The growing elderly population has been a boon to providers of specialty beds and support surfaces for bed-ridden people who run the risk of developing pressure sores. An analysis by the consulting firm Frost & Sullivan found that the specialty bed and support surfaces market for pressure management totaled $935.5 million in 2001 and is projected to reach $2,098 million by 2008.

As the number of obese individuals requiring special beds during hospitalization continues to rise, the sales of specialty beds for bariatric patients will also rise, making this a profitable area for many dealers.

Although experts in the field predict that there will be continued double-digit growth in this niche in years to come, dealers who are currently in this market stress that the specialized nature of these products poses certain challenges to providers. “This is not a market you want to enter into lightly if you do not have the expertise,” says Luciano Sbuttoni, director of the wound care program at Long Island-based Wound Care Management Inc, a division of New York Home Healthcare. “You have to employ individuals with the appropriate clinical background in wound care management and they must have knowledge about the various products that can help individuals who are bed-ridden.”

Product Overload?
It is because of the specialized nature of this market that New York Home Healthcare decided to launch Wound Care Management 2 years ago to focus entirely on customers who need specialty beds and support surfaces. A staff of 10 individuals, including a registered nurse/certified case manager, an enterostomal therapy (ET) nurse, service technicians, and marketing professionals, work together closely to determine exactly which products will prevent or minimize skin breakdown for a particular patient. Monthly phone calls and visits to the patients’ homes are also provided by the Wound Care Management team to ensure that the patients are getting the best results from the products.

Bill Saffron, a marketing consultant for RXM Healthcare & Services in Fort Lauderdale, Fla—which offers specialty beds and support surfaces—agrees that one of the difficulties of this market is that there is such an array of products from more than 70 manufacturers. The costs of these devices range from several hundred dollars to several thousand dollars. This plethora of products makes it extremely challenging to grasp which systems work with certain patients. “You are not going to give a bone cancer patient with a stage 3 decubitus ulcer the same product as a person with a stage 3 or stage 4 ulcer who just had myocutaneous flap surgery,” says Saffron, who has 20 years of experience in the specialty bed business. “There are different products for different diagnoses and that is why you cannot stock just one product and expect that it will work for everybody.”

RXM Healthcare has 12 employees involved solely in the specialty bed business. Saffron stresses that those working with support surfaces should be educated on the different modalities of therapy offered, such as alternating pressure, low air loss, high air loss, and kinetic therapy. “Most DME sales reps have some knowledge about hundreds of different products, but do not master the support surface area,” he says. Yet providing the wrong support surface for an individual, he notes, could be harmful and in some cases could even be life-threatening.

Good Listeners Needed
However, it takes more than just being knowledgeable about products to succeed in this market, says John Cassar, vice president of SuperCare in Industry, Calif. Strong communication skills are essential in working with patients, caregivers, physicians, case managers, and referral sources. “An employee needs to be a good listener when talking with patients and their caregivers to find out what product they need,” Cassar says. Each of SuperCare’s patient care coordinators involved in specialty beds and support surfaces has a list of questions for the patient that are based on the clinical requirements of a specific product. For example, the patient’s height, weight, ambulatory status, medications, existing skin breakdown, and transport capabilities are all noted in order to determine which products are most suitable. After the SuperCare employee obtains this information, the patient’s insurance status is determined and it may take several days before authorization is granted. “Once we have the documentation we need for our Medicare patients, it’s fairly easy to get approval on low air loss beds,” Cassar says.

Strong clinical support also is essential in the specialty beds and support surfaces market. SuperCare uses an integrated nursing team to perform patient evaluations, and the staff is trained to give home health organizations, insurance companies, and other agencies monthly updates and outcomes data. Cassar stresses that this type of reporting need not be expensive. “We have been able to provide our payors with positive results since our products have been linked to a reduction of bed days in homes and transitional care units,” he says.

Working with Payor Constraints
Most dealers in the specialty bed market have noticed an increasing demand for more functional, less expensive products as payors have curtailed spending for high-ticket items. “There are a lot of basic and less costly systems that are often preferable since they are easier for the caregivers to use,” Cassar says. “A bed may have a lot of bells and whistles but it still needs to be user-friendly for the caregiver.”

Although many dealers are backing away from high-end products, there are still many providers who feel more expensive systems need to be available for certain patients. Sbuttoni offers many of the same products he has provided for the past 12 years because they work well. “You really have to look at the entire picture when selecting a bed or support surface,” he says. “Cheaper products often break down and don’t allow for adjustments, which might be necessary for certain patients.”

In some cases, a person’s diagnosis dictates the need for a more expensive product. An example is an amputee who would benefit from a mattress with a blower motor so that continuous air pressure would support his or her weight. Less expensive alternating pressure products would not be as effective.

Saffron has also found that many of the lower-end products are less durable because they are made with cheaper goods and with overseas labor. “As long as there are dealers that are looking for a quick return on their investment, there will be manufacturers that will produce a cheap E0277 product that meets the minimum requirements for Medicare reimbursement,” Saffron says. “The problem is that even though these dealers think they are saving money, in the long run this will cost them more because they will usually have to replace the product at a later date because it failed.”

Educating Payors and Caregivers
Even though managed care companies tend to focus on cost containment, Saffron points out that small specialty dealers such as RXM Healthcare can succeed in winning contracts by selling insurers on the importance of providing high-quality products and services. RXM Healthcare received a contract with southern Florida’s largest HMO after the company’s service representatives visited the HMO and set up various equipment in the HMO’s conference room to show how the products would offer more aggressive therapy, which would end up costing less in the long run. “If one dealer is charging $14 a day for an air mattress and I’m charging $20, you might think that most payors would sign with the dealer offering the less expensive product,” he says. “But more payors are starting to recognize that all it takes is one case in which a patient goes from a stage 3 to stage 4 pressure ulcer and it ends up costing them a lot more in wound care dressings and other treatments.”

Educating referral sources and payors about the preventative aspects of some of these products can be an uphill battle. As Saffron explains, the proper bed or support surface is only one part of the equation in preventing and healing pressure sores. The other factor is the management of incontinence, nutrition, and mobility. “By introducing a good support surface to the equation, you have a greater chance of the wound healing or preventing further skin breakdown,” he says. “Yet it is amazing how many people think that just placing an air mattress underneath their patient will prevent or heal pressure sores.”

Sbuttoni estimates that teaching medical professionals about these products is 75% of what his company does each day. “We are constantly educating our referral sources,” he says.

Experts currently in the specialty bed and support surfaces industry believe the market will continue to increase as the geriatric population grows. Saffron predicts that the area within the niche that will experience the largest increase will be preventative mattresses, since financial health care gurus are realizing that prevention is cheaper than treatment. “It’s all about proving clinical efficacy,” he says. “If dealers want to go beyond just offering the Medicare Part B business and be known as providers to hospitals and nursing homes, they must maintain a strong dialogue with physicians and field nurses to show that they understand how patients can benefit from using their products.”

Carol Daus is a contributing writer for Dealer/Provider.