Competitive bidding has annihilated profitability for many HME/DME providers in the bedding and support surfaces category. The program does not take into account the cost of service and delivery for providers who put beds out as rentals, says Cynthia Counts, Graham-Field’s vice president of home care sales and marketing. The most recent Round 2 reimbursement rates continue to show a decrease in the fee schedule, much to the detriment of providers. Lower rates may force providers to choose a lower-cost bed or support surface as opposed to evaluating product quality and the comfort of the user, says Counts. Alternatively, some providers are looking at specialty areas not impacted by competitive bidding and even cash sales from the growing popularity of adjustable beds. “Medical providers, especially those in retail, have the opportunity to show end users the quality of the product,” says Counts. “If we can change the focus from price, price, price to quality, comfort, quality, there is an opportunity to sell more beds and remain profitable.” Graham-Field designs and manufactures products in the United States, including beds and support surfaces. Continued investment in high-capacity, high-technology manufacturing systems ensures quality and innovative products to enhance providers’ ability to compete in the changing health care environment, says Counts. An example of innovation is the Patriot LX Home Care Semi-Electric Bed, whose grid deck provides mattress support that will not sag over time like a spring deck. The head and footboards have no moving parts, which reduces the number of components that would require routine service. The design offers home care providers a bed that is easier to deliver, set up and maintain, making the bed’s lifetime cost-in-use among the lowest in the industry. Counts also sees opportunities to up-sell on mattress selection versus only selling the low-end basic support surfaces available. “Sleep is a critical and very important part of the day, and there are many products on the market today that sell extremely well due to their promise for comfort during sleep,” says Counts. Providers should make options of support surfaces available in their stores for users to touch and feel, Counts suggests, and they should know the differences available and allow users to choose. “When it comes to sleep, most likely, the end user will pay to have the most enhanced sleeping experience,” she says.
Preventing Pressure Ulcers
Drive Medical offers both preventative and treatment pressure redistribution support surfaces to address pressure ulcers, according to Mitch Yoel, Drive Medical’s executive vice president of business development. Products include Group 1 surfaces (gel overlays, APPs and dry pressure mattresses), Group 2 surfaces with therapies such as True Low Air Loss, alternating pressure and non-powered self-adjusting technology and three full-line foam mattress series of Long Term Care preventative surfaces. Drive emphasizes its comprehensive and turn-key “Match the Product to the Patient” branding program. Product category reimbursement rates for DME providers were cut an average of 63 percent in Round 2 of competitive bidding and 47 percent in Round 1 Recompete. In response, Drive streamlined product feature offerings, but kept the clinically critical features to supply DME providers and their customers Group 2 surfaces that meet clinical needs while allowing providers to make a profit. The majority of patients who qualify for Medicare benefits for a semi-electric bed would most likely qualify for and benefit from a Group 1 support surface, says Yoel. Drive offers easy-to-read flowcharts and additional resources to assist DME providers in determining eligibility. Group 1 and Group 2 support surfaces fit hospital beds, but many can also be used on marital beds or even pull-out couches and lift chairs. Drive’s Masonair AS8800, a recommended go-to powered air mattress for HCPCS code E0277, is an affordable, combination alternating pressure and low-air-loss powered mattress (LAL/APM) replacement system. It is available in a standard hospital bed size, an 84-inch size to accommodate taller patients, and with raised side rails for enhanced safety and fall prevention. All three use the same pump, the AS8800 digital pump, whose microprocessing sensor technology means simpler operation (fewer phone calls to the DME) and better pressure redistribution. Sometimes the sickest homebound patients refuse to use a powered Group 2 support surface because they fear either a power failure or an increase to their electric bill. Drive now offers the Balanced Aire Non-Powered Self-Adjusting Group 2 (which fits HCPCS E0373—far less audited than E0277). The mattress offers comparable therapy and effectiveness of traditional LAL/APM mattress systems without relying on a pump, so it isn’t dependent on electricity and doesn’t increase a customer’s power bill. Yoel says DME providers sometimes follow Medicare rules and regulations related to support surfaces, even for payers that do not require it. He notes that when a non-Medicare insurance case manager is involved or a patient has a licensed clinician who will write a letter of medical necessity for them, support surfaces often get approved irrespective of Medicare guidelines. DME providers can sell support surfaces to help relieve or manage patients’ pain, too. Yoel says Drive’s support surfaces have been engineered to enhance patient comfort. For example, Drive’s LS9000’s powerful blower-based low air loss system also provides pulsation, which may help to control pain. Medicare does not cover support surfaces for pain, but other payers, and certainly hospices, cover support surfaces for pain relief, and many patients are willing to pay out-of-pocket for pain relief. Pain centers, head and neck physicians (neuro and orthopedic surgeons), physical and occupational therapists, hospice and palliative care agencies present potential opportunities to sell support surfaces beyond the usual support surface call points.
Assured Comfort offers customizable cash-sale beds, sometimes covered by private insurance.Products for Low- to High-Risk Patients
Referral sources for therapeutic support services are the same as those for other sectors of the HME/DME business—wheelchairs, beds, oxygen, etc. In addition, referrals also come from home health agencies and wound care facilities, according to Cali Thomson, business manager, therapeutic support surfaces, Invacare. Invacare offers a broad range of products for low to high risk patients for treatment and prevention of pressure ulcers, which are a serious health problem and a major financial burden to hospitals, nursing homes, Medicare, Medicaid and third-party payers. Cost estimates to treat one pressure ulcer can be quite high, says Thomson. Not only is there a financial cost, but pressure ulcers cause pain and suffering and can even lead to death. Avoiding pressure ulcer problems begins with prevention. Invacare’s microAIR MA55 mattress has alternating pressure plus on-demand low-air loss and includes a power outage safety feature. The mattress remains inflated as long as the air hose remains connected to the compressor, and it also has a 2-inch safety mat as an added feature to prevent patients from bottoming out. The product also has constant pressure monitoring. Sensor technology adjusts the pressure to regulate the air inside the mattress and maintain the pressure at or below 32mm/HG to avoid capillary occlusion.
The Rules Have Changed
Blue Chip Medical Products manufactures dynamic therapeutic support surfaces, and can custom-make products in their Suffern, N.Y., factory to any size and specification, whether it’s a gel overlay, a non-powered systems or custom foam products. Not all support surfaces use hospital beds, and Blue Chip Medical can customize surfaces to fit any size bed or a mattress that is powered on one side and not on the other side. Blue Chip Medical’s Airus A210 is a Group 3 air fluidized therapy bed for the home health care market. Air fluidized therapy redistributes pressure over the body contact area, significantly reducing tissue interface pressure and the forces of friction and shear. Air fluidized therapy is created by using a high flow of air, which diffuses microsphere beads to create a fluidized support surface allowing for proper immersion and an effective microclimate for the healing of pressure ulcers. The bed is applicable to the skin graft and wound care markets and has not been impacted by competitive bidding. Ron Resnick, president of Blue Chip Medical Products, says low Medicare reimbursements make it critical that providers look to expand their market and be more efficient, whether by embracing a specialized market, becoming a rental specialist, or looking for new referral or payer sources. “The rules have changed but the customer is still there,” says Resnick. “Dealers can succeed by learning a different set of marketing tools. We have helped dealers all over the country to navigate these shark-infested markets. We give you both patient care and profitability and act as your clinical liaison.” The daily or monthly rental model in the acute care or long-term care market can be an attractive alternative route for providers, Resnick says. Training and education can help providers become expert in specialized equipment, such as air fluidization, and distance themselves from a dependence on Medicare, he says.
New Sales Opportunities
Star Cushion Products offers pressure relief with its StarMat overlay, which consists of four large sections that fit together to go on an existing mattress. The non-powered system enables each section to be pumped up individually by hand, and an adjustable valve ensures the ideals level of immersion for various body sections. Multi-cell technology enables more exact adjustment of pressure compared to using larger air pockets, says Brandon Fraser, COO of Star Cushion. The StarMat replacement system is similar, but comes with a foam mattress and a cutout so that the mat does not add height to the bedding. The system is reimbursable using Code 0373 (Group 2). Star Cushion also provides customized products using the same technology in various sizes. “A lot of caregivers are familiar with this type of technology,” says Fraser.
Blue Chip Medical’s Airus air fluidized therapy bed is applicable to wound care markets not affected by competitive bidding.SleepSafe Beds create a safe sleeping environment for children, eliminating all areas of entrapment identified by the FDA and virtually eliminating pinch points and burrowing. The beds also offer an appealing design that avoids the hospital-room look, according to Al Flora, sales manager of SleepSafe and Assured Comfort beds. For pediatric patients, the beds provide parents and caregivers peace of mind that their children are safe. The beds may be covered by public or private insurance. A new extension now increases the safety rail height to 53 inches. The beds continue to evolve with new enhancements to adapt to the changing pediatric market. The company also offers Assured Comfort beds, which are similar except there are no sides or safety rails; the beds will adjust to a variety of home health care needs. Each Assured Comfort bed is customized—the customer chooses the head board and footboard (if desired), made of wood from Virginia forests, and among different types of mattresses. They can also choose whatever controls they need, including high-low control to make transfers easy and to enable the bed level to be raised to a convenient height for caregivers. Welded, aluminum and bolted bed frames—in a fixed foundation or with manual or electric adjustments—adapt to any mattress suitable for an adjustable bed, including memory foam and cooling gel-infused choices. Assured Comfort beds are cash-sale items, although they can sometimes be covered by workman’s comp, private insurance or disabled veterans groups.
Selling Adjustable Beds for Cash
Flex-A-Bed was one of the first adjustable beds in the United States in 1969. Each Flex-A-Bed is built by hand in the LaFayette, Ga., factory. In addition to head and food adjustments and massage options, Flex-A-Bed also offers high-low functionality that is especially attractive to HME clientele. Offering the same functionality as a hospital bed, the bed has a luxury appearance and can be lowered down to 19 inches from the floor, making wheelchair transfer easier. Raising the bed can provide a better working height for the caregiver. Flex-A-Bed is embracing changing market demands and just added a memory foam mattress infused with gel particles to help air circulation and provide a cooler surface. Consumer-oriented enhancements include a USB port to charge a smart phone or tablet, and new LED lights illuminating the underside of the bed make it easier for someone to get up at night. Flexible beds are desirable in post-surgery situations, offering luxury beyond an uncomfortable hospital-type bed but with similar functionality. The beds are also being embraced for lifestyle advantages in various markets. They are a cash sale opportunity for HME/DME providers looking for alternatives to low Medicare reimbursements. There is also untapped potential for sales among workman’s comp insurance companies, says Groce. Ben Groce, CFO of Flex-A-Bed says many people who come into DME stores looking for mobility or other products may not have considered an adjustable bed. The best, most successful dealers provide a floor model and a couple of different mattresses to choose from. The big players have spent millions paying for commercials to explain what an adjustable bed is, so there is already a lot of awareness of the product, Groce says. “Educate your staff on what the options and benefits are,” says Groce. “Adjustable beds are not just for the senior citizen crowd.” They can be for teens wanting to play video games or for someone who just came out of the hospital. Baby boomers who enter a DME store because of the needs of their aging parents might themselves be good customers for an adjustable bed.
Embracing Stealth Therapy
Transfer Master has been making adjustable bed solutions for 20 years, including twin, full and queen sizes with two to five functions, in standard and bariatric weight capacities and low-bed options. The one-stop custom manufacturer ships beds across the country, offering a home-style appearance rather than an institutional or medical look. The company sells beds for hospital postpartum wards and sleep labs, as well as through the HME/DME channel. Transfer Master’s new Supernal adjustable bed, going on the market in March 2014, looks like expensive furniture. All modular from the mattress to the bed frame, the Supernal provides stealth therapy. The mattress can be a therapeutic core covered with high-end wool and bamboo fabrics. Existing beds can be upgraded over time as an end user’s medical needs change—guard rails could be added or a vapor barrier to deal with incontinence. Anyone coming into a bedroom would not know it’s a medical bed. Fully loaded, the beds can sell for around $3,000 and be an attractive cash sale to any customer of lift chairs, for example. Given their medical market knowledge, HME/DMEs are well positioned to sell the new beds, which otherwise might be sold by high-end furniture stores, says Aaron Goldsmith, president of Transfer Master. “We’ve been to Medtrade 17 times, and this is the first time (in Orlando) that we were one of the busiest booths,” says Goldsmith. “We were jammed for two days with people seeing how comfortable and easy to operate the beds are. It shows how HMEs are starting to think about cash products.” Transfer Master offers catalogs, PDFs and a new kiosk system to help HMEs sell adjustable beds. “Many people sell lift chairs and don’t understand how much they can make on adjustable beds,” says Goldsmith. “We make it easy for a dealer to have minimal knowledge and still become a specialized supplier of customized beds.”
