If there's one consistent message in mainstream media, it's that Americans are larger than ever before. According to the National Institutes of Health, approximately 34 percent of Americans are overweight and 27 percent are obese. There's no doubt that the number of people needing bariatric products and services is increasing, but are durable medical equipment providers (DMEs) prepared to meet those needs? What if you are new to the bariatric business and are wondering how to be prepared to be a bariatric dealer? What do you need to know?

Selling bariatric products is a specialized business; dealers need to learn about the products and understand how to support a total care plan for each bariatric client — whether a client is 500 lbs. or 1,000 lbs.

Dealers have to ask several questions to assess their preparedness. Do we have the necessary delivery trucks? Do we need a larger truck? How much store space do we need to showcase these products? Do we have enough inventory space? Are we willing to make the financial commitment necessary to get into the bariatric business? Do we have enough drivers to load and unload, set up and take down bariatric equipment and rental equipment?

Many bariatric clients are bedbound and therefore need support surfaces to prevent the development of decubitus ulcers or pressure sores.

Renae Dawley, sales and marketing associate who specializes in bariatric products at Blackburn's, a home medical equipment store in Erie, Pa., said the bariatric business is booming at her store and in affiliated stores near Pittsburgh and Buffalo. "We do a lot of business for customers weighing between 800 to 1,000 lbs.," she said.

"We also do a lot of rentals to nursing homes, but there also is a lot of bariatric business for home care. If dealers want to get into the business, it's a growing market but you have to be prepared," Dawley said. "There are different HCPCS codes for every item and the allowables are not all that great. You really have to watch your products and how much they cost because in this business, the bigger the product, the bigger the cost."

When it comes to preparation, Ron Resnick, president of Blue Chip Medical, said, "First of all, if dealers want to go into the bariatric business they have to be fully committed to it. You can't just go half way. Any dealer that really wants to be in this market and service this market has to have an array of products to fit the needs of the patient. If a dealer buys a true bariatric bed, say 48 inches, with a weight capacity of 1,000 lbs., these tend to be much more expensive. They have to make a financial investment."

Hill-Rom Hosts National Bariatric Conference April 27-28

Know How to Bill

Dawley asserts that dealers who are interested in entering the bariatric market must be willing to invest a lot of money into their bariatric inventory. She also recommends that dealers establish a relationship with a manufacturer to get the best pricing. "We buy a lot of our stuff from Invacare, so we get good pricing, but if you are just going to buy a bariatric bed here and there, it could be costly."

HHS and VA Target Diabetes and Obesity Among American Veterans

Resnick stressed the importance of establishing a long-term relationship with manufacturers.

"My father taught me to 'pick your fox hole partner very carefully,'" Resnick said. "In any business relationship you need to choose your referrals and business partners very carefully. Dealers should have a great working relationship with manufacturers. You have to do some creative investigation about your client base and have really good relationships with manufacturers. You have to have manufacturers who work with you and for you, not just ones that sell you a quality product.

"There are a lot of issues that are involved with bariatrics. We teach dealers how to bill for bariatrics, about other health issues related to the bariatric market such as caregiver issues, medical efficacy, outcomes and patient safety. Most dealers look for a manufacturer to give them the full support. Education is the most important thing we manufacturers can offer today in addition to a quality product," Resnick said.

Dave Jacobs, president of Medline's durable medical equipment division, said, "Bariatric products, by the nature of their size and durability, are manufactured using more raw materials and stronger materials thus making them more expensive. Dealers should educate themselves on the new HCPCS codes to be sure that they are being properly reimbursed."

Ensure You Have the Necessary Space

The size of the products can create an inventory problem if you aren't prepared to keep several 1,000-lb. beds on hand. Delivering products of such size and weight can be potentially costly because special equipment might be needed to load and unload these products and deliver products of this size to customers.

"It takes up a lot of room in your inventory," Dawley said. "If you don't have a warehouse that is big enough, you have a problem. Sometimes our driver has to leave bariatric beds in the van for a few days because we don't have any more room. And then the driver gets called for another delivery and what is he supposed to do with the bed in the van? It can be a problem. Make sure you have enough space to have bariatric products in stock."

Resnick said that dealers need to be prepared to provide quick turnaround service to clients and therefore dealers should never have just one bariatric bed on hand. Resnick also advises remembering that this type of product — due to its bulk, weight and size — will require a truck delivery with more than one person delivering it.

Market Prediction: Wellness and Obesity

Reach Out and Establish Referral Relationships

Establishing a referral system is another important component for a successful bariatric business. Dealers and manufacturers need to be closely connected with bariatric physicians and surgeons. While bariatric physicians have the medical expertise, they don't necessarily know all of the products that exist to help their patients and it's up to manufacturers and dealers to educate these referral sources. Offer free in-services to bariatric surgeons and staff as a way to build solid referral relationships.

Dawley said she heard of a new bariatric physician at a hospital in Erie, Pa., near her home medical equipment store and went to the hospital to introduce herself and her store. She suggested dealers do the same in their area and host an in-service to create a rewarding referral relationship. Now this bariatric surgeon recommends his clients to Blackburns for their bariatric needs.

"We get a lot of referrals from him. Try to make that contact in your area with a bariatric doctor or surgeon," she said.

While many physicians have a working knowledge of some of the bariatric products in the market, it can be helpful for dealers to ensure that area physicians are kept up to speed on any new technologies or bariatric products as they are developed. If physicians are aware of an entire product line available for their patients just a few miles away, they might be more likely to refer patients to that store or write additional prescriptions for that product.

Dawley recommends that dealers also establish referral relationships with area case managers, wound care specialists and nursing homes.

Resnick advises that dealers do a survey of their area and know the demographics — the percentage of bariatric patients — in the area near their store.

"If you are a dealer, do a little bit of work to make sure you have referral relationships, the local doctors or bariatric physicians in your area. You have to want to be committed to guarantee success in this business," Resnick said.

Medline Launches Bariatric Readiness Program

Understand Client Needs

  • Make sure clients have products with the appropriate weight capacity. Bariatric clients, due to their large size, tend to have great fluctuations in weight and may need a product with that type of flexibility built in. Meaning, a 550-lb. client might need a product with a 600-lb. weight capacity.
  • Follow-up with clients. For clients who decide on gastric bypass surgery, their product needs may change as they lose the weight.

"When they get discharged from the hospital, they may need a walker to help them get around, but as they lose more weight, maybe that client will switch to a cane. After awhile, the client might not need anything or maybe they need compression hosiery," Dawley said. Point is, if you have a good relationship with the client and stay in touch with that client from the initial product purchase, you can supply their product needs as those needs change.

  • Keep a full line of support surfaces in stock. Many bariatric clients are bedbound and therefore need support surfaces to prevent the development of decubitus ulcers or pressure sores. Bariatric clients also tend to have increased moisture and this can lead to decubitus ulcers as well. "We have bariatric wheelchairs, beds, Hoyer lifts, bathroom safety products such as commodes and shower chairs, bariatric walkers, heavy-duty crutches and canes, compression hosiery as well as wound care products," Dawley said.
  • Don't forget the caregiver. The caregiver of bariatric clients generally is at risk for back strain or injury. Suggest that the caregiver consider bariatric patient lifts to eliminate the risk.
  • Bariatric surgery patients need a lot of post-surgery support.
  • Gain a full understanding of reimbursement for bariatric clients.
  • Know the unique circumstances of the bariatric clientele. Overweight and obese people have an increased risk of a number of diseases compared with those of normal weight and waist circumference. Some of these diseases include hypertension, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis and sleep apnea. As a result of these co-morbidities, clients may need additional home medical equipment to support their individualized care plan.

"A general dealer should look at the bariatric market as a means to expand their business, and that requires some preparation and some specialization," Resnick said.

Medicare Expands National Coverage for Bariatric Surgery

Market Prediction: Wellness and Obesity

According to a report by PricewaterhouseCoopers Health Research Institute, consumers who pay for more of the direct cost of their health care have an increased incentive to manage their health and lifestyle. Poor diet and physical inactivity rose by 33 percent over the past decade and may soon overtake tobacco as the leading preventable causes of death in the United States. In 2006, expect a significant increase in voluntary and mandatory health promotion initiatives. In addition, health industries are likely to see a growing market for drugs, treatments and services oriented toward wellness and prevention.

Medicare Expands National Coverage for Bariatric Surgery

The Centers for Medicare and Medicaid Services (CMS) has announced that it is expanding coverage of bariatric surgery for all Medicare beneficiaries.

"Bariatric surgery is not the first option for obesity treatment, but when performed by expert surgeons it is an important option for some of our beneficiaries," said CMS administrator Mark B. McClellan, M.D., PhD. "While we want to see more evidence on the benefits and risks of this procedure, some centers have demonstrated high success rates, and we want to ensure access to the most up-to-date treatment alternatives for our beneficiaries."

CMS reviewed data and analysis that demonstrates that surgeons with more experience have the same outcomes for patients of all ages. CMS now covers open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding and laparoscopic biliopancreatic diversion with duodenal switch.

Because of a lack of success in weight loss programs, many people who are obese have turned to bariatric surgery at an increasing rate. When CMS evaluated the benefits of bariatric surgery in patients who have one or more diseases resulting from obesity, it found that the benefits of surgery are only seen in patients who have these additional problems. CMS denies coverage of the surgery for patients who are obese but don't have another disease such as cardiovascular disease or diabetes.

CMS will include a list of certified facilities for bariatric surgery on its Web site at

Hill-Rom Hosts National Bariatric Conference April 27-28

The Hill-Rom conferences will feature several experts on the subject of bariatric care including Dr. Joyce Black, president of the National Ulcer Advisory Panel; Tracy Owens, program director at Wittgrove Bariatric Center; Dr. Dominic Munafo Jr., medical director at Sleep Data Inc.; Dr. Alan Wittgrove, bariatric surgeon and former president of the American Society of Bariatric Surgery; and Walter Lindstrom, attorney at The Obesity Law and Advocacy Center. Continuing education credits are available for these conferences by visiting

Medline Launches Bariatric Readiness Program

To help home medical equipment providers prepare for a greater demand in bariatric products, Medline has a launched a Bariatric Readiness Assessment program.

According to Medline, its bariatric business has quadrupled over the last five years. In order to address the unique needs of bariatric clients, Medline's program provides a breakdown of areas and service points that dealers and facilities shouldn't overlook, such as accessibility issues.

"Dealers will certainly benefit from Medline's Bariatric Readiness Assessment Program," said Dave Jacobs, president of Medline's durable medical equipment division. Since dealers often supply hospitals and nursing homes with durable medical equipment, dealers can use the assessment as a tool to help their facilities better understand what areas of the facility should be updated to properly prepare for bariatric patients. Medline?s Bariatric Readiness Assessment provides essential guidelines and rules of thumb to guide hospitals. In addition, the assessment should help dealers create a checklist for the kind of bariatric items that they may need to stock or have quick access to.

Dealers can call their Medline representative or (800) MEDLINE to get Medline's Bariatric Readiness Assessment Program to guide them through the kind of products a hospital, nursing home and possibly a bariatric home care patient will need. "The assessment provides wonderful guidelines that will help dealers survey their own needs and be able to calculate the number of bariatric items they should have in stock or have readily accessible to them," Jacobs said.

HHS and VA Target Diabetes and Obesity Among American Veterans

With obesity and deadly diabetes at higher levels among America's veterans, the Department of Health and Human Services (HHS) and Department of Veterans Affairs (VA) announced a coordinated campaign to educate veterans and their families about ways to combat these health issues.

"Central to our goal of controlling the cost of heath care is the promotion of wellness, fitness and the prevention of chronic disease," HHS Secretary Mike Leavitt said. "We are working to encourage Americans to adopt healthy lifestyles and to take the responsibility for making wise choices to improve their fitness and health."

Veterans are nearly three times as likely as the general population to have diabetes, one of the major complications associated with being overweight. According to the National Institute of Diabetes and Digestive and Kidney Disease (part of the National Institutes of Health), 7 percent of the U.S. population has diabetes. Among veterans receiving VA health care, the rate is 20 percent.

"Inactive lifestyles and unhealthy eating habits can cause needless suffering for America's veterans," VA Secretary R. James Nicholson said. "Obesity and diabetes are major threats to the health and lifestyles of our veterans, who are deserving of a robust campaign to educate them on healthy habits."

The start of a campaign called "HealthierUS Veterans" is a multi-pronged educational effort to encourage healthy eating and physical activity among veterans, their families and members of their communities. VA medical centers will be the hubs of the program where they will promote nutrition and exercise with participating "Steps to a Healthier U.S." grantee organizations, throughout the country.

Overweight patients receiving VA health care may participate in weight loss programs tailored to their needs. They may also receive pedometers, diet advisories and prescriptions — suggestions on how much to walk — or, in the case of wheelchair users, how much to roll.

In May, the HealthierUS Veterans program will participate with the President's Council on Physical Fitness during the council's annual rally in Washington.

This article originally appeared in the April 2006 issue of HME Business.

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