An Uphill Climb

As with many sectors in HME, manufacturers say the market for manual wheelchairs continues to grow right along with the aging population that needs them.

“Even in an environment of reimbursement challenges, unit volume is going up,” points out Steve Cole, president of Dedicated Distribution. “More folks are entering the part of life in which chairs are more commonly required. The baby boomers just began turning 60 [this] year; we’re only at the front of the usage curve.”

“The need for independent mobility has and will continue to grow,” states Invacare’s John Vadeboncoeur, group product manager of IVC products. “While Medicare utilization appears to be slowing on certain HCPCS codes, additional volume is now being driven by other market channels, such as retail and Internet providers.”

Indeed, a recent report from Research and Markets lists among market drivers increased demand from consumers who may see mobility products in retail settings such as Wal-Mart. As the baby boomers age and need wheelchairs, “they will be willing to pay directly for mobility and comfort as they do for homes and cars now. This trend will assure market growth worldwide,” according to the report, which adds that, as a result, there is also strong potential in the companion vehicle lifts market.

“Because of the nature of the population, I think there will be a better opportunity for retail,” says Dave Jacobs, president of Medline’s DME division. “Baby boomers are affluent and used to a certain lifestyle, and they will do as much to maintain that as they can.

“People will be very interested in those [items that make their lives easier], and they will be willing to pay for them. I think there will continue to be more of a growing market on the cash side [for mobility products] that give people more flexibility and independence.”

Along with the strong demographics for manual chairs, the Research and Markets report points to concerted initiatives by major manufacturers that have resulted in help for providers who are dealing with cost-control struggles and increasing demands from customers. Drop-ship programs that offer delivery to end-users’ homes are evolving, giving providers no products to stock, no minimum order requirements and delivery within one or two days. The supply chain also is focused on maintaining low-cost and high-quality products to meet market needs, the report says.

So What’s the Catch?

As always — and again as in other product sectors — even in a market with strong potential there are funding jitters. The Deficit Reduction Act’s 13-month DME rental cap was unexpected, the particulars of competitive bidding are still unknown, and drastic cuts in power mobility reimbursement (set to take effect Nov. 15) have left the market unsettled.

“The reimbursement uncertainty in the market, especially now with power wheelchairs, has affected most of the market as providers become wary of both short- and long-term viability,” according to Vadeboncoeur.

“Providers are looking for products that address patient needs while still allowing them to be profitable. The recent changes in capped rental policy will definitely have an impact on what equipment they can afford to offer and how they will support that product once the title transfers to the patient,” he says.

“Due to this,” adds Invacare Group Product Manager John Lescher, “now more than ever providers will be looking for other avenues to increase revenue which will trickle down to manual wheelchairs. The need to offer low-cost manual wheelchairs will continue in the K1 through K4 reimbursement segment and will become more prevalent in the K5 market in the upcoming years.”

“We still feel pressure even in our niche market,” notes John Box, president of Colors In Motion, whose customers for sport and lightweight chairs are mostly in the preteen to mid-40s age range, outside of the Medicare market. However, Box points out, “Medicare sets the pace. As they lower the bar, everyone else lowers the bar as well.”

He says providers now place price above all else when looking at product. “The main concern is price, not performance,” says Box, who adds that as a wheelchair-user himself, that’s frustrating because a user spends an average of 14 hours a day in a chair and needs both comfort and performance.

“Today, consumers are more active, knowledgeable and independent. They expect the same things from their technology as everyone else,” agrees Brent Hatch, product manager for Quickie adult manual and sport products for Sunrise Medical.

The good news, he says, is that the technology is available to offer benefits that are not simply about improving lifestyle but also health. Unfortunately, he continues, “due to various funding modalities, not all people have an equal access to products that maximize their need from a clinical and lifestyle perspective. Limitations are growing in both the ultralight and geriatric market as funding becomes more constrained.”

And, says Medline’s Jacobs, “We’re going to continue to see pressure to reduce prices, especially with competitive bidding coming up. It is a challenge from a manufacturer’s standpoint. The demand is strong, but pricing has gone down dramatically. We’ve seen items where the selling price is down 10 percent.”

With the DME rental cap, Jacobs sees growth in the economy chair market as providers search for products for Medicare patients who will cap out after 13 months. At the same time, he explains, acquisition costs for materials such as aluminum and steel are up. “If we have to reduce costs any more, we’ll have to reduce quality, and that’s something that we’re not willing to do,” he states.

“It’s hard to bring new technology into a market that doesn’t want to pay,” Box sums up. If the situation continues, he says, “we’re going to have serious problems. There are consequences of putting people in an inferior product.”

A Couple of Hot Tickets

Nevertheless, there are some bright spots in specialty segments.

“Bariatric choices for mobility continue to be a need in the market, especially as our society becomes more educated on the bariatric epidemic and treatment options. Transport options, either through vehicle restraint systems or through lighter-weight chairs that are easier to lift, also are driving growth as those with mobility needs become more active day-to-day,” says Invacare’s Vadeboncoeur.

“As the bariatric patient becomes more ambulatory as a result of new treatments, our business will grow,” agrees Roberta Jacobs, national sales manager for Gendron, which specializes in bariatric products.

“Consumers … expect a manual wheelchair that fits them,” she continues. But because the needs for bariatric patients can vary so much, she points out — “You may have a 4’11”, 60-pound patient, or a 6’1″, 720-pound patient” — the company has added adjustable seat-to-floor height and back height adjustments to accommodate the range of sizes for these users.

The transport chair segment also is “growing significantly,” says Medline’s Jacobs. He notes a super-light transport chair weighing less than 15 pounds that has a carrybag and a cupholder is selling well, and says such lighter-weight chairs are particularly popular among elderly caregivers because they are easier to lift in and out of a car.

There is adjunct growth in accessories, Jacobs says, because people are looking for products that allow them to carry cell phones and keys. And continuing a trend of the past several years, he says, in addition to lighter chairs, consumers also want less institutional-style products and more variety in terms of colors and other aesthetics.

According to Dedicated Distribution’s Cole, in general consumers are looking for “improved functionality, lighter weight, ease-of-use, smaller size for portability and value.” And he believes consumers “will place more emphasis on value when more of the payment burden shifts to them.” In response, the company has recently introduced a combination rollator and transport chair.

But these manufacturers say that while the demand is there — and the products available to meet it — the future for the manual wheelchair market will be shaped by its reimbursement.

“Providers are looking for the best clinical solution at aggressive prices that make sense in a business environment where health care costs are constantly being evaluated,” concludes Sunrise’s Hatch. “The reality is that manufacturing costs associated with producing better product (lighter, faster, stronger) are higher, which presents a challenge.

“Providers are faced with the difficult task of matching the appropriate technology to the appropriate user while managing the funding.”

Experts Interviewed:

John Box, president, Colors In Motion, Corona, Calif.; Steve Cole, president and CEO, Dedicated Distribution, Kansas City, Kan.; Brent Hatch, product manager, Quickie adult manual and sport products, Sunrise Medical, Longmont, Colo.; Dave Jacobs, president, DME division, Medline Industries, Mundelein, Ill.; Roberta Jacobs, national sales manager, Gendron, Archbold, Ohio; John Lescher, group product manager, and John Vadeboncoeur, group product manager, IVC products, Invacare Corp., Elyria, Ohio