Go to the Mattresses

Nothing is scarier than the unknown, and HME providers tend to stick with what they know. While it’s not easy to branch out into new product categories, experts say, particularly during a tough economy, taking the time to explore beds and support surfaces could pay dividends.

Mike Sedlak, group product manager for beds and therapeutic support surfaces at Invacare, says most of the sector’s recent growth has been attributable to related support surfaces.

“There is a big focus on prevention of pressure ulcers, and providers can certainly play a big role in keeping the incidence of pressure ulcers down simply by the product that they are putting under patients,” Sedlak says. “We need the support of the providers to carry that message.”

Chris Ritter, senior director of global sales at The ROHO Group, believes more providers would embrace the support surface category, particularly for beds, if they knew more about it.

“A lot of home care providers are kind of afraid of the support surface market with regard to beds. I don’t think they know enough about it, but it is probably easier than the support surface market for wheelchairs,” Ritter says. The premise is simple: Medical mattresses play a critical role in providing the patient with the appropriate comfort and support.

With such a substantial focus on wheelchair cushions in the rehab community, Sedlak agrees that mattresses are often the forgotten element.

“The problem is at night, wheelchair users are put into a bed that may not have the same pressure reduction surfaces or capabilities that their chair cushions have,” says Sedlak. “It is an ‘aha’ moment where providers say, ‘You’re right, we are concerned with patients for the waking hours of the day, but what are we doing for them at night?’ Nighttime positioning and nighttime pressure reduction is vitally important.”

In today’s market, merely banking on the needs of an aging population is not enough to move the sales needle. To gain more business in the provider-driven product category, Ritter says HME companies need to capitalize on existing contacts at hospitals, home health agencies and long-term care facilities. “Ask if they could provide referrals for bed support surfaces as well as the ones for wheelchairs,” he suggests.

He also says focused presentations and in-services directed at new and current referrals sources are necessary. “Use manufacturer representatives to go in with you to provide support and a knowledge base,” he advises. “Know that nowadays, physical therapists and occupational therapists sometimes prescribe beds, as well as wheelchairs and wheelchair cushions. These therapists could be part of a wound care team with physicians and other members of the health care continuum.”

Often such professionals may not be up-to-date on the latest cushions and/or beds, and this is the perfect opportunity for providers to serve as the crucial knowledge base. “Clinicians are looking for education because hospitals are no longer sending clinicians for continuing education,” adds Ritter. “Providers can offer those services, and that is just one more way to add to value and maintain that referral source.”

Beyond Medicare

Medicare Group 2 mattresses for beds are the most typical item sold for most providers, and Group 1 mattresses are also routinely purchased with Medicare funds.

Selling bed frames and mattresses can also be an avenue to avoid Medicare altogether. Flex-a-Bed sells into two different markets: home furnishings and home health care. Overall sales for the last two years have been down, but home health is not down as far as the furniture market, says Max Morrison, Flex-a-Bed president.

“Our home health care market has remained fairly stable, and that is because of the need,” says Morrison. “The need is still there, as opposed to the desire. I am no economic prophet, but based on what I’m hearing, I don’t expect a big increase in 2010, even though I do think our economy will improve. A lot of what happens in the home health care industry really has to do with how health care reform is handled.”

Morrison notes his company’s beds “are mostly for sale and not for rent, and they are cash items, not Medicare items. In this climate of diminished Medicare and private insurance reimbursements, home care providers are looking for cash customers. If Medicare is not going to reimburse at the same level they used to, providers can really benefit from these customers.” Baby boomers who want functional beds that do not look like hospital beds should be good news for HME companies willing to look at the option.

For non-Medicare cash purchases, Morrison believes it is vital to display the products properly. When a customer can see, feel and touch the bedding, it’s better than any catalog photo.

Providers with the floor space for bed display can also boost market share by telling people about what they’ve got. Morrison says HME providers breaking into retail are not as prone to advertising as those in other retail markets. They should be, he thinks. “You need to display it, but you also need to tell people that you have it,” Morrison says.

Products and Profits

Within the Medicare market, Sedlak says, “the need for beds is always going to be there.” Because most of the beds sold by Invacare are ultimately rented out, he continues, “we want to make sure that providers don’t get a perception that the product only needs to last for 13 months. That is a bit of a misconception on their part if they are buying a product that is going to last them through repeated rentals that will, over the long run, give them a better return on their investment.”

With the outcome of health care reform uncertain (as of press time) and competitive bidding ahead, Sedlak believes providers are being more cautious about what they buy; reimbursements could get tighter still. Hospital beds are included in the Round 1 rebid, as are support surfaces (Group 2 mattresses and overlays), but the latter is being bid only in the Miami competitive bidding area. Despite that currently limited scope, things could change in Round 2.

“I would expect support surfaces to be one on the list as competitive bidding moves into the later rounds,” says Sedlak. “As CMS goes on to the next round … they may expand that to a broader number of markets.”

As for technology, no market-shaking paradigm-shifters appear to be on the horizon. Instead, manufacturers are focusing on more subtle changes that can boost a product’s efficiency.

For example, Flex-a-bed made its own linear actuator for 30 years, but now Linak will make the motor that raises and lowers the bed. “We partnered with Linak because they are producing a quiet, powerful and durable linear actuator,” enthuses Morrison. “Our product is made in the United States, and even these actuators that we purchased are made in Kentucky. We need jobs here in the United States, and we are proud of the fact that we make everything here in America.”

One thing that is new, says Abbey Daniels, CEO of Anodyne Medical Device, are the terms being used to describe support surfaces. “Active products are power products, and reactive products are non-powered,” she explains. “Think of a foam mattress. When a patient lays on it, the foam is reacting to the patient’s weight. The foam gives a little bit.

“If you put patients on an air surface with an electronic control board that sits at the foot of the bed, you can turn that on and it fill up the air cells. This mattress moves the patient. It is not responding to the patient’s movement — so that is how we settled on the ‘active’ and ‘reactive’ terminology.”

Distinctions among products ultimately made a crucial difference at Anodyne, which is a consortium of support surface manufacturers that includes AMF Support Surfaces, SenTech Medical Systems, Anatomic Concepts and PrimaTech. The group offers support surfaces incorporating both active and static air, foam and gel technologies to accommodate various patient needs. Daniels says last year, the company’s non-powered support surface business had double-digit growth, while the powered side declined.

“In the three years prior, we grew by anywhere from 24 percent to 30 percent for each of those years,” says Daniels. “So considering the kind of growth that we came off of, I was happy to maintain a flat top line in 2009.”

While reimbursement rates continue to force providers and manufacturers to operate within tight margins, it’s a given products have to be cost-effective. At the same time, there’s a renewed focus on product quality and reliability, as well as on making sure the right products with the right options and benefits are chosen for individual customers.

Sedlak also points to trends such as greater sales of full electric beds, and more low beds, which are designed to keep patients closer to the ground while they are sleeping.

“There is a bit of a trend away from the use of bed rails,” says Sedlak. “You can have patients sleeping in beds that are closer to the ground. They may be on a mattress that has a raised perimeter, but they are not using rails. If they are prone to rolling out of bed, the risk of injury would be less if they were to fall onto a floor mat rather than get entrapped within the rail itself, or to roll into the rail.”

Working with referral sources to advocate for better mattresses is yet another trend that can only help patients in the long run. Sedlak has noticed that more providers are proactively offering a better sleeping surface.

“Providers are now putting out more comfortable foam mattresses that offer some degree of pressure relief or pressure reduction versus the innerspring mattress that is so common in the marketplace today,” says Sedlak. “That is something that they don’t necessarily get paid any more money for doing. They are taking it upon themselves to put a better product out there, and that is nice to see.

“That shows that they are thinking about their patients, and referral sources will also appreciate it.”

Rebid Rates Ahead

Among the categories included in the Round 1 rebid of competitive bidding, slated for implementation in January 2011:

• Hospital Beds and Related Accessories
• Support Surfaces (Group 2 mattresses and overlays) in Miami only

In the first Round 1, the average reduction across then-current reimbursements was 26%, but for these two categories it was higher. For hospital beds, rates resulting from the bid averaged a 29% drop, and for support surfaces, 36%. CMS has said rates for the rebid round will be released in June.

• Read the “Support Surface Primer” sidebar to learn more about the varying characteristics of the three CMS categories for support surfaces.

Experts Interviewed

• Abbey Daniels, CEO, Anodyne Medical Device, Coral Springs, Fla.
• Max Morrison, president, Flex-a-Bed, LaFayette, Ga
• Chris Ritter, senior director of global sales, The ROHO Group, Belleville, Ill.
• Mike Sedlak, group product manager, beds and therapeutic support surfaces, Invacare, Elyria, Ohio

Support Surface Primer

CMS categorizes support surfaces into three groups based on the complexity of their features. The three groups have varying characteristics:

• Group 1 support surfaces are mattresses and mattress overlays (foam, air, water or gel) that are generally designed for the prevention of pressure ulcers for patients with significant risk factors. These support surfaces may be rented or purchased.
• Group 2 support surfaces include powered air flotation beds, powered pressure-reducing air mattresses/mattress overlays, and non-powered advanced pressure reducing mattresses/mattress overlays. They are generally intended for use for patients with established, advanced stage pressure ulcers. These support surfaces may only be rented.
• Group 3 support surfaces are complete bed systems, known as air-fluidized beds, which simulate the movement of fluid by circulating filtered air through silicone-coated ceramic beads. They are intended for use for patients with established, advanced stage pressure ulcers who have failed a standard comprehensive wound care program. These support surfaces may only be rented and are the most expensive of the groups.