Joseph Lewarski, RRT, is the vice president of clinical and governmental affairs at Inogen, Goleta, Calif. Dealer/Provider spoke to Lewarski about what Inogen is doing to address the needs of patients and providers of long-term oxygen therapy (LTOT).

Q What do you feel successful HME providers are doing in LTOT and how can Inogen contribute?
A Since the Balanced Budget Act of 1997 and its very substantial oxygen payment cuts, many successful providers have been closely studying their business, learning to appreciate the small role of the upfront cost of oxygen technology and the significant role and expense operations play in the overall scope of their company. Providing home oxygen therapy 24/7 is a service-intensive process. Whether applying sophisticated activity-based costing models or simply monitoring deliveries and general overhead, many providers have come to the conclusion that the lion’s share of the cost of providing home oxygen is borne in the cost of servicing patients. This tends to be heavily weighted toward the regular and frequent home delivery and servicing of traditional oxygen systems. Many of the most successful companies I have worked with have been quick to recognize this and have been using new oxygen technologies to replace labor and drive down their growing operational expenses.

Robust and innovative nondelivery oxygen technologies such as the Inogen One, which essentially eliminate the unplanned and frequent delivery of cylinders and/or liquid, are being employed in place of the older, traditional oxygen systems to fulfill both the stationary and portable needs of many patients. This model creates a new level of independence for both the patients and providers. I also believe that with less time and expense spent on the entire oxygen refill and delivery process, providers will be able to more efficiently and effectively focus their resources elsewhere. This model also provides a growth opportunity for providers, allowing them to expand their oxygen program to a much larger geographic area.

Q Why is there a concern over the use of oxygen conserving devices at night and what have you done to address this?
A Over the last 5 to 7 years, oxygen conserving devices (OCD) have become one of the fastest growing home respiratory products. OCDs have been around for about 20 years and while initially there was some mild resistance to use from some physicians and providers, OCD use today is considered the standard of practice in awake and ambulating LTOT patients. Until recently, OCDs were used almost exclusively on finite volume devices, such as compressed cylinders or liquid portables, as a means to extend the duration of use. As a result, there was little call to use OCDs at night. Despite the lack of published data suggesting that OCDs perform any less effectively during sleep, there are some concerns regarding the OCD triggering sensitivity and response to nocturnal breathing patterns. In addition, the wide variance in OCD performance, especially in the areas of trigger sensitivity and response, has some clinicians concerned that OCDs may not perform as effectively in sleeping patients.

All of this was taken into consideration when designing the Inogen One. To address the possible shallow breathing, we designed the most sensitive and responsive OCD currently available. We also created two different sensitivity settings: the standard setting responds to -0.2 cm H2O and the sensitive setting to -0.12 cm H2O. To validate our performance, we have been studying the Inogen One in both awake and sleeping patients. The results of our first study are currently in review and pending publication at a scientific journal. A brief summary of the findings in this initial study proved the Inogen One very effectively delivers oxygen to sleeping patients essentially the same as traditional continuous flow oxygen.