Even before the Balanced Budget Act of 1997, getting reimbursement for sports and recreation products was tough. Now, manufacturers say, it's impossible-and that's changing the market.

"This thing really cut the heart out of reimbursement," says John Butler, national sales manager for St. Louis-based Airex/Alusuisse Composite. Since BBA '97, he says, he has added preventive sports and recreation items to his lineup of treatment products. This allowed his company to capture more of the market through athletic clubs and sports medicine clinics, he says.

The lack of reimbursement for sports and recreation products has prompted some providers to seek help from manufacturers in boosting their bottom lines. "We suggest that providers have the big-ticket sports and recreation items like hand cycles and racers in the store to let people get on them and play with them," says Mary Carol Peterson, product manager for Elyria, Ohio-based Invacare Corp.

Tim Ellis, a marketing manager for Invacare, says that because of providers' feedback, the company also now offers a program called the Marketing Advantage Partnership that includes co-op advertising and a financing program. "It's a broad program to enhance the cash business for providers whose products are not covered by reimbursement," he says.

Other manufacturers are helping providers market the products. "Manufacturers are getting creative," says Jim Black, sports and recreation product manager for Sunrise Medical, Longmont, Colo. "We have been sponsoring marketing events for providers and sending people like Dave Kiley, a Paralympics athlete, [along]."

Such efforts could help keep at bay another threat to providers' sports and recreation sales-the Internet. Some Web sites discount the products, says Black, "and if consumers are paying cash for the items anyway, the Internet is a cheaper alternative." Still, he points out, providers offer service that the Internet does not. "We do have to remember that we are talking about high-end athletes who know exactly what they want [when they go online]; most end-users are still relying on their local health care professional to introduce them to the market," he says.

Following is a sample of sports and recreation products.