It's not easy to grow sales in the home medical equipment environment. But due to increased obesity awareness, and better-designed products to help the
by Patricia-Anne Tom

It's not easy to grow sales in the home medical equipment environment. But due to increased obesity awareness, and better-designed products to help the overweight segment of the population, the adage “big is beautiful” has never been more true.

“Bariatrics is definitely growing — no pun intended — and becoming a larger part of the HME marketplace,” says Bill Baker, director of training for Drive Medical. In fact, both the increase in awareness and an increase in the morbidly obese population are key reasons why sales are growing, he says.

When Baker entered the HME industry 27 years ago, he says Medicare and most manufacturers did not recognize bariatrics as its own category. However, he notes, “the nationwide emphasis on obesity, diabetes research and the emergence of specialty physicians and bariatric centers have created more awareness in obesity and management of the bariatric market.”

Drive and numerous other manufacturers now offer extensive product lineups including mobility, beds and bath safety products, all designed to help patients live more productive lives. And after submitting a claim and processing Medicare paperwork, the margins are still reasonable, experts contend.

Big and Getting Bigger

There's no doubt bariatrics is starting to boom, according to Joe Zervios, director of communications for the Obesity Action Coalition. In the United States alone, an estimated 93 million people are obese, according to the Coalition's figures.

Obese individuals — as determined by a body mass index of 30 or higher, or a weight 100 pounds heavier than their ideal body weight — are at higher risk for impaired mobility. They also are more at risk of developing diseases such as diabetes, hypertension, heart disease, stroke, osteoarthritis and sleep apnea, among other conditions.

In 2002, the most recent year statistics are available, 25 percent of the morbidly obese were being treated for six or more co-morbid conditions.

As awareness of obesity grows, so do the products designed to assist that population.

“In the past six months, more and more people are starting to delve into this market,” Zervios says, adding that he frequently gets calls from people with bariatric product ideas. “It's not so much that these products didn't exist before; before we never saw a need for these products. Obesity is coming to the forefront and is finally being recognized by the health care community as a disease.”

DuWayne Kramer, president of Leisure-Lift, says sales of many HME products are growing in the 6 percent to 8 percent range. With bariatric awareness up in the past five years, however, he has seen sales of his company's bariatric beds growing at double that rate.

Additionally, weight requirements for equipment designed for the morbidly obese are going up. “We continue to increase the capacity and increase the capability of individual units,” Kramer says. “We now make chairs clear up to 675 pounds.”

“We have to assume people are getting bigger and heavier,” says Harmar Mobility President Chad Williams, who predicts the trend will continue. Williams says Harmar has had to increase the weight capacities on its lifts and ramps. “We had a 300-pound capacity lift five years ago, and last year we upped that to a 400-pound capacity,” he says.

Bundles Can Mean Better Sales

“The bariatric market is expanding at a very fast rate,” agrees Len Feldman, owner of bariatric bed-maker Big Boyz Industries. “The market is growing as needs are growing. People who use our products are using so many other products, such as respiratory products [and] diabetic products. Once they pass 500 or 600 pounds, [patients] develop so many health problems that anyone servicing them has a customer that is using a great deal of equipment.”

That situation offers providers good opportunities for multiple sales, manufacturers say, using one well-priced product to secure that first sale. Then, once they have the customer's attention, providers can often add to that sale simply by showing other bariatric products the customer might need, says Drive's Baker.

“Bundling items — i.e., a walker, commode, bed, etc. — seems to work well,” agrees Fran Spidare, patient transport product manager for Invacare. She projects annual growth rates for the bariatrics products market in the 7 to 10 percent range.

While there is good market potential and higher reimbursement for bariatric products, Spidare points out, the challenge is learning to “target marketing to the decision-makers.”

Product Integrity Is Key

As products proliferate to take advantage of available dollars in the marketplace, manufacturers caution providers to educate themselves about what is available. Even if a product is labeled appropriate for the bariatric market, it might not be. Providers need to pay close attention to product specifications and engineering, even for the simplest items they sell.

For example, the Obesity Action Coalition's Zervios recalls one vendor trying to sell hangers that would better hold an obese person's clothes. While that sounded good in theory, Zervios says, the hangers were virtually useless since they were too big to fit the depth of most normal -sized closets.

More practical features are those that add safety and durability to products. For instance, when selling wheelchairs, Jim Ernst, product manager for Leisure-Lift, advises providers to look at the incline rating, controller, motor, turning radius, stability and quality of components. The chair obviously should not tip over with someone sitting in it, but it also needs to be maneuverable around a house and have a strong enough motor to move uphill if necessary, he explains.

“Bariatric users are always much harder on their equipment. If you sell a marginal chair that isn't truly a bariatric product, you're more likely to have a problem,” Ernst says. “Many products in this category don't have the performance and quality to last in bariatrics. You can sell cheap, but it's going to be a problem when you can't get service reimbursements. … If you sell a product and it's junk and it falls apart, everyone else has to pick up the pieces.”

Granted, equipment materials being used today are much better than they used to be, manufacturers point out. Metals, wheels and welds have improved in the past decade. Electronics have also improved, and products continually evolve, Big Boyz' Feldman says.

Yet he cautions providers against choosing an “economy” product for their patients without also examining its quality. Products can be economical, but they should be durable. “You can save money going with a lighter steel, but in the long run, it's not worth it. Plus, I want to sleep very well at night,” he says.

Are Customers Apples or Pears?

Ultimately, serving the bariatrics patient requires education on what product features are available in the market, as well as on how to be sensitive to overweight patients, who already likely are facing the negative stigma that is associated with their condition.

“There is an educational process and approach that is needed in the marketplace,” says Roberta Jacobs, national sales manager for Gendron. “This includes educating the referral sources so they know what products are available to improve the quality of life for their patients.” She adds that both manufacturers and providers should be aware of sensitivity and dignity issues facing bariatric patients.

A sale involves much more than taking basic measurements, Leisure-Lift's Kramer adds. He suggests first just looking at the patient's body shape.

“Bariatric people come in two basic shapes: apples or pears,” he says. “They have different criteria needs and requirements, depending on that shape. Some have posterior problems. Some have their weight out in front.”

One way providers can educate themselves — and simultaneously increase sales — is to call on physicians and hospitals that specialize in bariatrics.

In speaking with hospitals or surgery centers, caregivers or even support groups in the area, a provider might learn that obese people are sensitive to skin issues and need a foot rest on wheelchairs, for example. Others might want a walker that folds because they are trying to get out and stay mobile. The goal is to make the patient more comfortable, and to make the caregiver's job easier.

Once providers understand bariatric patients' issues and “let physicians and hospitals know they know what their patients need, and that they have the right products available,” that opens up opportunities, Kramer points out.

“Dealers need to be aware of what equipment is available to them,” Harmar's Williams says, noting that this category requires special attention. “If they know what's available, they will be more able to help customers.”

Drive's Baker also urges providers to get involved and become active legislatively to try to increase reimbursements for the category. “That would take the stress off manufacturers so they can give outstanding and dedicated service to this important patient clientele,” he says.

Online Opportunities

Finally, providers should consider having an online presence for bariatric products.

“Let's face it, people who are morbidly obese are discriminated against,” says the Obesity Action Coalition's Zervios. “The last thing they want to do is go up to a dealer and say, ‘Do you carry such and such item for the morbidly obese?’ There's a ton of hesitation to go into stores to ask for product, so a lot is being sold online.”

“An online presence definitely helps,” Williams says. “These patients either don't want to get out and travel or it's more difficult. Being able to reach them via the Web makes a lot of sense.”

But with online sales, providers will need to consider what their return policies will be, Zervios notes.

Despite the sales challenges, “this is a good market,” Kramer sums up. “If a dealer takes a little time to familiarize himself with it, then lets customers and doctors know he understands this patient has special requirements, it can be very lucrative.”

Obesity Is Bad for Waistline, Employers' Bottom Line, Study Says

According to researchers at the Duke University Medical Center, among a study group, obese workers had seven times higher medical costs from workers' compensation claims and lost 13 times more work days from injury or illness than non-obese workers.

Researchers looked at the relationship between body mass index and the rate of workers' compensation claims for a diverse group of more than 11,700 Duke employees — ranging from groundskeepers to professors — who had health risk appraisals between 1997 and 2004.

Because BMI takes into account a person's height and weight, it is considered an accurate measure of obesity. For the U.S., a BMI of 30 and above is considered obese, while 25 to 29.9 is considered overweight and 18.5 to 24.9 is considered normal.

The analysis showed that per 100 employees in the study group, those considered obese lost an average of 183.63 work days in the study period compared with 14.19 for those within the normal BMI range. The average medical claims costs were $51,019 for the obese compared to $7,503 for the non-obese.

Study results also showed that the most common causes of injury for the obese were slips, falls and lifting, with injuries most likely to occur in the lower extremities, wrist, hand and back.

Supported by a grant from the National Institute for Occupational Safety and Health, the study was published in the Archives of Internal Medicine and reported by Insurance Journal.

Experts Interviewed:

Bill Baker, director of training, Drive Medical Design & Manufacturing, Port Washington, N.Y.; Jim Ernst, product manager, and DuWayne Kramer, president, Leisure-Lift, Kansas City, Kan.; Len Feldman, owner, Big Boyz Industries, Ivyland, Pa.; Roberta Jacobs, national sales manager, Gendron, Archbold, Ohio; Fran Spidare, patient transport product manager, Invacare Corp., Elyria, Ohio; Chad Williams, president, Harmar Mobility, Sarasota, Fla.; and James Zervios, director of communications, Obesity Action Coalition, Tampa, Fla.