It's a frustrating fact of manufacturing beds and support surfaces: technology or patient demand doesn't always determine whether a new product will be designed and marketed. Often, manufacturers say, it's whether the new product falls under the reimbursement umbrella.

And whether a device is necessary to a patient's existence is what determines its eligibility for reimbursement, says Joylyn Pedigo, administrative manager of Toledo, Ohio-based Vail Products, which makes an enclosed bed system. All other products are considered additional and, usually, unnecessary, she says.

"Getting the insurance companies to realize that certain products not only can be beneficial to a person but, in the long-run, can decrease cost by preventing injury is almost a losing battle," Pedigo says.

Manufacturers are finding different ways to fight back. According to Joe Benedict, director of medical marketing for Span-America Medical Systems, Greenville, S.C., long-term care reimbursement for beds and support surfaces is forcing manufacturers to design less-expensive, less-complicated "treatment surfaces."

Its PressureGuard CFT, a nonpowered pressure-reducing mattress, is one of these products. "The timing couldn't have been better for us and the handful of companies offering a nonpowered treatment surface with a track record," Benedict says. "More and more post-acute providers are going this route based on cost and getting the clinical outcomes they're looking for."

Sometimes, reimbursement constraints even prompt product innovation. Dynamic Systems, Leicester, N.C., received the Space Technology Hall of Fame award from NASA and the U.S. Space Foundation for being a leader in technological advances in cushion materials in 1998, officials said. It created the SunMate, a 100 percent open-cell foam that can be used as a wheelchair cushion or mattress pad. "Right now, there are lots and lots of cuts in funding," says Cathy Ramsey, the company's Foam-in-Place seating coordinator. "But luckily with our SunMate, we haven't been hard hit yet."

Following is a selection of beds and support surface products.