Concentrators continue to evolve

Tuesday, November 24, 2009

Stationary and portable oxygen concentrators both have vital roles in respiratory therapy and manufacturers are continually modifying them for improved performance, durability and value. Despite their different purposes, the technology for both types of concentrators has advanced significantly and each modality makes a critical contribution to oxygen patients’ quality of life, said Ron Richard, president of San Diego-based SeQual Technologies.

“The current generation of portable concentrators offers the patient options better suited to their lifestyles and needs compared to products developed in the mid-1980s,” he said. “The long-term oxygen therapy market has come a long way since the times when many patients were serviced via welding suppliers who delivered oxygen tanks to their homes. Taking a look back at the very first home-based concentrators, many providers saw these systems as a clear pathway away from delivering oxygen tanks except to only the patients who were ambulating and requiring a greater number of deliveries per week or month.”

Richard believes there is a role and place for both stationary and portable systems in the long-term oxygen therapy continuum of care.

“Stationary devices are clearly used for patients who don’t ambulate very much and are homebound, as well as for those requiring a higher Fi02 and flow rates above what a portable device can deliver. The trends in global long-term oxygen therapy seem to be focusing on reducing deliveries and visits to the patient’s home unless there is a clinical need or something related to the equipment needing maintenance or service. In the future, the adoption of portable systems or non-delivery oxygen technologies will displace concentrators and liquid systems.”

Kim Snyder, U.S. marketing manager of Home Respiratory Care for Murrysville, Pa.-based Philips Home Healthcare Solutions, says stationary oxygen concentrators are the most frequently utilized home oxygen equipment and, as such, they need to be cost-efficient not only in terms of purchase price, but also in the cost to service.

“Manufacturers have continued to optimize the design of stationary concentrators to meet those market requirements,” she said. “At the same time, since these are used in patients’ homes, there has also been a focus on making them lighter, quieter and smaller, so that they are less obtrusive in the home environment. Stationary oxygen concentrators have continued to get smaller, lighter and quieter, and the cost to purchase and maintain stationary concentrators has continued to go down. There are fewer parts than earlier concentrators and longer maintenance windows.”

Evolution and growth

Portable oxygen concentrators continue to evolve, Snyder said, with manufacturers seeking to find the perfect balance between battery life, oxygen output and size.

“With more portable oxygen concentrators on the market, there is more choice available than ever before and manufacturers have focused on optimizing different features,” she said. “For example, some POCs are very lightweight, but produce less oxygen and have a shorter battery life. Others may focus more on extended battery life and higher oxygen output, but they weigh more than the lightest POCs in the category.”

Concentrator use will continue to grow domestically and worldwide because “they continue to prove to be the most practical, reliable and cost effective way” to deliver low-flow oxygen in a variety of settings, added Joe Lewarski, vice president of Elyria, Ohio-based Invacare’s Respiratory Group.

“In developing markets, the entire liquid and compressed gas models are being skipped while concentrators and self-generating systems like HomeFill and the portable concentrators are used right from the start,” he said. “The technology will continue to improve over time, although the changes now versus the last 15 years will be different as we focus on size, oxygen production, noise, portability and energy efficiency.”

Reimbursement dilemma

The manufacturing community is unanimous in its concern about reimbursement for concentrator systems now and in the future.

“The problem with CMS is they pay for what they consider a fair price based on the acquisition costs of a product to meet the needs of the patient,” Richard said. “No real explanation as to how to factor payment for service to the patient has been defined by CMS or any payers, thus they apply a very simplistic economic model to the situation and ultimately the patient suffers as they as caught in the middle.”

Lewarski agrees that the payer methodology must change in order for reimbursement rates to be fair.

“Reimbursement continues to be an Achilles’ heel and will likely stay an area of concern until we can stop looking at home oxygen therapy as ‘equipment’ and recognize it as the comprehensive service set it really is,” Lewarski said. “Without such change, I fear it will continue to be an easy target.”