It's been 40 years since a debate over health care coverage for seniors gave birth to Medicare, and while lifts, ramps and transfer systems have come a long way since then, manufacturers of these products say the program hasn't kept pace.
“The biggest funding source is back in the 1950s,” says Tom Herceg, president of SureHands Lift & Care Systems. “Imagine if Medicare didn't reimburse power wheelchairs,” he says. “Medicare is the biggest player in home care, and it's limiting … until reimbursement shifts into a new age.”
But, he points out, while lack of funding is a hindrance, it is compensated for by an aging population who can afford this equipment without relying on insurance. “It's a huge country, and not everybody has to rely on Medicare.”
The funding problem does, however, limit innovation. “Innovation is sparked by need and funding,” says Herceg. “It's a paradox in the market: The funding isn't there, so how innovative can you be?”
Nevertheless, manufacturers of lifts, ramps and transfer devices say they are developing subtle changes that make products more user-friendly and adaptable to a diverse range of home and vehicle applications.
“Solutions are getting more application-specific,” explains Brenda Terris, marketing director for Harmar Mobility. “The more mobile you are, the more mobile we'll make you,” she says.
The Safety Factor
“The driving factor [in the patient lift] market is the whole idea of safety for the patient and caregiver, and preventing injuries for either party,” says Fran Spidare, product manager, patient lifts and transport devices, Invacare.
According to research from Frost & Sullivan, floor units dominate the home care market, but there could be some changes, says Sheila Ewing, the research firm's medical device analyst. During the coming years, “Medicare reimbursement changes are expected … [to shift] dominance from floor to ceiling lifts in the home segment.”
Behind the trend, she says, are caregivers. Nursing associations and other organizations are pushing for regulations that would require institutions to install ceiling lifts in institutions, and Ewing thinks those efforts should trickle down into the home setting.
“OSHA studies have drawn more attention to the fact that lifting people is not the same as lifting boxes,” Herceg explains. “Injuries are occurring at an alarming rate to a nursing population already in short supply. So imagine what is happening in the home care market, where the caregivers have received little or no training in proper body mechanics.
“Yes, we have the solutions to eliminate these injuries,” he continues. “But because Medicare, the single largest funding source in our industry, still only funds hydraulic lifters, purchase of new, cutting-edge solutions for the home are still the exception. Even private insurance carriers, many of whom are tied to Medicare purchase guidelines, still consider these motorized solutions as luxuries.”
For a look at where the patient lift market could be if funding sources get up to speed, Herceg points to Europe. There, “hydraulic lifts are no longer considered as appropriate solutions for difficult lifting problems,” he says. “Motorized lifting and, especially, ceiling-mounted systems, have been deemed as the appropriate solution for the ever-increasing home care population. Access to the bath as well as the toilet and the bed are possible when approached from the ceiling instead of the floor. It just makes sense.”
Funding sources aside, the ultimate focus for product-makers in this segment is to manufacture systems that are easy to operate and offer multiple applications.
“Our products have continued to become easier and easier to use, both from the standpoint of ergonomics and operating procedures,” says Dan Gilmore, marketing director for Liko, Inc.
Manufacturers are designing products that maximize safety and dignity by providing a smooth, easy transfer that is pain-free for both the patient and caregiver. For this reason, Invacare's Spidare says she sees the use of more motorized lifts in the domestic market within the coming years. “A hydraulic [lift uses] really old technology,” she says. “While it is less expensive, it's not the most comfortable for the patient,” she explains, sometimes giving a “jerky” ride. Motorized lifts “give a much smoother lift and return.”
Manufacturers are also working to make it easier for patients operating this equipment independently. “We're pushing harder and harder to help people be self-lifting and independent,” says Herceg. “In this sense, there's plenty of room to go forward with accessories that assist an individual on their own toward independence. It's a niche within a niche.”
The challenge to providers in this market, then, is to educate end-users on what equipment and accessories suit their needs and their environment. Patient-handling is more widely discussed today among insurance providers, experts say, so the referral sources are there for dealers. But consumer awareness still lags.
“We're not having to do as much ‘missionary’ work educating insurance carriers about these products. We've come a long way since the hydraulic lift. It's been gradual, with everyone's efforts over the years pounding away at it since the late '90s. In the last four years or so, I don't feel like we're explaining it as much,” says Herceg. “But this is not true with end-users who need patient lifting equipment unless they've been disabled since birth.”
When consulting with a patient or caregiver, providers “need to look at the length of the illness involved and really approach the situation from a safety point of view,” Spidare explains, adding that the approach “makes the sale go much easier.”
Lifting systems are the last step in a progression, according to Herceg, preceded by a cane, then a wheelchair. “The process is so fast from rehab to discharge, and these products are not visible like power chairs,” he says. “It's a hidden category, so referral sources are very important, and the home care dealer is key.”
A Smooth Ride
Cash sales are essential to maintaining market growth, particularly for vehicle lifts and ramps, experts say.
“The future is headed toward cash sales,” says Andrew Bayer, product manager, automotive division, Bruno Independent Living Aids.
“With all the changes in reimbursement, dealers are looking for ways to boost cash sales,” says Chad Williams, president of Harmar. “‘Cash sale’ is the buzzword right now,” and lucky for manufacturers in this market segment, he notes, “vehicle lifts and ramps are the ultimate cash sale.”
Today's vehicle lift and ramp equipment is more tailored to end-users and integrates more seamlessly with a variety of vehicle settings.
“These products are not just one-size-fits-all,” adds Terris. “We work to really integrate them into an individual's lifestyle. If you drive a pickup truck, we're going to provide equipment that works with that pickup truck.”
“Gone are the days of telling the customer they have to go out and get a minivan in order to transport their scooter or wheelchair,” says Williams. Today's market “is about looking at the total package and total solution. These are not just functional products anymore,” he says. “They're more mainstream and look more homogenous with the vehicles themselves.”
According to Bayer, the trend comes from more collaboration between auto makers and mobility dealers. Traditionally, “car manufacturers build the car, and mobility dealers and manufacturers make the products to fit into the vehicle, with limited support.”
But that trend could begin to change, Bayer says. In 2001, Toyota approached Bruno for a project that resulted in a unique seat for the Sienna minivan; it automatically travels outside of the van and stops at a desired height for the consumer, who then sits in the chair and is lifted inside.
“There was a lot of sharing on the front end to make this product fit seamlessly into the vehicle,” Bayer says. “When you get car manufacturers involved, they bring a different level of expertise.”
But overall, lift and ramp market players must continually adjust to an increasing number of new and redesigned automobiles and vans.
“Vehicles are changing and progressing rapidly,” explains Terry Miller, product manager for Vantage Mobility International. For example, he says, auto makers have integrated a standard folding third-row seat into some vehicles, “which makes installation of lifts much more difficult.”
Vehicle ramp manufacturers, too, are designing new ways to adapt. “Door openings are tending to get smaller, and power chairs and scooters are getting bigger,” says Judson Branch, national sales manager for Homecare Products. “The ramp has to accommodate both, and the margin of error is getting slimmer.”
Yet Branch, Miller and others say manufacturers are quick to accommodate such changes, and are finding innovative ways to get more people with mobility needs on the road.
Today's vans take into account “people lugging equipment,” says Jim Ernst of Leisure-Lift, adding that as auto makers increase their product lines, consumers are seeking new ways of taking their mobility equipment with them.
“Vehicles are changing, and we're adapting as they change,” Ernst sums up.
End-User Education
In each of these markets, from patient lifts to vehicle lifts and ramps, the charge to the provider, according to manufacturers, is to educate clients about how products meet their specific home or transport needs, painting a picture of how these products can enable an independent lifestyle — whether in the driveway, the back deck or the bath tub.
“An end-user needs to see the benefit of getting in and out of the tub — how a product integrates into the home,” Herceg explains. “It may not click if the product is just on display; it's more about the knowledge.”
The key to making sales is attention to individual customer need, says Liko's Gilmore. “Sales success hinges on adequately and effectively assessing each individual home care situation prior to recommending a product.
“This helps to ensure the best possible clinical solution and thus the best possible patient outcome.”
Walking an end-user through product instructions is also a necessary role the provider should play, according to Gilmore. “We always attempt to provide simple-to-follow instructions in order to ensure proper usage,” he says. “We constantly strive to design our products to be intuitively operated and to minimize the possibility of accidents due to improper use or faulty operation.”
Manufacturers say communication with providers and, through providers, with end-users, is what keeps these specialty market segments fresh. And ultimately, with this open dialogue, they expect to see continued growth in patient transfer and transport.
Concludes Williams, “This is still a niche market, but we expect it only to get stronger.”
Experts Interviewed
Andrew Bayer, product manager, automotive division, Bruno Independent Mobility Aids, Oconomowoc, Wis.; Judson Branch, national sales manager, Homecare Products, Kent, Wash.; Jim Ernst, Leisure-Lift, Kansas City, Kan.; Sheila Ewing, medical device analyst, Frost & Sullivan, San Antonio; Dan Gilmore, marketing director, Liko, Inc., Franklin, Mass.; Tom Herceg, president, SureHands Lift & Care Systems, Pine Island, N.Y.; Terry Miller, product manager, Vantage Mobility International, Phoenix; Gene Morton, Accessible Vans and Mobility LLC, Farmingdale, N.J.; Fran Spidare, product manager, patient lifts and transport devices, Invacare, Elyria, Ohio; Brenda Terris, marketing director, and Chad Williams, president, Harmar Mobility, Sarasota, Fla.
Tim Heston contributed to this report.
Patient Lift Market Growth
The patient lift market is expected to grow at a steady pace over the next few years. According to Sheila Ewing, a San Antonio-based industry analyst from Frost & Sullivan, the home market for patient lifts is expected to grow by 11 percent in 2006, 13 percent in 2007 and 14 percent in 2008. In 2003, revenue for the market segment hovered at $71 million, but Ewing says she expects that number to more than double, to $154 million, by 2010.
VA Contract Hits Providers Where It Hurts
Vehicle lift providers face a challenge this year with the pending culmination of a manufacturer contract coming from the Department of Veterans Affairs.
“This is the single most talked about thing going on in [the vehicle lift] industry,” says Terry Miller, product manager for Vantage Mobility International.
The VA is planning to buy mobility lifts directly from manufacturers. Those manufacturers, in turn, would subcontract the lift evaluation and installation to their dealer networks. A request for proposal (RFP) was posted in January, according to Kimberly Cowan-Tucker, a contracting officer with the VA's Hines, Ill., office. She added that plans are to implement the new contracts by the fall.
Since the VA announced its intent to work directly with vehicle lift-makers last year, both manufacturer and provider groups including the National Mobility Equipment Dealers Association (NMEDA) have been lobbying to ensure the contract allows fair prices for dealers. Nevertheless, as the giant government department wields its purchasing clout, advocates say it's clear that lift providers will take a financial hit.
“It's a terrible deal for providers,” says Harmar's Chad Williams. “Dealers are going to make 50 percent of what they used to for a lift sale, because they're no longer selling the product. They're just going to get paid for the evaluation and installation.
“There are good margins in lifts,” Williams continues, “so it's going to be a big hit. Lifts [were] one of the last profit centers for dealers working with the VA. The [VA] first took away the scooter and power chair revenue. About all that was left to make money on was the lifts. Even if [dealers] delivered a scooter for $75, they knew they could make money on the lift. That's being taken away from them, so this could have an impact on scooter and power chair deliveries as well.”
“The level of service that will be available to the veteran is going to be diminished,” says Gene Morton, president of Accessible Vans and Mobility LLC, and president of NMEDA. “[The association has] been involved going back to July of last year, trying to influence this thing in a different direction than it's gone.”
Specifically, dealers have been fighting for verbiage in the contract that would require manufacturers to work with factory-trained providers, Morton explains, adding that “factory training is not stated” in the RFP.
This creates a danger for manufacturers, some say, that may result in uncertain and inconsistent quality of installation, which could ultimately damage their brand name and reputation.
According to Miller, manufacturers don't have the ability to go out and interact with end-users — in this case, veterans. “It's really, really important to us that those vets get the right lift and the right service. Our strength is in our dealers,” he says.
Solutions According to Dependency Level
| Totally dependent patient | Full-sling mechanical lift device |
| Extensive assistance level | Full-sling or stand-assist lift |
| Lifts from floor (dependent) | Full-sling mechanical lift; if manual, specify number of caregivers needed |
| Lifts from floor | Transfer belt or gait belt |
| Limited patient assistance | Stand/assist lift; friction-reducing device |
The American Nurses Association, Silver Spring, Md., has been waging an ongoing campaign, called “Handle with Care,” to help prevent injury for nurses and patients in hospitals, institutions and the home. According to the ANA, lifting, transferring and repositioning patients are the most common tasks that lead to injury. The association says patients should be matched to equipment by assessing their ability to provide assistance and bear weight, upper extremity strength, height and weight, as well as special circumstances and specific orders.
