Precise tallies of the number of Americans meeting the criteria for severe and morbid obesity are elusive. Bariatric expert Kevin D. Huffman, DO, agrees with estimates that put the figure at about 170 million overweight or obese Americans. It is expected that about 160,000 such individuals will undergo stomach bypass surgery during the year ahead in a bid to shed their excess poundage (some 400,000 are projected to receive that same procedure in 2008).

These men and women—officially referred to as bariatric patients—will then spend a month or more recuperating at home from the surgery that intentionally leaves them with little or no appetite, and in prime position to begin rapid weight loss. In that time, they will require a variety of home care products, including beds, commodes, walkers, and wound care items.

Huffman, who is president of American Bariatric Consultants (ABC), St Cloud, Fla, says this is a perfect time for providers to become members of the bariatric care team. “The surgeon sends patients home without a cane or a walker,” says Huffman. “Not to criticize my colleagues, but they are often not concerned about what happens when patients get home. Providers can educate these doctors about the need for bariatric products.”

But what of the possibly millions of morbidly obese who possess neither the inclination nor the ability to arrange for stomach bypass surgery? They are likely to need home care products as well, for morbid obesity is a condition found with increasing—and disquieting—regularity among geriatric and disabled patients (a strong argument can be made that obesity is itself a disabling condition). The common thread is that these large patients who need home care products generally cannot use items meant for patients of normal size, and so must be provided products designed with massive girth in mind.

Several ways exist to define a bariatric patient. One is to apply the label to anyone weighing more than 300 pounds (approximately the place where the readout dial on most bathroom scales ends). Another is to embrace Medicare’s definition, which is 600 pounds or more. Yet another is to assign the mantle of bariatric just to those individuals who have undergone stomach bypass surgery.

Peggy Bland, owner of Power Chairs of Kentucky in Campbellsville, Ky, defines the bariatric patient as someone who is way oversized. Not overweight—oversized. Bland prefers the term “oversized” because it takes into account a person’s weight plus their height and rotundness. Says Bland, “A 6-foot-tall person weighing 350 pounds might be able to use a standard hospital bed, but a 350-pound person who is only 5 foot, 2 inches tall probably would not be able to because a standard bed is not going to be wide enough for someone of those proportions.”

Typically, providers who want to start serving the bariatric population can test the waters by stocking lower dollar items—personal care products such as bath safety and ambulatory aids. If that works out, then the sky’s the limit. However, it is recommended that newcomers focus on products related to their existing core business. For instance, if you are deep into respiratory, there is an entire range of bariatric-oriented respiratory products that would extend and complement your oxygen and mechanical ventilation lines.

Because bariatric patients vary dramatically in size from one to the next, products must be chosen with an eye toward adaptability, Bland contends. “In the bariatric market, one size does not fit all—especially when it comes to wheelchair seating and positioning,” she says. “There has to be lots of built-in capacity for making adjustments.”

Bland is careful to select just such products. But, occasionally, a user’s dimensions exceed the limits of easy product adjustability. When that happens, modifications must be made. “For one of my bariatric customers, we first had to weld onto his new power wheelchair a custom footrest after it became apparent that the version we had could not be extended far enough,” she says. But it was not as simple as that. Additional alterations had to be made elsewhere on the chair to compensate for the change in center of gravity brought on by the installation of the aftermarket footrest, an item with heft enough to bear the weight of the patient’s legs (roughly 250 pounds right there alone). Says Bland, “Any time we have to make modifications like that, we must do so in close consultation with the manufacturer to make sure we are not creating liability issues for ourselves.”

When it comes to purchasing bariatric products, Bland buys from just three vendors. These are sources she has determined offer the best goods and technical support for this niche. “My business is a small one; I can’t praise my vendors enough for the help they are giving me as I go about trying to be successful,” she says. “They are giving me the level of attention I would think other vendors give only to their biggest customers.”

Meanwhile, reimbursements for bariatric products are all over the map. The ones that are reimbursed well enough to yield a decent profit include walkers and beds. According to Bland, reimbursement for bariatric beds is roughly double that of standard beds (in her state of Kentucky, Medicaid pays nearly $3,000 more for one). Basically, payors reimburse better for the bariatric version of a product out of recognition that extra materials and parts go into their construction—one example: power wheelchairs, which can require twin motors and lots of heavy-duty reinforcement bracing.

By the opposite token, products that draw miserly reimbursements (if even that) are those that do not precisely fit the coding descriptions used by Medicare and other payors. A bariatric-specific drop-arm commode is a perfect illustration. It must be billed under a miscellaneous code (1399 in the case of Medicare). And, because of that, the claim is assured of receiving special scrutiny. Much time will pass before approval or (as is far more likely) rejection of the claim occurs. Even more time will go by if the denial is challenged. For mom-and-pop providers, such protraction can cause cash-flow problems enough to make them wish they had never offered the product in the first place.

Capacity Race
Right now, the bariatric market is still in a nascent stage. The main improvement to date involves weight capacity, and, indeed, manufacturers have been engaged in a sort of arms race to see who can roll out products bearing the highest capacity rating. This race got started in earnest about 2 years ago. First there were products rated to accommodate up to 500 pounds of weight. Then it was 600. Now it is up to 800 and 1,000. A motivator in this capacity race is the desire among providers for assurance that the product they buy is going to meet the requirements of every bariatric patient they are likely to encounter—even though they might see an 800-pound patient only once in an entire business lifetime.

Naturally, working with bariatric patients can be challenging. Provider staffs must in particular address their own aversion to close interaction with severely obese patients. “Many people are uncomfortable touching or even being near someone who weighs over 400 pounds,” says Bland. “They act like obesity is contagious. What you have to do is train your staff to remember at all times that, when they are helping bariatric patients, they are dealing with individuals who deserve respect.”

Bland estimates that sales and rentals of bariatric-oriented product account for 20% of her total business. She says it could become appreciably larger in the future. “Some of the gain is going to come from people who have allowed their condition to go untreated to the point that they are actually at the end stage of their life,” Bland shares. “I am saddened by that. But some of the gain also is going to come from people who have received a stomach bypass operation and will be losing a great deal of that dangerous weight. That I’m happy about, and I hope to see a lot more of that kind of business.” DP

Rich Smith is a contributing writer for Dealer/Provider.