxygen and live seemingly normal lives.” Kent says providers should consider continuous flow POCs for the 15 percent of patients classified as high usage (10 or more E cylinders per month). On average, it’s $2 to fill an E cylinder and $35 per delivery stop, so the costs can quickly eat up the $110 average reimbursements. A continuous flow POC allows providers to bill both E1390 and E1392 for an average $130 reimbursement—with lower monthly out-of-pocket costs than 
servicing tanks. “We see many of our customers add $45,000 to annual profits by switching more than 50 patients,” says Kent. “Don’t let cash flow keep you from moving to a more efficient non-delivery model,” says Kent. “You can often get 36-month financing and still keep half your billings when moving to portable concentrators for non-delivery. You may pay a little more in the long run, but 
you can enjoy being cash-flow positive out of the gate.”

Improving Quality of Life

Inova Labs offers lightweight POCs that are less than five pounds. The LifeChoice Activox Sport and Pro models for active patients have a proprietary pulse-wave delivery system that senses the patient’s breathing and delivers oxygen congruent to the patient’s needs—at the speed they are breathing. Designed for active 
patients, the technology is a tool to provide early oxygenation. Lightweight POCs are helping to keep patients active and improve their quality of life, says Keith James, Inova Labs’ vice president of marketing. Patients don’t have to pull carts or refill oxygen tanks. Developments include software that uses power more 
efficiently and extends battery life. The LifeChoice Activox Pro model weighs 4.3 pounds and has more than 12.5 hours of battery life. The Auto Mode feature works with Pulse-Wave technology to adjust sensitivity automatically, whether the patient is active or at rest. At a $3,995 MSRP, the low-maintenance device is an attractive option for providers looking to reduce operational costs—the patient never runs out of oxygen. Dependability during the last two years of the product’s five-year life cycle is especially attractive to HMEs, who stop receiving Medicare reimbursement at 36 months but continue to service the patient the next two years. The only likely service costs during that time would be to refresh the sieve bed (required of any POC). The approach also can help an HME increase his market share by creating happier customers, says James.

Benefits of Oxygen Conservers

Oxygen conserving devices benefit 
patients by allowing them to use lighter-weight oxygen cylinders for longer periods of time. Drive Medical Design & Mfg.offers a full-line-suite of oxygen regulators and conservers to afford respiratory providers the opportunity to thrive in this competitive environment. By allowing these patients to ambulate more, oxygen conservers contribute toward independence, quality of life and lung function. Conservers also benefit providers, says Kiran Shetty, Drive Medical’s director of marketing, respiratory. As compared to other portable oxygen modalities, they represent the best balance between initial acquisition cost (much lower than non-delivery modalities), operational costs (reduced compared to continuous flow, but higher than non-delivery), size, weight, clinical efficacy and opportunity. Non-delivery modalities certainly have an important place in the portable oxygen market, but they mitigate the value the provider can bring to the patient or to the referral source once the initial delivery is completed, says Shetty. Drive’s auto-adjusting conserver technology, present in its electronic oxygen conservers, senses breath rate or motion changes and uses a patented algorithm to adjust oxygen dosage automatically to match the user’s need as his or her activity level changes. Providing at least a year of battery life and lightweight design, auto-adjusting conserver technology permits oxygen patients to live even more active lives. By providing the appropriate oxygen dosage during rest and activity, patient oxygen saturation is better maintained and cylinder durations are increased, thus providing longer ambulation times. Auto-adjusting electronic conserver technology can quickly deliver a bolus of oxygen and match oxygen dose to patient need as their activity levels change. The SmartDose Mini, CTOX-MNO2, auto-adjusting electronic conserver’s patented technology monitors breath rate and adjusts oxygen dosage as activity changes.