Problem Solvers

Serving the Bariatric Spectrum

How can providers offer a complete array of bariatric services?

Over the last 20 years, the prevalence of obesity in the United States has skyrocketed. According to the CDC, approximately 35.7 percent of adults and 17 percent of children are obese. And a string of studies published over the last year point to Americans reaching an obesity rate of 75 percent to 80 percent by 2020. With that will come a rise in the number of bariatric patients. Supportive findings from the November 2012 Bariatric Supplies Market Research reportpublished by Novation include:

  • 38 percent of responding facilities have seen a slight increase in admissions of morbidly obese patients in the last 18 months
  • 74 percent of the respondents have seen an increase in the number of bariatric surgeries over the last 18 months.
  • 61 percent of the respondents have seen an increase in the number of related reconstructive surgeries over the last 18 months.
  • 6 percent of the respondents indicate they offer bariatric programs specific for pediatric patients.
  • 60 percent of the respondents indicate the average age of pediatric patients is Under 12; 40 percent of the respondents indicate the average age of pediatric patients is 15 to 18.

This unfortunate situation has created the opportunity for providers to expandtheir business by selling additional products and services to bariatric patients.

“Any products and service that can assist the homecare patient can be profitable,” says Ron Resnick, President, Blue Chip Medical Products, Inc., and a former bariatric patient. “Due to competitive bidding, a lot of dealers are going to have to look at alternative sources of revenue. For bariatrics, whether it be in the long-term care market, acute care hospital or the Veterans Administration, there are a lot ofopportunities out there.”

Bariatric patients can suffer from multiple co-morbidities. This equates to multiple product needs that HME providers can offer. Resnick lists some of the co-morbidities of bariatric patients: pseudotumor cerebri; lower-limb circulatory stasis; ulcers; dermatitis; thrombophlebitis; reflux esophagitis; abdominal hernias: possibly,hypertension and nephrotic syndrome.

“These co-morbidities are physiological responses to obesity,” says Resnick. “Keeping the patients active, mobile and trying to increase their activities of daily living is the key. Alternating pressure has been shown to relieve skin pressure and possibly increased perfusion to wounds. Kinetic therapy has shown to help with theoxygen exchange.”

Resnick points out that there is a big opportunity in the long-term and acute care market. “Many long-termcare facilities do not want to take in bariatric patients due to the high cost of the products,” he says. “A homecare dealer can benefit by renting bariatric equipment and then possibly providing the service if and when the patient is discharged. The same goes for the acute care market, as well. There are additional opportunities for bariatricwheelchair sales targeted to airports, museums, colleges and universities.”

Parker Humphreys, CEO, HB Rehab Supplies, Inc., sells and rents bariatric products, which make up approximately 30 percent of his company’s revenue. HB Rehab Supplies concentrates on the long-term and acute care market versus homecare because he says reimbursement is better. He also services some private insurancebilling and workers comp patients.

Humphreys says that more people with ailments are coming out of their homes and joining the ranks of bariatric patients by going to nursing homes and hospitals for treatment. Therefore, Humphreys creates relationships with the discharge planners at the hospitals and nursing homes, as well as care plan nurses working for state Medicaid. He shows them products and services and lets them know that hiscompany can take care of their patients.

He believes that for providers to be successful in the bariatric sector, they have toconsider the quality of the products they are going to carry.

“One of the key things is carrying the better products,” he says. “Some of the products are big and you have to move them around a lot. Better products work better for bariatric patients. We’ve tried cheap products and they don’t work. Before long you have a service call and then you have to go out there in the middle of the night andyour cutting your revenue even more.”

For providers who want to sell to homecare patients, where Medicare or Medicaid is going to reimburse, Humphreys suggests talking to the state Medicaid office about the products and getting a good understanding about building a sustainable business model. He says that a lot of the nurses who are ordering products to the patients at home really don’t understand the costs and how hard it is to move the equipment. Humphreys also points out that additional services can be found by solving aproblem for the patients’ caregivers.

“We’ve provided patient transfer systems to hospitals and especially nursing homes,” says Humphreys. “A lot of people don’t want to take bariatric patients because they are scared of lifting them. They are scared that if the patient ends up on the floor, they are not going to be able to get them back up. There is a big workers comp issue with nurses trying to move these patients. A lot of times they are still trying to slide them using regular sheets. These transfer systems can allow you to take up to 1,000pounds and move the patient easily.”

Humphreys suggests that providers visit their local hospitals and nursing homes and see if transfer systems and similar products solve problems for the healthcarefacility.

Humphreys calls offering bariatric products and services “a growing industry.”

“There are still many people in the homes who nobody even knows about, people who haven’t left their homes in two or three years,” he says. “They aren’t using products; they are just coping with their situation until they get sick enough and they have to go to the hospital. It would be great if our government recognized what was goingon with these people.”

Resnick agrees: “The federal government needs to get serious because it’s not just the size of the equipment that should determine reimbursement, it’s the size, weightand clinical needs of the patient that should be the determining factor.”

Resnick provides is a list of common health conditions associated with bariatric patients a list of products that ailing bariatric patients may need during the course of their disease. Please note that many of these products can be used for many of the health conditions listed, depending on the stateand severity of the bariatric patient. Neither list intends to be complete.

Health conditions Products
Metabolic Syndrome
Type 2 diabetes
Hypertension
Dyslipidemia
Coronary heart disease
Osteoarthritis
Stroke
Depression
Non-alcoholic fatty liver disease
(NAFLD)
Infertility (women) and erectile dysfunction (men)
Gall bladder disease
Obstructive sleep apnea
Gastroesophageal reflux disease
Some cancers (endometrial, breast,
colon)
Asthma
Bariatric pressure redistribution support
surfaces and seating and positioning
systems
Oxygen
Nebulizers
Respiratory medications
Walkers
Commodes
Wheelchairs
Transfer lifts
Hover mats
Shower chairs
Grab bars
Incontinence pads
Wound dressing and supplies
Skin care products
BIPAP
CPAP

This article originally appeared in the April 2012 issue of HME Business.

About the Author

Joseph Duffy is a freelance writer and marketing consultant, and a regular contributor to HME Business and DME Pharmacy. He can be reached via e-mail at joe@prooferati.com.

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