Worth the Weight

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.