Diabetes: Sweet opportunity

What do sleep science, bariatrics and diabetes have in common? Besides being the three hottest categories in HME today, they represent connected points on a clinical triangle. So it stands to reason that providers serving any of those markets should ideally be in all of them. Of the three, HME companies appear to be most reluctant about entering the diabetic market, probably because it requires a lot of clinical expertise and involves products like footwear that go outside the traditional provider comfort zone. But the makers of diabetic supplies say retailers have no reason to be intimidated--that with proper due diligence, prudent selection, a modest amount of training and a little courage, HME providers can situate themselves comfortably in this discipline. "Don't be afraid of this category," advised Cathy Pereira, manager of national accounts and government relations for Fort Lauderdale, Fla.-based Home Diagnostics. "The biggest challenge is knowing the rules, but there is a lot of opportunity for brick-and-mortar businesses since mail order is subject to competitive bidding." The diabetic market is diverse, to be sure, with a wide array of products and different levels of insurance coverage, as well as a host of cash-and-carry items. Blood glucose meters and test strips are the foundation of any diabetic supply business and Pereira notes that there are certain aspects providers must know in order to best serve patients while maintaining the bottom line. "Verse yourself on understanding how often a patient needs to test and to match the right meters and strips," she said. "Investigate products to see which ones are in your patients' best interests and watch your costs on these items because reimbursement is the same for all brands." Diabetic consumers are demanding less invasive testing methods and "manufacturers are working tirelessly to bring a better widget to the industry," Pereira said. While she doesn't foresee a totally non-invasive system being developed in the near future, many blood glucose monitors now allow patients to use alternatives to the finger stick, such as the ear lobe, upper arm, abdomen or leg. "We have been trying to come out with monitors that are smaller and faster and overall we've done phenomenally well in this area," Pereira said. "What providers need to know is how to identify which meter is best for each patient." Once firmly established with blood glucose meters, retailers can gradually add related products to their repertoire, such as lancets, alcohol pads, diabetic creams, diabetic candy, hosiery and footwear. Pereria cautions, however, to use restraint and control in growing inventory. "Diversify, but don't try to be everything to everybody," she said. "Think of it as a three-ring circus, with a high-end, mid-range and low-grade assortment." Stocking stuffer Compression hosiery is the next most logical product line for diabetic suppliers to carry after blood glucose meters and strips, vendors say, because many patients suffer from poor circulation that affects feet and legs. Tom Musone, director of marketing for Cuyahoga Falls, Ohio-based Juzo USA, reports that 50,000 to 80,000 diabetics each year amputate a toe, foot, or even a leg due to poor circulation. "It doesn't happen overnight, which is why early prevention is the key," he said. "The sooner patients can start proper foot management, the better." Red spots, cuts, swelling and blisters are all signs of potential leg and foot trauma, Musone said, which if untreated, can progress into serious ulcers. Compression stockings and diabetic footwear help alleviate these symptoms by stimulating blood flow. To stave off infection caused by bacteria and fungi development, Juzo's hosiery line uses a layer of fibers made with pure-grade silver. In order to bolster product sales, providers should create a consumer awareness campaign--ideally in conjunction with Diabetes Awareness Month in November, Musone said. The promotion should highlight the importance of proper leg and foot health, with direct tie-ins to compression hosiery and footwear, he said. If the shoe fits Expanding into the diabetic shoe business requires the most preparation, but it also can generate the most substantial return in the realm of diabetes products, said Jerry Klein, director of pedorthics for Teaneck, N.J.-based Aetrex Worldwide. "Medicare reimbursement for shoes and inserts is much better than for equipment and other supplies--that alone should be a great incentive," he said. "And therapeutic shoes don't fall under competitive bidding, which is a big plus." Depending on the degree of expertise a provider wants to attain, there are accreditation and certification programs for therapeutic shoe fitting through the American Board for Certification in Orthotics, Prosthetics & Pedorthics and the Board for Orthotist/Prosthetist Certification. The Internet has made the logistics of training a lot easier, with a good portion of certification training now available online. Moreover, Aetrex provides training on proper insert fitting so that personnel can shape moldings that precisely match the patient's foot, Klein said. Sell the triangle Diabetic supply dovetails perfectly with sleep medicine and bariatrics, offering providers a wide range of cross-selling opportunities, Pereira said. The key, she said, is to probe customers in order to learn about potential corresponding symptoms. "Understand that your primary CPAP, wound care, ostomy or bariatric clients can be diabetic as well," she said. "It is likely that 10% of your oxygen patients are diabetic. Ask them about it."