This report originally appeared in the December 2009 issue of DOTmed Business News

Hospital furniture may seem like a rudimentary subject, but a great deal of engineering goes into a lot of the furniture in today's modern hospitals. In an intensive care unit, for example, patients spend the majority of their stay in bed, making it not only the most important point of care, but in some cases, an equally important part of their treatment. As for physicians, radiologists, nurses and other health care workers, workstations and exam room furniture dictate the level of comfort and productivity built into their busy schedules.

Resting on intelligence

Among the major players of hospital bed manufacturing, Hill-Rom offers some very sophisticated technology. In Mary Butler's estimation, as vice president of Hill-Rom's North America Acute Care division, the hospital bed is an essential part of the care patients receive.

At the top of the manufacturer's specialty beds is the Hill-Rom TotalCare Connect, which features a host of technologies engineered to not only prevent wounds, but to promote skin healing, healthy lung function and proper body fluid states. It can also help prevent hospital-acquired infections and aid safe transfer of patients - designs imparted by health care professionals and researchers. In fact, Hill-Rom partners with universities and retains research and development facilities in the U.S., France and Singapore. Not only does the technology make sense for acute care situations, but it is also in line with preventing what the Centers for Medicare and Medicaid Services (CMS) refuses to pay for - preventable patient falls and pressure sores and other notorious "never events."

Hill-Rom's state-of-the-art acute care bed has microprocessors used to gauge and adjust the pressure settings within the mattress. "These microprocessors run a variety of functions on the bed," says Butler. "We've built in an algorithm based on weight distribution. About 40 percent of your weight is above the waist and 60 percent below; the bed adjusts for any changes in pressure. For example, as you raise the head of the bed you get their lungs draining properly, but by doing that, you are increasing the pressure in the feet and you need to adjust for that pressure. Similarly, the beds help position the knees to accommodate sequential compression."




Even the mattress fabric is sophisticated. Silver antimicrobial nanotechnology helps protect surfaces, while just underneath, air is flowing through a complex system of air bladders further preventing skin breakdown. The acute care beds are also heavier and accommodate a lot more peripheral equipment - for instance, a C-Arm can slide underneath the bed for in-room imaging. "With this design you have less of the arm lifts and a lot of things are moved out of the way, which creates a unique architecture," says Butler.

Plugging into health information technology

The next generation of beds will be even smarter, aspiring to the kind of data tracking and interoperability that has become all the rage with the electronic medical record (EMR) and other major Obama administration trends in health care. "The next horizon is focusing on data transmissions," says Butler.

In line with that strategy, another major manufacturer, Stryker, offers the InTouch Critical Care bed. "We view it as the smartest bed in the world," says Derick Elliott, director of marketing. The InTouch was originally launched in 2007, but Stryker came out with some impressive enhancements in May of 2008. "The latest component is connectivity. The bed can connect to EMR through Capsule and Cerner technology."

The bed interfaces with Capsule, a data integration technology, which is then routed to the Cerner EMR and other applications in order to reduce the amount of documentation that nurses and other health care workers must manually input when using functions on the bed during patient care. Data is also used to document compliance with hospital protocols. "The primary focus is open architecture," says Elliott. "We then take that data and share it liberally."

As with Hill-Rom's TotalCare, Styker's InTouch can help to prevent and heal skin wounds with weight distribution features and treat pulmonary complications with rotation and percussion therapies, which are mainly used to clear fluid from the lungs. Both Stryker's and Hill-Rom's beds come with repositioning assist presets that can be activated with the push of a button.

H1N1 may call for more beds

In addition to offering incredibly sophisticated technology on their newest models, major manufacturers also offer bed rental programs to hospitals, which may come in handy as they gear up to address the flu season. An unprepared health care center could find itself dealing with some significant bed shortages if a worst-case scenario were to occur, and since the "swine flu" strain of influenza is now considered pandemic, many hospitals are taking that as a cue to open triage centers in preparation for any possible outbreak.

However, Butler says this doesn't necessarily mean they'll be going out and purchasing brand new or even used beds.

"The sales cycle is a significant decision," says Butler. Capital budgets are still tight, and renting may just make the most sense for a lot of hospitals. "Rental of equipment, from beds to stretchers, has been a growing business segment of ours for quite some time."

Hill-Rom offers trade-in deals when hospitals purchase new equipment, and the manufacturer has also set up a reconditioning division. Butler says it's not a major part of the business they do, but it has been growing.

"We do offer reconditioning here locally," says Butler. "It's full-service reconditioning. We strip it down until it is just the skeleton and replace all of the parts and rebuild, rebuff and repaint it back to its original condition."

Older beds that may not be as viable back on the market are sometimes donated to charity. Hill-Rom recently replaced all of the beds in a hospital in the Yucatan and has other plans to refurbish or replace beds in developing countries.

"The beds we replaced were very old and very manual," says Butler. "Some of these were 25 or 30 years old."

Stryker also offers bed reconditioning. "It's a significantly growing part of our business - what we call the Stryker Certified Program," says Elliott. The manufacturer entered a logistics partnership with Universal Hospital Services in 2007 to advance that portion of their business.

Late vintage beds go around again

In the business of hospital furniture, the aftermarket for beds and exam room furniture appears to be steady, although many brokers and dealers say that the major bed manufacturers hold a captive market and limit the amount of used beds that can be purchased from hospitals for reconditioning and resale. Regardless, it remains a viable business for a number of refurbishers and dealers.

"We're as busy as we want to be," says Herbert (Herb) Wayne, manager of eMedicalSales, a nationwide refurbisher and reseller of hospital furniture based in Yankinville, NC.

International sales are becoming a stronger segement of eMedicalSales' business. Wayne says hospital beds and other furnishings are oftentimes shipped to Vietnam, South America or parts of the Middle East, including Lebanon.

"We've been doing a lot of overseas business," says Wayne. "The more the dollar falls, the more people want to buy from us. Our goods are becoming more attractive to outside markets."

Some of the items in highest demand include Stryker beds circa 1995 to 2007. For a 2007 model, Wayne says the price of a used bed can be 30 to 40 percent off new, depending upon the condition and warranty requested.

Wayne says another sector of the business that is picking up is bariatric furniture. "Bariatric beds are a trend that is going to continue because the American population is getting heavier. Other customers looking for customized mattresses will buy a basic model used bed and then go out and purchase a new mattress, which can cost $5,000-$7,000 in the case of those that come with rotation, vibration and percussion modules that work through the bed.

As for the swine flu scare, Wayne says, "hospitals are in limbo because they don't know what to do about the pandemic situation. The fear is they won't have enough bed space."

Some resellers are in the process of repositioning themselves to aid hospitals looking for extra beds when needed.

Captive market pressures

Wayne says hospitals are becoming increasingly shrewder about snatching up used inventory. "They seem to be more aggressive as the economy gets worse," he says. "Being a manufacturer, they will try to sell at any cost."

Piedmont Medical resells Hill-Rom, Midmark, Stryker and other manufacturers' beds and stretchers. Byron Wurdeman, president of Piedmont, has the biggest inventory of used beds in the country. Facilities include a 40,000 square foot facility in Dobson, N.C., and another 75,000 facility in Mount Airy, N.C. His customers are hospitals and surgery centers, nursing homes, schools, governments, and "anybody else who wants a bed."

Wurdeman says sales in the business have been down because original manufacturers are holding all the cards. "You could say it's because there is less inventory to come by," he says. "And just recently, the market changed again because the manufacturers are cutting out parts discounts. Resellers are getting pinched by the price of original manufacturers' parts; when manufacturers go up on their prices, you have to increase your prices, which may make you less competitive."

For Piedmont, the Hill-Rom 850 has been the mainstay of the industry because of its simplicity, reliability and ease of repair, but they are becoming increasingly more difficult to come by, and the fact that manufacturers now offer reconditioning only makes matters worse for resellers. "The manufacturer has the pick of the litter and they've got feet on the street," says Wurdeman. "They've got a rep or two going back to the hospitals to get those trade-ins. They can sort out what they want and crush the rest if they choose to."

Frugal in the exam room

Martin Enterprises, owned and operated by Jim Martin, is a government surplus resale company specializing in hospital furniture, including exam room tables and other products. Some of the major manufacturers of exam room furniture are Midmark Ritter, Hamilton Medical and Clinton Industries. Martin says he gets a lot of demand for the Triton DTS chiropractic tables and the electronic-lift Hamilton series exam room tables, which can go for around $1,500.

"The government surplus market is quite active," says Martin. "Some of the equipment is brand new and has been just sitting on the shelf or in storage."

The finest in working conditions

Patient furniture is only one aspect of this industry. Another growing market is high-tech and fully customized physician and radiologists' workstations. As Eileen Fine points out the features of AFC Industries' top-of-the-line workstations, it sounds more like she's talking about a Cadillac or Mercedes Benz. The College Point, N.Y., manufacturer's newest product, the Whitestone Workstation, is designed to make the physicians' or radiologists' working environment as comfortable and efficient as possible.




"The Whitestone Workstation is our high-end workstation - it's more like a radiology dream station," she says. "It features more advanced environmental controls, new monitor arms that supports up to 50 lbs, ambient lighting for dark room reading and pop-up data ports for ancillary computer equipment."

AFC has designed workstations that can electronically adjust the position of multiple monitors so that radiologists, PACS administrators and IT professionals can connect with all of their essential technology in whatever position works best for them. Radiologists are often standing more than they are sitting. Everything is ergonomically designed with reduced risk of injuries in mind. The Whitestone features push-button adjustment of work-surface height and tilt, independent adjustment of monitor platform height and focal length, and a digital readout of all these settings.

"It's a technology-centric world," she says. "With the advent of PACS and digital X-rays and the electronic health record, the fundamental driver of our workstation business has become the digital environment."

In addition to the Whitestone, AFC offers a wide variety of patient carts, wall mounts for patient wards and operating rooms, and other workstations in a wide array of shapes and sizes.

Future of furniture sales

Wurdeman foresees sales picking up as early as first quarter next year. "Everybody was locked down on their budgets last year, but people are coming back to their senses and the economy is starting to pick up again."

Whether buying state-of-the-art smart beds, luxury workstations, surplus exam room furniture or like-new reconditioned beds, the health care industry has a lot to choose from and should be well looked after in case bed shortages put hospitals in search of great deals.

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DOTmed Registered Hospital Furniture-Exam Room Equipment Sales & Service Companies
Names in boldface are Premium Listings.

Domestic
Laszlo Vecsey, Barlopex, Inc., FL
Hugh Bailey, HB Enterprises, LLC, FL
DOTmed Certified
Wes Solmos, Creative Foam Medical Systems, IN
DOTmed Certified
William Montgomery, Bed Techs, Inc., IN
DOTmed Certified
Asif Bhinder, tekyard, MN
Byron Wurdeman, Piedmont Medical, Inc., NC
DOTmed Certified
Ray Carter, Hospital Equipment 4U, NC
DOTmed Certified
Alison Fortin, Global Inventory Management LLC, NH
Gary Hill, Casco Manufacturing Solutions, OH
Dave Hill, A to Z Medical, Inc., OR
DOTmed Certified/100
Scott Minich, KMA Remarketing Corp., PA
DOTmed Certified
Ken Smith, Traco Medical, Inc., SD
DOTmed Certified
Nancy M. Mills, Mid-America Medical, TN
DOTmed Certified
Herbert Wayne, eMedicalSales.com, TX
Stephanie Aston, A&W Medical Supply, TX
James Martin, Martin Enterprises, WA
Ronald Shedivy, Great Lakes Surgical, WI
DOTmed Certified

International
Marwan Habbal, B.M.D., Lebanon

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