As a means of offsetting the recent changes made to Medicare reimbursement, home medical equipment suppliers can now purchase the CoughAssist mechanical in-exsufflator (MI-E) directly from the manufacturer, J.H. Emerson, Cambridge, Mass. The CoughAssist is designed to reduce the occurrence of respiratory infections in those that have lost their ability to cough effectively. The non-invasive CoughAssist achieves this by gradually applying a positive pressure to the airway and then rapidly shifting to negative pressure. The rapid shift in pressure produces a high expiratory flow from the lungs, simulating a cough. It is ideal for patients with neuromuscular disease or other neurological disorders with some paralysis of the respiratory muscles such as spinal cord injury. More information can be found at www.coughassist.com.