Scaling Up

The government has a goal of reducing obesity among American adults to less than 10 percent by the year 2010. But instead of moving closer to that goal, all data indicates that Americans are only continuing to get larger.

Today more than 60 million Americans — 30 percent of U.S. adults — are obese, according to the National Center for Health Statistics. And the problem also is increasing among youth — more than 16 percent of children and teens are considered overweight.

Although the statistics are sobering, now is the ideal time for HME providers to reach out to this rapidly growing population, experts say.

“Baby boomers are the biggest demographic that will be retiring in the coming years. Many are sedentary and getting bigger. I don’t see this trend reversing any time soon, and we need to keep up with demand,” says Michael DiFranco, bariatric product manager for Invacare.

Even though there is a huge opportunity for suppliers in this arena, many are missing the boat, notes Steve Cotter, president and CEO of Gendron.

“I’m not seeing many providers jumping into this emerging market and aggressively recruiting these patients,” he says. “Dealers are accustomed to delivering equipment to the patient, billing with nice codes and getting paid. Many [dealers] don’t want to deal with bariatric patients because they require extra work and can be difficult to bill. But they are missing an opportunity, because these patients have lots of other needs, like for disposables for incontinence, diabetic supplies and respiratory [products].”

Growing Choices

Just a few years ago, the selection of home medical equipment was extremely limited for obese patients. Manufacturers typically offered only a few, if any, “heavy-duty” versions of their products. But today, companies have realized that this is no longer acceptable.

Some manufacturers now offer a separate line of bariatrics equipment — including in areas such as mobility products, beds, bath safety, sleep therapy, wound care, diabetic supplies and blood pressure monitors — specifically tailored to meet the needs of these patients. Some lines even carry products with weight capacities up to 1,200 pounds.

“What has changed over the last two to three years is [that] there is now a bariatric product for every category,” says Sue Jotblad, product manager for ambulatory and patient aids at Sunrise Medical. “If a dealer isn’t supplying these products, they are missing a segment of the market they should be servicing.”

Invacare and Drive Medical recently released new catalogs dedicated to their bariatrics lines. Tuffcare, which unveiled a bariatric line four years ago, says about a third of its catalog now consists of bariatrics products.

“In the past, most larger manufacturers have looked at bariatrics as a niche market to be handled by a couple of smaller players, and they didn’t want to invest the resources in it thinking they had the market wrapped up,” says Scott Higley, vice president of sales for Quantum Rehab, a division of Pride Mobility Products.

But that philosophy has changed due to customer demand, he believes. For example, savvy consumers are demanding more products from manufacturers that look stylish and less medical.

“The Jazzy [power chair] had lots of consumer appeal because it didn’t look like a wheelchair,” Higley explains. “Our dealers started getting requests for it from much larger people [asking us why we couldn’t] provide that and other types of products for them. So, we started to make products to meet their needs.”

And as the choices expand, manufacturers report substantial growth in the market.

“The market should be increasing at 15 to 20 percent a year if you include all the other problems that bariatric patients suffer from,” says Len Feldman, owner of Big Boyz, who says that his company has experienced 12 to 14 percent growth over the past five years.

At Invacare, the bariatric market is the currently the largest growth segment, says DiFranco.

If providers are fearful about entering the bariatric market, “they might as well close their doors,” he says. “This is something they will have to start eventually because of the market demand and growth in this population.”

Reaching Out

If a home care company is truly to meet the needs of bariatric patients, it must offer more than just “larger” equipment, experts say.

“Bariatrics is not just about their body weight but what that excessive weight is doing to the body, like diabetes, cancers and heart-related diseases,” says Dr. Kevin Huffman, a bariatric consultant for Invacare. Therefore, he says, providers need to look at the entire scope of patients’ needs to support their weights. “Obesity is a chronic disease that [patients] will fight their entire life, whether treated medically or surgically, and for the most part, their care needs to be offered in the home.”

For example, 80 percent of obese patients have difficulty with obstructive sleep apnea and breathing, which can require home health monitoring and the use of continuous positive airway pressure or home oxygen therapy. Many also have diabetes and must have monitors and supplies to test their blood sugars.

Hypertension is another major concern, so bariatric patients need special cuffs large enough to fit their arms on blood pressure monitors. This is all in addition to wheelchairs, mobility aids or other assistive devices that can help such patients with activities of daily living.

“The reality is that a dealer doesn’t have to invest in products, they just need to know what is available. They need to be aware so when they have a patient in need of a product, they can order as appropriate,” points out Jotblad of Sunrise.

Her advice to providers interested in entering the market is to start with the basics — wheelchairs, walkers, commodes and beds.

“This is a good line of business for a dealer to add that will increase revenue, but the strong focus needs to be placed on meeting the patients’ needs and properly maintaining the equipment,” adds Dan Apuzzo, marketing manager for Tuffcare.

“Over the years,” he continues, “we have seen a trend of dealers coming in to this business who don’t know how to properly maintain this equipment and don’t have a good understanding of the right products that are suitable for the patient. It’s important for dealers to do their homework.”

According to Apuzzo, bariatrics products currently experiencing the most growth are in bath safety and walkers, he explains, because “these products encourage people to start moving around.”

The Right Fit

Providers should note there is a great deal of custom work involved when dealing with bariatric products, points out DuWayne Kramer, president of Leisure-Lift. With bariatric wheelchairs, for instance, patients must transfer off the front of the chair instead of from the side, so features in that area, including the footrests, should be reinforced, Kramer says.

“Manufacturers make it easy for dealers to work with customization. It isn’t rocket science, but these simple things provide greater comfort for patients,” he says.

Patients also may need to be measured differently when they are fitted, Jotblad notes. “Width becomes an important factor when measuring for a walker, along with the height,” she says. “Checking all the important dimensions of a product becomes a vital factor. Weight capacity in itself isn’t always the [feature] they need.”

Tuffcare’s Apuzzo also notes that it is important for providers to know the exact weight of a patient, not just a weight range. Patients should be weighed on a regular basis as they continue to use the product, important both for patient safety and equipment durability.

Many HMEs haven’t entered the bariatric market yet because “these are high-maintenance patients,” says Apuzzo. “There is a great potential for things to break, and this equipment needs a great deal of maintenance.”

He explains that when an 800-pound person sits at the end of a bed in preparation to stand, that entire 800 pounds is focused at one end, and the weight isn’t distributed. “In working with providers and getting their feedback, we have needed to make adjustments to products in order to cope with these challenging patients,” says Apuzzo.

Providers also need to know the structure of the patient’s home, room layout, the width of the doors and whether there is sound structure in flooring.

“One of the main challenges is that some homes don’t accommodate the products that these patients require with extra width,” says Jotblad.

“You can make a product stronger and wider to meet the patient’s needs, but it might not fit in an ordinary home environment, so home modifications would be required.”

Dealers should also make sure to get familiar with reimbursement, special codes and how to bill for this equipment properly, she says. CMS is recognizing that these products are more expensive, she notes, so it is increasing reimbursement using a special heavy-duty code for wheelchairs and walkers.

Because bariatric patients have special needs and fitting requirements, offering a staff that has special knowledge in the area could give a provider a competitive advantage, DiFranco suggests.

“That would be a great way for a dealer to elevate business,” he says. “Not that many therapists specialize in bariatric care, so that may be an additional resource for them.”

One thing to remember is that by serving bariatric patients, providers can help improve their quality of life.

“There are lots of people who are shut-ins and have given up on life. Once they have done that, they are going down a very slippery slope to a negative end result,” Higley says. “It is positive for us if we can get someone what they need to become more active again and a viable part of the community.”

Providers who show genuine sensitivity and concern for their patients will be the ones to succeed, these experts believe.

“Home care providers who develop a relationship with a bariatric patient will have that patient for a very long time,” says Cotter. “Over time they will need more care for things like diabetes, sleep apnea and heart issues.

“If a provider gets good at working with these patients, a select handful of providers can earn a reputation for servicing these patients. Because of ‘word of mouth’ they will get the greatest segment of this market.”

Experts interviewed:

Dan Apuzzo, western region sales and marketing manager, Tuffcare, Anaheim, Calif.; Steve Cotter, president and CEO, Gendron Inc., Archbold, Ohio; Michael DiFranco, bariatric product manager, Invacare, Elyria, Ohio; Len Feldman, owner, Big Boyz Industries, Ivyland, Pa.; Dr. Kevin D. Huffman, D.O., Invacare Corp., Elyria, Ohio; DuWayne Kramer, president, Leisure-Lift, Kansas City, Kan.; Scott Higley, vice president of sales, Quantum Rehab, a division of Pride Mobility Products, Exeter, Pa.; Sue Jotblad, product manager, ambulatory and patient aids, Sunrise Medical, Longmont, Colo.

Laurie Schneider contributed to this report.

After Bariatric Surgery

Bariatric surgery is one of the fastest-growing subspecialities today, but that doesn’t mean that the market for bariatric products is expected to decrease. In fact, patients recovering from such surgery have a growing number of needs, according to Dr. Kevin D. Huffman, a consultant in bariatrics for Invacare Corp.

In 1992, there were only 16,000 bariatric surgery patients, but by 2004, that number had grown to 140,000. By 2008 there are expected to be 400,000 bariatric surgery patients, he says. Those patients needing care after surgery could increase even more as a greater number of insurance companies begin to cover the procedure, and Medicare is currently considering coverage for beneficiaries under 65.

Unfortunately, Huffman notes, “care usually ends with when the patient leaves the hospital after surgery, even though they still have many needs in the home.”

To help patients make the transition from hospital to home, Invacare is pioneering a new concept: bariatric planners. These case managers or nurse practitioners can identify patients’ special needs in the home, from equipment to physical therapy. The company’s sales staff is currently working on doing in-services at the acute level to show people what they should be looking for.

“There are people going through bariatric surgery who are passing through the hands of many medical professionals who don’t know all the special needs of these patients,” says Michael DiFranco, bariatric product manager for Invacare. “In the bariatric surgical community, the key is getting the person moving.”

Making sure a recovering bariatric patient is mobile is important, explains Huffman, as physical activity is vital for continued weight loss. “We’ll get them up and make them ambulate in the hospital, but when they get home, if they don’t have an aide to help them ambulate, they’ll get on that couch and sit there,” he says. “Somebody has got to say, ‘Do you have the ability to ambulate?’ ‘Do you have a walker or crutches?’ In 90 percent of the cases, physicians and surgeons aren’t asking those questions.”

Some other special needs of the post-operative care patient include wound care, respiratory care and monitoring, he notes. Huffman also says there is a market for home delivery of the weight loss products and supplements that these patients need for their medical therapy or post-surgery.

“These people are uncomfortable going outside of the home,” he says. “They have become socially isolated but they need these products, and sometimes they can be difficult for them to get.”

With or without a bariatric planner, the home medical equipment provider needs to be more involved in assessing the needs of bariatric patients at home,” he says.

“They [need to see the] home environment firsthand. Many bariatric patients will just sit on the couch because they don’t know there are products to help them become more mobile. They don’t realize there are many products now available to sustain their weight. Some patients will even sleep on the couch because their bed is unsafe due to their heavy weight. They don’t realize there are special beds approved for their weight capacity.”