Educating incontinence patients can reduce social isolation and allow them to lead more active lives.

The sale of products for the patient with urinary incontinence has risen dramatically over the last 20 years. According to the Agency for Health Care Policy and Research (AHCPR), Rockville, Md, sales of adult diapers alone were $173 million in 1982, rose to $496 million in 1987, exceeded $1.5 billion in 1996, and were projected to exceed $2 billion in 1999. Although these are the last AHCPR figures, the sales of products specific to the patient with urinary incontinence, appear to have continued to grow.

Favorable demographics likely are behind this trend. On average, people now live longer, more active lives. In addition, Baby Boomers are rapidly approaching age 60.

This is good news for HME providers. The typical patient with urinary incontinence spends approximately $1,000 to $3,000 annually on absorbent products, says AHCPR, and savvy HME providers have been quick to recognize the profit opportunities the increased sales in this product class represent.

The most profitable companies attribute their success to education. “We have to understand the whole picture to understand our part in the process and effectively service our patients,” says Keith Davies, president of Tidewater Medical Inc of Chesapeake, Va. “It is unrealistic to just stock and market incontinence products without being educated about the medical issues and misconceptions that surround urinary incontinence.”

AHCPR estimates that urinary incontinence affects more than 25 million Americans, but the actual figure is probably much higher because the social stigma associated with urinary incontinence causes it to be vastly underdiagnosed and underreported. Although the Agency estimates that 50% of elderly Americans suffer from urinary incontinence (85% are female), only one out of 12 subjects in one 1989 study reported the symptoms to a caregiver or health care provider, and those that reported incontinence did so on average 9 years after the onset of the problem.

The inconvenience and embarrassment often felt by people with urinary incontinence also may cause them to avoid social activities. Often, the fear of being too far away from a toilet makes them stop attending social events altogether, which can result in isolation.

“There are many myths about incontinence,” Davies says. “We strive to educate our patients on the causes of urinary incontinence and encourage them to talk to their doctor to determine causative factors and treatment options.”

For example, the myth that urinary incontinence is a normal and acceptable response to the ageing process is patently untrue. Urinary incontinence is pathologic. Risk factors vary, but include: pregnancy, childbirth, obesity, menopause, cigarette smoking, prostate enlargement and/or surgery, hysterectomy, radiation therapy to the pelvis, diabetes, Parkinson’s disease, back injury, cerebral vascular accident, dementia, neurologic impairment, and immobility.

Patients with urinary incontinence face additional medical risks that, while not life-threatening, are difficult to manage due to the causative factors. Urinary incontinent patients are more prone to pressure sores and sepsis. They may suffer repeated falls associated with nighttime urination and attempting to reach the bathroom quickly. Prolonged contact with urine may cause rashes and skin and urinary tract infections.

“Skin care and the prevention of skin breakdown are a significant part of our patient education program, as well as a very profitable portion of our overall incontinence sales,” Davies says.

Determining the correct urinary incontinence products to stock can be difficult. As sales of this product category grow, so do available products, and the old adage “you get what you pay for” has never been truer.

Research product availability carefully to determine those products that will both effectively meet patients’ needs and provide you with an acceptable profit margin. Never buy a product just because it is the least expensive. If the product quality is less than acceptable, your patients will switch to another company in droves.

Products available for the incontinent patient include both reusable and disposable supplies. Choosing the right product is a personal decision and the focus should be on meeting the patient’s absorbency needs. Occasional or light incontinence patients may obtain adequate protection using only a bladder control pad or shield. Patients who experience light to moderate incontinence may find the use of an absorbent guard acceptable. Those patients experiencing moderate to heavy or heavy/overnight incontinence will require an undergarment, protective underwear, or brief to obtain maximum absorption.

Additional considerations in product selection may include the product features and conveniences. Is cost a factor? Reusable products are quite popular, reduce frequency of purchases, and offer long-term savings for the patient. However, they are labor intensive as they must be washed and dried. Is ease of use (putting the garment on and taking it off) a factor? Is there a caregiver involved? Is the patient searching for a discreet product that will absorb the most? Does the patient prefer tapes, belts, pull-ups, etc? What are the size requirements and do these requirements limit product selection?

Fortunately, help is available. Incontinence product manufacturers have created marketing programs to aid providers—offering everything from free patient and physician educational literature to co-op advertising dollars. Frequently, manufacturers will offer HME providers product samples for patients to try out.

With manufacturer support, urinary incontinence products can be quite profitable. Most absorbent products are defined as “disposable” and are not routinely reimbursed by third-party payors. This means they are cash sales, and the reduction of costs generated by eliminating the claims filing and administrative processes, coupled with both competitive cost and retail margins, provides a lucrative opportunity. Retail HME companies recognize that often a patient would rather purchase these types of products in their facilities than stand in line at a grocery or discount store where friends and neighbors may see them. In addition, HME retailers afford the patient the best product selection and in-stock availability.

Finally, nursing homes present additional incontinence product sales opportunities. For nursing home administrators, purchasing from HME providers minimizes back order problems and assures them of prompt delivery and competitive pricing.

The sale of urinary incontinence products is a profitable arena that will continue to grow as the population ages. Understanding and meeting the needs of the patient with urinary incontinence provides a profitable and rewarding challenge.

Helen M. Farrell is a billing consultant in Chesapeake, Va.