Conservers and regulators: Quality, consistency key issues

In today's world of unstable Medicare reimbursement, oxygen conservers and regulators are critical to helping providers stay afloat. By maximizing respiratory patients' oxygen consumption, conserving devices play an essential role in managing costs. That's why some manufacturers are concerned about the current state of the conserver and regulator market, an environment where prices are being driven dramatically downward while the number of competitors continually rises. Moreover, respiratory specialists contend that disparity in flow rates among conserving units makes it difficult for patients to receive the correct amount of oxygen. While lower prices fueled by greater competition can be seen as positive for the provider, it can also pose hazards, said Scott Decker, president of Santa Ana, Calif.-based Cramer-Decker Industries. "With competitive bidding looming, providers are under pressure to reduce costs and are doing a lot more price shopping," he said. "Many of the competitors coming into the market produce cheap knockoff products. As a result, it's easy to be lured by low prices at the expense of quality. While saving money is very appealing, you may be subjecting patients to an unnecessary risk. It doesn't seem worth it." Though he acknowledges that the conserving device market has been inundated with products made by foreign manufacturers, Invacare's Bob Messenger contends that it's no different from any other product category. "There are definitely some foreign-made products making inroads in the market," said Messenger, clinical manager for respiratory products at the Elyria, Ohio-based manufacturer. "And they are increasing pricing pressures. But it's happening across the board." Poor quality products not only jeopardize patient safety, they threaten employee morale as well, he said. "No one wants to go out after midnight or on weekends to fix or replace a defective item," Messenger said. "This is one of the intangibles that go along with buying quality products." Rick Davis, vice president of marketing and product innovation at St. Louis-based Access Point Medical, says the pattern he has seen repeatedly over 25 years is that the tide of cheap products rolls in, lingers for a short time and recedes quickly. "Bad products don't last long in this industry," he said. "Once a referral source has a bad experience, that's it. People don't just throw purchase orders at you--it takes a long time to establish trust and earn your client's business. There are no shortcuts." Avoiding poorly made products doesn't mean the provider should buy the "fanciest products with gilded scrollwork," either, Davis said. Devices with mid-range pricing that deliver high levels of functionality and durability are readily available, he said. The proliferating quantity of conserving devices has some wondering if they will be relegated to commodity status. Others, like Messenger, believe the opposite is true. "We've actually come a long way with their development," he said. "When they first came out they metered out such small amounts that the patient actually de-saturated and the referral community frowned on their use. But the development of demand, and especially pulse conservers over the past few years, patients are being fully oxygenated." While referring clinicians may have a rudimentary knowledge of conserving devices, they are often wrongly prescribing oxygen rates based on flow rather than saturation rates, Messenger said. Because dial settings vary from brand to brand and the nature of demand and pulse oximetry differs from continuous flow, titration rates are inconsistent, he said. "If you take two different conservers from two separate manufacturers--even from the same manufacturer--and put the setting on 'two,' they will meter out at different oxygen rates," he said. "Physicians tend to prescribe a number to a flow rate and it doesn't necessary equate." Therefore, Messenger advocates uniform standards that would ensure each device's settings would provide the same dosage. So does Bob McCoy, managing director of Apple Valley, Minn.-based Valley Inspired Products, who plans to get that ball rolling with ASTM International, a standards development organization based in Conshohocken, Pa. The American Association of Respiratory Care appointed McCoy as its official representative to the group. "All the devices out there give a different dose at the same setting," he said. "The assumption is that a 'number one' setting on any device gives the same amount of oxygen and that's not so--they are built differently. To get the lightest, most long-lasting system, it must have the lowest dosing capability possible. That's not bad if it oxygenates the patient, but the problem is that prescribing physicians think the settings are the same when there can be huge differences in dosing volume." McCoy said he hopes that working with ASTM will result in standards that create consistency among conserving devices. "We need a standard that says the 'number two' setting will deliver 35 milliliters per dose no matter the make or model," he said. "When these devices are consistent, clinicians will know what they're prescribing is what the patient is getting." Conservation ratios also bear watching, because they get higher every year and saturation rates among the highest ratios are questionable, Decker said. "The theory is the higher the conservation ratio, the higher the savings," he said. "But these ratios are going up a notch each year. It has to reach a point where patient saturation is getting overlooked, which is the ultimate reason for the product." Messenger believes the ratio ceiling to be 5.1:1, even though there are ratios that are climbing much higher, up to 12:1. "To focus on the ratio is doing a disservice to the patient," he said. "The quantities are so small at those high ratios that they can't possibly benefit the patient."