The CDC estimates about a third of the U.S. population is obese, and the numbers are growing. It's an alarming trend that has engendered a wide range of home care products, even though providers can face additional costs when looking to serve bariatric needs. It's a market that requires sensitivity and awareness in addition to commitment and monetary investment.
"It all begins with understanding your customer, their pain points and their needs," says Gina Spinelli, customer manager for Philadelphia-based SCA Personal Care, which provides Tena brand incontinence products for the bariatric market.
"Selling bariatric products requires more than just putting them on a shelf," she says. "It is very important that the provider be fully prepared to support the customer with education to ensure proper selection and use of whatever products they choose to purchase. While we believe this to be true across the board for all our products, it is especially so for bariatric because it is a developing market and one that needs to be handled with sensitivity."
Understanding how incontinence can impact a customer, for example, enables providers to recommend the right products. Consider that many obese individuals with incontinence experience skin issues, which can be improved using wash creams, wipes and a diligent incontinence management program. "If HME providers can become more expert in the specific conditions that impact obese individuals, they have the upper hand," says Spinelli.
"Educating employees on the unique challenges bariatric patients face will improve your reputation in the market," adds Mike Sedlak, group product manager for home care beds/therapeutic support surfaces at Invacare, Elyria, Ohio. "Compassion and empathy will go a long way in serving this customer segment."
Selling Value and Durability
Moshe Klerer, CEO of K2 Health Products, Brooklyn, N.Y., which offers Kolb bariatric wheelchair cushions with up to a 500-lb. weight capacity, says bariatric reimbursement is healthy, which makes it a good opportunity. "Medicaid and Medicare understand that costs are higher, that you are using more materials and that there are fewer economies of scale, which increases production costs," he explains.
Klerer sees an opportunity for HME providers to differentiate themselves by carrying equipment for larger patients. "It is a very profitable end of the business," he says. "Referral sources are looking for a one-stop shop. You want to be known as the company that can provide a wheelchair for anybody. Some HMEs do not look at bariatrics because of stocking issues and because they think there are too many products. They are losing out. It's not so complicated. Companies can drop-ship products for you. There's no reason why you can't get a bariatric product from a manufacturer within a day or two."
But does reimbursement cover the additional expense? Not always.
"While reimbursements are considerably more for bariatric products than standard products, I would agree they are not adequate in a number of instances," says Sedlak. For example, sleep surfaces, both therapeutic foam mattresses and powered air surfaces, are reimbursed at the same rate as standard items yet cost significantly more. On the other hand, the sleep surface is an often-overlooked consideration for the bariatric patient, he points out.
"Also, the cost to serve these patients can be greater due to the special needs of installing the products," says Sedlak. For instance, in order to install a bariatric bed, a patient lift may be required to move the patient from the current bed, which increases the expense of the installation.
Whether the equipment is reimbursable or not, selling the value and durability of bariatric products is critical, say the experts.
"Most users know their own challenges, and if a product can keep them safer, selling via cash sales should be a simpler process," observes Cynthia Counts, director of home care/senior product manager for GF Health Products, Atlanta. "I believe that the typical consumer may not be aware that there are many bariatric products designed specifically for them." She notes it is critical to ensure that products designed for users under 300 pounds not be used for bariatric needs.
Regarding the cash side of the business, the bariatric market is a niche that retail isn't fully serving, SCA's Spinelli points out. "This provides the perfect opportunity for HME providers to supply their bariatric customers with everything they need, whether it is incontinence products, beds or anything in between."
Filling the Awareness Gap
Bryan, Ohio-based bariatric manufacturer Gendron approaches the market with an emphasis on education, awareness and relationships, says Roberta Jacobs, national sales manager. The company hosts medical advisor Dr. Kevin Huffman, a well-known expert in bariatrics, on its website.
"Products are always changing and improving to meet the needs of the patient," says Jacobs. "A common misconception within bariatrics is that all patients are candidates for surgery when many are not, and that all bariatric patients have the same needs," she comments. "There needs to be a selection of products to meet various needs." The company's beds, for example, are designed to accommodate patients from 500 to 1,000 pounds. and can be fixed or width-expandable for specific needs.
"[Another] common misconception is that bariatric patients are lazy," says Sedlak. "Nothing could be further from the truth. Through some ailment they have dramatically increased in size to the point that simple everyday tasks become nearly impossible, and as their activity level decreases, their size increases. Due to this increase in size, taking a walk around the neighborhood becomes an extremely difficult feat."
Invacare serves bariatric patients from 350 to 1,000 pounds with products including beds, sleep surfaces, wheelchairs, walking and bathing aids and patient transfer aids. The company's bariatric beds are wider to allow a patient to rest comfortably and have adequate room to reposition. "We also offer beds that expand in length for patients who need the extra leg room," Sedlak says.
"Products need to be designed more robustly," he says. "For example, simply taking a home care bed and making it wider will only cause it to wear at a faster rate … In extreme cases, some patients are spending their entire day in bed, so the design requirement of the bed needs to take this into account."
Ed Link, vice president of marketing for Drive Medical, Port Washington, N.Y., also sees "a void relating to consumer awareness." Drive has a dedicated bariatric catalog as well as videos to help fill the knowledge gap. With a full line of bariatric products, the company's new bariatric steel folding walker has a 700-lb. weight capacity, steel construction, contoured hand grips and easy push-button mechanisms that can be operated by the fingers, palm or the side of the hand.
Graham-Field concentrates in the 400- to 600-lb. market for bariatric products, offering a line from bath safety to wheelchairs to beds. Features include reinforced welding, dual crossbrace/frame supports and wider seats. The products must be both structurally sound and provide a level of comfort for the user, says Counts. For example, the company's Imperial Collection Three-in-One Drop Arm Commode combines seating support and weight capacity. The seat is blow-molded to provide wider seating support and has a 600-lb. weight capacity. Padded drop arms make it easier to slide in and out.
"Make sure the products you are offering come from a reliable source that does proper testing on their products to confirm weight claims," says Counts. "Keep durability and patient comfort top-of-mind when purchasing bariatric products. The bariatric market continues to increase, unfortunately, due to the growing size of the average American, so the opportunities for bariatrics are present even in today's economy."
Big Boyz Industries provides a range of bariatric beds to accommodate patients up to 1,000 pounds.
"HME providers tell us they are buying our beds because they hold up," says Terry Weisberg, Ivyland, Pa.-based Big Boyz' director of sales. The extra durability is worth the added expense, he says, because "with less expensive beds, after six to eight months, the service calls eat into the profits."
Weisburg cautions providers to be aware of a distinction between the "working weight" of a bed and the "patient weight" that it can accommodate. The "working weight" capacity doesn't allow for the weight of the mattress, bedding and accessories, which can effectively lower the weight limit of the patient. One consideration with Big Boyz' models, Weisburg notes, is that heavier beds do require two people for delivery.
Dan Gilmore, marketing communications manager for patient lift-maker Liko, Franklin, Mass., believes there is a critical lack of awareness about the National Institute for Occupational Safety and Health (NIOSH) recommendation of a 35-lb. weight-lifting limit for nurses and caregivers. "In a home care situation involving bariatrics, that's going to lead to an impossible lifting scenario," he says. "Something has to be done when a bariatric patient is unable to get out of bed."
Liko, which offers both mobile floor lifts and overhead lifting systems, operates a Web portal (www.safeliftingportal.com) to help educate HME providers and others about safe lifting. The company offers certification courses to instruct providers in installation and requirements to assess and fortify a structure to accommodate the extra weight that bariatric products (and patients) might require.
Boosting Bariatric Sales
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When consulting with referral sources, providers should address how their products make the lives of bariatric patients better, says Invacare's Sedlak, who also suggests holding lunch-and-learn sessions with wound care and bariatric nurses, doctors and therapists to showcase company knowledge of the segment. "Ask for input on the products and solidify relationships with those on the front line of care for bariatric patients," he counsels.
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Getting the word out about a provider's bariatric capabilities may be as simple as including two minutes on the subject during an in-service presentation, notes K2's Klerer. "Impress upon referral sources that these products exist. You're doing more harm than good when you try to squeeze someone into a wheelchair that is too small."
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Counts of Graham-Field recommends concentrating an area of a retail store on showcasing products that complement the bariatric selection. "For providers who are set up for retail who are doing pharmacy, it would help to perhaps create a health-and-wellness area that has bariatric products but also shows health/nutrition books, has health food nearby, etc."
She also recommends educating referral sources that there are both standard and bariatric products available so that careful selections are made. A GF brochure references the manufacturer's full line of bariatric products. "We keep this very simple yet detailed and provide it to our customers so they can use it when marketing to rehab centers, hospitals, etc.," says Counts. "On our website you can find detailed photos and information on our bariatric products so anyone can see exactly what they are getting."
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"Make sure you don't just have one or two bariatric products but rather a complete offering that will provide a one-stop shop. Also, take a step beyond selling products and really work on the service aspect," advises SCA's Spinelli. "Find conditions that are common among bariatric consumers and stock the products to meet those needs," she suggests. For instance, diabetic supplies are not branded as bariatric products, but a large portion of bariatric customers may need them, she notes.
Spinelli adds that for providers with a retail space, it is important that the store be physically easy to navigate. Widening the aisles and reducing clutter will make the shopping experience for bariatric customers — and, in fact, all customers — more positive.
Obesity Continues Troubling Climb
According to a June report from the Trust for America's Health and the Robert Wood Johnson Foundation, adult obesity increased in 28 states over the past year. More than two-thirds of states (38) have adult obesity rates above 25 percent. In 1991, no state had an obesity rate above 20 percent. In 1980, the national average of obese adults was 15 percent.
Among key findings of the annual F as in Fat report:
- Adult obesity rates rose for a second year in a row in 15 states, and rose for a third year in a row in 11 states. Mississippi had the highest rate of obese adults at 33.8 percent. Colorado had the lowest rate at 19.1 percent and is the only state with a rate below 20 percent.
- The number of states where adult obesity rates exceed 30 percent doubled in the past year, from four to eight: Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Oklahoma, Tennessee and West Virginia.
- Adult obesity rates for Blacks and Latinos are higher than those for Whites in nearly every state. Adult obesity rates for Blacks are greater than or equal to 30 percent in 43 states and the District of Columbia. In nine states, the rates exceed 40 percent. Adult obesity rates for Latinos were above 35 percent in two states (North Dakota and Tennessee) and at 30 percent and above in 19 states.
- Adult diabetes rates increased in 19 states in the past year. In eight states, more than 10 percent of adults now have type 2 diabetes.
- Ten of the 11 states with the highest rates of diabetes are in the South, as are the 10 states with the highest rates of hypertension.
- Currently, more than 12 million children and adolescents are considered obese.
