A World of Possibilities

Adam Fine has never been an inside-the-box thinker. So it’s probably no surprise to those who know him that his home medical equipment company is not your usual HME business.

There are, after all, not many providers who feature kitchen cabinets that raise and lower so users can reach the top shelf. It also isn’t customary for providers to install ramps that work in tandem with the wheelchairs they sell. Nor, for that matter, is it very common for an HME provider not to take Medicare. But more on that later …

A New Concept

Such out-of-the-box concepts are business as usual for Fine, who owns Accessible Design & Consulting in Santa Monica, Calif. The former marketing consultant started his company in 1999. His father was dying of Parkinson’s disease and, at the same time, Fine, then a marketing consultant, was hired by a contractor who wanted to gear his business more to seniors and those who were disabled.

The idea of accessibility for all people captured Fine’s imagination. “I could see there was a real niche in this market, and it was gratifying,” he says. “It’s doing meaningful work. We changed people’s lives.”

He broke away from marketing and started his own company with a focus on accessibility items. While he carries some ADLs and wheelchairs, his stock-in-trade is more in the renovation realm — ramps, elevators, chairlifts, grab bars and the like.

“First, I started out in a one-bedroom apartment, carting my demos and equipment around in an SUV. Then I came up with a concept,” he says.

Driven by the idea of being a one-stop shop for accessibility products, he created a showroom that is an accessible home. He found a site in an industrial area and transformed it into a home complete with hardwood floors, granite kitchen counters and French doors. He added art created by artists with disabilities.

Oh, and by the way, his showroom has those electric kitchen cabinets, a sink that raises and lowers, an accessible dishwasher and refrigerator, automatic door openers, overhead ceiling lifts, an elevator, a sliding swivel bath bench and even a hydraulic closet rack that lowers so people in wheelchairs can access their clothes.

“I did it so people could see what things would look like in their home,” Fine says, adding that it is a graphic way for customers to discover their options.

Few people have any idea of the products available that could make their lives easier, he says. “Most people who call are very overwhelmed. They’ve had some sort of catastrophic event in their life or their family’s life. A lot of people have their initial walker or wheelchair from Medicare and they need something to augment that. That’s where we come in.”

The first thing is for people to get acquainted with the products that are out there. And Fine wants them to be able to try out those products.

“Once people come into the showroom, they can try [the product] here,” he says. “But if they aren’t sure, they can take it home and try it. There’s no charge.

“I want to get the right thing and make them happy,” Fine adds. So he has a policy that if the client buys a product that doesn’t work for them, he will take it back as long as it is a non-hygienic item.

It’s a policy made easier by the fact that Fine does not accept Medicare, although he didn’t set out to be Medicare-free. “I accepted Medicare for one year,” he says, but then decided that keeping up with the paperwork and the changes wasn’t the way to go for his company.

Fine says he has developed a large base of dependable providers to which he can refer people if they prefer to use Medicare, including other HME providers who offer a greater range of equipment. He also refers people to home health agencies, caregiving companies and those who do the more obscure accessibility work that he does not, such as custom iron railings.

It may seem as if he is losing a lot of business by not accepting Medicare, but Fine doesn’t see it that way. Medicare doesn’t cover home modifications, he notes, and that is the major part of his business. And while he does sell items that could be covered by Medicare, by not accepting assignment he avoids living in the volatile Medicare environment.

A Freeing Experience

It’s a freedom that allows him to provide his clients with the best possible solutions, he says. Since they aren’t obliged to qualify a product for Medicare reimbursement, Fine and his staff are keen on finding out not only a buyer’s needs but also their likes and dislikes.

Because Fine doesn’t believe he can find out those things by sitting behind a desk, Accessible Design offers in-home consultations. “A lot of what I know is [from] being out there in the field. I’m in 300 to 400 homes a year,” he says. Because of those consultations, he is better able to find products that are individually suited to each client.

“Everybody’s home is different, everybody’s health needs are different and everybody’s budget is different,” Fine says, adding that there are no cookie-cutter solutions. “We don’t sell them anything, we act as a consultant: ‘Here are the possible options. You decide what’s best for you.’”

“I do a lot of high-end homes,” he continues. “The bottom line is that most people who want to stay in their homes don’t want it handicapped-looking. It’s rare that price is the most determining factor.”

However, he does work with people who are “economically challenged,” and either gives them a discount or works out a payment plan. He also works with other entities such as HHAs and gives them a discount so they can provide products to their clients for a reasonable fee.

Whatever the client’s economic situation, Fine’s passion is to find the best solution. He recalls one woman who wanted to get from her home to the sidewalk on a chairlift. None of the manufacturers made such a product, so he searched until he found a company that could do it. In another case, he was called out to look at a ramp that was twice as steep as it should have been. Fine was able to remedy the problem by installing a curving modular ramp.

“It’s very individualized,” he says of his work. “That makes it extremely interesting for me. But there’s definitely a lot of expertise [required] and a high liability, and you have to know what you’re doing.”

He didn’t know everything he knows now when he first started out, Fine is quick to admit. He learned by doing. “I didn’t start out doing elevators or chair lifts,” he says, “but we do that now. When we do an installation, I am on the job site because if there is a problem, I can solve it right there. It makes me more knowledgeable.”

He also broadens his knowledge by attending trade shows. Fine not only goes to the annual Medtrade shows in America but also attends the European equivalent in Germany. “That’s where the forward-thinking products are coming from,” he says, noting that his newest product is a vibrating exercise machine that is designed for wheelchair users.

While it may sound as if Fine has found the key to success in the HME business, there are challenges. Since he deals in high-end homes, that often means clients who are “very picky.”

But he has found the biggest challenge to be getting and keeping competent employees. “It’s hard to find someone who is construction-oriented and medically minded,” Fine says.

It’s been so difficult, in fact, that Fine has tabled plans for opening another store. So, for now, anyway, the Santa Monica showroom is the only one. But it’s providing more than enough satisfaction for Fine.

“I help people remain in their homes and be safe and accessible for as long as possible. I’ve had people who haven’t taken a physical shower for three years and they cried” after the company installed accessible products that made that possible, he says. “It’s very gratifying.”

Some Fine Marketing Tactics

It hasn’t hurt that Adam Fine of Accessible Design & Consulting in Santa Monica, Calif., has a background in marketing. Fine has managed to market his company in such a way that he has established not only much repeat business — extending as far as Japan and Saudi Arabia — but also a solid stable of referral parties. Among his strategies:

• Establish an easily accessible Web site. Fine’s site at wwwaccessibleconstruction.com garners 300,000 hits a month. “It’s simple,” he says. “It’s set up like a home — kitchen, living room, bathroom.” That way, he explains, people can easily find products for specific areas. He offers resources and links to other helpful sites, and everybody who orders online gets an automatic 10 percent discount.
• Reach out to complementary organizations and agencies by providing educational seminars. Fine invites occupational therapists and home health agencies and their staffs in and introduces them to the various products that are available. “Occupational therapists don’t get more than four to six hours of training on medical equipment,” he points out. “We educate them on the products so they can educate their clients.”
• If possible, open your location up for business meetings. HHAs, support groups and other organizations can have their business meetings at Accessible Design. Refreshments are provided, “and the members get a tour and education on what’s out there,” Fine says.