It is a national phenomenon: Americans are impatient. This is evident in our demand for faster computers, more powerful cellular phones and restaurants that promise lunch on the table in 15 minutes or it is free.

Americans' attitudes towards personal health and fitness demonstrate a similar impatience. Active people continue to search for solutions that delay the imminent threat of surgery, and once that threat becomes a reality, they search for products that shorten their recovery time. The market for physical therapy and sports medicine products is attuned to these needs, experts say, and providing solutions is what it does best.

But is the home medical equipment industry taking advantage of these opportunities? Maybe, maybe not, say experts.

“There is a lot of business they are letting go to mass merchandisers,” says Rhonda Machin, director of marketing, FLA Orthopedics.

Jeff Doty, Battle Creek Equipment Co.'s director of marketing, says providers should claim the market for sports medicine products. “These types of products are available at [mass merchandisers], but those stores are not going to give the needed personal attention,” he says. “These products can't be sold like toothpaste.”

Sporting goods stores are also taking away customers from the HME industry, says Jeff Regan, senior product manager, Breg. “The home health dealer has an image of supplying [only] bedpans and wheelchairs,” he says. “[Many people assume] it is not a place to go that is oriented to their activities.”

Aside from an uncertain image and a target audience that is often unaware of the equipment and services HME dealers provide, what other challenges do providers face? Like most other product lines, the market for orthotics, braces and continuous passive motion devices has seen its share of Medicare and managed care reimbursement cuts.

“The price has dropped so much that it has affected the gross margins,” says Charles D. Dillon, president of MMAR Medical Group. However, Dillon is optimistic about the future of this market, primarily because of the increasing number of older Americans. “The opportunity is excellent because there are going to be more people needing the services, and whoever can offer them is going to end on a positive note.”

Still, the HME industry is not necessarily the primary provider of these products. Many manufacturers target orthopedic surgeons, physical therapists and orthotists as their primary customers. So, where does that leave the HME provider? In a good — but not great — position.

“These types of products might not be their number one cash cow but [they are] a good residual type of annuity that is always bringing in business,” says Machin. “They may have limited space or dollars to put into it, but it doesn't take much to get in this product line.”

“The profit margins are relatively small,” says Thämert USA's president, George Mohr. “But home health care dealers are adding innovative rehabilitation products to their programs to create revenue.”

Doty agrees that there is opportunity and suggests that HME providers market within their community. “There is opportunity, but it is not a business that comes automatically,” he says. “HME providers need to work with their referral sources so patients can be made aware that home health care is for people beyond the infirm.”

The most exciting aspect of this market is that innovation has not been put on hold, industry players say. For example, most manufacturers are looking at new, more advanced materials. “Materials that we use have changed significantly,” says Machin. “We are using breathable materials and fabrics that wick moisture away as well as computerized sewing to ensure quality and consistency.”

Mohr says the newest trends reflect a move away from neoprene and toward knitted fabrics. “Traditionally, neoprene has been the fabric of choice because it provides compression and heat. For many patients it gives too much heat,” says Regan. “So, we are looking for alternative materials. One such material is known as a spacer fabric. Instead of being rubber, it is a polyester weave.

“We are always looking for products that will enhance compliance, durability and wear,” he continues. “We want to provide a product that patients are willing to wear, because if they are not willing to wear it, everybody has lost.”

Orthopedic Brace and Support Market

REVENUE FORECASTS

Year	Revenue ($ Million)	Revenue Growth Rate (%)
1999	678.8	6.4
2000	719.9	6.1
2001	765.3	6.3
2002	812.0	6.1
Source: Frost & Sullivan

When It is More Than Just Aches and Pains

OSTEOARTHRITIS, the most common form of arthritis, affects about 20 million Americans, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

About 6 percent of adults over 30 have OF of the knee, according to NIAMS. “It is a sizable population and it is one of the areas that all of us have looked at as the land of opportunity versus the [anterior crucial ligaments] market that traditionally has driven the knee brace companies,” says Jeff Regan, senior product manager for Breg.

Breg focuses much of its attention on OF of the knee, says Regan. Products that delay the need for surgery “buy people time” and help manage the pain, he says.

Moist heat is another pain management strategy for those with arthritis. Hot packs, and their contrast product, cold packs, are becoming staples in home health care stores, according to John Doty, vice president of marketing and sales for Battle Creek Equipment Co. “The moist hot pack is our lead product and is enjoying growing sales,” he says. The product is reimbursable by Medicare when it is used to manage arthritis pain.

Chris Linville, vice president of marketing and sales for The Chattanooga Group, says there is tremendous growth opportunity in the market for both hot and cold therapy products. “With hot and cold therapy reimbursement being eliminated at the physical therapist level, patients are sourcing those products at pharmacies and DME types of facilities,” he says.

At Home on the Range

THE BENEFITS of continuous passive motion devices — increased flexibility and a shortened inpatient and outpatient rehabilitation process — are why more people are interested in these devices, whether they are reimbursed or not. Tightened and limited reimbursement has made an impact on the market (only CPM devices for knees are reimbursed by Medicare), but patients are willing to pay to get the reported results, says Rick Suddendorf, national sales manager for Ormed USA.

Although CPM devices have been around since the 1980s, recent advances should make providers take a second look.

“The advances in electronics and technology are making CPM therapy better and certainly more profitable,” says Suddendorf, referring to Ormed's latest shoulder CPM which contains a chip card, similar to a credit card, that is programmed for a series of days or weeks.

“Therapists can program an entire series of cards to increase the range of motion so the dealer is not going out every week to reprogram the CPM,” he says. The chip card automatically sets the machine to increase the range of motion by a pre-prescribed amount.

The Chattanooga Group's CPM device has created some new awareness for clinicians about the market's possibilities, says its vice president of sales and marketing, Chris Linville. “In years past, the CPM business has been controlled by one or two manufacturers and one or two large dealers, and the opportunity is so much larger than that,” he says, adding that the market is opening up for more HME providers.

Lloyd McNutt, who is director of marketing for McKelor Technologies, takes a simple approach to CPM therapy. “We have tried to design a machine that is easy and simple to repair in the field,” he says.

McKelor has focused its recent energies into developing a hand CPM because of an increase in on-the-job injuries and workers' compensation claims, many of which affect the hand. McNutt says he sees great potential in the market for products that meet the needs of those occupational injuries.

Making It Easy

STROKE IS the third leading cause of death and the leading cause of long-term disability in the United States. According to the National Stroke Association:

• 4 million Americans live with the effects of a stroke

• 10 percent of stroke survivors recover almost completely; 15 percent die shortly after the stroke

• 25 percent recover with minor impairments

• 40 percent experience moderate to severe impairments that require special care

• 10 percent require care in a nursing home or other long-term facility

• 14 percent experience a second stroke in the first year following the first

For many stroke survivors, the rehabilitation treatment plan incorporates the use of off-the-shelf orthotic devices. “There are all kinds of new products and innovations that have hit the market that have made these products easier to use and understand,” says Charles D. Dillon, president of MMAR Medical Group. Some examples include color-coded straps, washable covers and new materials that lessen skin breakdown.

Experts Interviewed Charles D. Dillon, president, MMAR Medical Group, Houston; John Doty, vice president of marketing and sales, Battle Creek Equipment Co., Battle Creek, Mich.; Chris Linville, vice president of sales and marketing, Chattanooga Group, Hixson, Tenn.; Rhonda Machin, director of marketing, FLA Orthopedics, Miramar, Fla.; Lloyd McNutt, director of marketing, McKelor Technologies, Grove City, Ohio; George Mohr, president, Thämert USA, West Berlin, N.J.; Jeff Regan, senior product manager, Breg, Vista, Calif.; Rick Suddendorf, national sales manager, Ormed USA, St. Paul, Minn.

To follow up with these companies, check out the complete listing in HomeCare's annual Buyers' Guide.