Much attention has been given to the compression therapy market recently—most notably compression hosiery—because experts predict the market will grow exponentially in the next few years. Their reasoning is based on statistics that show one in three Americans over the age of 45 is affected by vein disease, and of those, only 4% are being treated.

This is most likely due to the unfortunate fact that vein disease is often ignored by both physicians and patients. With an estimated 20 to 25 million people suffering from some type of vein disorder, it is easy to see the market potential.

In addition to the vast target population, compression hosiery is seen as a lucrative cash market. Medicare, for the most part, does not cover hosiery, and many managed care plans are cutting back on hosiery benefits. As providers face imminent cutbacks in many areas due to new government legislation and diminished reimbursement from many MCOs and third-party payors, the quest to diversify their product mix has intensified. Many are shifting their emphasis from selling traditional home health products (that are insurance billable) to merchandise that is primarily private pay. Compression products often meet these criteria.

One reason that sales of compression hosiery are growing so rapidly is that there is an increased effort on behalf of manufacturers to raise consumer awareness. Many people suffer from venous disorders such as mild to moderate varicosities and edema, but rarely seek medical help. They have no idea that there are inexpensive products readily available that can help them effectively manage their condition, and prevent long-term, more serious problems. But when they see brochures featuring pictures of waitresses, schoolteachers, store clerks, and construction workers—people in professions that are highly susceptible to venous problems—they identify with them. This type of literature piques consumer interest and motivates people to help themselves by investing in compression stockings, or by seeking medical advice for more serious conditions.

Another factor in the rise of sales is physicians’ increased acceptance and use of medical compression hosiery as a viable and successful treatment option. Many clinical studies have proven the efficacy of using graduated compression stockings for treating and managing chronic venous and lymphatic diseases for which there is no known cure. In addition, cosmetic surgery is burgeoning in the United States, and sclerotherapy is becoming more and more commonplace. Many surgeons require their patients to wear compression panty hose immediately following the surgery, the length of wear time varying greatly by physician preference.

Lymphedema awareness has also had a significant impact on the increased use of compression stockings and arm sleeves. Although there are many compression therapy products used to treat lymphedema, hosiery remains the most popular method to maintain the results of other therapeutic modalities, such as manual lymphatic drainage, pumps, bandaging, or other compression devices. This is largely due to the fact that stockings and arm sleeves are relatively inexpensive, easy to apply, and are more cosmetically acceptable than bandaging.

Last, but not least, is the changing consumer perception of medical compression hosiery. It’s not the “grandma look” any more. Manufacturers have gone out of their way to change the image of compression stockings. Both the product and the marketing materials have changed. Packaging is now contemporary, featuring savvy, successful, and sexy images of men and women. The stockings have evolved into more cosmetically acceptable product.

In addition to a variety of styles, you will now find a vast array of color and fabric selections. There are sheer, opaque, and patterned fabrics; trouser, athletic, and casual socks; fashion panty hose and stockings; diabetic and sensitive feet socks; and silver ion therapy socks. Good selection is important because educated consumers and fashion-conscious Baby Boomers are demanding choices.

Knowledge and Success
It is important to differentiate between medical and over-the-counter compression hosiery. Medical compression hosiery exerts a graduated pressure against the leg to reduce venous distension, increase venous and lymphatic return, and prevent venous and lymphatic pooling and swelling. The pressure is greatest at the ankle and decreases gradually as it moves toward the heart, gently compressing the limb with gradient pressure and limiting the amount of swelling while maintaining the reduction achieved after other treatments. These products help control and prevent the progression of many chronic, recurrent disorders: blood clots, chronic venous insufficiency (CVI), deep vein thrombosis (DVT), edema, lymphedema, orthostatic hypotension, phlebitis, postsclerotherapy, post-thrombotic syndrome, thrombophlebitis, varicose veins, and venous ulcers. Medical compression hosiery is generally understood to provide 18 millimeters of mercury compression (mm Hg) or greater, is usually prescribed by a physician, and is covered by many insurance plans.

Hosiery below 18 mm Hg is used primarily as a preventive measure for potential venous-related problems, post-sclerotherapy, and tired, aching legs—in all, a population base that is virtually unlimited and largely untapped. Prescriptions are usually not required for this hosiery class. They are ideal for a retail environment, and are packaged for direct consumer purchase.

A typical customer would be someone whose job requires standing or sitting in one place for long periods of time. In either case, venous circulation is restricted, and mild swelling can result. These customers are often candidates for the higher, more therapeutic compression hosiery. Therefore, it is important that you work with them, determine their diagnosis, and help them select the most appropriate product.

The most important element in building a successful compression therapy business is education. Comprehensive workshops and seminars are hosted by the manufacturers, most offering continuing education credits. They teach the basic physiology of the circulatory system, and promote an understanding of the major diagnoses for which compression hosiery is used. Included is an overview of compression therapy garments, indications and contraindications for use, compression classes, and features and benefits. The courses also offer thorough instruction on proper measuring and fitting techniques, allow time for “hands on” training, and share suggestions for overcoming client objections. Keep your fitters abreast of new product technology by regularly inviting industry representatives to in-service your staff.

Fostering relationships with physicians and therapists is necessary for your success, but is contingent on gaining their trust and confidence. Position your company as experts in the field by promoting your qualifications—your training, experience, and certification. Become a resource for physicians by demonstrating your knowledge and understanding of venous diseases, your ability to accurately choose the most appropriate style of hosiery and compression, and your dedication to educating patients. Let physicians know that you always have their patients’ best interests in mind. Physicians want to work with providers who support them and make their jobs easier. If you keep their patients compliant and happy, then they are happy too. The goal is to build a long-term partnership that ensures continued referrals.

Customer service is paramount. Individual attention, custom measuring and fitting, and thorough instruction for the application, removal, and care of hosiery are the personal touches that will set you apart.

Have a liberal return policy. Most of the manufacturers have a satisfaction guarantee and will support you if you need to take back a pair of stockings from a dissatisfied customer. Always employ good listening skills to determine what the customers’ needs are, and to effectively resolve problems and overcome objections. It is important to offer options whenever possible, which allows the customer to make a choice instead of feeling powerless in the decision-making process. Providing product information and related educational materials helps reinforce your commitment to educating the consumer. These explanations and personal demonstrations will go a long way toward earning the customer’s trust, and will promote the customer’s understanding, acceptance, and compliance—all important steps to repeat sales.

The Right Inventory

The next step is maintaining a comprehensive inventory that allows you to meet the diverse needs of your customers. It is acceptable to have to special-order hosiery in nonstandard colors, but you should always maintain a full range of styles and sizes in stock to complete the fitting process in one visit. To inconvenience your customer as little as possible, offer to ship out products you do not routinely supply. No one manufacturer can meet the needs of every patient, so carrying multiple brands is ideal. But if that is not an option, at least be familiar with the competition, so you can special-order the products that will more accurately meet the needs of your more challenging customers.

If you plan to market compression therapy as a specialty field, you will need to be prepared to go beyond the ready-to-wear product lines. You will undoubtedly encounter customers with unique needs that will require custom-made hosiery and other specialty compression products.

Two growing areas that are currently underserved because of their problematic and complicated natures are the lymphedema and bariatric populations. Both of these groups present require special attention and advanced training.

“Bariatric” refers to obese patients who often require medical intervention, generally defined as patients in excess of 250 pounds. The bariatric population has grown dramatically in the last few decades. This population is often hesitant to seek help because they are embarrassed. The sheer size and disproportionate shape of their legs, and commonly occurring skin irritations, make measuring and fitting difficult. Physical challenges like diminished mobility, limited range of motion, and obstructed vision (not being able to see their legs due to their pendulous abdomens) create problems with application and removal. An extensive knowledge of custom hosiery measuring techniques, special adaptations and options, and the ability to think out of the box are helpful when working with bariatric patients. In short, there is no substitute for experience.

People suffering from lymphedema pose similar challenges. The swelling in the arms and legs can be extreme, is often disproportionate, and is, at times, fibrotic. Skin sensitivity is common, and occasionally there is pain and limited range of motion in the affected limb(s). Lymphedema management presents many complications for the fitter, and necessitates an open line of communication between the fitter, therapist, physician, and patient to coordinate care.

Lymphedema patients often become discouraged because treating and managing lymphedema can be frustrating and demanding. The results are slow in coming and hard to maintain without constant diligence. The fitter needs to be empathetic and patient, and have an advanced skill level to effectively help these patients. People who suffer from lymphedema are often anxious to try any and all treatment methods in their quest to reduce their swelling, so it is important that you are thoroughly trained in alternate treatment modalities, in addition to custom compression garments, if you plan on marketing a lymphedema program.

Being a full-service compression therapy provider makes you more indispensable to referral sources. In addition to measuring and fitting prefabricated and custom compression hosiery, you should consider supplying other related products such as compression bandaging, ulcer management supplies, compression pumps, limb containment compression devices, and in-elastic compression binders. Special accessories are also important—not just as essential aids to help the customer—but as add-on cash sales for your business. Many items will help boost your bottom line while benefiting the customer at the same time: lingerie bags, cold water wash, application aids, donner gloves, specialty creams and lotions, garter belts, and body adhesive are some examples.

To become a prominent player in the compression therapy field, you need to get the word out about your services. Develop a marketing strategy that will differentiate your company. One way is by marketing the niche within the niche—specialty services such as lymphedema and bariatric patient care. Remain flexible enough to adapt to changes in the environment.

There are many marketing strategies you can employ to gain exposure and increase public awareness. Use direct mailings or a company newsletter to introduce new products. Offer special sales or other buying incentives to remind customers of the limited product life expectancy, and emphasize the need to replace hosiery every 6 months to maintain optimal therapeutic benefit.

Attend local trade shows and exhibits for increased community exposure for your company and the products you sell. Offer to address lymphedema support groups, and in-service health care professionals with whom you would like to generate more referrals. Host an open house. Advertise in your local newspaper. Radio and cable TV ads can also be effective and are not necessarily cost prohibitive. Develop your own company brochure advertising the products and services you offer, highlighting your qualifications. Most important, teach your employees to sell.

Position the hosiery in your store to cross-sell with complementary products. Place it in a high traffic area. Use pictures and displays. Prominently exhibit product literature and educational resources, emphasizing your commitment to patient education.

As with any niche, the playing field soon becomes flooded and the competition more intense. The need to distinguish your company from the competition, and be regarded as a valuable resource to both patients and referral sources, is vital. In the end, it all comes down to education, experience, and exceptional customer service.

Cindy Ciardo, CO, is CEO of Knueppel HealthCare Services Inc, Milwaukee. She can be reached via email: clciardo@wi.rr.com.