Take a stroll through any mall in America and you will see an
HME market segment in the making.
Nearly two-thirds of American adults are either overweight or
obese, according to the National Health and Nutrition Examination
Survey for 2003-2004, the most recent available. (The survey
defines “overweight” as poundage in excess of ideal
body weight; “obese” is weighing more than 20 percent
over ideal body weight.) And most of those people still want to be
active. They want to go to the mall, go to the movies, visit
friends, travel.
But often, they can't do it without help. Enter bariatric
mobility. It's an unsung sector that could expand a provider's
bottom line, say those working in the field.
“It's growing rapidly,” says Michael DiFranco,
bariatric product manager for Elyria, Ohio-based Invacare. He
estimates the demand for bariatric products could grow between 10
and 15 percent in the calendar year. “It does represent new
business for the provider.”
Both manufacturers and providers point to three reasons HME
companies might consider establishing a presence in the bariatric
mobility market:
The prevalence of obesity in America — and its growing
numbers;
The fact that many in the obese category are baby boomers and
therefore are not Medicare-reliant, which could mean more cash
sales;
An increasing availability not just of bariatric mobility items
but also other bariatric equipment.
Could it be a market for you?
BARIATRIC BENEFITS
If you've been in the HME business a while, it's likely that
when someone mentions bariatrics, you envision a limited selection
of product, the need for a warehouse to store oversized equipment
and waits of up to six weeks for many products. Indeed, that's the
way it was not too many years ago.
Then, says DiFranco, there weren't many manufacturers developing
bariatric products. “Products cost a lot, oftentimes above
the Medicare allowable,” he points out.
Providers shied away from the market.
“In the old days when people came in for bariatric
products, dealers weren't as familiar with them or [didn't know]
how to get them,” says Harvey Diamond, executive president
and CEO for Drive Medical Design & Manufacturing.
The Port Washington, N.Y., manufacturer began making a big push
into the bariatric sector about five years ago. “We try to
get [providers] not to say no to those people, to realize [that the
products] are available, they are in stock, they're available for
quick shipment.”
Today, according to HomeCare's 2007 Buyers' Guide, nearly
65 manufacturers build bariatric wheelchairs and scooters alone.
Costs have dropped and availability has soared. Driven by what some
have labeled the “epidemic” of obesity in America, the
bariatric product segment has exploded. And products are available,
from canes, walkers and rollators to bathtub products, beds, lift
chairs, transport chairs, commodes and lifts.
Even CMS has recognized the variations in bariatric products.
The new coding for power mobility devices, for example, includes 23
codes for bariatric products, and it clearly defines categories of
“heavy duty” (301-450 pounds), “very heavy
duty” (451-600 pounds) and “extra heavy duty”
(610 pounds plus) with allowables for each, according to executives
at Pride Mobility Products in Exeter, Pa.
A number of manufacturers are designing chairs to fit those
codes, and that's making the sector much more
provider-friendly.
“Manufacturers are producing more wheelchairs. It makes
the market more easily accessible,” according to Tony
Rollins, operations manager for Fuller Medical in Gadsden, Ala.
John Velekkakan, owner of American Home Respiratory Care, which
does business as Monroe Oxygen and Medical Equipment in Rochester,
N.Y., agrees. “Basically, we can get things even the next day
if it is private pay,” he says. “If it is Medicare or
Medicaid, we need to go through all the procedures and that may
take more time.”
But the days of waiting for weeks for a bariatric wheelchair to
arrive are pretty much gone.
Still, many providers are reluctant to explore this new market,
says DiFranco. “Providers are in a passive mode where they
take orders as they come in the door. No one is establishing
themselves in the market,” he says. “They are
unfamiliar with it. They are probably distracted by all the other
Medicare things going on [so there's] inertia going into another
market and selling it in a different way.
“The thing is,” DiFranco continues, “providers
sell beds, they sell walkers, they sell power wheelchairs. It's not
really a stretch to get into bariatrics.”
Now, with swift availability, decent profit margins and an
expanded product line coupled with demand, the bariatrics market is
one providers would be wise to consider, DiFranco and others
say.
Jim Leedom, owner of Home Health Depot in Lomita, Calif., has
been working in bariatrics for about five years. It was his late
partner, a man who himself weighed 450 pounds, who persuaded him to
get into the market. “It has been rewarding. I have done
things for people who haven't been outside for two years,”
says Leedom, pointing out the personal side of providing bariatric
products.
Beyond that, Leedom says working in the sector has improved his
bottom line, and he notes one of the pluses of being in this market
is little competition. “The fact that you do it and no one
else does sets you apart from the competition,” he says.
“Most [providers] won't take the time to learn it.”
Diamond sees other benefits. “Along with regular mobility,
it can probably give the dealers a better blended gross profit
margin,” he says. “Another good thing is that while
some of the mass merchandisers have gotten into mobility, they have
not gotten into bariatric mobility.”
Adds Dale Nash, director of standard HME products for Longmont,
Colo.-based Sunrise Medical, while there certainly are challenges
in bariatrics, “the overall business is constant and offers
the opportunity to expand a provider's market
penetration.”
MARKET CHALLENGES
It may be a bright light in the current HME mobility market, but
there are some challenges for providers, namely knowledge,
inventory and advertising.
Providers not only need to know what's available in the market,
they need to know how to find the best product for the bariatric
patient. And that can be tricky, since not only size but a variety
of physical conditions — even skin breakdown — can come
into play.
“Bariatric mobility requires some extra effort and
expertise than that of the standard business,” says Nash.
“Naturally, there are different levels of need and challenges
for the client due to their specific physical
conditions.”
Because of that, Leedom says he works closely with the
manufacturers when he is fitting someone for a bariatric
wheelchair.
“We rely on the manufacturer to guide us,” he says.
“We do the specs and the measurements, and then the
manufacturer chooses the right product based on the measurements.
Even then, you have to tweak it. It doesn't take as much time as a
rehab product, but it does take more time than [a standard
chair].”
With the increasing popularity of gastric bypass and other
bariatric surgeries, providers must also do some research to find
out whether the end-user plans to go that route, Leedom says.
“If you know they are going in for gastric bypass or gastric
banding, then you consider that as you try to fit them. I've seen
people drop 100 pounds in a year, and they no longer fit the power
chair. Then you have to fit them again.”
A home assessment is also a must, providers say. Door and
hallway widths, table heights, bathroom accessibility — all
must be considered in choosing the right kind of wheelchair to
provide.
Because bariatric mobility products are heavier than standard
equipment, Rollins says he even asks how someone plans to transport
the wheelchair. “How are they going to get it in and out? A
husband or wife love each other, but you get a blinding rainstorm,
and are they going to love you enough to disassemble your
wheelchair when they're getting soaking wet?” he asks.
Rollins underscores the need for knowing and understanding the
Medicare guidelines related to bariatric products, and also knowing
the exact products that are available in this market sector. It's
critical for the provider to have that information, he says,
because referral sources often do not.
“Usually [the end-user] comes in with a physician order
for a specific item. And most times, the physicians don't know the
criteria [for Medicare qualification]. It's one of the biggest
problems in the industry. They just say to the patient, ‘Go
get this.’”
It's up to the provider, then, to try to figure out exactly
which equipment will work best for the patient and his or her
individual lifestyle and needs. “There are a lot of things
that go into getting someone into a wheelchair,” says
Rollins. “It's not just signing some papers and it's yours.
It goes back to total patient care.”
WHAT ABOUT INVENTORY?
For many providers, one of the biggest stumbling blocks to
entering the bariatric market is the matter of inventory. How do
you make space in a showroom for over-sized beds and wheelchairs,
for example?
Leedom says he keeps bariatric bathroom equipment on the
showroom floor because it's regular retail. “But there's no
reason to keep a bariatric bed on the floor,” he says.
“It takes up a lot of room, and your square footage use is
not good. So I rarely put bariatric products on the floor because
it doesn't pay.”
Manufacturers provide him with product catalogs so people can at
least see what the products look like and what their special
features are, he says.
Monroe Oxygen's Velekkakan and Fuller Medical's Rollins
warehouse some items. Rollins also has a showroom where he displays
a limited number of products.
“You have to have the ability to warehouse to whatever
extent you feel you need to have it available,” says Rollins.
“In this society, we want it and we want it right now. So the
companies that do have the warehouse ability, it's better for
them.”
Velekkakan notes that warehousing bariatrics can be complicated.
“You need more space,” he says. “We try not to
have too much inventory. Our inventory runs about $150,000, and we
try to turn it over as fast as we can.”
But providers and manufacturers alike say it is important for
providers to offer a full spectrum of bariatric products if they
want to be successful in the field.
Invacare's suggested Starter Kit 1, for example, includes two
types of commodes, a walker and walker wheel kit, crutches, an
offset cane and two quad canes, shower chairs, a transport chair, a
transfer bench, a rollator, a full-sized bed and an air
mattress.
Smart providers will also recognize their patients' need for a
lift chair or other equipment that will help with accessibility.
For example, says Leedom, “we also offer non-covered services
— outside ramps, elevators, things like that.”
Points out Nash of Sunrise, “If the client has the need
for mobility, they will also have the need for many other assistive
products.”
ADVERTISING IS ANOTHER KEY
But having knowledge and inventory won't lead to success in the
bariatric mobility field by themselves.
“You can stock the equipment, but if you don't promote
yourself to the individuals, it's probably going to sit there. Use
the manufacturer to help advertise,” recommends Invacare's
DiFranco.
It's important to market to referral sources to let them know
about the bariatric products you carry and the services you
provide, notes Nash.
Since Velekkakan sees bariatrics as a growth market for his
company, he is advertising the fact that the store carries
bariatric products with visits to each of his referral sources.
“Close to 500 doctors refer to us,” he says. With each
source, he goes over exactly what bariatric products are available
and shows them photos.
He's also trained his staff about bariatric products so that
every person at Monroe Oxygen is alert to patients who might need
such equipment.
“We're not going to leave anything to chance,” he
says.
Rollins doesn't rely on print or TV advertising. “Your
biggest marketing is word of mouth — informing the public and
informing the referral sources, the doctors' offices and discharge
planners,” he says. It's important, he believes, to get the
word out that “because of someone's size, it doesn't mean
they have to go home and sit on the couch for the rest of their
lives. They can continue with somewhat of a normal
lifestyle.”
Home Health Depot's Leedom says he markets mainly to hospitals.
“They are the ones who get the patients for gastric surgery.
The discharge planner is still the key person,” he says.
In the end, providers who want to enter the bariatric mobility
market will have to do their homework. And for those that do, it
could pay off.
A Helping Hand
Manufacturers are a good source for help if you are considering
entering the bariatric mobility sector. Most offer pamphlets,
catalogs and other marketing tools, and they can help you decipher
Medicare coding as well.
Elyria, Ohio-based Invacare has even created a Web site to help
— http://bariatrics.invacare.com
The site's goal, according to Invacare, is to “provide a
pathway to bariatric solutions, education and information for
consumers/family members, medical professionals and Invacare
providers.”
HME companies not only can point their customers to the site for
support and information, they also can find a bariatric product
catalog and arrange a bariatric conference or training seminar in
their area. In addition, there's a tool by which providers can
actually calculate their profit on bariatric products, according to
Michael DiFranco, Invacare's bariatric product manager.
The company also offers a bariatric marketing kit that contains
suggested starter kits, information about the Medicare HCPCS coding
for its bariatric products, a marketing guide and a full catalog of
bariatric products.
