Fears of competitive bidding, narrowing reimbursements and increased regulation have loomed large in the beds and support surfaces market, but the effects may not be nightmarish as they once seemed. In fact, several manufacturers in this category report sales are up from the previous year, thanks to the growing demographic of people who need these products.
“Normally bed sales in the summer are slow, but this summer [we saw] a steady increase,” says Sue Plaisance, director of sales and marketing for Sleep Safe Beds. “There's a lot [going on with] Medicaid and approving issues about restraint beds, and we thought that would affect sales; we were expecting a downturn.
“We're surprised, actually. In reality, we've seen an upturn … we've been growing more than 60 percent every year for the past five years.”
A Growing Need
Plaisance acknowledges that her company can't grow its product line at that rate forever, but there are several reasons the category isn't comatose. Chiefly, the need for beds and support surfaces isn't going away.
“We do have an aging population who wants to be treated at home,” says June Brennan, senior product manager for Gaymar, “hence the need for home care products will continue to grow.”
Mike Sedlak, group product manager for beds and therapeutic support surfaces for Invacare, agrees. “If we focus just on demographics and aging population, we're coming into a time period when more people are entering the senior category than ever before — they're entering the category at a rate of 1,000 per day,” he says. Seniors are living longer and requiring care for a longer period of time, meaning there's more need for better support surfaces in the home.
Meanwhile, “the younger generation is less active,” Sedlak adds. “Obesity is causing problems for individuals and diabetes. If [you're] bedridden, that can lead to pressure ulcers. For providers, this provides greater growth potential in the marketplace because these patients will need some sort of extended care.”
There's clearly an increasing need for product, says Mark Bidner, CEO of Anodyne Medical Device. He notes industry analyses predict annual growth in excess of 23 percent through 2012 when looking at sales of beds and support surfaces in all markets including home care, acute care and long-term care.
The home care market alone should not be far off from those figures, he says, adding that he expects the beds and support surfaces segment to continue solid growth for another 10 to 15 years.
“We're all getting older and fatter … We have a population that's aging and wealthier and willing to spend more on care for not just themselves but on family members,” Bidner says. “In the next three to five years, [growth] will be astronomical … If it's not 23 percent, it'll be in the high teens for the absolute minimum in annual growth. The marketplace is just moving in that direction so quickly.”
New regulation also is fueling sales growth, at least in the short term. In the past year-and-a-half, federal safety guidelines for beds and mattresses have tightened to reduce both bed rail entrapment and fires.
“That caused a windfall of activity to provide products to meet these federal guidelines,” Invacare's Sedlak says. “A lot of people are reevaluating what they have and are seeking new products.”
Plaisance says SleepSafe has benefited from the regulations — the company's beds are totally enclosed, which eliminates rail entrapment issues, suffocation and limb breakage, she says — as customers are looking for added safety.
An Ounce of Prevention
Dikran Tourian, executive vice president of sales and marketing for Anodyne Medical Device, which includes the SenTech, AMF Support Surfaces and Anatomic Concepts lines, says he is beginning to see a shift in the mindset from payers for appropriate support surfaces, because it is cheaper to prevent pressure ulcers than to treat them.
Some “50,000 to 60,000 people die from complications from pressure ulcers,” he says. “The cost in dealing with them is astronomical, and people are starting to realize that prevention is the wiser choice than waiting until [the patient already has] an ulcer …
“We can take care of the problems faster and cheaper by preventing them than we did in the past.”
Dave McCausland, senior vice president of planning and government affairs for The Roho Group, points to CMS' recenly published policy stating that it will no longer pay hospitals for specific conditions it believes are preventable and avoidable. That includes pressure ulcers.
“Hospitals are going to gear up to focus on prevention where we haven't seen that in the past,” he says, noting the emphasis will trickle down to the home care market as well. Additionally, if providers focus on all aspects of wound care prevention — paying attention to beds, seating and oxygenation — they're likely to increase business, McCausland predicts.
Because continuity of care is a factor in prevention and treatment of pressure ulcers, he explains, a one-stop shop that is knowledgeable about the entire wound care business and that works to build around it can increase sales because it can supply all of a patient's needs versus companies that supply only beds or support surfaces.
“To be as successful as you possibly can in the support surface business, you really need to be prepared to address all the needs of patients … because if they're doing well and getting ready to be discharged from the hospital, they want to go home with a product and vendor that's already shown success.
“There's going to be more emphasis on continuity of care as the patient moves through settings,” he says.
Emerging Technologies
Advancing technologies and better application of materials have also enhanced the category.
Gaymar's antimicrobial Silver3 top cover, for example, available on its Top-gard 3000 series foam mattress system, has silver ions embedded in the material. One of the most common surfaces to come in contact with bodily fluids in any care setting is the mattress, so a mattress with an antimicrobial cover is a benefit, Brennan says.
When it comes to gels, Bidner of Anodyne Medical Device, which offers products with both active and static air, foam and gel technologies, notes that while they are effective ulcer prevention products, they are heavier and there is risk in damaging the product or harming the caregiver during delivery, service and managing the patient's position. Gel overlays are used most often in the home care market, he says.
However, the market is seeing gels in certain parts of the mattress to alleviate pressure points on the back of the head, heels, elbows, and for some bariatric patients on the back and legs, says Brad Stern, national sales support for Supracor.
“The gels are not going on the whole mattress, but on the spots that need it most that are the most susceptible to skin ulcers,” he says. Low-air-loss foam or rubber is used on other parts of the mattress that aren't hitting pressure or hot points.
Stern explains that ulcers are not always caused by pressure, but they also can be caused be heat and moisture, which products like Supracor's flexible honeycomb can help to control.
Newer “air/foam combination products are addressing the weight issue and have equal or greater clinical benefits to the patient,” Bidner adds. “We're seeing a migration away from just foam to foam/ air products.”
Invacare's Sedlak agrees that composite products combining layers of foam and air are becoming more popular to create a fail-safe method of providing pressure relief. Composite products provide the pressure relief normally found in air mattresses but use foam to avoid a total reliance on electricity. “If the power goes out, with an air mattress, it usually goes flat,” he says.
Among trends in beds, Nancy Prossick, senior product manager for Graham Field Health Products, says her company has found success with products that fit in with consumer lifestyles, and with other household furnishings. For example, consumers want a high-quality bed with a quiet motor, she says, so that it's not obtrusive in a home environment.
Plaisance agrees, noting that Sleep Safe Bed is introducing products that compliment its beds, such as nightstands and other accessories. The company is also modifying some of its beds to add storage space underneath.
Pricing Pressures
Despite the growing market, manufacturers say providers can't sleepwalk through sales. Competition remains heavy, particularly with products entering the market from Asia, and that's bringing prices down.
“Pricing is much more competitive now,” Prossick says. “You have to have a bed with unique features so that it stands out so it's not just about the lowest bidder.”
Supracor's Stern says his company is addressing the pricing issue by introducing a mattress overlay that is less expensive than a full support surface.
Similarly, Invacare offers a broad range of products to address all price points, and has recently launched a new line of therapeutic support surfaces. The Solace foam line accommodates patients with up to Stage Four pressure ulcers, and features a series of products depending on the stage of the patient. MicroAir powered products have a new “Z-cell” turning design that allows the patient to be turned up to 45 degrees more efficiently.
And by packaging its bed frames and mattresses together, it has increased sales, Sedlak says. “We're starting to see more bundling throughout the market,” he notes.
“With fixed reimbursements and competitive bidding, people still want quality, reliable product, but every day price points are dropping,” Anodyne Medical Device's Tourian says. Further, with competitive bidding, people are looking to minimize vendors so that they can consolidate purchasing and benefit from lower prices by buying in greater quantities. That also makes deliveries and storage easier.
“If you look at the numbers, I've seen growth in actual units in preventive support surface sales and rentals,” says Roho's McCausland. “I'm hard pressed to think how competitive bidding will depress growth in units, but it's very likely to depress growth in revenue. You're likely to see total units go up but average dollar per unit drop dramatically.”
McCausland cautions providers to be wary of cheap products. “The biggest challenge for the support surface is that we don't have a good way to separate the wheat from the chaff,” he says, noting that some products may not have the benefits patients need.
To that end, he and others are working on domestic and international standards for the industry through the U.S.-based Support Surfaces Standards Initiative (S3I) and an international standard work group through ISO. “Until you have standards and have some way to compare all products using the same methods to evaluate them … how can you categorize products appropriately and pay appropriately?” he asks.
“Frustration with competitive bidding results because unless you can clearly identify which are high-quality products and … deserve a premium price, then all you are doing is incenting a situation where the cheapest product wins, which is hardly ever the best product for the patient.
“You don't need to have a custom fit like a shoe, but you need to make sure that the body lying on top of the support surface is well-distributed and individually adjusted to the person,” he says.
Because ultimately, providing a safe and comfortable sleeping space is about servicing customers.
When you truly meet customers' needs, “you can actually see instant gratification in this job,” says Sleep Safe's Plaisance. “There's nothing better than knowing you've helped a person to get a full night's rest and to feel safe.”
N.J. Collaborative Tracks 70 Percent Reduction in Pressure Sores
After nearly two years of applying best practices and preventive techniques, 150 hospitals, nursing homes and home care agencies in New Jersey tracked a 70 percent reduction in the incidence of new pressure ulcers in their patients.
Ranging from redness and irritation to extensive destruction of tissue, muscle and bone, pressure ulcers, commonly known as bed sores, affect more than 1 million patients annually. Costs associated with their treatment exceed $1.3 billion, according to the New Jersey Hospital Association.
More important, the association said, “the human toll of pain, depression, altered self-image, infection and increased mortality is immeasurable.”
Of the organizations taking part in the NJHA's Pressure Ulcer Collaborative, 48 reported achieving results of no new pressure ulcers for a period of three months or more. In addition, data showed that the prevalence of existing pressure ulcers as patients moved from one care setting to another was reduced by 30 percent.
Data was tracked from September 2005 through May 2007.
Improvement techniques used by staff across care settings included:
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an evaluation of the risk of skin breakdown;
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implementation of preventive strategies, such as proper positioning and use of assistive devices; and
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ongoing observation of the condition of patients' skin, particularly for those identified as being at high risk for developing a pressure ulcer.
As part of the bundle of interventions for home patients, “once an individual was identified as being at risk for development of pressure ulcers, we wanted [the care provider] to strive for implementation of some kind of preventive intervention within 24 hours of that risk being identified,” said Theresa Edelstein, NJHA's vice president of continuing care services.
The organizations taking part in the project were given a review of various positioning and support surface devices to help “understand the principles behind each of those different types of devices and how they are utilized with different patient populations, such as critical care and hospice,” Edelstein said.
As a result, she said, some of the home care agencies involved “documented a significant reduction in rehospitalization rates related to wound infection and wound care in general. The agencies have seen that they made a difference, and that's a very exciting and positive result for them and for their patients.”
Experts Interviewed:
Sue Plaisance, director of sales and marketing, Sleep Safe Beds, Callaway, Va.; June Brennan, senior product manager, Gaymar Industries, Orchard Park, N.Y.; Mike Sedlak, group product manager, Invacare Corp., Elyria, Ohio; Mark Bidner, CEO, and Dikran Tourian, executive vice president of sales and marketing, Anodyne Medical Device, Los Angeles, Calif.; Dave McCausland, senior vice president of planning and government affairs, The Roho Group, Belleville, Ill.
