The term paradox seems most appropriate when describing philosophy or physics. Yet, the support surfaces industry is a paradox in itself. Manufacturers strongly disagree regarding which support-surface technology is changing and why. The one thing they do agree on, however, is that the home medical equipment industry is ripe for continued growth.

“The abundance of new products that are emerging reflect the growing awareness of the importance of preventative measures with regard to pressure ulcers,” says Susan Wilson, director of research and development for Supracor. “However, the funding for prevention is still lagging.”

Henry Lin, vice president of American Bantex, agrees that manufacturing efforts are increasing. “All of the manufacturers are doing such a good job in doing research in this industry,” Lin says. “I am just amazed at the new products and ideas that are coming out, and it makes all the other manufacturers want to get interested in the high-end market.”

Lin credits a reasonable reimbursement rate for support surfaces for this growth explosion. “Reimbursement is already at a very high point, so we [manufacturers] owe it to the industry to develop higher-end products.”

High-end products seem to be the primary target for support surface manufacturers. “Clinical needs are driving product innovation and design,” says Ann Fleming, Invacare's product manager for home care beds and therapeutic support surfaces. “Providers are looking not only for a cost-effective product, but also a system that provides an efficient and effective solution for their client — they are looking for a high-performing product.”

High-performing or “high-end” support surfaces, as many manufacturers refer to them, may present an opportunity for the market. “I can see these products geared toward the private payers and the people who have the ability to purchase them outright,” says Anthony DaCosta, president of Mellen Air.

A Push for Performance

Pressure ulcers are a costly condition, both financially and clinically. Medicare, state Medicaid programs and other private funding entities, including managed care organizations, spend between $1.68 billion and $6.8 billion each year treating pressure ulcers, estimates the National Pressure Ulcer Advisory Panel, an independent, not-for-profit professional organization in Reston, Va. Therefore, there is clearly a financial obligation to lower the incidence of pressure ulcers in the home and long-term care setting.

Clinically, the reasons are just as compelling. Current guidelines for the treatment of pressure ulcers focus on prevention and support surfaces as a critical part of that plan. “Clinical research has documented the need for ventilation in support surfaces designed to prevent and treat pressure sores. New products are attempting to address this need,” Wilson says.

Neill McKinnon, vice president of ValMed, also sees ventilation as an increasingly important aspect of pressure ulcer prevention and says new technology is being developed to address this issue. “The technology we are developing is going to be an inexpensive way to give some pressure relief as well as comfort to the patient without some of the heat build-up that typically occurs,” McKinnon says.

According to industry insiders, the challenge is matching the right patients with the right equipment. Fortunately, providers are becoming more educated about wound care prevention and treatment. “Increased knowledge in the medical community on wound care prevention and treatment and the benefits of support surfaces over the last 10 years have driven the demand for the products,” Fleming says.

Fleming adds that HME providers should take a holistic approach to managing their clients' health care. “These clients are users of wheelchairs, respiratory products and personal care products, as well as home care beds,” she explains. “Many consumers using a home care bed qualify for a therapeutic support system Group I product and Group I products are important because they are intended to prevent pressure ulcers.”

The beds themselves are a substantial product category for many providers. Steve Allee, director of marketing for Burke, says home care beds are certainly ripe for innovation, with patient and provider needs being top considerations. “We are certainly staying ahead of the curve to constantly improve products while still ensuring the changes that people want will allow the products to maintain their reimbursement code,” he says.

The improvements to home care beds that most positively impact HME providers focus on delivery — making it easier, safer and simpler, Allee says. Safety and comfort are top concerns for patient and end-user improvements.

The growth in research and development within the industry is a good thing, most manufacturers say. “Providers will benefit from this because there are better products and the competition will make them affordable,” Lin says.

The support surfaces business is one that inspires optimism. “Look at the demographics,” says DaCosta, referring to the large number of users and potential users of home care beds and support surfaces. “If you are a full-line HME provider with an array of products and services and you are looking to grow your business and you have the wherewithal to accomplish that growth, then you need to have a well-rounded array of services and products,” he says. “Certainly support surfaces should be one of them.”

Competitive Bidding: Its Impact on Beds and Accessories

Hospital beds and accessories were one of the categories chosen for the Centers for Medicare and Medicaid Services' Medicare competitive bidding demonstration project in Polk County, Fla. and San Antonio. The following chart details how this category faired in these demonstrations.

Polk County, Fla.
DMEPOS Category	Average Price Reduction (%)	Estimated Percent Saving Oct. 2001-Sept. 2002
Hospital Beds/Accessories	34.1	33.2
San Antonio, Texas
DMEPOS Category	Average Price Reduction (%)	Estimated Percent Saving Feb. 2002 — Dec. 2002
Hospital Beds/Accessories	25.7	27.6
Source: Second Annual Report to Congress: Evaluation of Medicare's Competitive Bidding Demonstration for Durable Medical Equipment, Prosthetics, Orthotics and Supplies

Creating a Level Playing Field

Providers want to ensure positive clinical outcomes for their patients, while manufacturers of support surfaces want to provide equipment that will enable providers to accomplish their goals. The caveat, though, is making sure reimbursement structure that is in place is adequate for the technology being incorporated.

“There was a time when the patient was first,” says Anthony DaCosta, president of Mellen Air. “Quality of care and the quality of product being used were foremost. Now, it seems that the beneficiary is at the lower end of the spectrum.”

The National Pressure Ulcer Advisory Panel is creating standards that will level the playing field for support surface guidelines and reimbursement. “To help clinicians properly evaluate the numerous support surface products, NPUAP is working on an initiative to develop guidelines for support surface testing,” says Susan Wilson, director of research and development for Supracor. “Characteristics such as flammability, infection control, life expectancy, pressure relief, friction, and heat and moisture control will be addressed in the initiative.”

According to DaCosta, the initiative will benefit the entire industry. “If you have a standard and you bill to a standard, it would be fair to assume that if your standard is high, you deserve a better return on your investment,” he says.

For more information on the NPUAP initiative, see the organization's Web site at www.npuap.org.

Experts Interviewed:

Steve Allee, director of marketing, Burke, Kansas City, Kan.; Anthony DaCosta, president, Mellen Air, Long Beach, Calif.; Ann Fleming, product manager for home care beds and therapeutic support surfaces, Invacare, Elyria, Ohio; Brian James, president, James Consolidated, Walnut Creek, Calif.; Henry Lin, vice president, American Bantex, Burlingame, Calif.; Neill McKinnon, vice president, ValMed, Little Rock, Ark.; and Susan Wilson, director of research and development, Supracor, San Jose, Calif.