Just a few days ago we referenced and commented on the changing face of the distribution channel in the homecare industry in the US and Europe.

In that article we highlighted by way of example Merits (a general homecare manufacturer) and Shoprider (predominantly a scooter manufacturer).

Kymco, a motor cycle manufacturer based out of Taiwan has now established Kymco Healthcare in the UK where they will now have a direct local presence - in fact they are busy recruiting a sales organization.

From OEM product introduction to direct in about 3 years or so. Not bad.

So what? Well it is just another example of where an OEM relationship established by healthcare companies that have shared their product and market expertize has led to a direct market entrance by the Asian manufacturer.

Innovate in the distribution channel or else.

It’s also about Asian sourcing, low barriers to product development and market entry - and who takes what and how much in the value chain.

Invacare has just announced (HME News) that they will no longer sell powerchairs to the Scooter Store. This follows last weeks announcement from the Scooterstore recommending that higher end rehab power chairs be included in the the (divisive - according to the majority of the industry) - national competitive bidding process (pdf download).

While the reason for the split from the Invacare perspective is related to their commitment to individual independent homecare dealers this is symptomatic of a much bigger issue.

What are the key factors…

The power wheelchair manufacturers (and others) have seen dramatic cuts in Medicare reimbursement in this category. Furthermore the new competitive bidding process is also sure to have a negative impact on margins. It also pits traditional manufacturers against the dealer distribution channel as to who and how will both parties participate in this new (coming -already here) environment.

In fact, everything that the major payers (reimbursement agencies, governments and de facto “consumers”) desire.

In order to deal with prices that continue to fall, the major manufacturers, started a few years ago, outsourcing heavily to Asia - as other industries have done when confronted with cost issues (or to increase their margins).

The issue for the manufacturers however is that they outsourced products with little or no intellectual property attached to them - only manufacturing know how. As one would expect, now that Asia has learned (with the help of the manufacturing industry) how to make rehab products - these same Asian companies are doing two things:

• Firstly they are establishing their own operations in the US and other markets. Some examples being Shoprider and Merits. Of course what these Asian companies have is products largely developed with the help of the US domestic manufacturers over the years - but what they still don’t have a great deal of is dealer and direct consumer customers.
• Still no big surprise - except that these (and several others) not only supply the traditional manufacturers with power chairs and other products, now have their own US direct operations, but they also supply national and / or large distributors with product, competing with the self same traditional manufacturers that essentially put them in business.

What’s next.

The competitive bidding process and the lines between manufacturer, importer, distributor and dealer are going to become increasingly blurred.

Companies like The Scooter Store, essentially breaking conventional ranks is a sign of things to came, not only in the US but also in other big rehab markets, like Germany - in fact its already started.

So, unless rehab “manufacturing” companies have IPOD (r) type patents and distributors of enhanced OEM rehab products have lifetime guaranteed customers - be ready for rapid change.

Or better yet be the change maker - and prosper.

Update January 28, 2007: Doug Harrison from the Scooter Store getting more isolated - maybe not. Lou Slangen from Invacare notes

“This is the most defining moment we’ve had in our industry on rehab products”.

Invacare and Scooter Store Heat Up Rhetoric - hmetoday

November 14 is World Diabetes Day

Go here to see how the world can join in in fighting this disease.

On 20 December 2006, the United Nations General Assembly passed Resolution 61/225. This landmark Resolution recognizes diabetes as a chronic, debilitating and costly disease associated with major complications that pose severe risks for families, countries and the entire world. It designates 14 November, the current World Diabetes Day, as a United Nations Day to be observed every year beginning in 2007.

Diabetes in Children and Adolescents

The theme of this year’s World Diabetes Day campaign is Diabetes in Children and Adolescents.Diabetes is one of the most common chronic diseases of childhood. It can strike children at any age, including pre-school children and even toddlers. Yet diabetes in children is often diagnosed late, when the child has diabetic ketoacidosis (DKA), or it is misdiagnosed completely. In many parts of the world, insulin, the main life-saving medication that children with diabetes need to survive, is not available (or is available but remains inaccessible for reasons of economy, geography or constraints on supply). As a consequence, many children die of diabetes, particularly in low and middle-income countries. Those closest to the child - family, school staff, family doctor - may not be aware of the ominous signs. The World Diabetes Day 2007 and 2008 campaigns set out to challenge this and firmly establish the message that ‘no child should die of diabetes’.

Governments have acknowledged that diabetes is increasing at epidemic rates and is affecting all countries. For the first time, a non-infectious disease has been seen as posing as serious a global health threat as infectious epidemics such as HIV/AIDS.

Update: If you are going to be in San Francisco be sure to go and visit Coit Tower. Read more about it at Diabetes Mine.

After all the trauma of the recent deep reimbursement cuts by Medicare, the Office of Inspector General in the United States has found that Medicare, in certain cases pays 35% to 45% more than internet advertised prices for certain power wheelchairs.

The industry is quick to protest and will argue “the higher bar” that Medicare providers have to attain accounts for the difference in cost.

Nevertheless - here is the recommendation of the Office of Inspector General.

RECOMMENDATION
We found that consumers could have purchased most power wheelchairs over the Internet at prices lower than the Medicare fee schedule amounts. We recommend that CMS: Consider performing additional reviews to determine whether the current Medicare power wheelchair fee schedule amounts for certain groups and procedure codes are appropriate.

And Medicare agrees:

AGENCY COMMENTS AND OFFICE OF INSPECTOR GENERAL
RESPONSE
CMS concurred with our recommendation. In addition, CMS noted that, in mid-2008, Medicare payment amounts for power wheelchairs in 10 large metropolitan statistical areas will be based on power wheelchair suppliers’ competitive bids. CMS further noted that it has the authority in future years to use payment information from the competitive bidding program to adjust payments in areas not included in the program. OIG work is continuing in this area. We plan to conduct further evaluations to compare Medicare fee schedule amounts to actual prices paid by suppliers.

The report goes on to estimate a total saving to Medicare and consumers of close to $40 million in the first quarter of 2007.

Again there will be a counter argument from the industry which will point to the extra regulatory and service hurdles that Medicare imposes.

The fact of the matter is that - pricing (and reimbursement) on Power mobility products is under strong review (again). CMS is looking to their newly established national competitive bidding process to lower prices - and it, together with other measures it will take, will again reduce the price of power wheelchairs to the government and consumers.

The full OIG (smallish pdf download) report can be found here.

Michael N. Cannizzaro has been hired as Vice Chairman, President, and Chief Executive Officer of Sunrise Medical. He is described as an executive with significant experience in successfully leading healthcare businesses, and will also join the company’s Board of Directors. His recent experience includes six years at J.W. Childs Associates, a Boston, MA private equity firm. Prior to that he was President and Chief Executive Officer of Beltone Electronics from 1998 until June 2000 when he sold the company to GN ReSound.

This comes shortly on the heels of the announcement by Sunrise to split its business into two parts - Sunrise Mobility and Devilbiss Healthcare.

“Jim Elrod, Managing Director at Vestar Capital Partners - the major Sunrise shareholder (who took Sunrise private in 2000) and is a major equity investor in Sunrise, commented, “Success in today’s healthcare environment requires a solid understanding of underlying clinical solutions, reimbursement, competitive dynamics, and the changing patterns of distribution. We are very pleased to attract someone with Mike Cannizzaro’s experience. Mike has the ability to build upon the solid foundation that Mike Hammes developed in creating highly attractive, focused businesses from the historical operations of Sunrise Medical.””

The full release is here

“Sunrise Medical Appoints Healthcare Industry Veteran as Vice Chairman, President, and Chief Executive Officer

Michael N. Cannizzaro to Lead the Newly Separated Sunrise Mobility and DeVilbiss Healthcare Units

[Read more →]

Topchair is a brand new powered wheelchair (and concept) that enables its drivers to easily be able to climb and descend stairs, steps and other obstacles - all of this in addition to having similar performance to an industry leading powered wheelchair on the road or at home.

After several years of development by French scientist and engineer Hervé le Masne, and following the completion of a significant clinical study amongst a representative user group, the powered wheelchair is now ready for commercialization.

In addition to its speed, maneuverability and performance on the ground, the Topchair automatically detects the first step while driving with infrared sensors and then goes on to detect the last step as it retracts its built in climbing mechanism.

In this video the driving performance and step climbing mechanism is shown:

Owner and inventor Hervé le Masne goes on to demonstrate the impressive mobility potential of the chair as he heads down the stairs at Trocadero in Paris, France on the way to the Eiffel tower.

Additional detailed information is available at the Topchair website in English or French.

Topchair has passed all the regulatory certifications in France and is available for sale to local consumers.

It will soon be made available in several other countries through the development of key partnerships.

Interested parties should contact Frank Barlin or Topchair for further information.

In a far reaching move to be ahead of the game in the new world order of NCB (National Competitive Bidding), reimbursement cuts worldwide and Asian competition - Sunrise Medical CEO Mike Hammes has announced a fundamental structural change.

As from July Sunrise Medical will split into two distinct organizations, Sunrise Mobility and Devilbiss Healthcare. Hammes while being overall group chairman will run Sunrise Mobility and Kees Regeling will run Devilbiss Medical as its President and CEO. The change is not purely superficial and customers will be required to order their products from the distinct responsible business.

In addition to the above the sales force of the specialty ART group will be combined with the Sunrise Mobility salesforce.

In an excellent communication package - including a video, Hammes outlines clearly the reason for change as well as admitting to not necessarily having all of the answers in this change process.