Observation Deck

The Next Big Opportunity?

Providers should explore the renewed world of airway clearance.

• By John Eberhart
• Apr 01, 2017

In a world of decreasing reimbursements and diminishing opportunities in DME, a more advanced approach to airway clearance therapy is making a resurgence and bringing DME companies a new and exciting opportunity to do a number of things.

This resurgence is allowing DMEs to leverage a new revenue stream that is much needed in our industry, and that is providing patients with a different approach to managing a difficult disease process that is highlighted by shortness of breath and recurrent lung infections that keep them on and off antibiotics and much worse in and out of the hospital with exacerbations. It is also providing physicians a way to keep their patients at a healthier baseline and probably most importantly it is saving the healthcare system and payers much needed resources in an increasingly expensive healthcare market. I would argue that the therapy modalities that can be offered in the airway clearance market create a win-win dynamic that DME companies and primary care providers would be smart to take a closer look at.

Some Perspective

For some perspective on how important recent airway clearance advances have become, let’s first look at some innovations that changed the trajectory of DME. One of the clear advances was power wheelchairs, which really took hold in the 1960s after their first forays in the 1950s.

Another key innovation was oxygen concentrators. Prior to the invention of oxygen concentrators in the 1970’s, therapeutic oxygen was either delivered via heavy tanks, through small liquid oxygen systems, or it was not readily available at all. An influx of new DME companies not only benefited financially thanks to a more efficient way to provide oxygen therapy, but played a big role in extending the lives of respiratory patients.

Moving forward in the 1980s Dr. Colin Sullivan came up with the idea of mechanically creating a “pneumatic pressure splint” to keep patient’s airways open that were collapsing during hours of sleep, and by the mid 1980s CPAP was born in the U.S. market. Another key development, home ventilation not only changed the lives of countless patients by creating a higher quality of life deep into the golden years, it created a revenue stream for and increasing number of DME businesses all over the country.

With the implementation of the competitive bidding program, we are all looking for the next power wheelchair, oxygen concentrator or CPAP, and I believe we have found it in high frequency chest wall oscillation (HFCWO).

Understanding HFCWO

There are two different technologies in delivering HFCWO therapy, pneumatic using an airbladder vest, or oscillation motors that are incorporated in a vest using portable battery technology. These two technologies provide two different pathways in delivering this therapy, airflow or direct oscillation. There are several manufacturers (such as Hill Rom, Electromed, RespirTech) in the pneumatic airflow/air bladder style market that focus mostly on pressure and airflow to mobilize secretions and one (Afflovest), which is the newest technology, that provides direct motorized oscillation waves in a portable and mobile during use vest that transmits oscillation waves into the chest and lungs to mobilize secretions designed to mimic manual hand Chest Physical Therapy (CPT) performed by RTs which is the gold standard in delivery of this therapy. Just like any therapeutic intervention one approach will not work for all of your patients, so be sure to speak with your vendors and partners to decide what approach will benefit your patient’s most.

The therapies that airway clearance is most frequently ordered can vary in intensity and effectiveness depending on the diagnoses that are being treated and the stage of the disease at time of prescription. These include positive expiratory pressure (PEP) devices such as the Flutter Valve, Acapella, Aerobika and others that target secretions in larger airways, cough assist devices such as from Respironics that are helpful with patients who have a diminished cough effort and High Frequency Chest Wall oscillation (HFCWO) systems as described above for the more severe diagnoses that require secretion mobilization and pulmonary clearance in the distal portions of the lung fields and smaller airways.

The most common diagnoses that are appropriate for these therapies are the Cystic Fibrosis and Bronchiectasis patient populations. By far bronchiectasis is the largest population of patients that may benefit from this therapy. According to lung.org and the CDC there are approximately 15 million, and as many as 24 million, COPD patients nationwide and approximately 30 to 40 percent of these patients have bronchiectasis. This translates into approximately 5 to 8 million Bronchiectasis patients. As comparison there are about 1.5 million oxygen patients. As these patients progress down to stage 3 and 4 in their COPD disease management path it is very important to verify or rule out bronchiectasis via high resolution computed tomography (CT). This might allow these patients an opportunity to decrease antibiotic use, admissions and readmissions into healthcare facilities that take up a large portion of Medicare resources.

In addition to bronchiectasis and the cystic fibrosis patient, there are a number of neuromuscular diagnoses that can benefit from airway clearance therapy. Amyotrophic Lateral Sclerosis, Multiple Sclerosis, Muscular dystrophy, Quadriplegia and others have been shown to clinically benefit from maintaining good management of secretions that create pulmonary insufficiencies.

The financial opportunities are both on the cash sales side of the business in addition to HCPC codes that can be billed to payers on patient’s behalf. At the lower reimbursement range DME providers are submitting claims for some PEP devices as low as $100 dollars and on the higher reimbursement side for high frequency chest wall oscillation devices for as much as $16,000 dollars. Reimbursement opportunities are going to depend on insurance allowable amounts and patient’s responsibilities but providers across the board are seeing good profit margins for most of these modalities ranging from the low single digits to as much as 50 percent margins.

Be aware that for most of the patients using the more advanced airway clearance devices, they will need to provide a tried and failed therapy of a less advanced device as part of the qualification requirement for payments for the more expensive devices. This allows insurance providers to ensure that resources are not being spent on very expensive devices when a simple PEP device will suffice at the time. Insurance providers recognize that these disease processes are progressive and most of the patients living with these afflictions will require higher and more intense therapeutic interventions at some point in their care but a tried and failed requirement does help in maximizing healthcare dollars.

This article originally appeared in the April 2017 issue of HME Business.