Letters to the editor:

I am writing in response to John Andrews' article titled “Oxygen remains stationary” (HME News, December 2008). I think John's article is relevant but I am concerned that some key data was missing or misrepresented. Stationary oxygen technologies, particularly concentrators, are the base component of all home oxygen systems. Concentrators represent the majority of stationary systems because of the relatively low acquisition cost and extremely high performance and reliability. The stationary concentrator code, E1390, represents all concentrator-based home oxygen systems, including the newer technologies such as HomeFill and the numerous portable oxygen concentrators (POCs). John's article appropriately discussed the impact lower reimbursement is having on providers and their business operations, and points out the need to look to new technology as a solution. However, I think it failed to adequately recognize the magnitude of this movement. Many providers are now believers in non-delivery oxygen methods, and many of them are actively integrating oxygen generating portable equipment (OGPE) into their businesses. Few argue against the economics of non-delivery. This year, Invacare will ship its 150,000th HomeFill system domestically. While we may not have accurate sales data from our competitors, we can estimate the impact that non-delivery systems are having on providers and their patients--and it is significant. If we conservatively estimate that total non-delivery device domestic sales have exceeded 200,000, we can measure the penetration into the home oxygen community. While there are no accurate data on the number of home oxygen users in the United States, a safe estimate suggests there to be about 1.6 million home oxygen users. Claims data indicate that about 35% use only a stationary device, so we can estimate the “ambulatory” population to be about 1 million patients. If we assume about one-third to be low ambulators and not ideal candidates for OGPE, this number is about 690,000. If our conservative estimate of 200,000 OGPE systems is accurate, this would suggest about 29% of ambulatory home oxygen patients are using a HomeFill or other OGPE. Due to favorable economics, clinical efficacy and reliability of some systems, this technology is clearly carving its place in the home oxygen space. Modern OGPE systems empower patients to be independent and ambulate more frequently, a scientifically proven benefit, while concurrently helping control and reduce operating expenses. JOSEPH LEWARSKI, Vice President and General Manager, Invacare Respiratory