The landscape for the airway clearance industry is poised for dramatic change, and technology is helping to take the segment in a new direction.
By Lori Sichtermann
Clearing airway secretions relies on effective technology and devices. In their efforts to optimize patient comfort, mobility, and therapy compliance, respiratory care departments face rising healthcare costs and growing emphasis on reducing hospital readmissions. New developments in airway clearance therapy, including the shift to home care, are having an impact on the market.
To gain additional insight, RT Magazine recently spoke with industry experts regarding the segment’s advancements, its areas of concern, and where the future lies for airway clearance. Contributing to the discussion were:
- Eli Diacopoulos, VP, general manager, Home Respiratory, Philips Respironics;
- Loel Fenwick, MD, managing director, Percussionaire Inc;
- Jeremy LaPlante, director of worldwide sales and marketing, VORTRAN Medical Technology 1 Inc;
- Kelly Lunder, manager of marketing and communications, Electromed Inc.
RT: What’s new in the airway clearance product market, and how have products and technology changed in the last few years?
Eli Diacopoulos (Philips): With the changing healthcare landscape and the implementation of the Affordable Care Act, leading manufacturers in the airway clearance market are driving innovations that enable cost-effective and outcome-based patient care. We’re seeing this with the development of devices that offer less invasive solutions, greater patient comfort, and smaller, lighter products that offer enhanced mobility for easier use in the home. Devices are also smarter, providing clinicians with the data they need to monitor treatment and enhance therapy effectiveness.
Loel Fenwick (Percussionaire): What we have seen over the last several years is the change in hospital reimbursement, and this is driving the changes and trends of ventilation. With tighter controls on what a hospital is able to charge, due to the requirement of having an admitting diagnosis, they are opting for products and technologies that minimize costs, shorten stays, and reduce readmissions. To do this, they are integrating airway clearance into a compressive overall process that improves patient care and benefits their bottom line.
In conjunction, hospitals and RTs are leveraging home care ventilation and airway clearance as a way to keep patients healthier longer, avoid readmissions, and reduce exacerbations.
Jeremy LaPlante (VORTRAN): The trend I am seeing is a need for effective, low-cost options that help keep ambulatory patients at home, as well as higher quality airway clearance devices to be used in the hospitals where initial cost is less of an issue. This type of therapy is being looked at more frequently, and is becoming a very important topic in the market, even in the neonate arena, which recently highlighted our PercussiveNEB for use on neonates for high frequency oscillation through a nasal cannula.
VORTRAN Medical currently is working toward reducing flow requirements on our PercussiveNEB to meet the needs of the home care patient who has only a small portable compressor due to insurance coverage issues.
Kelly Lunder (Electromed): The SmartVest Airway Clearance System, Model SQL has been recently cleared for market by the FDA. In addition, there have been some new handheld PEP devices that have entered the United States. As a high-frequency chest wall oscillation (HFCWO) device company, we appreciate that. Other less aggressive forms of airway clearance, such as PEP devices, address a portion of the airway clearance market so that some patients may receive benefit.
Further, we’re seeing a market expansion with new diseases being indicated—and some reimbursed—for airway clearance therapy. On the one hand, a younger population is being introduced as physicians treat patients at a much earlier age, and on the other end of the spectrum, we’re also treating an older demographic for diseases such as COPD.
Regarding product trends, we see a focus on increasing therapy compliance through more user-friendly features and benefits, including ease of use, increased comfort, and making accommodations for that broad spectrum of age demographics.
RT: Do you believe the trend toward home care affected the airway clearance market? In what ways has this trend affected your company’s product development?
Diacopoulos: In the current healthcare environment, there is a comprehensive focus on reducing hospital readmissions and keeping patients out of the hospital and in their home. Solutions like CoughAssist T70 help patients with chronic respiratory disease more effectively clear their airways, reducing the chance for infection that can lead to hospitalization.
These trends have also enhanced the need for solutions that address the long-term tracking of a patient’s disease progression. We identified this need, and with CoughAssist T70, incorporated a software accessory that gives clinicians the ability to download the patient’s therapy data and better manage patients.
Fenwick: Yes; the home airway clearance market is growing and will only get bigger. Home care ventilation is being rapidly adopted as a viable, safe means to keep patients comfortable, prevent exacerbations, and reduce hospital visits. It has become an integral, automatic part of the pulmonary component of patient care. We have had a home ventilation unit on the market since 1996. In 2009, it became truly portable. As we move forward, we are refining the portability and ease of use in our machines that provide ventilation plus airway clearance at home.
LaPlante: The type of devices that offer the most effective treatments for airway clearance are typically more expensive and fall outside the reimbursement allotments from Medicare. Thus, patients typically purchase less effective devices to use at home because that is all they can afford. As a result, these patients become repeat visitors to their local hospitals, which keeps our healthcare cost high and increasing.
There needs to be more reimbursement for airway clearance treatments, as well as new studies supporting airway clearance devices and their effectiveness. We are working diligently to come up with a new option to help meet these needs. We are working to develop a lower-cost option to meet the trend of at-home treatment.
Lunder: The healthcare trend toward home care is a very positive one for Electromed Inc. The majority of our products are placed in the home. Penalties to hospitals for certain readmissions brought on by the Affordable Care Act will further support keeping patients in the home rather than receiving their treatment in the hospital.
That movement has certainly affected our product development and innovation. If the patient isn’t compliant with their prescribed treatment regimen, the economic benefit is not realized. We’ve designed the SQL for improved therapy compliance by making it comfortable, easy to use, and more portable, allowing the patient to administer their therapy in most cases without a caregiver present.
RT: Tell us about your company’s most recent products and what makes them innovative. How are your products responding to the need for healthcare facilities to reduce costs?
Diacopoulos: Philips Respironics’ latest airway clearance product release, the CoughAssist T70, incorporates updates driven by the desire to improve patient quality of life and clinician support in their daily practice. These new advancements are designed to help clinicians optimize therapy and enhance patient comfort, mobility, and compliance, helping to reduce the risk of hospital readmissions and overall disease management costs.
To enhance patient mobility, the device is lightweight, weighing less than 9 lbs (4 kg), and can be used with an integrated detachable battery. A new Cough-Trak algorithm triggers a full cough upon every inspiration, giving patients more control of their therapy and better synchronization. CoughAssist T70 mechanical insufflation-exsufflation provides an effective, noninvasive alternative to deep suctioning and can be used in the hospital, home, or alternative care sites. It’s effective in clearing secretions from the lungs while avoiding complications linked to invasive deep suctioning methods, such as hypoxia, tissue damage, and infection. This can lead to fewer hospital readmissions and may contribute to a decrease in the total cost of patient management.
Fenwick: We use flow ventilation to simultaneously improve oxygenation and recruit the lungs by eliminating mucus and debris. Flow ventilation can best be described as high speed puffs of air that reach the lowest levels of the lung, bathing the alveoli in good air and aerosol while the puffs gently slough off mucus and push debris back out of the lung, all while allowing the lung to heal and rest. Published, peer reviewed articles on flow ventilation, also known as HFPV, have shown these key outcomes: reduced length of ICU stay; 50% less pneumonia; improved P/F ratio; and decreased exacerbations.
LaPlante: Currently, we have made an upgrade to our PercussiveNEB by changing the way we deliver the percussions. The diaphragm that is in our modulator achieves a higher frequency range and provides a more comfortable and effective treatment to the patient, whether it be COPD, cystic fibrosis, acute asthma, etc.
We’re working on our next generation PercussiveNEB, and hope to have a prototype on the market by the end of 2014 or the beginning of 2015, as well as other products in the works for the respiratory field.
Lunder: We recently received FDA marketing clearance for our next generation SmartVest, the SQL. The model SQL is an electrically powered precursor device designed to deliver HFCWO to promote airway clearance, improve bronchial drainage, and enhance mucus transport. It is prescribed to patients with a wide range of pulmonary-related health conditions, including bronchiectasis, COPD, cystic fibrosis, muscular dystrophy, and cerebral palsy.
HFCWO has been demonstrated to reduce lung infections and reduce healthcare costs associated with recurrent pneumonias, antibiotic use, and hospital stays. Integrating the voice of the customer, we innovated many features that provide users with maximum comfort and the freedom to live their lives to the fullest. The outcome was 25% smaller, at least 5 dB quieter, and 25% lighter than our previous model. We also added some new programmable features, such as ramp, pause, save, and restore. When HFCWO is easy, the patient is more likely to use it, thus reducing hospital and clinic visits and overall treatment expenses.
RT: What do you believe will be the effect of the Affordable Care Act’s 2.3% medical device tax on the market? How will it affect your company’s product development?
Diacopoulos: [Although the tax does not apply to our devices], Philips Respironics is committed to serving as an ally to healthcare providers and developing products and solutions that will enrich patients’ lives. Whether for secretion clearance, ventilation, or sleep-disordered breathing, Philips Respironics will continue to focus on developing products and solutions to meet the needs of our customers and the patients they serve. In today’s evolving home healthcare environment, payors are looking to reduce hospital readmissions, and this requires the development of solutions that enable clinicians to track long-term care and disease progression, as well as to be more proactive in the treatment of respiratory conditions.
Fenwick: The 2.3% tax will increase costs and reduce innovation and capital for reinvestment in the medical device industry. It may depress the market for capital equipment and potentially deprive patients of devices they need.
LaPlante: This tax is already affecting sales, but it’s hard to really say how this will directly affect the airway clearance market. I think we are all in a bit of a holding pattern with the administration constantly changing the rules—who knows if this tax will remain in effect come election time?
VORTRAN Medical is dedicated to our valued customers, and we plan to continue to develop new products. We feel this tax is not right, but we will have to deal with it and move forward.
Lunder: Electromed believes the excise tax is adversely impacting patient care and overall healthcare innovation, which will substantially increase the costs of healthcare. The impact is especially hard on smaller companies whose innovations are not immediately profitable. Although the tax will not affect our product development, it will certainly have an effect on how we manage costs in other areas of our business.
RT: What does the future hold for airway clearance devices? What future technology trends can RTs expect to see in the next few years?
Diacopoulos: From our perspective, the future of airway clearance will be shaped by technologies that better enable clinicians and caregivers to care for patients with chronic respiratory disease, with an added emphasis on care in the home. Through education, we hope to expand awareness of mechanical insufflation-exsufflation so that clinicians may incorporate products, such as CoughAssist, into their practice, as a safe, effective, and more comfortable secretion option for patients.
Fenwick: Hospitals, doctors, and RTs will have more demands placed on them to improve patient care while managing costs and outcomes. Their needs will drive our market. With regard to future products, you will have to wait and see—but it’s only good air.
LaPlante: I think the future is very bright for airway clearance. It’s a segment that is getting more and more exposure and is being seen as an effective therapy for patients as small as neonates up to elderly adults. I feel that with the amount of people in the world who suffer with airway problems, it is only natural that we continue to develop better devices to help them with this. I foresee a continued push into developing more effective, less costly airway clearance treatments. This push is being driven by the cost of healthcare. I feel if we had more preventative and more effective treatments readily and easily available to patients, the overall visits and costs obtained in hospitals will reduce.
VORTRAN is currently working on a redesign of our PercussiveNEB. The product is an effective airway clearance treatment, but we can always make it better. We have listened to the feedback of our customers and distributors, and are working on meeting their needs and providing a superior treatment device. We are also working on a few other new products with the same ideas in mind: low cost, disposable, and effective treatments for patients. We hope to introduce them this year.
Lunder: The need for airway clearance will continue to grow with the aging population. Years ago, you may not have expected to see a device used in a hospital setting go home with the patient. That is becoming more and more common as preventative medical practice is advocated by most insurers, including Medicare/Medicaid. Medical treatment in the home rather than the hospital or clinics is very cost-effective. The SmartVest is a product used in the acute care setting and bridges over to the outpatient and in-home therapy.
From a technology standpoint, Electromed sees efforts focused on cost-effectiveness and more efficient ways of reporting compliance with the prescribed treatment. We see insurance companies wanting more and more details about how their patients are complying with their therapy and tying that to outcomes. Electromed continues to work toward innovating our current product line as well as bring complementary airway clearance products to market. RT
Lori Sichtermann is associate editor for RT. For further information, contact [email protected]