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This report originally appeared in the September 2009 issue of DOTmed Business News

Respiratory therapy is one of the most widely used medical practices in the health care industry. Widespread use can translate to big money. So, naturally, advances in respiratory equipment occur regularly in respirators, oximeters, airway pressure monitors, ventilators and other such equipment. One recent trend finds its influence in mobility and ease of transport. Manufacturers are creating more compact machines in order to take up less room in already crowded operating rooms and other places where space is at a premium.




One of the leading global providers of health care products, CareFusion, is coming out with two brand new ventilators unlike any others currently on the market. As of right now, the most compact ventilator is their LTV 1200, which weighs about 14 pounds. Soon, they will be unveiling their Palm Top Ventilators (PTVs).

The first PTV, the ENVE ventilator, is made and used for critical care. It is about the size of a tissue box and weighs approximately eight pounds. According to Kim Zipse of CareFusion, "the new PTVs have four-hour swappable batteries where, if a change of battery is needed, an internal one takes over so that respiratory therapy can continue without disruption." Providing an uninterrupted service is especially important given that respiratory ventilation is key in life or death situations.

The second series of PTVs that CareFusion is introducing is called the Revel. The Revel is a ventilator system designed for long-term care, ambulatory and airlift use. Also weighing about eight pounds, it is small and lightweight while maintaining a high level of functionality. For the most part, the Revel's production is geared towards transport, making it useful for a number of situations such as military field use.




In the past, patients needing oxygen at home have used a machine called a concentrator that relies on an electric power source and is about the size of a mini-fridge. Ken Johnston of Delta Technology, Inc., a provider of portable travel oxygen systems and accessories, says, that under the current Medicaid reimbursement policies, "Durable Medical Equipment Companies (DMEs) are required to supply eighteen months worth of concentrated oxygen." After that time, it's up to the DMEs to determine if they will continue to provide the services and at what costs. The DMEs provide an oxygen-concentrator "that weighs upwards of forty-five pounds which they consider portable," says Johnston. In order to leave home, patients would need to carry the system requiring an amount of effort difficult even for healthy individuals. Since patients will naturally find this inconvenient, they will look for more viable options, like Delta Technology's portable travel oxygen systems or CareFusion's PTVs. These concentrators are less than ten pounds and can run on batteries or house current.

Respiratory therapy, pulmonary rehabilitation (PR) in particular, available to those suffering from Chronic Respiratory Disease, is currently provided in outpatient facilities. At the facility, the patient is provided with appropriate training, as well as a much clearer understanding of, and the ability to cope with their lung disease. Pulmonary rehabilitation also provides personalized advice that sets the patient up with a life-long exercise routine. Additionally, if something were to go wrong - a ventilator malfunction for example - the patient would have ready access to a health care provider.

Because respiratory therapy equipment is not only used in hospitals and ambulances but also in homes, preventative and precautionary measures must be taken in order to ensure patient safety and comfort. Like any piece of technology, things can go wrong. Technological advancements are being made every day in order to help patients in need of immediate assistance. In fact, the development and integration of remote care telemedicine, to help those patients who live far from any health care facility, is underway.

Telemedicine, according to the American Telemedicine Association (ATA), is the "use of medical information exchanged from one site to another via electronic communications to improve patients' health status." The electronic communication being used is a telemonitoring system and most recently, a live feed between patient homes and health care facilities in the event of a malfunction. According to the ATA, "Closely associated with telemedicine is the term 'telehealth,' which is often used to encompass a broader definition of remote healthcare that does not always involve clinical services. Videoconferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education and nursing call centers are all considered part of telemedicine and telehealth."




Remote care and telemedicine provide care in cases where a patient is miles away from a health care facility. In many instances, patients don't have a way of getting to the facility for immediate help. Instead of a nurse traveling the distance to help the patient when they are in need, telemedicine and remote care can enable the patient to get the help they need through the use of monitors and step-by-step direction. Telemedicine and telehealth allow health care providers to, on a daily basis, monitor the patient and make real-time decisions with regards to the care of their patient. Remote monitoring of ventilators, for instance, can lead to stable symptom management, improved healthy behaviors, and follow-through with treatments.

By providing telemedicine, more respiratory patients will be able to receive the help and education they need in order to maintain healthier lifestyles while dealing with their disease.

A more thorough integration of telemedicine and remote patient care for the future is not far on the horizon. In terms of the future of respiratory therapy, many companies are striving to create closed-loop ventilators - ventilators that will monitor breathing and will respond automatically if a problem occurs. It is believed that new developments will be made in the future for long-term respiratory patients. "There is a greater demand for products and people to continue to improve the quality of life for long term ventilator patients in the home," says Bill Rosas of Midwest Biomedical Recourses.

Currently, the biggest challenges facing the respiratory industry are finance and economic recovery. The demand for respiratory products is very strong, yet the industry faces the issue of how customers are going to pay for equipment. The economic downturn has "made refurbished products more attractive to buyers both in the domestic and international markets," says John Wittenberg of Inventory Solutions, Inc. He adds, "Buyers are seeing that they can get excellent quality and warranties as well as discounted prices from reputable resellers."

Judy Engle, RRT/RCPT and owner of Frontier Medical adds, "Every market is different, but the economy has slowed down and put a hold on purchasing new equipment due mostly to lack of budget."

With advancements constantly being made in respiratory technology, today's new respiratory equipment can run anywhere from $10,000 to $14,000. In the refurbished market, equipment can be as much as 50% less expensive. John Wittenberg says, "The main thing is that the refurbished equipment industry is becoming more mature; people know they can get really high quality equipment that comes with paperwork indicating it will last. It changes the face of the industry."

Inventory Solutions, Inc. specializes in the sale of refurbished respiratory equipment like ventilators, pulse oximeters, sleep products, concentrators, patient monitors, phototherapy, apnea monitors and liquid oxygen. He adds, "We don't look at one particular product selling. If someone needs something, we want to have it patient-ready and on the shelf in order to get our product to them quickly."




It seems that despite the downward turn of the economy, the respiratory equipment sector is doing well. However, as a result of Medicare/Medicaid reimbursement cutbacks and adjustments, changes will occur. Ken Johnston told DOTmed, "Right now, in home oxygen delivery, reimbursement systems in Medicare/Medicaid are about $140 plus per month and $70 per month for portable oxygen."

According to Carl Willoughby, Pulmonary Rehabilitation Director of Mad River Community Hospital, "CMS (Medicare) has been reducing the reimbursement to Durable Medical Equipment providers over the past decade." As a result, reimbursement levels may not allow DMEs to provide the new technology to the very patients who need it, which Willoughby says is "an unintended result of the government trying to save money."

In addition, competitive bidding for providing outpatient oxygen services has been legislated into place. Willoughby says, "This will drive all the small and medium companies out of business leaving only one or two mega oxygen companies standing." Some believe this competitive bidding will ultimately result in no competition and more incentive to provide only the cheapest, low-tech equipment, again a disservice to the patients who need up-to-date care.

The respiratory industry, large as it is, seems to be focusing most of its improvements in downsizing their equipment. The current state of the economy hasn't affected the industry much because there will always be a need for respiratory machinery. With the daunting health care reforms on the horizon, the state of independent supplier organizations comes into question. However, for the time being, even though the health care providers' demand for new equipment may not be high at this time, refurbished respiratory equipment can offer 'good-as-new' stock at affordable prices, giving facilities and patients a reason to breathe easy.

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DOTmed Registered Respiratory Equipment Sales & Service Companies
Names in boldface are Premium Listings.

Domestic
Susan Nelson, Air Lift & CareFore Medical, CO
Judy Engle, Frontier Medical, Inc., CO
DOTmed Certified
Del Tillman, American Telemedicine Association, DC
Ken Johnston, Delta Technology, Inc., GA
Chris Bridges, Colossus Medical, GA
Bill Rosas, Midwest Biomedical Resources, Inc., IL
Jerry Riley, DRE, Inc., KY
Ana Ortega, General Biomedical Service, Inc., LA
Asif Bhinder, tekyard, MN
Kim Zipse, CareFusion, MN
Don Grimm, Bemes, Inc., MO
DOTmed Certified/100
Paul Fau, First American Medical Equipment, NJ
Ray Carter, Hospital Equipment 4U, NC
DOTmed Certified
John Wittenberg, Inventory Solutions, Inc., NY
DOTmed Certified
George Rebitski, Predictable Surgical, OH
Mark Brinkerhoff, Marco Systems, OH
David Zobeck, Lancaster General College of Nursing and Health Sciences, PA
Nelson Shertzer, Medical Support Products, Inc., PA
DOTmed Certified
Chad Looney, Canyon Drive Sales, TX
DOTmed Certified
Rick Weekley, US Med-Equip, TX
DOTmed Certified
Juan Sandoval, Monterrey Medical Equipment, Inc., TX
Jake Mathews, Impact Biomedical, TX
Bill Murdock, VIP Medical, Inc., VA

International
Argie Valenzuela, Mideast Medical Equipment, Philippines

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