Medicare Patients Starting Volara Respiratory Therapy Show Fewer Emergency Visits and Hospital Stays

A new real-world analysis of medical claims data offers one of the first detailed looks at who uses the Volara respiratory therapy system in the United States and what happens to their healthcare utilization and costs after they start the device. The study, published in the journal Advances in Therapy, examined Medicare and Medicaid enrollees who initiated Volara therapy and tracked their emergency department visits and hospitalizations for respiratory exacerbations in the twelve months before and after treatment began. The findings reveal striking differences between the two insurance populations, with Medicare beneficiaries showing consistent reductions in respiratory-related emergency care and hospital use, while patterns among Medicaid enrollees proved far more variable.

Volara is a respiratory therapy device designed for secretion mobilization and lung expansion, delivering what clinicians call oscillation and lung expansion therapy, or OLE. The device works through two complementary mechanisms: continuous high-frequency oscillation, which loosens and mobilizes mucus from the airways, and continuous positive expiratory pressure, which helps keep airways open and supports lung expansion. Uniquely, the system can simultaneously administer aerosolized medication through an integrated nebulizer, combining three respiratory therapies into a single unit. It is prescribed for patients with chronic respiratory conditions that impair airway clearance, including bronchiectasis, chronic obstructive pulmonary disease, cystic fibrosis, cerebral palsy, amyotrophic lateral sclerosis, muscular dystrophy, and other neuromuscular disorders. Its portability and ease of use make it suitable for home settings, allowing patients who require long-term airway clearance to receive therapy outside the hospital.

The research team, led by investigators at Mathematica with collaborators at Baxter International and Johns Hopkins School of Medicine, conducted a retrospective descriptive analysis using complete administrative claims and encounter data from the Centers for Medicare and Medicare Services Virtual Research Data Center. They identified Medicare fee-for-service and Medicare Advantage beneficiaries who initiated Volara between January 2023 and June 2025, along with Medicaid fee-for-service and managed care enrollees who started the device during calendar year 2023. Initiation was defined by the earliest claim containing the relevant healthcare procedure codes paired with a supplier identifier specific to the device. Patients needed to be at least five years old and continuously enrolled for twelve months before initiation, and Medicaid enrollees dually eligible for Medicare were excluded to avoid incomplete capture of their utilization.

The two cohorts differed dramatically in their demographic and clinical composition. The Medicare cohort comprised 391 enrollees with a mean age of approximately 68 years, of whom 63 percent were female and 78 percent were non-Hispanic White. The overwhelming majority, 93 percent, had pre-existing bronchiectasis, COPD, or neuromuscular disease, with bronchiectasis alone accounting for 36 percent and bronchiectasis combined with COPD for another 33 percent. The Medicaid cohort of 220 enrollees was strikingly younger, with a mean age of just 21 years and 72 percent under age 21. Its disease distribution was broader and different: 37 percent had bronchiectasis or COPD, but substantial proportions had cerebral palsy at 22 percent, neuromuscular disease at 18 percent, prior COVID-19 at 22 percent, and cystic fibrosis at 7 percent. The Medicaid cohort was also more racially and ethnically diverse and lived in neighborhoods with considerably higher social vulnerability, as measured by the CDC Social Vulnerability Index, with 70 percent classified as high vulnerability compared with 43 percent of Medicare patients.

To assess outcomes, the researchers classified patients into mutually exclusive disease segments and measured emergency department visits and inpatient hospitalizations for respiratory exacerbations, along with associated costs, standardized as annualized rates and per-member-per-month costs to account for varying follow-up times. Respiratory events were captured under a broad tier that included COPD, bronchiectasis, COVID-19, asthma, pneumonia, bronchitis, acute respiratory failure, and unspecified respiratory disorders. Clinical risk was assessed using the Elixhauser Comorbidity Index, while social risk was assigned at the ZIP code level. Because payment information is not reported for most Medicaid managed care encounters, the team imputed costs using fee-for-service claims, deriving average shadow prices stratified by year, state, disease segment, event type, demographics, and proxies for severity such as length of stay.

Among Medicare enrollees, the post-initiation period showed consistently lower respiratory-related emergency department use. Annual emergency visit rates fell from 26.3 to 11.0 per 100 patients, a 58 percent reduction, while associated per-member-per-month costs dropped from 21 dollars to 12 dollars, a 39 percent decline. These differences held across all disease segments, ranging from 44 percent lower among patients with both bronchiectasis and COPD to 70 to 81 percent lower in other segments. Hospitalizations also declined, though more modestly: rates fell from 41.2 to 30.4 per 100 patients, a 26 percent reduction, and hospitalization costs fell 11 percent, from 512 dollars to 456 dollars per member per month. The hospitalization improvements were not uniform, however. Patients with COPD saw rates and costs fall by 38 and 36 percent respectively, while neuromuscular disease patients showed similar rates between periods with slightly higher costs afterward.

Subgroup analyses added further nuance. Emergency department reductions appeared across both clinical risk groups and both age groups, but hospitalization patterns diverged sharply. Among Medicare patients with higher clinical risk, hospitalization rates were 33 percent lower after Volara initiation, whereas lower-risk patients actually saw rates rise 8 percent. Social vulnerability produced a similar split: patients in higher-vulnerability neighborhoods experienced 41 percent lower hospitalization rates and 49 percent lower costs post-initiation, while those in lower-vulnerability areas saw costs rise 30 percent despite modestly lower rates. By age, hospitalization rates fell 25 percent among patients 65 and older but rose 6 percent among younger Medicare beneficiaries. Because the pre-initiation period overlapped the COVID-19 pandemic for many patients, the team ran sensitivity analyses excluding COVID-19-related events, and the overall pattern of lower post-initiation utilization and costs remained qualitatively unchanged. Excluding patients with ALS from the neuromuscular segment also did not meaningfully alter the findings.

The Medicaid picture was considerably messier. Emergency department visit rates were nearly flat, at 31.4 per 100 patients before initiation versus 29.6 after, a 5 percent decline, but associated costs rose 24 percent, from 135 dollars to 168 dollars per member per month. Segment-level patterns conflicted: patients with bronchiectasis or COPD had higher emergency visit rates and dramatically higher costs afterward, neuromuscular disease patients had higher rates but lower costs, and cerebral palsy patients showed lower utilization and costs. Hospitalizations told a more favorable story, with rates 24 percent lower and costs 6 percent lower post-initiation overall, though neuromuscular disease patients again moved against the trend. The authors caution that the smaller Medicaid sample makes these exploratory results especially sensitive to noise.

The study’s limitations are substantial and the researchers are explicit about them. As a purely descriptive one-group pre/post design without a comparison group, the analysis cannot establish causation, and regression to the mean may partly explain the lower post-initiation utilization, since some patients likely began Volara after a period of heightened respiratory morbidity such as a hospitalization. Secular changes in healthcare behavior during and after the pandemic cannot be excluded, claims data contain no information on how often or how long patients actually used the device, and concomitant treatments were not examined. Roughly 80 percent of Medicaid costs were imputed, introducing additional uncertainty, and small sample sizes limit generalizability. The study was funded by Baxter, which manufactures the Volara system, though the analysis was conducted by Mathematica under a data use agreement with CMS.

Despite these caveats, the study fills a genuine gap. Prior literature on related airway clearance therapies, including high-frequency chest wall oscillation and oscillating positive expiratory pressure devices, has reported reductions in hospitalizations and costs, but economic evidence specifically for oscillation and lung expansion therapy has been sparse. By documenting who initiates Volara under public insurance and how their utilization patterns shift, the analysis provides hypothesis-generating context for clinicians and payers alike. The pronounced heterogeneity across disease segments, risk strata, and age groups suggests that any future evaluation of the device’s effectiveness will need to account for the fundamentally different populations served by Medicare and Medicaid, from older adults with smoking-related lung disease to children with genetic and neurologic conditions that impair airway clearance. The authors call for comparative study designs with appropriate confounding adjustment to determine whether the observed favorable trends among Medicare beneficiaries reflect a true treatment effect or the interplay of disease course, patient selection, and broader healthcare dynamics.

Subject of Research: Real-world healthcare utilization and costs among Medicare and Medicaid patients initiating Volara oscillation and lung expansion respiratory therapy

Article Title: Characteristics of Medicare and Medicaid Patients Initiating Volara Respiratory Therapy: A Medical Claims Study

Article References: Characteristics of Medicare and Medicaid Patients Initiating Volara Respiratory Therapy: A Medical Claims Study. (n.d.). https://doi.org/10.1007/s12325-026-03762-6

Image Credits: AI Generated

DOI: 10.1007/s12325-026-03762-6

Keywords: Volara, oscillation and lung expansion therapy, Medicare, Medicaid, bronchiectasis, COPD, healthcare resource utilization, emergency department visits, hospitalizations, medical claims, real-world evidence, respiratory therapy