Recent studies predict tremendous growth in the beds and support surfaces market within the decade. But the market is plagued with reimbursement woes that could keep many home medical equipment providers from reaping the benefits.
According to a June report from research and consulting firm Frost & Sullivan, the overall beds and support surfaces market hit $1.6 billion in 2005 and is projected to reach revenues of $2.9 billion by 2012. While the report includes hospital beds and support surfaces, these figures also point to growth in the home care arena.
Contributing to such rapid growth are the usual factors: an American population that is increasing in age and size, both groups that are more likely to require a specialty bed and both prone to developing pressure sores. According to Frost & Sullivan, approximately one million pressure ulcers occur annually in the United States, costing about $1.3 billion each year to hospitals alone.
According to Jim Acker of Blue Chip Medical Products, the standard patient market is growing due to the number of aging Americans. In addition, Acker notes the “ever-increasing size of Americans makes bariatrics a huge area. The demand for 48-inch and 54-inch-wide support surfaces is becoming more prevalent.”
“Clearly the market continues to grow — especially on the beds side,” adds Leisure-Lift/Burke Beds' DuWayne Kramer.
“The main thing we're starting to see with major manufacturers is a clear distinction between a bariatric bed and a home care bed. With more emphasis on caregiver safety — bariatric patients are dangerous — with more zero-lift policies, the fact that the caregiver can move the bed around or have a lift that helps move the patient is becoming a big issue.”
“Take a look at the market,” explains Invacare Corp.'s Mike Sedlak. “The rate of obesity has doubled over last decade, and the average age of someone considered obese has dropped down to the mid-40s. You really have a changing demographic in the market, and this is a different need altogether.
“Many homebound bariatric patients might not have proper beds; that is, their beds may not be able to hold or support them. Therefore, many sleep sitting in recliners or chairs, or even on the floor.”
Sedlak points out that these makeshift sleeping arrangements can often lead to secondary problems, in addition to being homebound.
The benefit of a bariatric home care bed is that most can adjust to a sitting position, which may take pressure off the patient's chest or legs. In turn, that may reverse the effects of swelling. Bariatric beds also can allow some patients to get out of bed more easily. With a full electric bariatric bed, Sedlak says, the patient or caregiver can raise the bed to a point where the patient may be able to get up or stand.
Angela Mayfield of Graham-Field Health Products confirms a general interest in full- electric beds, and not only in the bariatric sector. “I think we'll continue to see that grow because of ease of use for the caregiver,” she says. Even though consumers may have to pay out-of-pocket for an upgrade to full electric, “there is a segment of the market that can and will pay more for this feature,” she says.
“It's a very arduous thing to have to care for someone who is bedridden or not able to help themselves for a long period of time,” Mayfield continues, “and for a little more in cost, the ease of use of a full-electric bed is worth it.”
Paying for Prevention
Frost & Sullivan says preventive therapy — utilizing products that focus more on prevention than simply on treatment — will begin increasing in sales. “[An] increasing number of patients with pressure ulcers boosts demand for [preventive] therapy,” explains research analyst Sheila Ewing. “Products with a greater focus on prevention are likely to experience a significant increase in sales.”
Others agree. “Prevention — not just treatment — of ulcers is important. Pressure ulcers can leave the body vulnerable to infection and lead to other injuries,” Sedlak states. “For example, Christopher Reeve had access to the best products [but] a pressure ulcer caused an infection and led to heart failure. Prevention is important, but generally overlooked.”
Trouble is, most Medicare Part B patients don't qualify for higher-end and higher-tech support surfaces until they've already developed a pressure ulcer. And HME providers often make little or no money from Medicare for supplying these products.
“If a patient has private funding or secondary insurance, HME dealers can provide a better quality surface like gel overlay, but they would have to bill secondary insurance, and a lot of Part B patients don't have this,” Blue Chip's Acker explains.
“Hopefully, Medicare will take into consideration the suggestions manufacturers have made about what's available. The current criteria … was put into place about 10 years ago, but [they are] based on technology that's well over 15 years old. With so many new advances out there, we need to rework the whole policy.”
According to Acker, the National Pressure Ulcer Advisory Panel along with the SADMERC and other groups are putting together a draft of what new Medicare policy should look like.
“Medicare is reviewing [its reimbursement practices] for preventive products, but,” he notes, “it may take a few years to see a change.”
In this type of reimbursement climate, it's becoming harder to fall back on good service, though the experts still assert that service makes the difference.
“At the end of the day, the providers that provide the good service will be rewarded — I do believe that,” says Susan Wilson of Supracor. “Are they able to get adequately reimbursed for the service they provide? That's a whole other issue.”
(Im)Possibilities
Cost-containment is another trend — though not necessarily one leading to growth — identified by Frost and Sullivan. According to its report, health care facilities are asking for lower-cost products that, paradoxically, are higher-functioning than those currently available. Though the report does not specifically mention payer sources for HME, it's easy to assume that Medicare, Medicaid and private pay sources likely are pushing for the same.
“In the Medicare Part B market, the allowables have been cut so severely that manufacturers can't make a viable product of true quality,” Acker states. “When [Medicare] implemented the current policy several years ago, it knocked a lot of people off Group II treatment products and didn't provide adequate coverage for preventive treatment.
“Fifty percent of CMS codes for Group I are useless codes — we can't make products that meet the criteria for the amount providers are being reimbursed.”
Along with an increasing focus on bariatric products, an area most agree is a fairly reliable niche market, many manufacturers of beds and support surfaces are emphasizing related, alternative products as potential growth sources — and they encourage providers to consider diversifying their product lines in order to do the same.
Aside from its traditional home care support surfaces, for example, Supracor makes a baby mattress for home and neonatal care that is completely ventilated and designed to reduce the risk of Sudden Infant Death Syndrome.
Wilson sees the most potential for growth in products like this mattress, because it does not fall under Medicare payment guidelines, and other after-market bed accessory items. “These items are reimbursed differently, not necessarily by Medicare or insurance, and don't fall under same kind of criteria,” she says, explaining that lifestyle products — lumbar supports, pillows, car seats — can offer providers and customers greater options.
“Some dealers do very well with accessory-type products,” Wilson says.
Flex-a-Bed manufactures adjustable beds for home use, another growing niche. “This customer needs an adjustable bed but wants something nicer and more comfortable than traditional hospital beds,” explains the company's Sandy Thomas.
“Letting folks know providers carry adjustable beds is critical. Advertising the products as comfortable and luxurious will also keep from limiting the market to only those who need it medically — and appeal to folks who don't need it medically (for watching TV or reading in bed) or don't want to admit they need it medically,” Thomas continues.
“In this way, providers can add to their existing business by attracting older customers to their store, often cash customers, rather than only dealing with insurance situations.”
Both Invacare's Sedlak and Graham-Field's Mayfield also identify growing activity in low beds, which are designed to keep the sleep surface close to the floor. By comparison, most standard beds are about 15 or 16 inches off the floor. With the addition of a mattress, patients can wind up sleeping about two feet off the ground.
A low bed “provides an extra measure of safety for the person sleeping in the bed,” Sedlak explains. “Two feet off the ground doesn't sound like a lot, but if someone rolls out of bed — especially if the person is elderly or has just had surgery — the fall could do more damage.”
According to Mayfield, “Because of the number of falls and the increasing number of patients with Alzheimer's and conditions of that nature, we're seeing the importance of low beds in the institutional market work its way into the home care market.
“This goes right along with other patient safety issues that are coming to the fore in home care,” Mayfield adds, referring to recent FDA hospital guidelines for reducing the risk of bed entrapment.
And with support surfaces, she says, “if you look at what happened in wheelchair cushions, from an efficacy perspective it is probably going to become much more of a focus for the government to make sure that support surfaces actually do what they're supposed to do … and there are also new flammability regulations.
“This is going to require additional testing and more record-keeping on the part of the manufacturer, but it will be the best thing for safety and for the industry. It's the right thing to do.”
Wait-and-See Attitude
In the end, experts say reimbursement — not projected growth — is the biggest issue for most HME providers. Despite manufacturers' efforts to offer quality products and to educate providers about the complex coding involved in reimbursement, many are waiting for a clearer, more positive view of the beds and support surfaces market to make a large commitment to selling the products.
And with competitive bidding still looming, “dealers are really concerned about what the climate is going to be,” says Supracor's Wilson. “There's a lot of uncertainty, a cloud over everybody's head right now. People are taking a wait-and-see type of attitude.”
Experts Interviewed:
Jim Acker, vice president of sales and marketing, Blue Chip Medical Products, Suffern, N.Y.; DuWayne Kramer, president, Leisure-Lift, Kansas City, Kan.; Angela Mayfield, director of marketing, Graham-Field Health Products, Atlanta; Mike Sedlak, product manager of beds and therapeutic support surfaces, Invacare Corp., Elyria, Ohio; Sandy Thomas, national sales director, Flex-a-Bed, Long Beach, Calif.; and Susan Wilson, director of research, design, and development, Supracor, San Jose, Calif.
