HME providers have long recognized the value in offering bariatric equipment to their home health care customers. After all, according to recent studies, the US adult obesity rate has doubled since 1980, and the number of morbidly obese people—those who are 100 pounds or more overweight—is also rising. According to a Rand Corp study, in 2000 about one in 80 men weighed more than 300 pounds, a 50% jump from the number of men that weighed more than 300 pounds in 1996.

But as obesity increases, some home bariatric equipment providers have found that there also is money to be made from renting and selling bariatric equipment to hospitals and nursing homes that are treating more and more plus-size patients.

Breaking Into the Niche
Because of the growing numbers of patients with co-morbidities related to obesity and the increasing popularity of gastric bypass surgery, hospitals that just a few years ago had one or two rooms equipped for bariatric patients are now devoting entire wings to them. Reflecting this trend, nursing homes are also experiencing greater numbers of admissions of obese patients, many of whom gain additional weight after being admitted.

However, up until recently, only large national medical equipment companies supplied bariatric equipment to hospitals and nursing homes. The equipment was simply too heavy and too costly for small HME dealers to easily maintain adequate inventories to satisfy the demands of hospitals and nursing homes. But as manufacturers began making bariatric equipment more affordable and less bulky, HME dealers began to recognize this growing niche.

Shortly after Columbus, Ohio-based American Medical Equipment (AME) opened its doors in 1993, it noticed the need for supplying bariatric equipment to health care providers, including hospitals, nursing homes, and assisted-living facilities. According to Tushar Shah, vice president of AME, the large national providers did not stop his company from entering this market because health care facilities recognized that, as a smaller, regional business, AME possessed many advantages.

“It didn’t take long for hospitals and nursing homes to realize that we were more suited to handle certain rehabilitation and patient-handling challenges than the traditional, national rental manufacturers,” Shah says. “These providers viewed us as a valuable asset for short-term equipment needs as well as for our experience and education in being able to clinically manage bariatric patients.”

AME’s success in working with this market has brought considerable growth to the company. It currently has 12 offices, servicing Ohio, Michigan, West Virginia, Virginia, Pennsylvania, Maryland, and Delaware.

Charles Blackburn, president of Blackburn’s Physicians Pharmacy in Tarentum, Pa, concurs that many smaller HME dealers succeed in this market by providing high-quality service above and beyond what the national companies offer.

“A smaller dealer in this business has to be able to offer fast deliveries of products,” he says. “There might be a patient admitted to an emergency department who needs a bariatric bed or wheelchair immediately, and you have to be able to deliver within a very short period of time.”

Working Outside the Home Market
Bariatric equipment suppliers who sell and rent to hospitals and nursing homes stress that it is important to offer a wide range of bariatric products—such as beds, support surfaces, wheelchairs, lifts, trapezes, commodes, walkers, and recliners—when courting the business of these health care institutions. Initially, health care facilities may be focused only on bariatric beds, Shah says. However, they soon start to seek comprehensive rehabilitation and safety equipment to both reduce injuries to hospital staff and improve the rehabilitation needs of the patient.

“We work with risk management committees at hospitals and evaluate where the injuries are occurring to their staff, particularly when they are caring for obese patients,” Shah says. “Our educational efforts have brought about a reduction in low-back strains that many staff experience when transferring obese patients.”

Bill Barr, cofounder of Sten-Barr Medical Inc in Tampa, Fla, a full-service medical equipment company, agrees that the education component is an invaluable service for hospitals and nursing homes. Sten-Barr offers a continuing education program with CEU credits for the clinical staff of hospitals and nursing homes. By participating in these programs, general nurses, enterostomal therapy nurses, physical therapists, occupational therapists, and other clinicians learn about safety issues associated with treating bariatric patients, as well as the latest information on treatment strategies and equipment needs.

“We even offer education programs for the administrators, since many are still unfamiliar about how to best serve these patients,” Barr says.

One Size Does Not Fit All
For dealers considering entering this market niche, Barr stresses the importance of recognizing that obese patients have different equipment needs. “One may need a lift, while another may need a transfer device, or a patient may be totally immobile while another patient may need to become active following a gastric bypass surgery,” he says.

Blackburn concurs that a key to success in this business is to offer a full range of bariatric equipment. “It can be a struggle for some smaller dealers to keep a full inventory, but if they want to be taken seriously by the larger hospital chains or nursing home companies, they must be able to supply a wide variety of equipment on very little notice,” he says.

Patience Required
Another challenge is that many hospitals and nursing homes are part of much larger parent organizations that often prefer signing contracts with larger medical equipment suppliers. As a result, it is often easier for local and regional dealers to market to small, suburban hospitals or nursing homes that are either independent or privately owned. Blackburn has experienced many challenges in working with large medical institutions and says that occasionally it might take 6 months or longer before closing a deal with a large hospital chain to supply bariatric equipment. Shah says his company’s sales staff may spend as long as a year or more with a hospital, providing consultative services, trial periods, and cost savings proposals, prior to signing the actual equipment rental or purchase agreement.

There are also significant fixed costs associated with offering a bariatric line to health care facilities. In addition to having the warehouse space to store inventory, trained staff is needed to deliver and set up the products. Unlike most home health care equipment that can be delivered by one individual, two people are often needed to deliver bariatric equipment. Furthermore, trucks with hydraulic lifts are also needed for transporting some equipment.

Buying vs Renting
Most dealers that supply bariatric equipment offer both rentals and sales. Blackburn notes that in the beginning, hospitals and nursing homes typically rented the equipment because of their size and cost; however, today he finds that many more institutions are purchasing the equipment due to the increase in bariatric admissions. Barr points out that despite growing numbers of obese patients, some providers still prefer renting the equipment in order to minimize their liability risk.

“Many of our customers prefer that we maintain the equipment by taking it back to our service center for regular cleanings and adjustments,” Barr says. He adds that some facilities also prefer to rent the equipment because there may be occasions when there are very few bariatric admissions. “Some just don’t want to store the equipment if it’s not needed,” he says.

For the most part, bariatric equipment dealers stress that marketing these products is relatively easy because of the high demand from health care providers. Most clinicians are also knowledgeable about bariatric equipment and appreciate working with suppliers to learn about the latest improvements in products. Yet despite progress in the development of this specialty niche, many dealers are quick to point out that obese patients in hospitals and other institutions are still not always receiving the equipment they need. Recent articles in The New York Times, The Wall Street Journal, and The Washington Times have reported on the nationwide shortage of appropriate equipment for the increasing number of obese patient admissions.

“The obese patient has been under-served in recent years, and we’ve been learning from our customers that the current product mix doesn’t always clearly fit the clinical application,” Shah says. “We are constantly working directly with manufacturers to design solutions to meet the needs of the bariatric population.”

Carol Daus is a contributing writer for Dealer/ Provider.