Seating and positioning professionals share a high level of passion and caring about what they do and how they affect patients' lives.
“[The passion] imbues the whole corporate culture. Everything we do physically touches clients and makes their lives better,” says Don Gordon, vice president, marketing, Adaptive Equipment Systems. “Every little bit matters. You don't find that in other industries.”
“Providing equipment to improve the lives of physically challenged children is socially beneficial and very rewarding,” says Merv Watkins, president of pediatric-mobility manufacturer Convaid. “For some children, this means a degree of independence, for others an enhancement of their capabilities and a broadening of their horizons.”
“Seating and positioning is important because every wheelchair user is an individual with personal postural support needs,” adds Randy Willett, director of medical, Cascade Designs, parent company of Varilite. “Properly designed postural supports can have a dramatic effect on a person's long-term health and well-being.”
“Something as simple as power elevating totally changes how clients interact with the environment,” points out Brad Peterson, vice president of education for Motion Concepts. Today's systems allow clients to live more independently inside and outside the home, he continues. “Therapists, providers, families, even funding sources are expecting more. From a manufacturer's standpoint, it's fun to come up to the challenge.”
Incremental Improvements
Experts peg overall market growth at about 15 percent annually, although certain segments, such as seat backs, have seen greater increases, Willett says.
Despite the growth, many experts say they have not seen any market-changing technology this year. “To be honest, seating and positioning is becoming a commodity market,” Gordon explains. “My main competition has access to 95 percent of the same materials [as I do].”
The seating and positioning market is now about “how well you use those materials, and how well you service and relate to the dealer and clinician,” he continues. “If you have a tight communication stream going, you can have a good product.”
The sector's small manufacturers are focusing product development and marketing toward specific niches, Peterson says. “I've noticed a lot of smaller companies come up with different things to challenge the Goliaths. They're starting to change the [industry's] mindset.”
Some manufacturers believe the market is being shaped by incremental improvements in design flexibility, such as seating systems that expand as a child grows.
Other product ideas come directly from rehab providers themselves. “They direct us as to what needs to be changed,” says Phil Mundy, president, Product Design Group. “[Providers give us] all sorts of subtleties you can't get in front of a drafting board.”
Comfort Rules
In seating and positioning design, comfort still rules, and cushions remain central to product development, according to Gordon. “It's still ‘cushions first,’” he says, whether the cushions are out of the box or custom.
Uncomfortable seating systems ultimately can cause users to sit out of position, which could lead to “some serous injuries, like pressure sores, down the road,” says Steve Schlegel, product manager for seating and positioning at Invacare.
Foam, a standard cushion material that is easily cut and fitted to a variety of configurations, boasts high flexibility. “There is a certain degree of modularity to foam,” explains Schlegel, adding that a manufacturer can modify the material “without damaging the integrity of the product.”
Nevertheless, “modular products still leave you unfinished in some respects,” says Kevin Fraser, president, Star Cushion Products, adding that custom cushioning products can “cover anything from pediatrics to bariatrics.”
Cushions should distribute weight evenly to reduce the chance of pressure ulcers and allow proper ventilation to keep the skin cool and dry, according to Brad Stern, national sales support for Supracor. The company manufactures cushions made with honeycomb, a memory-retaining material that consistently returns to its original shape.
Memory-retaining material, including visco-elastic foam, “allows us to shape into the initial relief area,” explains Invacare's Schlegel. “It increases overall contact and redistributes pressure … away from sensitive areas.”
When it comes to overall product development, simplicity remains a driving factor, says Scott Higley, vice president, sales, Quantum Rehab, a division of Pride Mobility Products.
For instance, in the past, planar seating systems held extensive bracketry for positioning adjustment. “Now we use slide tracks that allow infinite adjustability within the channels,” Higley says. “They facilitate easier adjustment because you don't have to remove any clamp system … We've cleaned up the whole side of the chair and removed all the bolts and holes.”
This creates several benefits, he says. First, it simplifies servicing, which in turn, creates cost-effectiveness. Service, though vital, “is the most expensive thing for a provider,” Higley explains, “so if we can design a product so [a provider's employees] can be utilized more efficiently,” it reduces the costs associated with labor and service.
Second, simple designs allow engineers to design more aesthetically pleasing products, Higley says.
Motion Concepts' Peterson agrees. “A lot of tilt and recline hasn't changed that much in the last 10 years,” he says. “[The market] will evolve aesthetically. [Products] will look more attractive, but also give more function.”
Simplicity also drives another product trend, Higley says. Traditionally, a wheelchair or power base has shaped seating and positioning design. But, “we're also making power bases designed for seating systems,” integrating the chair's function and style into an existing seating and positioning system, complete with “power seat, full recline and tilt, and a low seat-to-floor height.”
Funding Challenges
Reimbursement cuts weigh heavy in the minds of many seating and positioning professionals. “I am hearing more people concerned about funding than I've heard in a long time,” Peterson says. “[With] the budgetary crisis in the states and the uncertainty around Medicare, manufacturers are less apt to introduce cutting-edge [products]. People are hesitant about the future of funding.”
“I'm not seeing the growth that I've seen in previous years,” says Phil Newell, rehab manager for NuTec Rehab, a division of Triquality. “The primary forces behind this are the reimbursement cuts.”
Funding pressures can force manufacturers to rethink production methods to contain costs, causing “us to do more with less, and change both our products and internal production methods,” says Adaptive Equipment's Gordon.
Product Design Group's Mundy says manufacturers are now taking an active role in educating funding officials, most of whom are “at least two times removed” from the realities rehab patients face every day. “I met with [California's Medicaid agency] MediCal to give a very generic presentation about why a person would need tilt,” he says. “We take every opportunity we can to talk to and educate funding sources.”
Such education can shed new light on what it means for a patient to be “truly independent,” Peterson adds. “Independence shouldn't be just independence in the home, but in the workplace and elsewhere.” If manufacturers convey this idea in the right way to funding sources, it can “change the way they look at things,” he says. “In the end, I don't think you can put a price on independence.”
There is an economic argument, too, says Fraser of Star Cushion. “Either [funding sources] pay now for prevention or they pay for repair,” he says. “The cost of repair of a cubitus [pressure] ulcer has skyrocketed. Taking away prevention will hurt the industry” and, in the end, cost payers more money.
Future Alliances
Despite funding challenges, few believe growth in the seating and positioning market will stop anytime soon, especially considering the country's aging population.
“We see the demographics as something you can't hide from,” says Invacare's Schlegel.
Watkins of Convaid points out that “birth rates are rising again, and medical advantages are keeping more premature and high-risk babies alive. Short- to medium-term, the outlook for the industry is for continued growth. The range of requirements for special needs children is so broad that there will always be a receptive market for … innovative and useful new products.”
To cope with these market forces in years to come, Adaptive Equipment's Gordon says the industry will see more consolidation and alliances to spread out expenses and lower delivery costs. Such alliances “will create a stronger presence without diluting individuality,” he feels.
According to Mundy, those alliances will make operations more efficient from the dealer's perspective. A decade ago, he says, “a power base would come from one company, a tilt mechanism from a second company and the seat and back from two other companies. From a dealer's point of view, it made for a lot of work.”
Alliances and collaboration allow for “sophisticated, one-stop shopping,” he adds.
“We are an industry where the needs are not going to change,” Peterson concludes. “Demand is always going to be there. It's inherent, funding be damned. The money's going to have to be found somewhere, because our society won't stand for it otherwise.”
Experts Interviewed:
Tom Borcherding, senior vice president, global medical sales, The Roho Group, Bellevue, Ill.; Kevin Fraser, president, Star Cushion Products, Freeburg, Ill.; Don Gordon, vice president, marketing, Adaptive Equipment Systems, Everett, Wash.; Scott Higley, vice president, sales, Quantum Rehab, a division of Pride Mobility Products, Exeter, Pa.; Phil Mundy, president, Product Design Group, Vancouver, B.C.; Phil Newell, rehab manager, NuTec Rehab, a division of Triquality, Sacramento, Calif.; Nancy Perlich, product development and reimbursement specialist, and Jackie Kaufenberg, marketing manager, Altimate Medical, Morton, Minn.; Brad Peterson, vice president of education, Motion Concepts, Tonawanda, N.Y.; Steve Schlegel, product manager, seating and positioning, Invacare, Elyria, Ohio; Brad Stern, national sales support, Supracor, San Jose, Calif.; Merv Watkins, president, Convaid, Torrance, Calif.; Randy Willett, director of medical, Cascade Designs/Varilite, Seattle, Wash. For more information on these companies, check HomeCare's annual Buyers' Guide.
Smart Staffing Is Key to Sales
To be successful in seating and positioning, industry experts say a company requires three kinds of people: a rehab specialist, a business-savvy marketer and an organized billing professional who can manage funding sources effectively.
“A rehab provider has to sell [its] expertise,” points out Brad Peterson, vice president of education, Motion Concepts. “A lot of rehab providers are [very] qualified and caring about what they do,” he says, but how well they market these qualifications will determine their success.
Beyond marketing, a dealer must retain expertise for the other end of a transaction: the paperwork and billing.
“This business is full of super clinicians who don't know squat about business,” says Don Gordon, vice president, Adaptive Equipment Systems. “They're great with the patient, but not … paperwork. The biggest thing a dealer can do to be successful is manage its funding sources. This benefits the end user and the provider.”
Gordon cites one successful business that lost its billing expert and didn't find an adequate replacement. “They delivered items, paperwork didn't get done and the money didn't come in for a year.” The business ultimately folded, he says.
Along with marketing and front-office sense, a rehab provider should be able to recognize all available technologies and how each will work for their clients, Peterson says. “I want somebody [who] knows as much as possible to fit me best for what I need. A qualified rehab provider can do that.”
“Seating is one of the most serious aspects of fitting someone for a chair,” says Scott Higley, vice president, sales for Quantum Rehab, a division of Pride Mobility Products. It takes more than a “femur and seat-width measurement. [Rehab professionals] must understand the capabilities and limitations of products they're using and apply them properly.”
Bottom line: Providers should not enter the seating and positioning market without the proper technical staff, says Phil Mundy, president, Product Design Group. Seating and positioning is “a sophisticated end of the DME business,” he says. “There's no point in getting involved without providing the full service.”
One overlooked market for seating and positioning is schools, says Jackie Kaufenberg, marketing manager for Altimate Medical. For this reason, the company published a small booklet, Pioneering Standing into Schools: A Rehab Technology Suppliers Guide for Selling in Schools. Schools, the booklet says, can generate referrals for future sales and can be a direct link to the end user.
