For HMEs willing to devote precious floor space to bariatric equipment, the market is ready and waiting.
by Greg Thompson

A persistent obesity problem in America all but guarantees a
growing need for bariatric equipment designed to support morbidly
obese individuals. The question is, how can home medical equipment
providers capitalize on this expanding demographic?

Consultant Jack Evans says the first step is letting customers
know the equipment exists. With most showrooms measuring 1,200 to
1,500 square feet, the Malibu, Calif.-based industry veteran admits
that finding the necessary room can be difficult. However, HME
owners with retail floor space in the 2,000- to 3,000-sq. ft. range
should seriously consider showing off at least three products such
as a walker, wheelchair and bath chair, he says.

Whether you choose to devote an entire department to bariatric
products, or merely a few items, the point is to get the message
across that you have the goods, Evans points out. In his work
crafting retail showrooms across the country, Evans consistently
finds that awareness builds sales.

“The economy has affected home care companies across the
board, with some sales down 25 percent to even a third,” says
Evans, founder of Global Media Marketing. “A lot of people
are out of jobs, have lost their insurance and can't afford to pay
out-of-pocket. What we have done to counteract this is to go back
to layaway plans for the big-ticket items. To make the products
accessible to people who otherwise could not afford them, we start
advertising three or four payments to buy a chair or
scooter.”

While Evans is a big believer in quality products —
medical grade if possible — he also believes there is a place
for cash equipment. For non-Medicare patients who have lost
insurance, these types of bariatric options could be the only way
to go.

“Carry affordable cash lines, which means the cheap cash
lines,” says Evans. “That's the way to approach the
bariatric market. You have your reimbursable model, and you also
have a down-and-dirty cheap cash product; I recommend that to
capture the sales.”

If you can only show one product to get the awareness message
across, go large — and that usually means a wheelchair
— some of which can be 40 inches (or more) wide. Evans
stresses that the visual image can awaken a market that even
bariatric customers did not know existed.

“Sometimes people show a bath chair or a walker, and that
doesn't instantly convey the message,” cautions Evans.
“They will even have a bariatric lift chair or scooter, but
that to me does not do the trick. Put a sign on the wheelchair that
says, ‘Ask us about our heavy-duty equipment or our plus
sizes and triple XL sizes.’”

Kevin Huffman, DO, a board-certified bariatric physician, agrees
that the much-talked-about obesity epidemic is not just hype, and
the aforementioned “plus sizes” show no signs of
disappearing. As founder and president of American Bariatric
Consultants, Vermilion, Ohio, Huffman predicts continued sound
financial health for the bariatric industry based on
“explosive growth” on the consumer side.

Huffman points out that the physician-preferred definition of a
bariatric patient is anyone 100 pounds over his or her ideal body
weight.

For practical purposes, Evans contends that bariatric solutions
should be contemplated for anyone over 300 pounds, though he
acknowledges that there is no hard-and-fast rule.

Amanda Biedess, senior marketing manager, U.S. Therapeutic
Support Systems for Kinetic Concepts Inc. (KCI), San Antonio, adds
that many standard acute care products today are capable of
handling the weight of a patient up to 500 pounds, where five to
eight years ago most standard products had a weight capacity of
only 350 pounds. As a result, she says “standard” acute
care products are now being positioned as capable of managing most
bariatric patients.

“It's important for clinicians to keep in mind that the
weight of the patient is just one aspect to consider when ordering
products for bariatric patients,” says Biedess.
“Clinicians also need to ensure that the width of the product
is appropriate as well.”

After treating more than 10,000 bariatric patients, Huffman
confirms that many large individuals are not aware that equipment
with varying widths and weight capacities is out there.

“We need to do a better job of getting the message out to
patients and to their health care providers that there is bariatric
equipment available,” he says. “It is still largely an
untapped market. Most primary care doctors are not even aware of
bariatric equipment and why patients of a certain size need this
equipment.”

But Huffman believes that through conferences, seminars and
education for health care providers and others such as discharge
planners, the market will only grow.

“Patients can go back to their physician and demand the
right type of equipment,” says Huffman. “Charge nurses
may send patients home and advise them that they need a walker or a
wheelchair, but the discharge planner may not be knowledgeable
about the special needs of bariatric patients.”

As a manufacturer consultant, Huffman is a veteran of the
educational seminars frequently held in physician offices, where he
is careful to talk not only about the equipment but also about
morbid obesity and the statistics associated with it. He stresses
that bariatric equipment can help with activities of daily living
and even occupational tasks. “Physicians are less likely to
want to hear just about selling equipment,” cautions Huffman.
“They want to be educated. We come in with lunch, and we come
in with the topic of morbid obesity. After you outline the medical
complications, you can then start showing the physicians how the
special HME equipment can help patients function.

“We need to get physicians, surgeons and hospitals to buy
in,” he continues. “HME people really need to get into
the hospitals and into the bariatric surgical hospitals and do some
educational programs with physicians, surgeons, discharge planners,
occupational therapists and physical therapists.”

Worth the Effort

The average HME provider does not even bother with bariatric
equipment, a tactical blunder that mystifies Evans. Going beyond
the occasional question and special order can expand a provider's
market and establish a crucial new product line.

“If you put it on the floor, people are going to see it
and they are going to buy it,” says Evans. “People
don't like to special order anything, and they just go with the
standard mix that they have always had. But I think that is
wrong.

“The good home health care provider should have a
bariatric piece in every core department. You can go across the
board with a bed, lift chair, scooter — whatever your
specialty is, you can find a bariatric product in that
category.”

Evans has worked with Kathy Hundley, manager of the Home Town
Healthy Living Store in Chillicothe, Mo., on boosting the bariatric
product category and improving its visibility on the retail floor.
In addition, Hundley evaluates the local market and maintains
referral contacts with receptive physicians. Successful in-person
appointments, breakfasts and lunches all indicate that the need for
bariatric products is likely to expand.

While Hundley notes bariatric equipment represents only a small
percentage of overall sales, she is confident that numbers will
increase as awareness goes up for the company's rollators, walkers,
commode and beds. “Lunch meetings can take place at the
physicians' office and/or lunch room,” says Hundley.

“We bring in brochures and actual pieces of equipment, and
doctors are receptive. After all, you are giving them lunch. I also
hosted an open house at my store.”

The good news, Hundley says, is that with a little savvy and
experience, the average provider can do well with bariatric
products. “It is a relatively easy thing to get into, but you
need to educate yourself about the bariatric lines,” she
says, adding that “reimbursement and billing are is pretty
hassle-free and fair.”

Solid Outlook

When asked, corporate executives such as Biedess express
optimism and a willingness to back up products with educational
initiatives. Training and service support programs at KCI are
designed to help both facilities and home care providers deliver
better patient outcomes while containing costs. The company has
been developing products specifically targeted for the
“patient of size” since 1986, and when it comes to the
country's obesity epidemic, Biedess believes the overall market
will remain solid.

“We are continuing to see a rise in the prevalence of
morbid obesity, but not at the growth rate of obesity that's
happening across the general population,” she says. “At
KCI, we continue to see a demand each year for our bariatric
systems that help facilities avoid the pressure ulcers associated
with immobility and that comply with a variety of state-specific
‘no lift’ policies.”

At Gendron, which offers a range of bariatric products, Roberta
Jacobs describes 2009 as “good” so far, especially when
measured against expectations.

“We anticipated it would be slower, but need is growing,
whether it be for a bed, wheelchair, lift, commode or a
walker,” says Jacobs, national sales manager for the Bryan,
Ohio-based company. “We serve a lot of different markets such
as acute care, subacute care, long-term care and the patient's
home. Our bariatric beds are probably our biggest-selling
products.”

Jacobs agrees that awareness and education is crucial to fueling
the market now and in the future. Working throughout the
educational continuum with physicians, hospital officials,
long-term care facilities, rehab centers, caregivers and patients
will go a long way toward boosting sales and improving patient
outcomes. From there, she says, providers should look for products
that will last.

“Quality of the product is No. 1, and the old cliche that
you get what you pay for is true,” says Jacobs, whose company
manufactures all items in the United States. “You want the
product to last, and hopefully it is going to last as long as you
need it. The reputation of the manufacturer is crucial, because you
want availability and support after the sale.”

ALARMING OBESITY RATES ON THE RISE

Adult obesity rates increased in 23 states and did not decrease
in a single state in the past year, according to “F as in
Fat: How Obesity Policies Are Failing in America 2009,” a
report released in July by the Trust for America's Health and the
Robert Wood Johnson Foundation.

Mississippi had the highest rate of adult obesity at 32.5
percent, making it the fifth year in a row that the state topped
the list. Four states now have rates above 30 percent, including
Mississippi, Alabama (31.2 percent), West Virginia (31.1 percent)
and Tennessee (30.2 percent). According to the report, Colorado had
the lowest percentage of obese adults at 18.9 percent.

Adult obesity rates now exceed 25 percent in 31 states and
exceed 20 percent in 49 states and Washington, D.C., with
two-thirds of American adults either obese or overweight. In 1991,
no state had an obesity rate above 20 percent. In 1980, the
national average for adult obesity was 15 percent.

In addition, childhood obesity rates have more than tripled
since 1980. The percentage of obese or overweight children is now
at or above 30 percent in 30 states. Here again, Mississippi topped
the list with the highest rate of obese and overweight children
(ages 10 to 17) at 44.4 percent; Minnesota and Utah had the lowest
rate at 23.1 percent.