Quality Counts

When it comes to being successful in the manual wheelchair market, quality is “job one,” to borrow a quote from Ford Motor Co. The quality of products affects the market’s sales, innovations, reimbursement structure — and reputation.

Providers should not “chase low-cost products specifically for the sake of money. If they do, they are [providing a disservice to the disabled community] along with creating a more-difficult [reimbursement] environment, which costs society more in the long run,” says John Box, president of Colours in Motion.

A Mature Market

Why does high quality count for so much in this particular market? Perhaps because there are many opportunities for low-quality products to make it to end-users.

“The manual wheelchair market is a mature market that is increasingly becoming diluted by off-shore competitors who compete mainly on price,” says Michele Salimbeni, product manager, manual wheelchairs, for Invacare.

“[Pricing] pressure continues to go downward,” says Joe Ticer, director of rehab and mobility for Graham-Field Health Products, “and I don’t see that changing in the immediate future.” He notes that manufacturers are adding smaller product offerings and “concentrating on the high-use products as a strategy of bringing their pricing down. Most of the low-end products are going off-shore.”

According to industry experts, some foreign-made products may look like high-quality models — K0004 wheelchairs, for instance — but really be substandard in construction. And, they say, the discrepancy could hurt providers in the long run.

“The government is looking at these products to determine reimbursement,” says Walt Yercheck, national sales manager for Evermed. “If you’re being reimbursed now at a K0004 level,” and the government decides your particular chair can be reimbursed for a lesser amount because of the cheaper look-alike models, “the government may only reimburse you for a K0003, or not at all.

“It’s fine to bring in products from overseas; there are quality products that providers can import. But you can’t just look at dollars and cents. You have to look at quality and price and what the government will reimburse you for,” Yercheck continues.

“The average consumer sees a product that’s shiny, new and looks the same [as another product], but costs less, so he asks, ‘Why can’t I get that?’ The consumer doesn’t understand all of the service that should come with the wheelchair — fitting, maintenance,” says Christy Shimono, Sunrise Medical’s senior product manager, adult mobility. “Just having some other company import it cheaper is not the whole package. You need the manufacturer behind the product to provide the service.”

“It’s not fair for the government or anyone else to pay the same for that [low-quality] chair as for a good-quality chair,” Yercheck says. Plus, he believes, the industry — everyone from providers to distributors to manufacturers — should aim at providing average- to above-average-quality equipment, because “sooner or later, we will be inspected, and, when [the inspectors] see the quality provided versus what is being paid for the product, ‘something’ will hit the fan.”

However, notes Graham-Field’s Ticer, “The industry sometimes considers ‘high quality’ and ‘low end’ mutually exclusive. I do believe you can get a high-quality product at a reasonable price.” In June, Graham-Field introduced several manual wheelchair models with a focus on strict quality standards, Ticer says.

‘Reimbursement Affects Everything’

Some experts hint that the reimbursement structure itself may force providers and distributors of manual wheelchairs to look for lower-cost products.

“Reimbursement affects everything, all the time. It affects product design and price,” Shimono says.

Lightweight and high-end chairs haven’t traditionally been Medicare-funded. However, according to Shimono, now private insurers are considering using guidelines set by Medicare to determine reimbursement on these wheelchairs, which could affect the market if those payers decide to use the Medicare allowables. The impact? “Downward,” Shimono says, referring to the possibility of reimbursement cuts for manual chairs.

“Medicare does drive a lot of the downward pricing pressures,” says Ticer, adding that providers are faced with the challenge of making a reasonable margin in a very service-intensive market.

“There is plenty of demand or need for the product [but] fewer dollars from third-party payers to fund custom manual wheelchairs and other like equipment,” says Ben Kingery, product manager, custom manual wheelchairs, Invacare. “For example, Medicare reimbursement for a manual adult tilt-in-space wheelchair is now approximately $2,366, while fully optioned models retail for approximately $2,900. Under these conditions, it is going to make it much more difficult for medical equipment dealers to provide the appropriate equipment and much more difficult for [manufacturers] to push the envelope when it comes to innovation.”

Growth Still Possible

A perspective on growth in the manual wheelchair market depends on whether you’re looking at the market over the short or long term.

“I would say the overall market has been on the increase, even though it currently looks flat. It’s growing slightly … but not by leaps and bounds,” says Shimono of Sunrise. “If you look at the market over the years, beginning when lightweights really came into the market, there was a big surge then because [manufacturers could offer] rigid and folding wheelchairs, then another surge when manufacturers came out with niche products, like tilt-in-space, that were lightweight.

“Brand-new products are probably getting the most gains,” she continues, “but in the process are taking [market share] away from an existing product.”

Other experts say the outlook for manual wheelchairs is the same as that for many segments of DME: growing or poised to grow due to aging consumers, yet hindered slightly by occasional fraud and the whims of federal and local governments.

Success for providers in the market lies in differentiating themselves with good service, says Graham-Field’s Ticer. “I’m just a firm believer in the dealer network that provides such an important link in service to the end-user. It’s the dealer who pays attention to the service and follow-through to the customer, and the ones that are the best at it take care of the end-user.”

“We just need to weed out the unscrupulous dealers and people out there and let everyone know that the industry, and the dealers and manufacturers in it, are still great,” states Yercheck of Evermed.

“Much ‘circus talk’ is surrounding the DME/rehab marketplace ’ everyone is running around in a paranoid state,” says Colours’ Box, referring to speculation about how the Medicare Modernization Act and government scrutiny of powered mobility products will affect the manual wheelchair market. “Only time will tell what is really going to happen.

“Do people really believe that elected officials are going to take away benefits for someone-child or adult-who uses a wheelchair for more than 5,000 hours a year? And why would elected officials go after the smallest section of spending with the [potential for] the greatest detriment to society? I don’t buy it.”

Experts Interviewed

John Box, president, Colours in Motion, Anaheim, Calif.; Ben Kingery, product manager, custom manual wheelchairs, and Michele Salimbeni, product manager, manual wheelchairs, Invacare Corp., Elyria, Ohio; Christy Shimono, senior product manager, adult mobility products, Sunrise Medical, Longmont, Colo.; Joe Ticer, director of rehab and mobility, Graham-Field Health Products, Atlanta; Walt Yercheck, national sales manager, Evermed, Anaheim, Calif.

Business Tactics

Education and efficiency pave the road to success in the manual wheelchair market, experts say.

“Dealers who can help their referrals and their accounts get the best equipment [will succeed],” says Christy Shimono, senior product manager, adult mobility products, Sunrise Medical, adding that the key is that dealers should be familiar with all of the products and funding available.

“Therapists have to understand and take care of the consumer, so they need to refer [the consumer] to a person to whom they can say, ‘I need a product that will do this,’ and who knows the funding. The dealers who stay on top of [product and funding information], and who understand the team approach to providing products to end-users, will be the ones who win, who will make money in this market,” Shimono says.

According to the experts, the best ways to become educated about products and funding are to visit manufacturers’ Web sites, work closely with manufacturers’ field representatives, participate in manufacturer- and industry association-sponsored education programs, and read industry publications. In addition, Shimono says, “dealers should get involved with the funding sources in their area [to educate them] on the products. Often, the funding sources just read a description of a product that sounds like something that it isn’t.” And finally, according to Shimono, “Hands-on is still the best way to learn.”

Providers also need to focus on efficiency in terms of product and service costs, and in terms of staffing.

“One way dealers can take advantage of opportunities in this market is to focus on purchasing a product that has the lowest ‘total’ cost, taking the lifetime of the wheelchair into account,” says Michele Salimbeni, product manager, manual wheelchairs, Invacare. “Lowest ‘invoice’ cost is not always the lowest ‘total’ cost.”

Incorrect billing due to uninformed — as opposed to fraudulent — providers is a big problem in the manual wheelchair market, experts say. “When providers have billing problems, it causes problems for everybody because they will be scrutinized eventually,” explains Walt Yercheck, national sales manager, Evermed.

Manual wheelchair providers who don’t have a dedicated billing staff should outsource their billing, he says. “A good billing service is the key.”

Even providers who do have staff dedicated to reimbursement should be vigilant about keeping that staff educated by, for example, working with manufacturers who will provide training on billing for their products.

“Dealers need to work with manufacturers to come up with creative solutions in this funding environment,” says Ben Kingery, Invacare’s product manager, custom manual wheelchairs. “We need to continue to innovate!”

More for the Money

Product innovations in the manual wheelchair market now focus not only on products that are lighter and easier to maneuver but also lighter on the pocketbook. The most popular cost-saving measure in today’s market are chairs that pull double-duty by adjusting to fit users’ immediate and future needs, from fitting through restaurant doorways to sitting comfortably in a tilt chair.

Almost every manufacturer of manual wheelchairs now offers products that can be reconfigured and adjusted in a myriad of ways, without requiring many extra parts or tools. Sunrise Medical’s Guardian Chameleon, for example, has interchangeable parts and height- and depth-adjustable seating and is “designed to adapt to the multiple demands of the user and the supplier,” the company says.

Some products, such as Evermed’s K0004 offering and Pride Mobility Products’ Stylus, feature quick-release axles on the back wheels, “[which means users] can pop the large rear wheels off and change the chair into a transport chair for people to make it into restaurants or through narrow doorways in their homes,” says Walt Yercheck, national sales manager for Evermed.

Invacare and Tonawanda, N.Y.-based Product Design Group both offer tilt-in-space manual wheelchairs — the Compass SPT and Stellar Tilt, respectively — that can be propelled by the chair user. These products are designed to “help a person with changing needs be able to use the chair for a longer period of time and reduce the lifetime costs for the funding source — a creative way to innovate and work within today’s funding environment,” says Ben Kingery, product manager, custom manual wheelchairs, Invacare. He uses the example of a nursing home patient to explain the benefits of this type of wheelchair:

“[Initially], the person can manage to get independently from point A to point B in the wheelchair by foot and/or arm propelling the chair. However, the patient is in the early stages of dementia, and his ability to self-propel in the future is questionable. In the past, the patient’s therapist had a couple of options: One, recommend a non-tilting manual wheelchair … but risk that the user will decline to the point of not being able to self-propel before he is eligible for funding for another wheelchair; or, two, recommend a tilt-in-space wheelchair and take away any chance of self-propulsion and a large part of the patient’s independence. This isn’t a choice many therapists like to make.”