Weighing In On Bariatrics
"Bariatrics has shifted from a fragmented marketplace of suppliers to big leaders in the marketplace, making bariatrics a main priority of their organizations. All of the big DME players have developed formal bariatric offerings that are more pronounced, with more choices, and at higher ranges. Years ago, a provider may have seen a smattering of choices from a variety of suppliers, all with different selections. DME manufacturers have fully recognized the business potential in bariatrics and are now finally catching up to the demand created by morbid and super morbidly obese clients." --Mike DiFranco, Invacare's product manager, bariatric division
The bariatric market has become a true specialty market. DME providers have to consider many factors before diving into the business. Do you have enough delivery personnel to deliver, transport and set up a bariatric bed? How will you display these products in your store? How many bariatric products will you keep in your on-hand inventory? Are you making sure your client has all the products he or she needs to treat co-morbidities? While providers have many questions to answer before entering this specialty market, manufacturers are busy answering questions of their own, mainly: How has the bariatric market shaped product development?
Weight capacities are increasing.
"The most obvious and apparent way the bariatric market is affecting DME is the weight requirements of the products," said Mike DiFranco, product manager of Invacare?s bariatric division. "The days of 300-lb rated DME products to satisfy the market are long gone, and we are in the era of 1,000-lb. capacity requirements. Just a few years ago, providers and manufacturers thought that 400-lb. rated products were good enough to cover the extreme bariatric patient cases, but as obese populations morphed into morbid and super morbid patient populations, the requirements have continued to escalate."
"With nearly every product we design and manufacture, we need to consider the needs of bariatric patients," said Dave Jacobs, president of Medline's DME division. "As a result, we more often look to increase the weight capacity of standard items and also more frequently and quickly develop bariatric versions."
According to DiFranco, "the growth rate of morbidly obese patients (more than 100 lbs. over ideal body weight) has quadrupled in the past decade. This is being called the epidemic within the epidemic, and manufacturers have felt those rates in the upsurge of requests for 500-lb.-plus products. It is alarming to think that what may have been the infrequent capacity request of 500 lbs. and over is now steadily becoming common."
Other manufacturers agree. "Hoveround has a new product that was designed for people who require a special power wheelchair due to their weight," said Diane McDonald, Hoveround Corp. marketing coordinator. "Our HD-7 power wheelchair is designed to carry up to 700 lbs. and still power around with ease. Prior to the development of the HD-7, our XHD power wheelchair carried weights up to 500 lbs. We found that we were having to turn away clients due to weight requirements and decided that we needed to manufacture a power wheelchair to accommodate their needs."
Manufacturers are factoring width into their product development more so than in the past.
"More and more, we are also considering width, not just weight capacity. That is why we have expanded the range of wheelchairs we offer," Jacobs said. "We now offer extra-wide wheelchairs with widths ranging from 20 inches to 30 inches. On our new bariatric rollator, we not only looked at the weight capacity, but paid special attention to the width of the seat since that has a significant impact on the comfort and dignity of the user."
Bariatric products need to reflect the unique needs of this client demographic.
"Bariatrics is also changing DME by challenging manufacturers like Invacare to look at the special needs of this new type (of) user," DiFranco said. "The applications of these products have gone beyond what they were original designed for. For example, a shower chair has historically been used by a geriatric patient who required stability and safety in a wet environment primarily because of arthritis, hip replacements and general frailty. Compare that to the morbidly obese patient who requires a shower chair because they have poor balance due to extreme weight, low muscularity and poor hygiene. Poor hygiene is a very real issue for the bariatric patient, and the thought of slipping in a bathtub or not fitting in the tub is enough to discourage regular bathing. Products will start to be designed beyond their original purpose and introduce features that assist with the limitations and challenges of the bariatric user."
Support Surfaces and Wound Care
Wound care expert Cynthia Fleck, MBA, BSN, RN, ET/WOCN, vice president of clinical marketing, Medline Industries, agrees that the bariatric client affects the development of overall DME. "There is a peer-reviewed article in July?s Ostomy/Wound Management about skin care issues in the obese population. You know the issues with DME, support surfaces, cushions, etc. and of course there are huge issues with lymphadema, venous hypertension, diabetes mellitus and its sequalae (foot ulcers, neuropathy, etc.) and poorly vascularized fat or adipose tissue."
Bariatric Beds
"The market for home care bariatric beds does not seem to be growing as fast as other product groups," DiFranco said. "Invacare is showing respectable growth in this category by expansion of our offering to now include a 1,000-lb. capacity bed. There is a very small market for users in this capacity range, but there is business to be captured. We also recognize that there is more attention paid to the care of bariatric patients at home. As such, the health care providers (home health/visiting nurse agencies) will continue to get the super morbidly obese patients off recliners or the floor and up onto the proper bed surfaces. The discovery of these forgotten patients that are tucked away from society is slow, and the demand for a bed product will be moderate."
A day in the life: Understanding bariatric clients is the key to advancing product technology.
This new user group is also forcing manufacturers to look at new product ideas that fall outside the confines of traditional DME product families. "There are many unarticulated needs that bariatric patients have that we must start to understand and process into new product concepts," DiFranco said. "We are just now scratching the surface of what the typical day entails for a bariatric patient. Invacare is investing in extensive research with those who treat these patients as well as observation of the bariatric patient's lifestyle to help spearhead next generation product breakthroughs. We truly look forward to this new frontier of product innovation for the bariatric client."
Bariatrics is unique in the cost and affordability of products.
This specialty market has challenged product development from point of cost and affordability. "There are two adversarial truths about these products and those who desperately need them. First, the products need to be physically larger, more robustly built and must possess new feature sets never seen before that cater to the everyday plights of the bariatric patient," DiFranco said. "A larger product with more material usually equates to a more expensive product that needs to be bought by Medicaid or Medicare patients who have limited incomes. This makes it that much more difficult to afford the DME they need to function and recover from their many comorbid conditions."
Five Tips for Bariatric Providers
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1. Take stock of the fastest moving items.
"I think most often DMEs need to consider keeping some stock of the fastest movers (wheelchairs and rollators) and items that someone might need right away if they were discharged from a hospital or nursing home (commodes, bath benches, crutches, etc.)," said Dave Jacobs, president of Medline's DME division.
2. Consider your options in inventory management.
For providers who do not have the capacity to keep many products on hand in their inventory, many manufacturers offer convenient shipping options. "An increasing number of HME providers recognize that companies like Medline stock these items all over the country in relatively large amounts. As a result, we have a lot of customers who use us as their warehouse," Jacobs said.
3. Offer more than products and solutions.
"I believe that all of the main DME manufacturers have effectively marketed themselves and their bariatric lines where HMEs are adequately aware of what is in the marketplace. Invacare chose a different approach to bariatrics by going beyond products and offering solutions from the very start -- solutions for every person, health care professional or business owner in bariatrics," said Mike DiFranco, Invacare's product manager, bariatric division.
Invacare offers solutions such as marketing kits for providers, a bariatric profit calculator, selection materials and catalogs, and educational information for consumers, therapists and providers on its Web site.
4. Educate the end-user and referral sources.
There is still a steep learning curve with consumer awareness on bariatric equipment. Bariatric clients are sometimes last in line to be introduced to the myriads of new products available for their diseases and co-morbidities, according to DiFranco. "The bariatric consumer will typically be introduced to bariatric equipment after they are hospitalized/discharged for an obesity-related condition of injury or after a home care nurse/therapist conducts a home evaluation. This is where the education and awareness begins, and also where the health care professional can increase the acceptance and usage of the equipment."
Jacobs said, "Generally consumers are not aware of all the bariatric options available today. They are not often displayed prominently in the showroom of an HME provider, and the referral sources are not as familiar with the availability of these products as they are the standard versions." Savvy providers are doing more to let their referral sources know about the availability of bariatric products across the spectrum.
5. Market to the end-user.
Advertising to the bariatric client directly and establishing brand preference first is an important marketing component. DiFranco said that advertising on television is an "effective advertisement vehicle."
Consumer News: Childhood Obesity
Results from a new Harris Interactive Health-Care Poll recently released found that a whopping 74 percent of parents or guardians of a child aged 12 and younger consider childhood obesity a "major problem" in the United States, up from 70 percent in 2005. The poll also shows "a strong majority of adults believe more physical activity is part of the solution," with 94 percent indicating "parents should lead by example by being physically active themselves and encouraging their children to be physically active."
Child health advocate Merilee Kern, CEO of HealthyKidsCatalog.com, notes that, "There's little doubt that childhood obesity is fast becoming a nationwide epidemic, and, as these poll results reveal, although caregivers are well aware of the problem, far too many don't have adequate information or resources to help inspire healthy lifestyle habits among children."
This article originally appeared in the July 2006 issue of HME Business.