Growing Expectations

As Americans’ waistlines continue to expand, so does the market for bariatric wheelchairs, beds, bath aids and other home medical equipment to accommodate them.

“There are far more companies entering the [bariatrics] market, and it’s growing by leaps and bounds,” says Len Feldman, owner of bariatric bed maker Big Boyz Industries.

Each year new products designed for the severely obese are rolling out, helping patients to become mobile and live more productive lives.

“It’s obviously a growing market. It’s hard to go through a week without reading about something related to obesity and the obesity epidemic,” says John Lescher, group product manager of bariatrics for Invacare, which carries a full bariatrics line. “I don’t see this epidemic decreasing in the next five to 10 years.”

That means there’s also a big opportunity for HME providers to expand in the market. “If someone needs a bed, they’re going to need something to [help them] get out of that bed,” explains Lescher. “It’s almost a one-stop shop [for bariatrics equipment].”

For example, just one bariatric patient may require several pieces of equipment such as a wheelchair, bathing aid, commode, bed and transfer device. These customers also are more likely to suffer from complications such as sleep apnea, diabetes, high blood pressure, heart disease and osteoarthritis, which means they may need additional equipment.

Even though more players and products have entered the field in recent years, there is still plenty of room for growth in this area, says Kelly Lee, national director of bariatrics for Custom Medical Solutions. “It’s a market that’s been left out for awhile,” he said. “Now everyone’s trying to catch up. The demand for the equipment is unreal.”

Form and Function

As obesity awareness increases and more choices become available, patients and their caregivers are demanding much more than products that are simply larger. Products must be engineered and designed to meet the specific needs of bariatric patients.

“The trend is to make patients comfortable,” says Lee, who once weighed 487 pounds, but has trimmed down to 180 pounds with the help of bariatric surgery several years ago. “You have more patients demanding better care, better products, things that allow patients more dignity when being moved.”

Getting out of bed and becoming mobile is one of the top concerns for severely obese patients who cannot support their own weight, and now patients are looking for more features on a wheelchair or scooter.

“In the past, because of limited product availability, [bariatrics patients] tended to make do with what was available, and it didn’t afford them the freedom they were looking forward to,” says Scott Higley, vice president of sales for Quantum Rehab, a division of Pride Mobility. “Function was met on the most fundamental level only.”

Today, patients not only expect the same functionality in a bariatric chair as one with a 250-pound weight capacity, he explains, but they also expect the same style. “Now, much more focus is being put into the overall design of the chair, how it works with that client and their environment,” Higley continues. “Can that product not only make them mobile but improve their overall functionality?

“We’re trying to go above and beyond that to offer a lot more styling to the product.”

Some manufacturers say the appearance of the product is almost as important to patients as its performance. Just as the apparel industry started producing more fashionable plus-sized clothing in recent years, Higley explains, manufacturers are working to improve the look of bariatric equipment. For patients who are already sensitive about their weight, there is nothing appealing about unattractive products or equipment that draws attention to their condition.

“The thing is to make it so everything doesn’t scream out ‘bariatric,’” explains Lee. “These people have been ridiculed all their lives. We have to be sensitive to their needs.”

The Right Fit

Making sure equipment is appropriate for individual bariatric patients goes beyond a product’s weight capacity.

“Coming up with a product that fits all the needs of the bariatric client as far as widths and depths is a challenge,” says Lescher. All 500-pound patients do not necessarily hold weight in the same place, he explains. While some hold more weight in their legs or stomach, others are more top-heavy.

It’s a struggle Hans Sigvardsson, president of lift manufacturer Liko, is all too familiar with. “A bariatric person doesn’t have a clear definition of body and is to some degree kind of fluid, so we need to have slings that conform to their body,” he says. “If they’re short and bariatric, they have a different body structure than if they’re tall and bariatric. It’s a real challenge to be flexible enough to accommodate every single one of them.”

To make sure that patients are fitted properly with appropriate products, providers who sell bariatric equipment must assess each individual and ask the right questions, manufacturers say. “[Providers] have direct contact with the customer,” says Higley. “They can assess the function of that client, what their mobility needs are and their funding. They are the eyes and ears to determine the environmental situation.”

For example, if the floor in a patient’s home is carpeted, he will have to exert a tremendous amount of effort just to move a manual wheelchair. The widths of doorways, hallways and other tight spaces in the home also need to be considered.

Steve Cotter, president and director of sales and marketing for Gendron Inc., which specializes in bariatric products, says it is crucial for providers to become knowledgeable before fitting a patient. “It’s not like putting a 100-pound patient into a standard wheelchair,” he said. “It doesn’t work the same way.”

He also advises providers to communicate with bariatric product vendors, who can, with their specialized knowledge, supply information on what to ask, what to measure and other environmental concerns.

When marketing bariatric products, manufacturers point out, providers should keep in mind that patients typically are not the only ones using the equipment.

“When you’re dealing with a bariatric person, you’re dealing with someone who’s a severely disabled person in a way, and it’s very difficult for the caregiver,” says DuWayne Kramer, president and CEO of Leisure-Lift. “That’s one thing many people in this industry don’t understand.”

Those who transport and transfer patients, who may weigh three, four or even five times their own weight, are at increased risk for injury and need products that will allow them to care for patients with the least amount of strain.

Making equipment as light as possible is one way to improve safety.

“If you have 600 to 800 pounds in a patient, and then add 250 for the lift, the caregiver is going to have to work their rear end off to move that thing,” says Liko’s Sigvardsson.

Big Boyz’ Feldman says that he has seen a greater demand for beds that sit close to the floor, making it much easier to transfer the patient. “You must do things that help the caregiver,” says Feldman. “If the caregiver isn’t considered, you’re ignoring the patient. The patient needs all the help they can get.”

Cost Challenge

Making quality bariatric products — which require additional materials, stronger parts, more powerful motors and increased customization — that are cost-effective is a constant challenge for manufacturers. And Medicare’s reimbursement policy does not help, they say.

“The problem is you see a lot of low-cost entrants who are trying to mimic the performance of other products by introducing low-cost materials that simply do not work,” says Thomas Olesky, president and CEO of The ROHO Group, which offers bariatric cushions and mattresses. “They’re playing to those [Medicare] codes and playing to those audiences.”

For example, a cushion with a product life of six to eight years may be more expensive, but can be more cost-effective in the long run than replacing a cushion that lasts only half the time.

“You think you’re making a deal initially,” Olesky says. “Long-term, you’re not.”

In another example, Sigvardsson points out that lightweight aluminum lifts can be more costly than their steel counterparts. “You need very specialized tools to [make aluminum products], which means you have to have a very high volume of business to do that.”

“We can do anything, but you can’t do everything at a reasonable price,” admits Feldman. “You have to consider cost. We fight like the devil to make a profit and still have units cost-effective.”

Some manufacturers say it’s unfortunate that Medicare does not always recognize such additional costs when determining reimbursement for bariatric products. And providers face an extra challenge because there are no billing codes for some products, forcing them to custom bill.

“It’s cumbersome right now for providers,” Cotter says. “A lot of providers are standing back because of uncertainty [about] getting paid.”

When providing service to a bariatric patient, sensitivity is crucial, Lee points out. Many people — including those in the health care community — do not give bariatric patients the same respect as someone with another disease because they view the patient as lazy or an overeater.

“Obesity is the last great prejudice,” he believes.

Some insurance companies are still unaware of the needs of obese individuals and view a product such as a bariatric wheelchair or scooter as a luxury item, informs Higley.

“As manufacturers, we’re focusing on educating payers to help providers,” he continues, adding that in time, more payers may see the benefits of extending coverage for bariatric care.

“If anything, [becoming mobile] will help their mental well-being.”

Lee recommends that home care companies providing bariatric equipment train employees on the subject. “I have watched people deliver bariatric beds and make a huge production with no consideration to the patient’s feelings,” he says.

“The [providers] who are in this and do the business for the right reasons are going to succeed as this market becomes more sensitive,” Lee concludes.

“People in it just to make a buck will fall by the wayside.”

Experts Interviewed

Steve Cotter, president and director of sales and marketing, Gendron Inc., Archbold, Ohio; Len Feldman, owner, Big Boyz Industries, Ivyland, Pa.; Scott Higley, vice president of sales, Quantum Rehab, a division of Pride Mobility Products, Exeter, Pa.; DuWayne Kramer, president and CEO, Leisure-Lift/Pacesaver, Kansas City, Kan.; Kelly Lee, national director of bariatrics, Custom Medical Solutions, Jackson, Miss.; John Lescher, group product manager of bariatrics, Invacare, Elyria, Ohio; Tom Oleksy, president and CEO, The ROHO Group, Belleville, Ill.; Hans Sigvardsson, president, Liko, Franklin, Mass.

Getting the Word Out

Education and communication are key to providing quality bariatric care, manufacturers say.

“Good providers know manufacturers’ products and are able to talk to the end-user and give guidance on what he or she needs,” says Lescher. “Good providers will sit down and speak with end users, make sure everyone is on the same page and give clients the right products for their needs.”

In addition to becoming familiar with the variety of bariatrics products on the market, some manufacturers recommend that providers find a physician who specializes in bariatrics to learn more about patients’ needs and let them know they can offer quality service to their patients.

But patients aren’t likely to visit a provider’s store if they don’t know the products are available. Some manufacturers say that they get phone calls from patients who don’t know where to order.

Make sure to note in the phone book, and in other means of advertising, if your shop specializes in bariatrics, says Higley. “You kind of take away [the stigma] placed on bariatric products that makes the customer feel uncomfortable. They’re going to go where they feel most comfortable.”