Nothing is scarier than the unknown, and HME providers tend to
stick with what they know. While it's not easy to branch out into
new product categories, experts say, particularly during a tough
economy, taking the time to explore beds and support surfaces could
pay dividends.
Mike Sedlak, group product manager for beds and therapeutic
support surfaces at Invacare, says most of the sector's recent
growth has been attributable to related support surfaces.
"There is a big focus on prevention of pressure ulcers, and
providers can certainly play a big role in keeping the incidence of
pressure ulcers down simply by the product that they are putting
under patients," Sedlak says. "We need the support of the providers
to carry that message."
Chris Ritter, senior director of global sales at The ROHO Group,
believes more providers would embrace the support surface category,
particularly for beds, if they knew more about it.
"A lot of home care providers are kind of afraid of the support
surface market with regard to beds. I don't think they know enough
about it, but it is probably easier than the support surface market
for wheelchairs," Ritter says. The premise is simple: Medical
mattresses play a critical role in providing the patient with the
appropriate comfort and support.
With such a substantial focus on wheelchair cushions in the
rehab community, Sedlak agrees that mattresses are often the
forgotten element.
"The problem is at night, wheelchair users are put into a bed
that may not have the same pressure reduction surfaces or
capabilities that their chair cushions have," says Sedlak. "It is
an 'aha' moment where providers say, 'You're right, we are
concerned with patients for the waking hours of the day, but what
are we doing for them at night?' Nighttime positioning and
nighttime pressure reduction is vitally important."
In today's market, merely banking on the needs of an aging
population is not enough to move the sales needle. To gain more
business in the provider-driven product category, Ritter says HME
companies need to capitalize on existing contacts at hospitals,
home health agencies and long-term care facilities. "Ask if they
could provide referrals for bed support surfaces as well as the
ones for wheelchairs," he suggests.
He also says focused presentations and in-services directed at
new and current referrals sources are necessary. "Use manufacturer
representatives to go in with you to provide support and a
knowledge base," he advises. "Know that nowadays, physical
therapists and occupational therapists sometimes prescribe beds, as
well as wheelchairs and wheelchair cushions. These therapists could
be part of a wound care team with physicians and other members of
the health care continuum."
Often such professionals may not be up-to-date on the latest
cushions and/or beds, and this is the perfect opportunity for
providers to serve as the crucial knowledge base. "Clinicians are
looking for education because hospitals are no longer sending
clinicians for continuing education," adds Ritter. "Providers can
offer those services, and that is just one more way to add to value
and maintain that referral source."
Beyond Medicare
Medicare Group 2 mattresses for beds are the most typical item
sold for most providers, and Group 1 mattresses are also routinely
purchased with Medicare funds.
Selling bed frames and mattresses can also be an avenue to avoid
Medicare altogether. Flex-a-Bed sells into two different markets:
home furnishings and home health care. Overall sales for the last
two years have been down, but home health is not down as far as the
furniture market, says Max Morrison, Flex-a-Bed president.
"Our home health care market has remained fairly stable, and
that is because of the need," says Morrison. "The need is still
there, as opposed to the desire. I am no economic prophet, but
based on what I'm hearing, I don't expect a big increase in 2010,
even though I do think our economy will improve. A lot of what
happens in the home health care industry really has to do with how
health care reform is handled."
Morrison notes his company's beds "are mostly for sale and not
for rent, and they are cash items, not Medicare items. In this
climate of diminished Medicare and private insurance
reimbursements, home care providers are looking for cash customers.
If Medicare is not going to reimburse at the same level they used
to, providers can really benefit from these customers." Baby
boomers who want functional beds that do not look like hospital
beds should be good news for HME companies willing to look at the
option.
For non-Medicare cash purchases, Morrison believes it is vital
to display the products properly. When a customer can see, feel and
touch the bedding, it's better than any catalog photo.
Providers with the floor space for bed display can also boost
market share by telling people about what they've got. Morrison
says HME providers breaking into retail are not as prone to
advertising as those in other retail markets. They should be, he
thinks. "You need to display it, but you also need to tell people
that you have it," Morrison says.
Products and Profits
Within the Medicare market, Sedlak says, "the need for beds is
always going to be there." Because most of the beds sold by
Invacare are ultimately rented out, he continues, "we want to make
sure that providers don't get a perception that the product only
needs to last for 13 months. That is a bit of a misconception on
their part if they are buying a product that is going to last them
through repeated rentals that will, over the long run, give them a
better return on their investment."
With the outcome of health care reform uncertain (as of press
time) and competitive bidding ahead, Sedlak believes providers are
being more cautious about what they buy; reimbursements could get
tighter still. Hospital beds are included in the Round 1 rebid, as
are support surfaces (Group 2 mattresses and overlays), but the
latter is being bid only in the Miami competitive bidding area.
Despite that currently limited scope, things could change in Round
2.
"I would expect support surfaces to be one on the list as
competitive bidding moves into the later rounds," says Sedlak. "As
CMS goes on to the next round … they may expand that to a
broader number of markets."
As for technology, no market-shaking paradigm-shifters appear to
be on the horizon. Instead, manufacturers are focusing on more
subtle changes that can boost a product's efficiency.
For example, Flex-a-bed made its own linear actuator for 30
years, but now Linak will make the motor that raises and lowers the
bed. "We partnered with Linak because they are producing a quiet,
powerful and durable linear actuator," enthuses Morrison. "Our
product is made in the United States, and even these actuators that
we purchased are made in Kentucky. We need jobs here in the United
States, and we are proud of the fact that we make everything here
in America."
One thing that is new, says Abbey Daniels, CEO of Anodyne
Medical Device, are the terms being used to describe support
surfaces. "Active products are power products, and reactive
products are non-powered," she explains. "Think of a foam mattress.
When a patient lays on it, the foam is reacting to the patient's
weight. The foam gives a little bit.
"If you put patients on an air surface with an electronic
control board that sits at the foot of the bed, you can turn that
on and it fill up the air cells. This mattress moves the patient.
It is not responding to the patient's movement — so that is
how we settled on the 'active' and 'reactive' terminology."
Distinctions among products ultimately made a crucial difference
at Anodyne, which is a consortium of support surface manufacturers
that includes AMF Support Surfaces, SenTech Medical Systems,
Anatomic Concepts and PrimaTech. The group offers support surfaces
incorporating both active and static air, foam and gel technologies
to accommodate various patient needs. Daniels says last year, the
company's non-powered support surface business had double-digit
growth, while the powered side declined.
"In the three years prior, we grew by anywhere from 24 percent
to 30 percent for each of those years," says Daniels. "So
considering the kind of growth that we came off of, I was happy to
maintain a flat top line in 2009."
While reimbursement rates continue to force providers and
manufacturers to operate within tight margins, it's a given
products have to be cost-effective. At the same time, there's a
renewed focus on product quality and reliability, as well as on
making sure the right products with the right options and benefits
are chosen for individual customers.
Sedlak also points to trends such as greater sales of full
electric beds, and more low beds, which are designed to keep
patients closer to the ground while they are sleeping.
"There is a bit of a trend away from the use of bed rails," says
Sedlak. "You can have patients sleeping in beds that are closer to
the ground. They may be on a mattress that has a raised perimeter,
but they are not using rails. If they are prone to rolling out of
bed, the risk of injury would be less if they were to fall onto a
floor mat rather than get entrapped within the rail itself, or to
roll into the rail."
Working with referral sources to advocate for better mattresses
is yet another trend that can only help patients in the long run.
Sedlak has noticed that more providers are proactively offering a
better sleeping surface.
"Providers are now putting out more comfortable foam mattresses
that offer some degree of pressure relief or pressure reduction
versus the innerspring mattress that is so common in the
marketplace today," says Sedlak. "That is something that they don't
necessarily get paid any more money for doing. They are taking it
upon themselves to put a better product out there, and that is nice
to see.
"That shows that they are thinking about their patients, and
referral sources will also appreciate it."
Rebid Rates Ahead
Among the categories included in the Round 1 rebid of
competitive bidding, slated for implementation in January
2011:
- Hospital Beds and Related Accessories
- Support Surfaces (Group 2 mattresses and overlays) in Miami
only
In the first Round 1, the average reduction across then-current
reimbursements was 26%, but for these two categories it was higher.
For hospital beds, rates resulting from the bid averaged a 29%
drop, and for support surfaces, 36%. CMS has said rates for the
rebid round will be released in June.
- Read the "Support Surface
Primer" sidebar to learn more about the varying
characteristics of the three CMS categories for support
surfaces.
Experts Interviewed
- Abbey Daniels, CEO, Anodyne Medical Device,
Coral Springs, Fla. - Max Morrison, president, Flex-a-Bed,
LaFayette, Ga - Chris Ritter, senior director of global sales,
The ROHO Group, Belleville, Ill. - Mike Sedlak, group product manager, beds and
therapeutic support surfaces, Invacare, Elyria, Ohio
Support Surface Primer
CMS categorizes support surfaces into three groups based
on the complexity of their features. The three groups have varying
characteristics:
Group 1 support surfaces are mattresses and
mattress overlays (foam, air, water or gel) that are generally
designed for the prevention of pressure ulcers for patients with
significant risk factors. These support surfaces may be rented or
purchased.
Group 2 support surfaces include powered air
flotation beds, powered pressure-reducing air mattresses/mattress
overlays, and non-powered advanced pressure reducing
mattresses/mattress overlays. They are generally intended for use
for patients with established, advanced stage pressure ulcers.
These support surfaces may only be rented.
Group 3 support surfaces are complete bed
systems, known as air-fluidized beds, which simulate the movement
of fluid by circulating filtered air through silicone-coated
ceramic beads. They are intended for use for patients with
established, advanced stage pressure ulcers who have failed a
standard comprehensive wound care program. These support surfaces
may only be rented and are the most expensive of the groups.
