A Sleeper Hit

As Americans grow older and increasingly choose to stay in their homes to receive care, the demand for special beds and support surfaces will continue to flourish, sector experts say.

“I think it’s a phenomenal marketplace to be in right now,” says Jim Acker, vice president of sales and marketing for Blue Chip Medical Products. “There’s always going to be a need for preventive and treatment products, and it’s an ever-growing marketplace with the graying of America.”

Today the demand for beds and support surfaces is stronger than ever, agrees Mike Sedlak, group product manager for Invacare. And many of today’s patients are willing to pay out-of-pocket for higher-quality products.

“Not only is there a larger population of people entering into that fray of needing services or care at home but there’s more disposable income out there as well,” Sedlak says. “We’re starting to see higher-end products becoming more in demand than in the past.”

Providers can remain viable with this equipment, manufacturers believe, although many are taking a wait-and-see attitude about competitive bidding’s effects on the beds category, where Medicare payment reductions across the 10 round one CBAs average 29 percent.

The scenario is brighter on the support surfaces side.

“Support surfaces are a good place for providers to maintain profitability and stay in business,” states Dikran Tourian, executive vice president of sales and marketing for Anodyne Medical Devices, which includes SenTech Medical Systems, AMF Support Surfaces and Anatomic Concepts. “With some other products, it doesn’t even make sense to do the product anymore because people aren’t making any money.”

Tourian says he has seen new interest in support surfaces from providers who have never sold these products before. “With competitive bidding, people are looking for ways to replace lost revenue from other products,” Tourian says. “Every day we’ve got people looking to replace lost revenue from oxygen cuts or a bid they lost on a product area that was a key product line for them.”

Reimbursement Rewards

While reimbursements for Group 1 surfaces — which focus primarily on prevention of pressure ulcers — are “a little tight,” Sedlak says providers can do well in Group 2, which provides treatment of existing pressure ulcers.

“Group 2 is a fantastic reimbursement structure right now,” he notes. “There are many situations out there where a provider could purchase a product, put it out under a patient and recoup their money in one month for that investment.”

Further, Medicare is putting more emphasis on preventing dangerous, and possibly deadly, pressure ulcers, he explains.

“The focus and awareness of what a person is sleeping on and possibly spending most of their day on is growing,” Sedlak says. “The reimbursement for Group 2 surfaces is very well-justified because of the nature of what’s involved with them.”

For many HME businesses, this includes providing a clinician to evaluate wounds and make sure the patient’s treatment surface is working, ongoing support to caregivers and servicing products when they break down.

Despite the benefits of working with Group 2, “you’re leaving dollars on the table as a typical provider if you are not using Group 1 products,” cautions Mike Serhan, executive vice president of Drive Medical.

Paying for Extras

Another plus for the market is that many patients are willing to pay extra to have a product that provides convenience and additional features, Sedlak says.

One area that has seen dramatic growth in the past year is full-electric beds, which are difficult for most patients to qualify for under Medicare, he points out. The main reason these beds are becoming so popular is that they allow patients to raise and lower themselves at the push of a button without relying on a caregiver, he explains. They also can help patients get up out of bed.

“The manual beds are going away,” Sedlak says. “We’re seeing fewer and fewer of those sold.”

Semi-electric beds, however, remain the strongest sellers for home care, Sedlak and other manufacturers say.

“That is based on reimbursement primarily driven by Medicare,” says Laurie Gutzwiller, executive director for home care marketing and strategies for Hill-Rom. “Medicare considers a full-electric to be a convenience or luxury, even though the majority of acute care beds are fully electric.”

Smart providers who want to make sure their patients know what is available will take the opportunity to offer those customers an upgrade, Sedlak says. “Providers should be aware of the options available to them and present those options to the patients. Give them the opportunity to go to a low bed or a full-electric bed.”

Many patients are also willing to pay more to upgrade to a better sleeping surface, he notes: “It’s not that substantial a cost. It’s very manageable.”

Goodbye, Rails

As the safety of bed rails have been called into question in recent years, Sedlak predicts that their use will become less common on beds.

From 1985 to 2006, the FDA received nearly 700 entrapment reports involving bed rails resulting in more than 400 deaths at hospitals, nursing homes and other facilities, as well as private homes. In response, the FDA issued a set of design guidelines in 2006 on hospital beds to reduce the risk of entrapment.

Bed rails, which typically are used with patients who are heavily medicated or have mental disorders, can be especially dangerous when a patient attempts to get out of bed and tries to climb over them, Sedlak explains.

“The FDA put the responsibility on providers to ensure they are putting out a safe product, but you don’t know what happens once it gets set up in the home,” he notes. “Rails could get flared out, they could be bent or other things could happen that could lead toward a patient getting entrapped.”

Aside from safety issues, rails also are inconvenient to set up and are not aesthetically pleasing, he says. “We’re projecting that the use of bed rails is going to start to go away, and providers are going to start looking at safer alternatives,” he says.

One popular alternative is a low bed, for which demand also has increased over the past year, Sedlak says. “If you’re thinking of the lesser of two evils, it’s better to have someone roll out of bed when they’re closer to the floor than to try to climb over the top of rails in a bed that’s higher from the ground,” he says.

Another option is a specialty bed designed to prevent falls and entrapment.

Sleep Safe Beds, which manufactures such beds, has seen 300 percent growth from 2004 to 2007, says Joe Hallock, CEO. The company was started in 2001 with a goal of manufacturing safer and more aesthetically appealing beds for special needs patients, such as children with cerebral palsy, adults with loss of muscular control or other conditions that can confine patients to their beds.

Sleep Safe’s wooden beds have framework in contact with the mattress all the way around so there are no gaps where a patient can get an appendage stuck, Hallock explains. The company has plans to expand into the elderly care market, where Hallock says he sees a “huge” need.

New Technologies

One of the challenges of producing beds and support surfaces for the home care market is that it often stifles innovation, says Blue Chip’s Acker. “When you look at some of the mattresses we make for long-term care or the hospital market, the products are far more sophisticated and are clinically documented to be more effective,” he says.

“The problem is no one is going to try to sell that same product for the home care marketplace. It’s not that people don’t want to buy it, it’s that the Medicare allowables don’t cover it.”

But this doesn’t mean there are no new technologies in the home care market, manufacturers say.

Hill-Rom is incorporating many of its features once exclusive to beds used in facilities to its home care beds, according to Jeanne Bohen, vice president of sales.

“With the consumer being much more informed, we’ve seen patients, family members and caregivers who have seen products in the hospital and are now asking that those products be available to them in the home,” says Bohen.

One such bed, which is now available for the home care market, has pulmonary features like percussion vibration, which loosens secretions in the patient’s lungs and helps prevent the development of pneumonia, she notes. Another bed that is often requested has scale options that weigh the patient, making it easier for people who have difficulty leaving the home if a doctor needs to check their weight frequently.

For support surfaces, Tourian says he is seeing a trend toward hybrid products that combine multiple technologies, such as air, foam and gel. Anodyne, for example, has developed a foam and air mattress that gives the patient support even if the power goes out.

“With a traditional low air-loss mattress, if it goes flat, the patient freaks out, and the provider has to go out at 3 a.m. to fix the problem,” he explains. “But with this mattress, the patient has uninterrupted therapy in the event of a power outage.”

Invacare has technology in its powered surfaces that prevents the mattresses from bottoming out. For example, if a patient sits up in bed, their body weight shifts so there is more weight on the trunk. The wireless technology then sends a signal to the power unit to put more air in the mattress so the patient will not bottom out.

Blue Chip has support surfaces that include a pressure mapping system. The system not only can tell if the mattress is redistributing pressure on the surface of the skin but it also measures temperature and shear force.

“You’re not just trying to relieve pressure from the skin, you’re trying to reduce shear and heat, which builds moisture, which is not good for the skin,” Acker says.

Blue Chip also has an expandable width mattress that can be used on 36-, 42- or 48-inch bed frames. The mattress is convenient for providers because they don’t have to stock different mattresses for regular and bariatric bed frames. “It’s one product you can use across the board,” he says.

Providing Product

While many providers are intimidated by this market, providing support surfaces is not any more difficult than for any of the other capped rental items, Tourian says. “The biggest challenge for providers is lack of education,” he says. “It’s more of a technical sale than some of other products, and people are threatened by the documentation.”

Providers should look for vendors that will educate them on what it takes to qualify a patient under Medicare guidelines and what documentation is required, Tourian advises. In turn, providers need to educate their referral sources about what a patient needs, he says.

Then, make sure to give “top-notch customer service” to patients, Acker recommends. “The best way you can keep those referral sources coming is to take care of the patient properly,” he says. “Provide products that actually work, provide products that are not going to break down and provide service at all times, no matter what.”

One thing Drive’s Serhan says savvy providers should do to increase sales is to data mine current patients to find out which of them are at risk — those with hospital beds, diabetes, incontinence or mental deficiencies such as Alzheimer’s or dementia.

“DME providers are in a very good position to sell these products,” Serhan says. If a patient is getting a bed, they also should have the proper support surface that goes on top.

Similarly, Sedlak advises that providers who sell wheelchairs and seating products also should sell support surfaces.

“Where providers can help themselves out is to ask the question, ‘We’re protecting you during the day while you’re in a wheelchair, but what are you sleeping on for eight or 10 hours?’ There’s an opportunity for them to address the other half of that person’s life,” he points out.

Editor’s Note: This article was prepared before H.R. 6331, which delays competitive bidding, became law. For the latest updates on how CMS will shut down round one and enact other provisions in the measure, visit our Web site at www.homecaremag.com, and sign up for your free subscription to the HomeCare Monday weekly enewsletter.

Little Support for Miami?

When it comes to competitive bidding, support surfaces, which are part of the first-round program only in Miami — where 38 suppliers were offered contracts — are causing some concern. (The category was to be included in the San Juan CBA as well, but CMS withdrew it when round one contracts were released, citing a lack of qualified bidders to meet projected demand.)

“It is going to have some backlash on both the level of service that people get and, quite possibly, the quality of products,” says Invacare’s Mike Sedlak, group product manager. Sedlak says he is concerned that some providers that won bids have a large area to service and may not be able to get to patients in a timely manner.

“If you put a lesser quality product under a patient and it goes out in the middle of the night, someone is going to have to go out there and get that product up and running again,” he points out. “If they’re 100 or 200 miles away, that’s a long time that person has to be on a surface that isn’t providing any type of relief.”

But Jim Acker, vice president of sales and marketing for Blue Chip Medical Products, says he was heartened at Medtrade Spring this year when he talked to winning providers who said they were looking for good-quality products.

“It’s up to the provider to make a decision whether or not they want to buy good-quality products that are going to provide positive outcomes, or if they’re just going to buy the cheapest products out there,” Acker says.

Experts Interviewed

Jim Acker, vice president of sales and marketing, Blue Chip Medical Products, Suffern, N.Y.; Jeanne Bohen, vice president of sales, and Laurie Gutzwiller, executive director for home care, Hill-Rom, Batesville, Ind.; Joe Hallock, CEO, Sleep Safe Beds, Callaway, Va.; Mike Sedlak, group product manager, Invacare Corp., Elyria, Ohio; Mike Serhan, executive vice president, Drive Medical Design and Manufacturing, Port Washington, N.Y.; and Dikran Tourian, executive vice president of sales and marketing, Anodyne Medical Devices, Los Angeles, Calif.