Completing the Equation

Athritis and other rheumatic conditions currently affect nearly 43 million Americans or about one of every six people, according to the Centers for Disease Control (CDC). As the United States' population ages, arthritis is expected to affect 60 million people by 2020. The leading cause of disability in the United States, arthritis patients make up a large portion of the home accessibility market's customer base.

Arthritis is the leading cause of disability among adults 65 and older. As the baby boom generation reaches this age, the market for arthritis-related products will grow. According to the U.S. Census Bureau, one in five U.S. citizens will be elderly by 2030.

"We know for a fact that the market is growing based on the whole industry," said Bill Page, applications manager for Bruno Independent Living Aids, Oconomowoc, Wis. "It is growing for a few reasons: people are living longer, the baby boomers, which we are just at the start of for the next 20 years, and the amount of disposable income people have is much greater than before."

As more people with arthritis opt to stay at home, home medical equipment (HME) manufacturers specializing in home accessibility products are continually updating their existing product lines to meet the changing needs of their customers. Manufacturers offer stair lifts, ramps, vehicle and other products to assist individuals maintain an active lifestyle and independence.

"You have to have an evaluation of a customer and determine what they need," Page said.

The needs of the customers often need to be determined before the product is manufactured. Bruno Independent Living Aids customizes its products to meet the accessibility and mobility needs of end users.

"We manufacture our standard product line to a schedule, but the majority of orders are customized and are built after the order is placed," Page said.

Bruno makes battery-powered three- and four-wheeled scooters, automobile, truck and van lifts to transport scooters, wheelchairs and power chairs, and stair lifts. According to Page, 98 percent of its customer base is residential retail, and the products they need vary from person to person.

Each customer has different needs, and the needs of a single customer can change as his or her condition or physical environment changes. Not only do home accessibility products have to be tailored to meet individuals, they also have to tailored to meet different vehicles, different homes and different types of stairways.

Page said the type of stair lift would be different for a customer who has a standard staircase as opposed to the curved or spiral type. The vehicle lifts also vary depending on the type of vehicle a customer owns and the equipment that needs to be lifted - either a wheelchair or a scooter.

Some lifts are designed to lift the customer and the equipment, and other lifts can transport unoccupied equipment. Providers have to know their customers and keep abreast of their changing needs.

"We have to stay informed on the changing vehicle market," Page said.

Bruno is continually working to make improvements to its product lines using customer feedback. He said changes are also industry driven based on the new vehicles on the market.

"We are very reactive to what is happening out there both from a design standpoint of vehicles and all the wheelchairs and scooters out on the market. We have to react to what everyone else is doing," Page said.

Although a majority of patients include those with arthritis, those with birth defects or spinal cord injuries also make up the customer base for home accessibility products. Barrier Free Lifts Inc., Manassas, Va., offers patient transfer lifts for homes and institutions, including anyone who requires lifting and transferring help.

"Our clients have taught us to be a well oiled machine when it comes to service and changes in technology. They are the ones who use (the products), and they are the ones who give us the help," said Deborah Hensley, vice president of operations.

Manufacturers offer many products to help end users maintain independence. Unfortunately, many end users are not aware that these products exist.

According to Hensley, Barrier Free Lifts receives suggestions or changes from the Cerebral Palsy Association or from the Multiple Sclerosis Society, and those comments are collected, reviewed. The information is subsequently used to work with engineers on design changes. Using customer feedback for the development of new technology is essential, Hensley said.

"We review the information quarterly and given the need for changes, we make them based on the information from the field," Hensley said.

In addition to customer feedback, new technology drives improvements in product lines. Barrier Free Lifts developed a new system called the Intelligent Battery system that does not allow the battery usage to be depleted on lifts. All of its lifts are battery operated. An audible warning reminds the user to recharge the battery, but if the user does not it will automatically shut off to conserve the remaining battery life. In the event of a power outage, the lifts still work.

"This intelligent battery system protects caregivers and users from depleting their batteries and it keeps the system functioning," Hensley said.

In addition to adult patients, Barrier Free Lifts maintains an important pediatric product line.

"Children are a focus we have been honing in on for the last 4 years, developing lifting devices specifically for their needs and size," Hensley said.

Barrier Free's "Tonya Lift" can pick children off the floor and lift them as high as changing tables. It can also be broken down to fit into a car.

Access Industries, Grandview, Mo., manufactures stair lifts for straight, curved or spiral stairways. Evelyn Johnson, marketing manager said they are offering a new heavy duty stair lift that can hold up to 375 pounds.

Marketing

Manufacturers offer many products to help end users maintain independence. Unfortunately, many end users are not aware that these products exist. Some may do without, or rely on homemade devices to go over obstacles in or around their home. HME providers can offer a valuable service to educate their customers about available products and finding the ramps or lifts to meet their needs.

According to Johnson, Access works with a provider network of 800 members to market and sell its products. Johnson said Access Industries continually works with providers to give them with updated product information. Providers also attend a week of service school where they learn how to assemble or repair lifts. Bruno and Barrier Free Lifts also work with large provider networks to sell their products.

"We have an in-staff marketing department to help our dealers. Depending on what their budget is for marketing, they may need help putting an advertisement together. We also do co-op programs with our dealers and we customize it to what they need from us," Page said.

These companies maintain a database of all customers that is continually updated.

"Every customer goes into the client agency database," Hensley said. "Companies can utilize the database to follow-up on clients to see if they need any additional products in the future."

According to Miriam Lieber, a home medical equipment (HME) consultant, manufacturers of home accessibility products can market their products by taking a look at the type of patient who needs this equipment and separate the database by disease state.

Lieber said this is a good method for determining the needs of patients and what products fit those needs. For example, she said a patient with multiple sclerosis (MS) who lives in a multi-level house would need a stair lift. It is best not to cold call patients but to check up on existing customer and see if there are additional products or services they need to improve mobility or independence.

"The best way to market is to your existing customers and then sell in. Especially if they have a progressive disease state," Lieber said. "You keep track of them, and every 6 months you give them a call and ask them how they are doing."

A large part of advertising for these companies is referrals from other health care providers and from satisfied customers. Page said this is true for the stair lift market. Bruno may be working with a HME provider who is working with a customer, who was referred by a case manager or discharge planner. After a patient is referred, it is a matter of asking them the right questions to determine their needs, Page said.

"Once they sell them a scooter the next natural question is: 'Do you have a vehicle to transport it and have you considered an automobile lift to transport your equipment,'" Page said. "The key is to let those people who are giving recommendations to patients as they are being discharged know what products are out there. A good dealer will call on discharge planners."

Another method of marketing is to attend trade shows. There are trade shows that target the provider and those that target the end user. Some of the shows include: ability expos, specialty shows, National Association of Elevator Contractors, drivers education conventions, regional shows and the National Home Builders show.

Manufacturers set up demonstrations at HME shows like Medtrade. Page said setting up the demonstrations is easy, and providers may want to set up a demonstration lift in their showroom or at ability expos and other shows.

Installation

Home accessibility companies also work to make installation and repair a simple process. Bruno trains providers to install vehicle and stair lifts.

"Sometimes they have to contract out to a second party depending on what their abilities are, but the majority of the time the dealers handle it by themselves," Page said.

At Barrier Free Lifts, if a lifting device needs service, the company provides loaner lifts at no charge.

"We do not want people to be out of service," Hensley said.

Barrier Free Lifts also works with clients if the product is no longer needed. They assist the client in finding a purchaser, donating the product, or the company buys it back.

At Bruno products can be sold back to the provider when they are no longer needed and the resell value is determined by the amount of customization that occurred to the product. A standard stair well lift sold back to the provider will be used as a rental in the future, or it will be sold as used equipment, Page said.

Reimbursement

Stair and vehicle lifts are typically cash sales to the consumer because these are items not typically covered by insurance. This can challenge some providers because customers may not want to make an expensive purchase, but these barriers can be overcome.

"It is just one of those things that hasn't made it into the payment, like Medicare for example, or private insurance. Usually they don't have all the answers on why it is not covered, it is just one of those things that has just not made it on the list. We certainly feel it is something worth considering," Page said.

Bruno gives its providers various payment options depending on the end users financial situation. Through Bruno, providers can offer their customers payment plans, rental, leasing or straight buy-out.

According to Page, there is a wide price range for stair lifts depending on the type of stairway. He said they can range from $3,000 to $3,500 for a standard staircase and up to $15,000 for a curved or winding stair case. Stair lifts can be a relatively inexpensive alternative to moving to a one-floor house or nursing homes, Page said.

Lieber said Medicare does not cover stair lifts or ramps. Medicare looks for the functional impairment of the patient to correlate directly with the equipment, and this makes it difficult to get coverage for these items.

"Medicare will not cover these expenses unless there is a proof that you can connect it to a functional impairment that is going to prevent or retard a deterioration of some kind of body organ or a non-functioning body organ," Lieber said.

Lieber suggested that consumers be creative in finding methods to purchase home accessibility equipment. Lieber gave examples such as City of Hope foundation, other private charities, churches, as well as investigating private insurance. Page said some states or cities have funding plans reserved for their products. He said providers should keep abreast of this information and give it to their customers.

"There are creative resources, but you need to tap into your community," Lieber said. "Private insurance typically likes to follow the protocol of Medicare, but not always, so it is definitely worth investigating. It varies because every private insurance plan is different."

Hensley said Barrier Free lifts lobbies insurance-based case managers and state agencies on the benefits of lifts and reimbursement issues.

"It is a matter of having a continual education process for people to understand what the need is and what the savings will be," she said. "Our distributors have a person in their offices who is designated in assisting clients in capturing reimbursement; nationally we lobby with Medicare and state funding streams. I think we have made some progress because they have seen the savings both monetarily and health-wise."

In addition to private and public insurance funding, Bruno has a mobility program for its automobile lifts. If a customer purchases a vehicle from General Motors, Ford or Chrysler, these companies have a cash allowance available to adapt different equipment to their vehicles.

"We are approved from the three of them and that helps from a retail standpoint to defer some of the cost of the equipment," Page said.

Despite the dearth of reimbursement, providers should not be deterred from aggressively marketing and selling patient lifts. A large obstacle is education, and there is a large customer base available that simply may not know such products exist or what products they need. As baby boomers age and need mobility products, they will need products - like lifts - to help them maintain their active lifestyles and independence.

This article originally appeared in the May 2000 issue of HME Business.

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