A women undergoing physical
therapy at Cleveland
Physical Therapy Associates
in North Carolina
therapy at Cleveland
Physical Therapy Associates
in North Carolina
DOTmed Industry Sector Report: Physical Therapy
July 01, 2009
by Keith Loria, Reporter
This report originally appeared in the June 2009 issue of DOTmed Business News
For more than 100 years, physical therapists have been dealing with assistive, adaptive, rehabilitative and analytical devices to help their patients. While the equipment has become more advanced both technically and physically, the basic concepts have stayed the same.
Since physical therapists deal with the entire body, there are a wide array of tools and equipment they can use - it all depends on what the PT is trying to accomplish and what he or she is comfortable with.
Rehab and fitness products continue to grow in popularity as companies as create products useful for treating a broad range of conditions. Standard equipment still remains the cornerstone of most physical therapy facilities, though technological and manufacturing improvements have helped upgrade even the most basic rehab and fitness products.
"Since so many physical therapists these days are leaving clinics or hospitals to go out on their own, the refurbished equipment market is huge for physical therapists," says Rob Rankin, president of Rankin Biomedical Corporation. "The savings realized can be 50% or more and of course, cost is of primary concern to most people."
This equipment ranges from basic items, such as tables and lifts, to more complex devices, such as testing and analysis systems. Modalities also require capital expenditures, and can include electrical stimulation, TENS, ultrasound, electromyography (EMG) equipment, biofeedback, paraffin, short-wave diathermy, infrared radiation, and hydro collator packs.
"I buy used refurbished PRE machines, free weight equipment and cardio equipment," says Don Miller, a physical therapist and owner of Cleveland Physical Therapy Associates in North Carolina. "I know owners of gyms and through them learned where to find the best deals on refurbished equipment. You have to be careful and know what to look for. Over the years, I have saved thousands of dollars."
With so much available, it's almost impossible to buy everything, so a PT must focus on the necessities. Tables and chairs tend to be purchased first, while more sophisticated technologies containing all the bells and whistles typically follow as volume and budget allow.
"Physical therapists can use second-hand gym equipment, traction tables, treatment beds, treatment modalities like ultrasound, biodex isokinetic units, aquatic treadmills, other cardiovascular equipment and small items like weights, BOSU's, wobble boards and really anything," says Kate McDonald, a physical therapist based in Atlanta. "Even office equipment such as computers, skeleton models and posters can be purchased on the used market as they are more expensive than you would think."
Economy Effects
While almost anything can be refurbished and sold as good as new, there are some products that are hard to come by.
"Locating quality late model used equipment is a problem," says Dawn Errigo, sales manager for ProMedixMD. "We have seen a decrease in business due to the economy and a lack of available equipment. I have the orders in hand, we just can't locate the equipment at a price that's profitable for us and is a discount for our customers."
The economy can also be blamed for a decrease in business for some, as a number of physical therapists have decided to hold off on buying anything new for the time being and are turning to other equipment in the case of a break down.
"With the current state of the economy, business has slowed but not stopped," Errigo says. "The first choice is to have their equipment repaired and if that fails, then purchasing quality refurbished equipment is the next economical solution."
James Hayward, owner/president of Hayward Medical, Inc., also mentions the rising cost of steel in manufacturing as a rising economic problem. Since most exercise equipment uses steel, it has seen a price increase in recent years.
Refurbishment Trends
Ultrasound therapy is another modality seeing consistent growth. While the market may generally be sluggish for this equipment, orders for refurbished and quality used ultrasounds are experiencing reasonable sales for physical therapy applications.
"We are seeing a lot more home therapy and pain care doctors popping up and buying this type of technology and adding to their rehab type atmosphere," says Randy Smedley president of Clinical Engineering Consultants, Inc. "They are adding more and more of the ultrasound technologies to their office and looking to buy used models."
Older systems are in demand because a doctor can save 40% to 60% compared to the cost of buying new ultrasound equipment.
"Ultrasound technology has not changed. Waves are waves and the method of application and delivery has not changed so as long as the units are remaining calibrated and are checked periodically, and the therapy criterion doesn't change, there is no reason not to go with a refurbished unit," Smedley says.
According to Michael Zanish, president of Pro Select Services, there are a number of physical therapy trends out there that have brought better opportunities to the refurbished market.
"Decompression therapy is new, though controversial," he says. "Lasers and SLDs are making inroads lately, but only a few brands seem to work well such as MicroLight and Medex, and Richmar."
Continuous PassiveMotion devices, which are used in the treatment protocol of applying slow, rhythmic and continuous movements to joints following joint surgery, are also popular equipment to refurbish.
"This segment is very popular with regards to customers either refurbishing and/or repairing equipment themselves or through us as manufacturers," says Mark Reep, president of KLC Services, Inc. "CPM equipment can be totally repaired or refurbished and made almost as good as new while still being capable of generating the same amount of revenue."
To properly maintain this type of equipment, physical therapists should take the time to become educated about very basic signs of equipment breakdown.
"Therapists should learn when certain pieces of equipment need routine service, repair, or replacement. This is not simply about dollars and cents of equipment maintenance-unsafe equipment can lead to serious accidents, which can require hospitalization," Reep says. "And then there's the possibility of onerous lawsuits. Be proactive and not reactive in dealing with equipment problems. Ultimately it will save money, time and frustration."
No matter what the equipment, the refurbishing process is generally similar according to Zanish.
"We run it through a full functional test to see how it works and assess everything. Look for cosmetic things and replace anything obvious that is cracked or that isn't working. We take everything apart and clean dust out of electronics and clean thoroughly. We do any maintenance required and go a little deeper and get an idea of the wear and tear on components," he says.
Senior Treatments Remain Strong
Continuing on a trend that has been growing over the past decade, physical therapists still report a growth in working with senior citizens as the ever-growing population of the over-60 crowd is prone to the chronic and debilitating conditions that require therapeutic services.
"PT's are seeing more senior citizens than ever before. A majority of our business is providing equipment, exercise equipment and supplies, exercise bikes, etc., for patients to be used at home after being discharged," says Hayward. "Many PT's are incorporating Nautilus type exercise equipment to be utilized in a membership based fitness center in their facility, especially equipment designed for senior citizens."
Consider these numbers: In 1990, 31.1 million Americans were 65 years of age or older. By 2020, the elderly population is projected to increase to 54 million persons. In 2050, the elderly population will number about 79 million.
The U.S. Department of Labor recently released projections showing that the job of physical therapists is expected to grow 27% over the next 10 years, largely because of the elderly sector. Since the baby-boom generation is entering the prime age for heart attacks and strokes, the demand for cardiac and physical rehabilitation will also increase.
"As we see aging baby boomers and their parents accelerate the graying of America, studies confirm that balance, strength, and cardiovascular fitness contribute greatly to the quality and duration of life," says Ed Kalotkin, a physical therapist in Palisades, NY. "Exercise by seniors can prevent osteoporosis, increase bone density and prevent adult diabetes."
Hayward adds that several vendors, such as Nautilus, HUR and Cateye are developing easier access to equipment so seniors and handicap patients can utilize more of the exercise equipment in the clinics.
Other growth areas for therapy are more clinical, such as gate training, partial amp and plank technology.
IT Advancements
The evolution of IT technology means more powerful, expansive tools as more companies are using the power of technology to provide physical therapists with highly advanced assessment methods, tools for pinpointing problems, and areas to focus on in training.
"Walking is an activity taken for granted, but it's the ultimate sign of independent mobility. Stroke survivors often face barriers to walking on their own and the trouble often derives from neurological and musculoskeletal problems affecting their gait and balance," says Maui Agoncillo, president of Morigon Technologies, which provides asset management programs to hospitals and health care facilities. "Motion analysis and capture is a technology formerly reserved for highly scientific studies, but increasingly, PTs are recognizing its power for stroke therapy."
Motion Analysis Corp. based in Santa Rosa, Calif., has built an industry reputation for leading the motion capture field, providing real-time optical motion capture systems for therapists, researchers, and even the movie industry. The Motion Analysis systems acquire, analyze, and display 3D motion data on patients as they walk. The resulting video and images can help PTs analyze gait and function, and determine appropriate next steps.
Final Thoughts
Physical therapy is a slow moving industry and improvements in technology seem to be in baby steps, making the used market a great place for physicians to get their equipment at a fraction of the cost.
"I do a lot of start-ups and independents and the used equipment can get them up and running," Zanish says. "There are a lot of strip malls with those who don't have a lot of capital and you can find plenty of the used equipment in good condition at a low cost."
It's important to remember, no matter what piece of equipment one is purchasing, the evaluation processes should take into account factors such as performance, reliability, and cost. The weight of each factor, however, will differ according to the buyer's priorities. The goal is to maximize value for the cost and the smart buyer will look at the total cost of ownership for any device, considering not only purchase price but also maintenance costs and expected impact on income.
DOTmed Registered Physical Therapy Equipment Sales & Service Companies
Names in boldface are Premium Listings.
Domestic
James Hayward, Hayward Medical, Inc., AL
DOTmed Certified
Amaury T. Agoncillo, Morigon Technologies, LLC, CA
Thomas Marr, Arrowhead Biomedical, GA
Travis Nipper, Clinical Engineering Consultants, Inc., KY
Rob Rankin, Rankin Biomedical Corporation, MI
DOTmed Certified
Asif Bhinder, tekyard, MN
Michael Zanish, Pro Select Services, MN
Thomas Zieser, JACE Systems, NJ
George Batchelor, Hausmann Industries, Inc., NJ
Edmund Kalotkin, Palisades Physical Therapy, NY
Mark Reep, KLC Services, Inc., OH
Dawn Errigo, ProMedixMD, PA
Louie Finco, CPM Sales & Service, Inc., WI
International
Neil Segal, Canadian Medical Products, Canada
For more than 100 years, physical therapists have been dealing with assistive, adaptive, rehabilitative and analytical devices to help their patients. While the equipment has become more advanced both technically and physically, the basic concepts have stayed the same.
Since physical therapists deal with the entire body, there are a wide array of tools and equipment they can use - it all depends on what the PT is trying to accomplish and what he or she is comfortable with.
Rehab and fitness products continue to grow in popularity as companies as create products useful for treating a broad range of conditions. Standard equipment still remains the cornerstone of most physical therapy facilities, though technological and manufacturing improvements have helped upgrade even the most basic rehab and fitness products.
"Since so many physical therapists these days are leaving clinics or hospitals to go out on their own, the refurbished equipment market is huge for physical therapists," says Rob Rankin, president of Rankin Biomedical Corporation. "The savings realized can be 50% or more and of course, cost is of primary concern to most people."
Dr. Kalotkin educating a patient
on the importance of proper
form during exercises at
Palisades Physical Therapy
on the importance of proper
form during exercises at
Palisades Physical Therapy
This equipment ranges from basic items, such as tables and lifts, to more complex devices, such as testing and analysis systems. Modalities also require capital expenditures, and can include electrical stimulation, TENS, ultrasound, electromyography (EMG) equipment, biofeedback, paraffin, short-wave diathermy, infrared radiation, and hydro collator packs.
"I buy used refurbished PRE machines, free weight equipment and cardio equipment," says Don Miller, a physical therapist and owner of Cleveland Physical Therapy Associates in North Carolina. "I know owners of gyms and through them learned where to find the best deals on refurbished equipment. You have to be careful and know what to look for. Over the years, I have saved thousands of dollars."
With so much available, it's almost impossible to buy everything, so a PT must focus on the necessities. Tables and chairs tend to be purchased first, while more sophisticated technologies containing all the bells and whistles typically follow as volume and budget allow.
"Physical therapists can use second-hand gym equipment, traction tables, treatment beds, treatment modalities like ultrasound, biodex isokinetic units, aquatic treadmills, other cardiovascular equipment and small items like weights, BOSU's, wobble boards and really anything," says Kate McDonald, a physical therapist based in Atlanta. "Even office equipment such as computers, skeleton models and posters can be purchased on the used market as they are more expensive than you would think."
Economy Effects
While almost anything can be refurbished and sold as good as new, there are some products that are hard to come by.
"Locating quality late model used equipment is a problem," says Dawn Errigo, sales manager for ProMedixMD. "We have seen a decrease in business due to the economy and a lack of available equipment. I have the orders in hand, we just can't locate the equipment at a price that's profitable for us and is a discount for our customers."
The economy can also be blamed for a decrease in business for some, as a number of physical therapists have decided to hold off on buying anything new for the time being and are turning to other equipment in the case of a break down.
"With the current state of the economy, business has slowed but not stopped," Errigo says. "The first choice is to have their equipment repaired and if that fails, then purchasing quality refurbished equipment is the next economical solution."
James Hayward, owner/president of Hayward Medical, Inc., also mentions the rising cost of steel in manufacturing as a rising economic problem. Since most exercise equipment uses steel, it has seen a price increase in recent years.
Refurbishment Trends
Ultrasound therapy is another modality seeing consistent growth. While the market may generally be sluggish for this equipment, orders for refurbished and quality used ultrasounds are experiencing reasonable sales for physical therapy applications.
"We are seeing a lot more home therapy and pain care doctors popping up and buying this type of technology and adding to their rehab type atmosphere," says Randy Smedley president of Clinical Engineering Consultants, Inc. "They are adding more and more of the ultrasound technologies to their office and looking to buy used models."
Older systems are in demand because a doctor can save 40% to 60% compared to the cost of buying new ultrasound equipment.
"Ultrasound technology has not changed. Waves are waves and the method of application and delivery has not changed so as long as the units are remaining calibrated and are checked periodically, and the therapy criterion doesn't change, there is no reason not to go with a refurbished unit," Smedley says.
According to Michael Zanish, president of Pro Select Services, there are a number of physical therapy trends out there that have brought better opportunities to the refurbished market.
"Decompression therapy is new, though controversial," he says. "Lasers and SLDs are making inroads lately, but only a few brands seem to work well such as MicroLight and Medex, and Richmar."
Continuous PassiveMotion devices, which are used in the treatment protocol of applying slow, rhythmic and continuous movements to joints following joint surgery, are also popular equipment to refurbish.
"This segment is very popular with regards to customers either refurbishing and/or repairing equipment themselves or through us as manufacturers," says Mark Reep, president of KLC Services, Inc. "CPM equipment can be totally repaired or refurbished and made almost as good as new while still being capable of generating the same amount of revenue."
To properly maintain this type of equipment, physical therapists should take the time to become educated about very basic signs of equipment breakdown.
"Therapists should learn when certain pieces of equipment need routine service, repair, or replacement. This is not simply about dollars and cents of equipment maintenance-unsafe equipment can lead to serious accidents, which can require hospitalization," Reep says. "And then there's the possibility of onerous lawsuits. Be proactive and not reactive in dealing with equipment problems. Ultimately it will save money, time and frustration."
No matter what the equipment, the refurbishing process is generally similar according to Zanish.
"We run it through a full functional test to see how it works and assess everything. Look for cosmetic things and replace anything obvious that is cracked or that isn't working. We take everything apart and clean dust out of electronics and clean thoroughly. We do any maintenance required and go a little deeper and get an idea of the wear and tear on components," he says.
Senior Treatments Remain Strong
Continuing on a trend that has been growing over the past decade, physical therapists still report a growth in working with senior citizens as the ever-growing population of the over-60 crowd is prone to the chronic and debilitating conditions that require therapeutic services.
"PT's are seeing more senior citizens than ever before. A majority of our business is providing equipment, exercise equipment and supplies, exercise bikes, etc., for patients to be used at home after being discharged," says Hayward. "Many PT's are incorporating Nautilus type exercise equipment to be utilized in a membership based fitness center in their facility, especially equipment designed for senior citizens."
Consider these numbers: In 1990, 31.1 million Americans were 65 years of age or older. By 2020, the elderly population is projected to increase to 54 million persons. In 2050, the elderly population will number about 79 million.
The U.S. Department of Labor recently released projections showing that the job of physical therapists is expected to grow 27% over the next 10 years, largely because of the elderly sector. Since the baby-boom generation is entering the prime age for heart attacks and strokes, the demand for cardiac and physical rehabilitation will also increase.
"As we see aging baby boomers and their parents accelerate the graying of America, studies confirm that balance, strength, and cardiovascular fitness contribute greatly to the quality and duration of life," says Ed Kalotkin, a physical therapist in Palisades, NY. "Exercise by seniors can prevent osteoporosis, increase bone density and prevent adult diabetes."
Hayward adds that several vendors, such as Nautilus, HUR and Cateye are developing easier access to equipment so seniors and handicap patients can utilize more of the exercise equipment in the clinics.
Other growth areas for therapy are more clinical, such as gate training, partial amp and plank technology.
IT Advancements
The evolution of IT technology means more powerful, expansive tools as more companies are using the power of technology to provide physical therapists with highly advanced assessment methods, tools for pinpointing problems, and areas to focus on in training.
"Walking is an activity taken for granted, but it's the ultimate sign of independent mobility. Stroke survivors often face barriers to walking on their own and the trouble often derives from neurological and musculoskeletal problems affecting their gait and balance," says Maui Agoncillo, president of Morigon Technologies, which provides asset management programs to hospitals and health care facilities. "Motion analysis and capture is a technology formerly reserved for highly scientific studies, but increasingly, PTs are recognizing its power for stroke therapy."
Motion Analysis Corp. based in Santa Rosa, Calif., has built an industry reputation for leading the motion capture field, providing real-time optical motion capture systems for therapists, researchers, and even the movie industry. The Motion Analysis systems acquire, analyze, and display 3D motion data on patients as they walk. The resulting video and images can help PTs analyze gait and function, and determine appropriate next steps.
Final Thoughts
Physical therapy is a slow moving industry and improvements in technology seem to be in baby steps, making the used market a great place for physicians to get their equipment at a fraction of the cost.
"I do a lot of start-ups and independents and the used equipment can get them up and running," Zanish says. "There are a lot of strip malls with those who don't have a lot of capital and you can find plenty of the used equipment in good condition at a low cost."
It's important to remember, no matter what piece of equipment one is purchasing, the evaluation processes should take into account factors such as performance, reliability, and cost. The weight of each factor, however, will differ according to the buyer's priorities. The goal is to maximize value for the cost and the smart buyer will look at the total cost of ownership for any device, considering not only purchase price but also maintenance costs and expected impact on income.
DOTmed Registered Physical Therapy Equipment Sales & Service Companies
Names in boldface are Premium Listings.
Domestic
James Hayward, Hayward Medical, Inc., AL
DOTmed Certified
Amaury T. Agoncillo, Morigon Technologies, LLC, CA
Thomas Marr, Arrowhead Biomedical, GA
Travis Nipper, Clinical Engineering Consultants, Inc., KY
Rob Rankin, Rankin Biomedical Corporation, MI
DOTmed Certified
Asif Bhinder, tekyard, MN
Michael Zanish, Pro Select Services, MN
Thomas Zieser, JACE Systems, NJ
George Batchelor, Hausmann Industries, Inc., NJ
Edmund Kalotkin, Palisades Physical Therapy, NY
Mark Reep, KLC Services, Inc., OH
Dawn Errigo, ProMedixMD, PA
Louie Finco, CPM Sales & Service, Inc., WI
International
Neil Segal, Canadian Medical Products, Canada