Pricing Pressure

Technology for home care beds and support surfaces is consistently advancing, with new products in these sectors focused on positive patient outcomes — and cost-efficient options.

Patient need is a driving factor, according to Jonathan Schein, Sunrise Medical’s product manager for support surfaces.

“Ultimately,” says Schein, “the patient’s health is our primary driver in developing products, but understanding that the provider is also one of our customers, we keep their kind of business model in mind in pricing and the other services that we offer.”

While Schein and other experts say there are numerous goals for the new products introduced in these markets, price is an important part of the equation. Unfortunately, they explain, reimbursement rates don’t always reflect the most efficacious therapy.

Gregg Garland, senior vice president of support surface sales for The Roho Group, notes that price often “plays a large role” in product selection. Particularly with the support surface market, he points out, manufacturers and providers are under increasing price pressure “due to the current reimbursement process … lower-end products are reimbursed at the same rate that much more sophisticated systems are reimbursed.”

According to Mike Irvine, Invacare Corp.’s product manager for beds and therapeutic support surfaces, “With therapeutic support surfaces, especially in the Group 2 market … price is the driving factor [for a lot of people].” On the other hand, he says, many providers are becoming more aware of the need for quality and recognize that certain products are more effective than others.

“[Providers] really do want to have their patients on the best products that they can offer, even if it costs a little bit more,” he explains.

Jim Acker, vice president of sales and marketing for Blue Chip Medical Products, says the focus on support surface cost fluctuates. “The industry is fickle because it just goes up and down in its interest in quality. Fortunately, we are starting to see people becoming more interested in high-end, quality products that are durable and result in a positive outcome,” he says.

The past mentality of “use it until it breaks” is changing as HME providers experience the correlation between patient satisfaction and referral source satisfaction, Acker says.

But Roho’s Garland explains that current reimbursement policy does not consider the quality or special features of any particular product, thus allowing the manufacture of some products that might meet a particular billing code as opposed to certain quality or performance standards.

Susan Wilson, Supracor’s director of research, design and development, believes that reimbursement policy also could be limiting technological improvements.

“Every manufacturer is very concerned because the reimbursements are getting smaller and smaller. So, when designing products, you have to be so aware of that, and you don’t have as much freedom in terms of being able to offer the best technology,” she says.

But she is optimistic. “At the end of the day, the best product is going to win,” says Wilson. “If you have strong technology with good features and benefits, then — one way or another — you are going to find a way to get the products to those who need them. It may not happen right away, but I do believe good technology will prevail.”

A Range of New Products

In spite of the reimbursement climate, manufacturers continue to invest in product development.

“You always have to change, and that includes looking for more cost-effective products without compromising therapy,” says SenTech CEO Abbey Daniels. “That sometimes is a challenge, but our bottom line is we’re not going to compromise therapy.” She notes the company has recently introduced products designed for the bariatric market and is in the development stage for several others.

Likewise, Sunrise is revitalizing its product line and bringing back the Bio Clinic brand, says Schein.

“We are expanding our portfolio to include some combination therapies of alternating pressure and low air loss,” he says. “We will also have a true low-air-loss system that will accommodate up to 1,000 pounds, which is exciting as it addresses the increasing need for bariatric products.”

The bariatric market is one that has gained attention across the spectrum of home care products, with beds and support surfaces no exception.

Invacare released a 600-pound capacity bed last year, and this fall introduced a 1,000-pound model. “There is a growing recognition among home care providers that this population needs specialized products,” says Irvine. He points out that HME providers should note new rental opportunities with patients who undergo weight-loss surgeries, such as gastric bypass, and may need home care beds during recovery.

He has also seen an increased demand for bariatric therapeutic support surfaces. Products that were introduced last year have “taken off,” according to Irvine.

Combination therapy is also on the product radar screen.

Invacare has introduced a combination low-air-loss alternating pressure mattress that is designed to provide the benefits of both in one unit. “The benefit is that the HME provider or the referral source does not have to guess which one should work for the patient,” says Irvine.

According to Schein, one continuing trend is “the use of mattress replacement systems as opposed to simple overlays. As the price differential gets smaller, people are moving toward the full mattress replacement system. The price differential between a 5-inch overlay and an 8-inch mattress replacement has become so minimal that a lot of people will choose a mattress replacement system over the overlay.”

Venturing into a new area, Supracor is exploring the acute and home care markets for neonatal and infant support surfaces, Wilson says. “We actually have a baby mattress that we are testing in hospitals for infants because the aspect of ventilation is potentially very important,” she explains.

“One of the causes of sudden infant death syndrome (SIDS) may be suffocation to the extent that the baby, no matter which way it ends up on its tummy or its side, can suffocate. In this case, the support surface of the mattress has complete ventilation.”

One of the newest categories in the bed market is the “low bed.”

Invacare’s Irvine says this product offers a solution to many home care challenges. The bed has its roots in nursing homes and has typically been used for Alzheimer’s patients. The bed can lower to 8 to 12 inches from the floor — decreasing the risk of injury to a patient who tries to get out of bed or who falls out — and then rise back to a height that enables the caregiver to provide care or for the patient to exit the bed safely.

Caregiver convenience is a consideration illustrated by the growing popularity of such adjustable low beds, according to Larry de la Haba, vice president of marketing for Graham-Field Health Products. The company introduced a low bed this fall, as well as an alternating pressure mattress that has a pressure sensor built in. “If the patient bottoms out on any part of the mattress, the mattress automatically responds to regulate the pressure inside the mattress. It can be used both in long-term care and in the home,” he says.

De la Haba also notes that single-motor beds — an offspring of semi-electric beds — are attracting the attention of HME providers. “The single-motor type bed … is easy to put together, it is lightweight and there is less cost associated with it than models with three motors,” he says.

Although semi-electric beds still make up the “lion’s share” of the market, Invacare’s Irvine says in the last year he has seen an increase in the use of full-electric beds, even though the cost difference is not covered by Medicare.

“There is a growing awareness within the health care community of lower back injuries to caregivers,” he explains. “A lot of visiting nurse associations recognize that even though Medicare says that the full electric function is a caregiver convenience and not a patient need, it’s a caregiver convenience that will actually reduce their insurance claims for low back problems and their sick days.”

Likewise, he points out, issues that affect bed delivery and maintenance are also important to providers.

The same is true for support surfaces, says Roho’s Garland. “The market continues to require high-quality, high-performing systems that are easy to set up, maintain and clean,” he says.

Education Can Pay Off

Along with new products and technology, Blue Chip’s Acker says it is important that providers stay educated on products, regulations and other market developments, which may suggest new ways to grow business. This education is also valuable because it enables providers, in turn, to educate referral sources, who he says may relate these products to outdated models or those that are more appropriate for acute care.

“Often, they will prescribe a model that is not needed for home care use,” Acker explains. “It’s overkill and costs way too much. So, the HME provider needs to understand the product and be able to educate the referral source.” He points out that savvy providers will be proactive in communicating with referral sources about available products and offering outcomes data that shows they provide patients with quality products that help.

For support surfaces in particular, Schein of Sunrise emphasizes that a holistic approach to wound management is most appropriate. “The air mattress is one part of a broader, holistic program in treating the patient,” he explains. “The same therapy and the same mattress might produce positive outcomes for one person, but if another has poor nutrition, it might not. It really comes down to understanding [wound care management], performing the appropriate evaluations and the importance of choosing the right system. It should be done on a patient-by-patient basis.”

Irvine adds that there is a growing realization among providers that either preventing or treating pressure ulcers can help keep patients from developing further complications that could result in hospitalization, or even death. “Pressure ulcers are not just uncomfortable; they can also be fatal,” he says.

De la Haba says the good news is that technologies once reserved for acute care, such as low-air-loss or alternating pressure therapy, are now appropriate for home care.

“People who would be hospitalized or in a nursing home five or 10 years ago are being taken care of at home due to the cost-effectiveness of home care,” he sums up. “The technology and the cost have come down significantly to the point that it can be used in all three markets.”

Experts Interviewed:

Jim Acker, vice president of sales and marketing, Blue Chip Medical Products, Suffern, N.Y.; Abbey Daniels, CEO, SenTech Medical Systems, Fort Lauderdale, Fla.; Larry de la Haba, vice president of marketing, Graham-Field Health Products, Atlanta; Gregg R. Garland, senior vice president of support surface sales, and Dave McCausland, senior vice president of planning and government affairs, The Roho Group, Belleville, Ill.; Mike Irvine, product manager for beds and therapeutic support surfaces, Invacare Corp., Elyria, Ohio; Jonathan Schein, product manager for support surfaces, Sunrise Medical, Longmont, Colo.; and Susan Wilson, director of research, design and development, Supracor, San Jose, Calif.

Show Referral Sources What You Know

Because referral sources are often unaware of new products or technologies in beds and support surfaces that can benefit patients, providers can put themselves ahead of the competition by assuming a consultative role, say the experts.

According to Abbey Daniels of SenTech Medical Systems, providers who educate referral sources on product choices and benefits can build trust in their company’s personnel and services, which can play a crucial role in determining which products patients receive.

And it doesn’t end with education, says Blue Chip Medical Products’ Jim Acker. Being knowledgeable about products and their benefits is a marketing technique that shows referral sources a provider is aware of products that offer positive outcomes, he says.

“Every time a patient complains about an awful mattress, the HME provider’s revenue flow — which comes from their referral sources — is jeopardized,” he says. “By being aware of products that offer optimal outcomes, providers can actually show their referral sources they are buying quality goods that are durable and are good for the patient.”