One Size Doesn’t Fit All

A challenge for the bariatric market is to define what the term means. Doctors may define an obese patient as one with a body mass Index (BMI) of 30 or more, while Medicare may define a bariatric patient based on weight. Neither definition accounts for body types and other variables.

HME providers may also be discouraged by the capital outlay required to provide bariatric products, says Phil Cunningham, business manager for home care beds, Invacare. The equipment is different — and more expensive — than standard home care products. However, Invacare and other manufacturers now offer financing plans that can help to spread out those costs and keep them in line with monthly receivables.

“I would say the market out there is significant enough that in almost any DME area, there’s a bariatrics market, but the challenge is to find referral sources and speak to them specifically about bariatrics,” says Cunningham. He encourages providers to bring up the subject with referral sources: “Tell me about your bariatrics, tell me about your obese patients.”

According to Cunningham, the sector remains largely untapped. “There are huge pockets in the country where they don’t have access,” he says.

But it’s a not a market for everyone. “I cannot stress enough the sensitivity and compassion [needed] when working in bariatrics as well as keeping yourself educated on the products available and the needs of the patient,” says Roberta Jacobs, national sales manager for bariatric product maker Gendron.

Understand Consumer Needs, Put Quality First

The market for bariatric HME products is growing right along with the country’s waistline. More than a third of U.S. adults are now considered obese, a number that has been trending up for two decades.

That’s something Elaine Latham, a bariatrics specialist at Electropedic, sees first-hand. “I have been called ‘an angel’ because I listen to people and help them,” says the Burbank, Calif., provider. Electropedic has two stores in California and one in Phoenix, with about 60 percent of its bariatric business online. Latham has a lot experience providing various bariatric products, from lifts to scooters to beds, which has given her a good view of the market.

She emphasizes the benefits of listening to bariatric patients to figure out the products that can help them at home. Too often, she laments, providers tend to favor a limited number of beds or other equipment that may not work for these patients. “The bed is the most important thing,” Latham says. “When you bring someone home from a nursing home, the first things you need are a bed and a proper mattress.”

She warns against the pitfalls of price sensitivity related to bariatric beds. Buying a less expensive model of lesser quality is unlikely to meet the patient’s needs, she says. Latham also emphasizes the importance of matching the right mattress to the person. “It’s very specialized,” she says. The same concerns extend to the assortment of available bariatric products, such as shower chairs and toilet products. “The whole industry has bariatric equipment,” says Latham. “The manufacturers are out there.

“I try to help people with different kinds of options,” she says. Latham knows all too well the challenges of being homebound. Her late husband suffered through a long illness and was confined to a bed. “The last year was not easy, so I can sympathize,” she says. “I understand what people go through.”

The government’s rules need to change related to bariatrics, contends Latham, but she doesn’t expect they will. “They go by weight [of the patient], not by the needs of the patient,” she notes.

For example, a patient must weigh at least 351 pounds to qualify for a 42-in. bed, and more than 600 pounds to quality for a 60-in. bed, Latham explains. She recalls a 37-year-old patient who weighed 557 pounds and had been in a flat bed for five years. “They wanted to put her in a 42-in. bed, so I had the nurse measure her girth. This woman is 51 inches and you want me to put her in a 42-in. bed?” asked Latham. In that case, she appealed to California’s MediCal (Medicaid) program and convinced authorities to pay for the larger bed — a successful outcome that happens all too seldom.

Appealing to Medicare is less successful. “I can’t change it,” says Latham. “Unfortunately, a lot of people who make the rules have not been in this position and don’t know what they are dealing with.” Latham remembers another patient who was unable to get out of bed, but Medicare didn’t cover the electric lift she needed. That means some bariatric patients whose caregivers may be frail or elderly, or those unable to handle the patient safely even with the help of a manual lift, are stuck, she says.

Choosing beds based solely on weight also presents other problems, says Latham. “People lie about their weight, so if someone says they weigh 350 pounds, I would never give them anything close to 350-lb. weight capacity.” Latham also notes that certain medications can cause rapid weight gain that could make a prescribed bed inadequate within weeks.

Latham’s bottom line on Medicare? “There are too many rules and regulations,” the frustrated provider states.

Make the Right Choices

Drive Medical also recognizes the challenge of identifying what is considered “bariatric,” according to Ed Link, vice president of marketing. The manufacturer offers a full line of bariatric products targeted to bath safety, mobility, beds, patient room pressure prevention and powered mobility. The company recently introduced a 22-in.-wide transport chair that can accommodate 450 pounds and weighs only 33 pounds.

Drive includes a BMI index in its catalog to help determine the extent of obesity, but Link recommends better training for staff to identify specific bariatric needs.

“If you are providing equipment for a specific patient to use at home, many measures should be taken to ensure you are getting the proper equipment,” adds Jacobs of Gendron. “Wheelchairs are not one-size-fits-all, and a patient should be measured for their chair. The same for the bed, depending on the patient’s size and ability. The bed should be selected that best meets the needs and functionality of the patient. This may require a width/length-adjustable bed, a low-height bed or both.”

When selecting a bed for a specific patient, Jacobs says, it is important to look at multiple choices “to ensure the patient is getting the proper product.” Gendron’s bariatric beds can meet the needs of patients up to 1,000 pounds. The company’s Model 3807 is an ultra-low bed designed to meet the needs of the patient when fall prevention is important. With a weight capacity of 500 pounds, the three-function electric bed can be width-expanded up to 48 in. The company also offers wheelchairs, walkers, recliners and bath safety products, and last fall, moved its assembly operations — for the second time in five years — in response to the growth in its bariatric business.

Jacobs adds that HME providers should be educated on the equipment that is available, be aware of the geographic market they serve and create relationships with referral sources for bariatric products. “Value-added service is also a key factor in establishing a solid bariatric business,” she says.

Let Customers Know You’ve Got the Products

Because bariatric equipment is not a high sales category, providers tend not to stock these items, says Brad Goodman, vice president of ConvaQuip. But he also believes that even “carrying one or two items in the better-selling categories can enable consumers to get a hands-on look at the product, which would help sales.”

In ConvaQuip’s wide-ranging line of bariatric products, including a single-point cane to a fully electric bed, products have weight capacities going from 350 to 1,000 pounds. One of the company’s products is a freestanding trapeze with a 1,000-lb. capacity that folds up and has wheels so it can be moved from room to room.

Goodman contends the bariatric market is about more than just providing equipment. Bariatric equipment can aid safety by preventing injury to a patient or caregiver. He recommends that providers’ websites include a specific “bariatric” category. They should also educate employees about the manufactures and distributors that deal in bariatric products, and the types of products that are available, he says. “Many times we get a call from a company looking for an item and wondering if they could set up an account, only to find their company already has an account,” Goodman says.

Cynthia Counts, director of homecare sales and marketing for GF Health Products, agrees. “The bariatric market is sometimes overshadowed by the standard products out there,” Counts says. “While the volume for DME products is larger with the standard options, some providers are doing very well with the category because they understand the need for it, which increases when consumers are informed of their options.”

Counts says HME providers can increase business in the category by researching their local areas and targeting rehab centers. “Many places that are working with bariatric patients are often not aware of the different product options available to them,” she says. She, also, recommends showcasing bariatric options on the sales floor. “Some retailers show the standard items and are unaware that they could be missing opportunities for someone to see an item that could benefit themselves or someone they know,” Counts suggests.

Last month, Graham-Field introduced its Lumex Bariatric Folding Commode to accommodate the growing bariatric population. The new product offers both a greater weight capacity and more seating surface to provide the same level of user comfort as a standard commode, and is easier to store, transport and deliver to the patient, the company says.

The Time Is Right

Invacare’s Cunningham sees some utility for bariatrics-directed equipment among non-bariatric patients. He gives the example of a patient whose spastic body movements, including tensing up and pushing on the footboard, were destructive to his standard bed. The patient was put in a mid-level, stronger bariatric bed, which was more satisfactory.

Cunningham says Invacare is seeing significant growth in wide-bed sales (39-42 in.) in the long-term care market, largely for safety reasons among patients likely to roll out of a 36-in. bed. While he notes that home care trends tend to follow those in long-term care, a challenge is that Medicare will not pay enough to supply a wider bed, and the difference often makes the approach cost-prohibitive.

In addition to beds, Invacare’s bariatric line includes sleep surfaces, wheelchairs, walking, bathing and patient transfer aids and is targeted to patients from 350 to 750 pounds.

One of the company’s key bariatric products is its BAR750 bed with a split frame that is expandable for various height and weight ranges. The bed is used both in long-term care facilities and for home care, so a patient going home from a facility can use the same bed he or she is familiar with.

Jeff Hollander, sales and marketing director of scooter maker Ranger All-Season, says his company, too, has “seen an upswing” in provider interest in bariatric products. The company offers several bariatric models, including the Solo HD in three- and four-wheel models with a weight capacity of 450 pounds, and the Solo XT550, a four-wheel scooter with a weight capacity of 550 pounds.

According to Hollander, he’s seeing an increasing number of providers who are putting higher weight-capacity scooters on the showroom floor so that bariatric clients can test drive an appropriate model on the spot. Displaying bariatric devices “increases the probability that a sale can be made,” Hollander says, adding that too many providers are overlooking an important source of new revenue by not providing bariatric products for the client base in their local areas.

He points out, however, that customer service reps should be knowledgeable about bariatric products from various manufacturers and about each product’s history of safety, reliability and longevity. (His company, he says, has begun to catalog the number of Ranger scooters that have demonstrated exceptional longevity, including some scooters that are 19 and 20 years old and still functioning.)

Hollander says providers should become known as the bariatric experts in their locale and communicate to consumers that expert, caring hands are waiting to serve them, that they have working models on the showroom floor and that friendly representatives can fully explain the benefits and use of the products.

ConvaQuip’s Goodman thinks providers should consider becoming a “one-stop shop” for bariatric items. “Typically, if the end-user needs one piece of equipment, it’s likely they need other items as well,” he points out.

With more demand for bariatric products among the burgeoning baby boomer population, he advises, “It is a good time to promote and position yourself as a provider of bariatric equipment. Get that message out now. State that in all of your literature and on your websites.”

Experts Interviewed

• Cynthia Counts, director of homecare sales and marketing, GF Health Products, Atlanta
• Phil Cunningham, business manager for home care beds, Invacare Corp., Elyria, Ohio
• Brad Goodman, vice president, ConvaQuip, Abilene, Texas
• Jeff Hollander, sales and marketing director, Ranger All-Season, George, Iowa
• Roberta Jacobs, national sales manager, Gendron Inc., Bryan, Ohio
• Elaine Latham, bariatrics specialist, Electropedic, Burbank, Calif.
• Ed Link, vice president of marketing, Drive Medical Design and Manufacturing, Port Washington, N.Y.