Passport to Portability

Oh, what a difference a year can make. In the summer of 2005, the Federal Aviation Regulation No. 106 began to allow passengers to use approved portable oxygen concentrators onboard commercial aircraft. Two manufacturers cleared the skies first with portable oxygen concentrators (POCs) approved by the Federal Aviation Administration (FAA). AirSep of Buffalo, N.Y., introduced the LifeStyle and Inogen of Goleta, Calif., introduced the Inogen One. Now more than a year later, three additional products and two new companies have acquired FAA approval. Respironics, Murrysville, Pa., recently introduced its EverGo and SeQual Technologies, San Diego, introduced The Eclipse. AirSep hit the market with a second product, The FreeStyle. More companies are expected to introduce POCs for FAA approval this year.

End-users want to remain more active and maintain the lives they had prior to their chronic obstructive pulmonary disease (COPD) diagnosis, and manufacturers are listening. FAA-approved POCs are lightweight, versatile and most importantly, portable. And the best part is that these POCs allow COPD patients to fly with the assurance that they will be able to breathe.

With the introduction of these five FAA-approved POCs, education for HME providers, end-users, airline personnel and security personnel, is a critical component in the overall process. End-users need to know that these products exist, and they need to know that preparing to use these POCs in flight is not daunting. While manufacturers are introducing Web sites and other educational tools to facilitate awareness, the burden of education often falls to HME providers as they interact directly with end-users.

HME providers need to know the five products that currently have FAA approval. But just because a device is FAA approved, doesn't mean it's ready for flight. After FAA approval is given, the individual airlines review each device according to their own policies and then approve it for flight. Find a description of each of the products that have been approved and the airlines that have currently approved the devices in Oxygen Systems. (Please check manufacturer Web sites for any additional airline approvals occurring after press time.)

How Difficult Is It to Fly with Oxygen?

In the last several years, flying has become cumbersome enough for people who aren't on oxygen. Going through security is no longer as simple as walking through a metal detector. Now travelers have to take their shoes off, remove laptops from cased, and place cell phones and car keys in those plastic bowls while managing to hang on to boarding passes. If that wasn't enough, now passengers have to make sure make-up is small and contained in a plastic bag, and remember not to walk through security with their morning coffee. It isn't surprising that many oxygen users think that the process of flying with an FAA-approved POC might be complicated. But according to manufacturers, it doesn't have to be.

"Requirements vary by airline, but typically, a patient must notify the airline of their plan to use a concentrator 48 hours prior to travel, notify airline staff at check-in and onboard the plane," says Pamela Jackson, director of marketing for SeQual Technologies. "Patients also need to bring a medical authorization form and enough batteries to last the duration of the flight, including any layovers."

Travelers on oxygen first need to obtain a signed physician statement that includes:

  • Ability to see and hear alarms and respond appropriately.
  • When oxygen use is necessary — all or a portion of the trip.
  • Maximum flow rate corresponding to the pressure in the cabin under normal operating conditions.

Travelers should check with the individual airline for specific requirements. While many airlines require similar information, some may specify that the physician statement has to be on that physician's letterhead. Typically, the same letter can be used for flights in the future, so a new statement isn't needed each time.

HME providers can recommend the following tips to their clients for ease of travel with oxygen:

  • Notify the airline 48 hours in advance that you will be carrying on an FAA-approved portable oxygen device.
  • Ask about seating accommodations to use electrical outlets on the aircraft. You may have the opportunity to request a seat with a power port. Check with the airline for availability depending on the type of aircraft. Always have sufficient battery power for the duration of your flight.
  • Carry extra batteries when an outlet is unavailable or to protect against any unexpected occurrences during flight.
  • Check in at the airport two hours in advance and notify airline personnel at check-in.
  • Ensure that your POC is in good working condition.
  • Use an electrical outlet to power your device while waiting for your flight in the airport terminal.
  • During flight, locate your power port, if applicable.
  • If your physician statement indicates that you should use your oxygen during taxi, take-off and landing, you shouldn't have a problem using it during this time. Most POCs for flight fit under the seat in front of you standing up or on its side.
  • Remember to recharge batteries prior to your next flight.

"HME providers do most of the patient education," says Jackson. "Providers are eager to let their traveling clients know about the Eclipse because providing an Eclipse is more cost-effective and easier than providing that patient with oxygen cylinders during their trip," Jackson says.

To assist providers in educating end-users, SeQual sends travel-related news to senior publications and keeps an updated "Travel Approved" list of airlines, railways and cruise lines on its Web site, www.SeQual.com. Soon SeQual will release a booklet that will include travel tips for use with The Eclipse.

"An oxygen patient's main concern has always been that they will run out of oxygen," says Jackson. "Before the Eclipse, during trips around town, patients had to be very concerned about staying out too long. Similarly, during longer car trips or cross-country flights, patients had to be concerned about running into traffic or flight delays, but The Eclipse eliminates these worries."

The Eclipse eliminates these concerns because it can be plugged into an electrical outlet.

Respironics EverGo, approved by the FAA in September of this year, is shipped with a user manual that contains product information for patients and an educational tool for home care providers that describes the EverGo operation, according to Michael Barsevich, of Respironics' marketing and communications.

"Since policies vary by airline, patients are advised to consult with their chosen airline as well as their home care provider to ensure they have the necessary paperwork and medical information needed to fly with the EverGo," Barsevich says.

Respironics is also in the process of adding pages to its Web site to include information on traveling with oxygen for patients and providers.

Assisting Clients to Travel

Flights on the Horizon

Sunrise Medical is in the final stages of production and moving into field testing on the iGo portable oxygen concentrator that will facilitate patient independence and freedom. According to Kees Regeling, president of Sunrise Medical's DeVilbiss respiratory product division, the iGo is small enough to fit under an airline seat. The iGo will be released in the latter part of 2007.

Sunrise Medical Acknowledges Significant Improvement in Published Versus Proposed CMS Home Oxygen Ruling

Returning Home: How Technological Innovations Can Help

After this year, the word "reimbursement" makes many providers of oxygen therapy cringe. The Centers for Medicare & Medicaid Services (CMS) has made it tough for HME providers with cuts to reimbursement and capped rental requirements, but manufacturers are using product and business model innovation to help providers stay afloat.

"Older technology comes with many built-in costs. Weekly (often bi-weekly) delivery of oxygen cylinders requires employees, delivery vehicles and gasoline as well as time to refill the cylinders once they are empty. Additionally, older technology requires more maintenance and patient training on multiple systems," says Pamela Jackson, director of marketing for SeQual Technologies, San Diego.

"A single-solution product like The Eclipse eliminates some of the costs of delivery and reduces other costs like patient training and maintenance," Jackson says.

LifGas, Independence, Ohio, offers all forms of oxygen services on a subcontracted basis to the home care provider. "It is in a packaged form and includes all equipment and services. We tailor the program to the needs of the home care provider. They pick and choose services desired, and we give them a fair market price for the services," says Deb Vermillion, director of marketing at LifeGas.

"Since we are providing services for many HMEs, we carry a patient density that allows us to maintain a very controlled distribution cost that we can then pass on to our customers. This is essentially outsourcing all or part of their oxygen services," Vermillion says.

"HMEs could potentially have no capital outlay of cash for assets, no FDA issues regarding filling and transfilling, no department of transportation issues related to the delivery of oxygen, liability and regulatory issues related to oxygen, and the costs therein are now outsourced. HMEs can concentrate on patient management, reimbursement challenges and growing their business, while we take on the time consuming and costly distribution responsibilities that accompany oxygen operations," Vermillion says.

How Home Filling Can Help

Many providers are offering home-filling solutions to clients as a way to save on the costs of service and delivery. Products like Sunrise Medical's iFill and Invacare's HomeFill can help providers reduce costs of fuel and repeated deliveries of oxygen tanks.

"The big savings are a result of a more operationally efficient business model," says Kees Regeling, president of Sunrise Medical's DeVilbiss Respiratory Product Division. "With iFill, providers no longer need to deliver portable oxygen cylinders to their ambulatory patients. Instead, patients can easily and quickly fill their own cylinders at home. For ambulatory oxygen patients, iFill is really about freedom and independence. When you give qualified patients the opportunity to control their own oxygen supply, they are empowered to live a more active and spontaneous lifestyle without fear of running low on oxygen. An M6 cylinder can be filled in a little over an hour, and when combined with our PulseDose conserver, this gives patients up to six hours of ambulatory oxygen," Regeling says.

"(The) iFill was designed to be convenient and easy for patients. Partially filled cylinders can be easily topped off, and the iFill will automatically shut off when filling is complete," Regeling says.

"The iFill technology provides the flexibility to fill most cylinder sizes including M6, ML6, C, D and E. The product's compact design is a vast improvement over having to store and empty cylinders," he says.

"We believe the best way to educate the public about iFill is to support our customers with strong turnkey marketing materials," says Regeling. "To that end, we have produced a provider marketing package that we call the iProsper Kit. It includes television commercials, print ads, post cards, referral marketing presentations and patient education brochures."

The demand for home filling is expected to continue to increase in the future. "Home filling is a perfect solution for providers who are dealing with a changing reimbursement climate as well as for patients who want freedom and independence," Regeling says.

Assisting Clients to Travel

Check the following airline Web sites for more information on traveling with oxygen.

America West Airlines
www.americawest.com

ATA Airlines
http://ata.custhelp.com

Delta Airlines
www.delta.com

Hawaiian Airlines
www.hawaiianair.com

Midwest Airlines
www.midwestairlines.com/MAWeb/

Northwest Airlines
www.nwa.com

Southwest Airlines
www.southwest.com

US Airways
www.usairways.com

Sunrise Medical Acknowledges Significant Improvement in Published Versus Proposed CMS Home Oxygen Ruling

Assessing the final CMS ruling on oxygen reimbursement and capped rental provisions (part of the Deficit Reduction Act of 2005 or DRA), Sunrise Medical expressed optimism that the new guidelines support a sustainable business environment for the industry and the patients that it serves.

"CMS balanced the interests of consumers and suppliers while recognizing the importance of new technologies," said Rita Hostak, vice president of Government Relations for Sunrise Medical. "The final rule allows for ongoing maintenance after ownership of the equipment transfers to the patient at 36 months. Without this provision, providers would not have received reasonable compensation for their efforts and consumers could have been left without the support of a qualified home medical equipment provider to service their equipment."

Hostak noted that Sunrise views the ability of oxygen patients to choose to adopt new technologies under the rule as offering multiple advantages for patients and suppliers. "This shows that CMS recognizes that the needs of oxygen patients often change and evolve over time. CMS deserves credit for understanding the many variables in patient needs and available technologies."

Sunrise Medical praised the efforts of the industry in coming together to work with CMS and providing the cooperation and input that made a difference in what became the November final ruling. "Manufacturers and providers and key industry groups like the CQRC (Council for Quality Respiratory Care) spent a great deal of time and effort providing critical information that was obviously ?heard' by CMS," said Hostak. "Now, Sunrise Medical, for one, believes that the final ruling is a significant improvement over the proposed ruling and we're encouraged by the changes that we saw evolve."

Hostak cautioned that the industry must continue educational and lobbying efforts with Congress to create deeper levels of understanding about oxygen therapy. "In this case, we were able to improve on the proposed ruling, but there will be many new members in Congress starting January 1st," she noted. "We have to stay proactive and vigilant because this is a complex, sophisticated industry. It's in the best interests of everyone — from patients to providers to manufacturers — to clearly communicate the nature of the personalized, nuanced oxygen care that we provide and the life-enhancing advantages of new technologies."

Within the last year, the prevalence rate for women emphysema sufferers has increased by 20 percent. Many people are being diagnosed at a younger age and want to be able to maintain an active and independent life. Manufacturers are responding to the growing number of COPD patients with products designed to support an active life. New products on the market are lightweight, versatile and most importantly, portable.

This article originally appeared in the January 2007 issue of HME Business.

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