Embodying the American Dream
It was refreshing to read the cover story on Michelle Jackson and Frontier Access and Mobility Systems (“Wild, Wild, West,” November 2002).

As the prosthetic chief at the Cheyenne Veterans Administration Medical Center (VAMC) during the birth and growth of Michelle’s business, we found her positive attitude and desire to go the extra mile for our veteran patients both refreshing and badly needed in that small community. We could always count on Michelle to take care of our veterans’ HME needs, even during weekends and holidays.

As the chief of the Denver Prosthetic Treatment Center and the Prosthetic & Sensory Aids Services for the Eastern Colorado Health Care System (VISN 19), I have continued to work with Michelle, and I continue to get exceptional feedback from the veterans she serves for ECHCS.

Michelle put a tender heart in the health care and HME business. All the success she has attained is a direct result of her hard work and positive attitude. She embodies the values of the American Dream: Hard work, honesty, fairness, and a desire to be the best equals success.

We wish her continued success.

—Richard J. Tremaine
Eastern Colorado
Health Care System
Denver

Walk the Talk
A “March on Washington” in support of the Medicaid Community Attendant Services Act or MiCASA is set to step off from the Liberty Bell in Philadelphia on September 3 and commence with a rally on the Capitol steps in Washington on September 17. MiCASA would require states to set aside a fixed percentage of the funds currently used to subsidize nursing home care for programs that provide attendant services that people with disabilities need to live in their own homes.

This is an opportunity for the HME services industry to literally “walk the talk” about forming a two-way advocacy partnership with consumers by showing solidarity with our customers as they push for passage of the most important item on their political agenda.

You can do that in several ways.

The original legislation died at the end of the 107th Congress and will have to be reintroduced this spring. Contact your representatives in Washington and demand that they sign on as cosponsors. You may also want to work with consumer groups in your town to organize a MiCASA rally—an event sure to make the front page of the papers as well as the 6 o’clock news.

You can also help make the MiCASA march and rally a success. Sponsor a consumer’s participation and join them at the event. If you can’t do that, make a contribution to help offset the $150,000 cost of permits and security that the organizers must raise by June 1. Make your checks payable to “Free Our People March” and mail them to Thomas Connaughton at the American Association for Homecare, 635 Slaters Lane, Alexandria, VA 22314.

The fact that MiCASA is a consumer issue is exactly why you should get involved. Our industry is ignored in Washington because we are seen as a special interest with no broad-based support. We must get consumers to become opponents of competitive bidding and advocates for our agenda. But we can’t expect them to become voices that support our issues until we demonstrate that we are willing to support theirs.

Wonderful things will begin to happen if providers are seen standing side-by-side with their customers on September 17 in support of an issue of critical importance to the disability community. It’s time to walk the talk about consumer involvement.

—David T. Williams
Government Relations Director
Invacare Corp
Elyria, Ohio

Home Filling Deserves More Credit
I was pleased to see Rich Smith’s informative article on the new generation of oxygen concentrators in your October 2002 issue (“More Than Price”). However, I wish to clarify two statements made in the article by Bob McCoy regarding transfilling concentrators. He states that these concentrators can manage only 93% oxygen purity. In the case of the TOTAL O2 Delivery System, 93% is merely the average concentration level, and a concentration of 94% to 96% is more typical.

In addition, Mr McCoy states that there have been no studies done on the effect of less than USP 99% oxygen when coupled with a conserving device. In September 1997, CHEST published an abstract of a study done at the Pomona Valley Hospital Medical Center in Pomona, Calif, entitled “Comparison of SaO2 from Compressed Concentrator O2 and USP O2 Delivered Via Continuous and Pulsed Flow.” The study found virtually no difference in SaO2 when using concentrator-filled cylinders at 94% oxygen and USP 99% oxygen during both continuous and pulsed flow delivery. This confirms the well-known recommendation of the 1986 Conference on Home Oxygen Therapy that oxygen concentrations of 85% and above should be considered therapeutically equivalent to standard USP oxygen.

While home-filling technology may be new, it has been built upon decades of accepted oxygen therapy practices—good news for those providers who want innovation, cost savings, and peace of mind.

—Carla Laureano
Marketing Manager
CHAD Therapeutics
Chatsworth, Calif

Thank you for furthering the debate on this topic. I hope that my comments haven’t been taken the wrong way. I am not trying to say that cylinders filled from concentrators are in any way bad, only that the therapy cannot be assumed to be equivalent to same setting therapy with 100% oxygen.

Studies on this are limited still, and it is difficult to pick up subtle differences between delivery devices, because of the host of patient variables. My information is based on bench studies, that, while they do not assess the effects on real patients, by removing the variables, make it easy to see differences in oxygen delivery.

Lower purity gas, 85%, or 95% oxygen for that matter, is not the same as 100%. There simply is not as much oxygen in it. In fact, 1 lpm of 90% oxygen has the same therapeutic benefit of .87 lpm of 100% oxygen. Some patients, if titrated high on the dissociation curve, may not be adversely affected by this drop in delivery. However, if they are already on the steep part of the curve, or get there by increasing their activity, the change may be important. This is to say, if the patient is at 94% saturation, a drop in oxygen delivery may only result in a drop to 93%. But if the saturation starts at 90%, the same drop in oxygen may cause their saturation to drop to 86%.

Finally, the 1986 conference recommendation was intended to remove the requirement for physicians to specify the oxygen purity when prescribing oxygen. The full text reads:

“The current regulations require that the physician indicate the concentration of oxygen to be used. If the delivery system provides greater than 85% oxygen at the liter flow prescribed, then the requirement for a statement of the concentration is unnecessary. For purposes of these regulations, oxygen levels of 85% or greater are therapeutically equivalent to 100% oxygen.”

It is easy to take the last portion of the last sentence out of context.

I am not trying to say that this type therapy is in any way bad or less effective than another. But I feel it is important to point out that the dose may need to be increased for some patients. Delivery devices should be labeled with the amount of oxygen they really deliver, not an estimated equivalency.

—Bob McCoy, RRT
Managing Partner
Valley Inspired Products, LLC
Burnsville, Minn

Corrections
• The November 2002 article “Wheelchair Wisdom” by Jane W. Bunch, RT, stated that question eight on the Certificate of Medical Necessity (CMN) must be answered “yes.” It should be answered “no.”

• The October 2002 article “More than Price” by Rich Smith defined PSA as pressure swing absorption. It should have read pressure swing adsorption.

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