A departure from the old ways of manufacturing is taking place in the seating and positioning market. It's not a new look for cushions, nor is it a new fabric or a contoured design. It's not the speed of production. It's not even the natural progression toward more durable, lighter-weight products.

At first glance, there doesn't seem to be anything different about today's seating and positioning products. The cushions look much the same as those on the shelves 15 or 20 years ago.

“There are more bells and whistles,” says Phil Newell, rehab manager for NuTec Rehab, a division of Triquality, “but it's still foam, plywood, fabrics and some upholstery on a wheelchair frame.”

Something else stands out as fresh and innovative in the seating and positioning market, at least according to industry experts: A change in the science behind product development. “We're on the cusp of understanding the science of seating,” says Tom Whelan, global product director for pediatrics and positioning at Sunrise Medical. In the past, according to Whelan, the seating and positioning market was “anecdotal,” based on “homegrown science: You try it, and if you think it works, you do it again.”

This pseudo-science no longer has a place in seating and positioning, experts say. “Real science is coming along,” Whelan says. Instead of putting products out there, seeing what works and then jumping on board, manufacturers are seeking a scientific path to product development, he explains. The payoff is higher-quality products that speak directly to patients' needs.

“Good science produces medical devices truly designed to serve a medical purpose,” Whelan continues, explaining that the formula for “good” science includes “products [whose] usefulness is substantiated by clinical data.”

The trend toward “good” science in the marketplace has led the majority of seating and positioning manufacturers away from generic, all-purpose cushions and seating systems, experts say. Rather than focusing on making a standard, low-cost product, manufacturers are trying to address each patient's individual needs.

Tammy Donelson, director of marketing for Biomedical Systems, says the “common mistake of the past” has been to manufacture products for a general population. But today's seating and positioning products are different. “They aren't just the generic products that meet every man's need, and actually end up meeting no one's needs,” she says. “Trying to be everything for everybody is a downfall.”

Today, products are “specifically designed [and] formed to the patient's body,” Donelson explains.

And patients are beginning to demand this kind of individual attention, Whelan says. “Fewer and fewer people every day are buying a standard wheelchair with a hunk of cushion thrown on it.”

The demand for custom products encourages manufacturers to collaborate, experts say.

“In our little segment of the market, every order is different and [thus] receives a different level of service,” Newell says. “You have to have trained professionals who do evaluations, who know patients and [patients'] disabilities, and [who] also have in their bag all the manufacturers and pieces of equipment that can be used together. There can be five or six manufacturers all involved in one case … everything is sold one at a time.”

One benefit of such collaboration is it allows for creativity, Newell says. “There's more than one way to work on a problem and come up with a solution. It's kind of like a puzzle being put together to help this one person achieve [his or her] goal of sitting up straighter or holding [his or her] head up higher.”

However, manufacturing products to meet a specific patient's needs rather than the needs of the general population is expensive, industry leaders admit. “This is not a low-cost market segment by nature of materials and labor costs,” says Susan Wilson, director of research and development for Supracor, a company that also manufactures equestrian products, customized bumper systems for Disneyland and bulletproof vests for American soldiers. “Seating and positioning products are expensive to produce.”

For this reason, smaller manufacturers entering the seating and positioning market are seeking out niche markets to find success. “Niche markets have potential over general, multi-purpose products [that are] based on price alone,” Donelson says. “That's a lesson right out of general economics.”

Merv Watkins, president of Convaid, says smaller manufacturers like Convaid “are able to achieve a more concentrated focus” in specialized niche markets. “The biggest challenge … is competing with the resources of the giants who can offer higher discounts and a vast marketing network,” he says.

But Neal Lampel, president of DTI, says the price-centered product development the “giants” often employ has no place in the seating and positioning market. The focus of product development should be independent of pricing, and manufacturers should strive to meet patients' needs, rather than to produce a $99 cushion, he says.

“If it becomes [a market in which] you have to make a $99 cushion to be in business, we can't do it,” Lampel says. “I won't take it down that road.”

A Dark Cloud on the Horizon

The big question casting a shadow on manufacturers' daily business in the seating and positioning market is whether or not competitive bidding will become a widespread practice.

“It's a cloud hanging over everybody's heads,” says Susan Wilson, director of research and development for Supracor. Wilson says that when the federal government tried competitive bidding in Florida, the system failed. “It's erroneous that Medicare is going to save all this money,” she says.

Wilson isn't the only manufacturer of seating and positioning products to voice her uneasiness with the threat of competitive bidding. Phil Newell, rehab manager for NuTec Rehab, a division of Triquality, has similar qualms about the not-yet-proven method of bidding for exclusive contracts with Medicare.

State officials in California and Texas — where much of the nation's seating business is concentrated — are considering the practice, Newell says. Unfortunately, the one manufacturer who wins the exclusive contract with that state may not be the best-qualified provider, he adds.

“Even with wheelchairs there are nuances and adjustments,” he says, “[Under] competitive bidding, these are ignored, and the patient doesn't get good service.”

“There is a concern that [competitive bidding] will negatively impact small providers while reducing the quality and choice available to the end user,” says Merv Watkins, president of Convaid.

“Competitive bidding will never work in seating,” Newell says. “It has no place in our business.”

The Future of Coding

Medicare can't be so big that it doesn't understand that to spend another $50 on a cushion will prevent someone from having surgery,” says Neal Lampel, president of DTI.

Nonetheless, in a market segment that experts describe as relatively stable with a promising future, Medicare reimbursement still poses a challenge, says Phil Newell, rehab manager for NuTec, a division of Triquality. “In states with very little funding, you don't see people getting the same products, because of percentages or maximum amounts or cost-plus.”

One problem with the current reimbursement system is that rigid codes can quell innovation, according to Merv Watkins, president of Convaid. “If reimbursement codes are too rigidly interpreted, they can significantly affect product design and features,” he says. “If the reimbursements are too low for the assigned code, the product could be discontinued.”

The challenge, according to Tom Whelan, global product director for pediatrics and positioning for Sunrise Medical, is “trying to make sure there's clarity, staying in tune with the reimbursement world and helping influence reimbursement.”

Lampel is optimistic about a future when products receive codes based on performance rather than appearance.

However, until these fundamental changes in reimbursement take place, “there's always going to be a market for the general products,” says Tammy Donelson, director of marketing for Biomedical Systems. While generic products only “sort of meet the needs, even if it's not the perfect thing for the patient, at least it helps.”

Experts Interviewed:

Tammy Donelson, director of marketing, Biomedical Systems, St. Louis; Neal Lampel, president, DTI, Garland, Texas; Phil Newell, rehab manager, NuTec Rehab, a division of Triquality, Sacramento, Calif.; Merv Watkins, president, Convaid, Palos Verdes, Calif.; Tom Whelan, global product director for pediatrics and positioning, Sunrise Medical, Longmont, Colo.; Susan Wilson, director of research and development, Supracor, San Jose, Calif.