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  • DME pricing

    Prices of DME are almost laughable (from a consumer's point of view). OTOH, you don't see these companies in the "Fortune 100"!

    I've been trying to understand the factors that go into these prices -- with an eye towards maybe seeing if there are ways to avoid some of those issues.

    My short list, thus far:
    • the products aren't commodities (in the same sort of quantities that other commodities are)
    • there is a fair bit of "selling cost" (interacting with customer)
    • there is a fair bit of purchasing cost (interacting with insurers on behalf of customer)
    • there are subsidies in effect (which seem to drive up the price of whatever is subsidized)
    • they are physically large (more space on showroom floor)
    • they need to be "tried on" (can't just buy out of a catalog and return it if you don't like it, like a pair of pants)

    Anything else I should add? How do you suppose they "rank" in terms of their (increased) impact on prices?

    And, more importantly, how can these be minimized?

  • #2
    Suing for medical equipment problems is a huge cost.

    Comment


    • #3
      A lot of DME has relatively small consumer bases. It's hard to maintain a business selling low cost goods to relatively few people. People who start DME companies take real financial risks when they decide serve a small population and those risks command prices that provide commensurate profits. Without socializing the risks (e.g. using tax dollars) it's a hard ask to expect folks taking genuine risks, on our behalf, to realize lower profits. That's the basis of capitalism. If you can solve for that, I'd be duly impressed.

      Some of the online DME shops have done a decent job at lowering their own costs and risks to extend decent price reductions, but they're at the end of the supply chain. Solving for the issues you cite would require revamping the entire chain. (E.g. Developmemt and manufacturing risks play a big part it pricing as well.)
      "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

      "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

      "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

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      • #4
        Now I'm the first to admit I ain't bright!!!!!!
        But, around here big nation wide DMEs are buying up small and independent DME shops.
        IMHO, as well as uneducated thinking that means DMEs are going push products they get best price or rebate on to end user.
        I ain't smart enough to know anything but kinda reminds me of a monopoly and as a end user, what is that phrase from Big Bang Theory goes something like we "were attached to another object by an incline plane wrapped helically around an axis!".
        In other words it was fair to middling in most part unless you located a great DME dealing with local DME's. Throw national company in mix that down to like 2 players then that funnel gets smaller. If you use insurance either public, Medicare or private insurance still caught in catch 22 take it or buy out-of-pocket with knowledge you will also be completely on your own for repairs, parts as well as maintenance.

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        • #5
          Originally posted by baldfatdad View Post
          Suing for medical equipment problems is a huge cost.
          But that's a double-edged sword.

          You (as a consumer) want lawsuits to drive up the price of crappy products to make them less attractive in The Market. And, ultimately, to force the manufacturer/seller out of business.

          Substandard materials, workmanship, design errors, bad designs, etc. should be "punished".

          OTOH, "nuisance" lawsuits (which might be justified in the eyes of the individual filing the suit) just make everything more expensive for everyone else, "needlessly". (sometimes, "shit just happens" and it's not really the manufacturer's fault).

          Its above my paygrade to sort out how you differentiate between these two.

          Comment


          • #6
            Originally posted by Oddity View Post
            A lot of DME has relatively small consumer bases. It's hard to maintain a business selling low cost goods to relatively few people.
            Of course! That's what I meant by my "not a commodity" comment. This is further aggravated by the fact that the small population is even further divided -- one size doesn't fit all.

            People who start DME companies take real financial risks when they decide serve a small population and those risks command prices that provide commensurate profits. Without socializing the risks (e.g. using tax dollars) it's a hard ask to expect folks taking genuine risks, on our behalf, to realize lower profits. That's the basis of capitalism. If you can solve for that, I'd be duly impressed.
            The solution, of course, is to make the devices useful beyond the originally targeted Market/population -- make it more of a commodity.

            E.g., SMS is useful for "normal folks" -- and a blessing to The Deaf (who would find a voice-only telephone pretty useless -- hence their need for TDD and The Relay Service!)

            Likewise, voice recognition is a boon to a quad and "a cool feature" to other users.

            But, not all DME can be made "universally useful". Who would want to use a lift if they didn't need it? Or, a wheelchair (other than as an occasional novelty)?

            Some of the online DME shops have done a decent job at lowering their own costs and risks to extend decent price reductions, but they're at the end of the supply chain. Solving for the issues you cite would require revamping the entire chain. (E.g. Developmemt and manufacturing risks play a big part it pricing as well.)
            Yes, you can't just "tinker around the edges (or ends)"; you have to consider the entire process if you want to make truly meaningful/significant changes.

            Comment


            • #7
              Originally posted by MikeP2013 View Post
              Now I'm the first to admit I ain't bright!!!!!!
              OK, I'll type this slowly as I know you can't read fast!

              But, around here big nation wide DMEs are buying up small and independent DME shops.
              That's the way The Market works. Ideally, they can then exploit their SCALE to lower their prices to command more of a market share. Or, bring their greater resources to tackle issues that smaller firms couldn't address adequately. This is supposed to be A Good Thing.

              Of course, theory often differs from reality!

              IMHO, as well as uneducated thinking that means DMEs are going push products they get best price or rebate on to end user.
              And, the consumer will often be ignorant of those behind-the-scenes transactions. Like trying to get a price for replacing glass in your vehicle:
              "Do you have glass coverage?"
              "Why? Does the price change based on whether or not I have insurance??"
              (yes!)

              Comment


              • #8
                My insurance just bought me a Zx=1. Listed price from Spinergy is around 9995.00. On the sheet I signed was 22,000.00 billed with another line that said Expected reimbursement was a little over 4 grand. The salesman, whom I've known for years, said the 4 grand is what they expect to get from the insurance, Workmans' Comp. Why the overcharging to 22 grand and only getting 4400. for payment? That's 20% billed. Can someone explain. I don't pay any deductible.

                Comment


                • #9
                  Originally posted by Patrick Madsen View Post
                  My insurance just bought me a Zx=1. Listed price from Spinergy is around 9995.00. On the sheet I signed was 22,000.00 billed with another line that said Expected reimbursement was a little over 4 grand. The salesman, whom I've known for years, said the 4 grand is what they expect to get from the insurance, Workmans' Comp. Why the overcharging to 22 grand and only getting 4400. for payment? That's 20% billed. Can someone explain. I don't pay any deductible.
                  This sort of "creative pricing" seems to be commonplace throughout the Medical industry. E.g., doctor/hospital bills $400 for blood work -- then "accepts" the $7 (that's a seven, not seventy) dollars allowed by insurance. So, what's happening to the other $393?

                  I suspect (pure SWAG, there) that they can write the $393 off as a loss, of sorts (?).

                  As to your $22K -> $4K ... maybe the initial figure is deliberately inflated (and why isn't that called FRAUD??) on the assumption that it will be covered at a 20% rate (?)
                  [If so, why not inflate it to $50K and get the $9995 that they were originally expecting?]

                  Something obviously broken with The System when this sort of thing is tolerated/encouraged!

                  [Did you ask the supplier what their "cash" price would be, had you not had any insurance?]

                  Comment


                  • #10
                    Shit! I offered ca$h to my DME, when I got my (3rd chair in 23 years!) aluminum Medicare chair, for him to also order me a titanium frame of the same dimensions too. I have all the accoutrements to take from my 2005 chair that cracked and create a new (for me) Ti chair.
                    WTF! Wouldn't even quote q price!

                    Why can't I buy this??
                    69yo male T12 complete since 1995
                    NW NJ

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                    • #11
                      No, I didn't ask the supplier what cash price was because my insurance paid for this one. It's goetten to the point where one can't trust anyone regarding true prices now a days.

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                      • #12
                        Originally posted by automation View Post
                        This sort of "creative pricing" seems to be commonplace throughout the Medical industry. E.g., doctor/hospital bills $400 for blood work -- then "accepts" the $7 (that's a seven, not seventy) dollars allowed by insurance. So, what's happening to the other $393?

                        I suspect (pure SWAG, there) that they can write the $393 off as a loss, of sorts (?).

                        As to your $22K -> $4K ... maybe the initial figure is deliberately inflated (and why isn't that called FRAUD??) on the assumption that it will be covered at a 20% rate (?)
                        [If so, why not inflate it to $50K and get the $9995 that they were originally expecting?]

                        Something obviously broken with The System when this sort of thing is tolerated/encouraged!

                        [Did you ask the supplier what their "cash" price would be, had you not had any insurance?]
                        Write off any profit with these "losses" and pay little to no tax. And people get pissed at the Trump/Kushner real estate tax schemes while demanding that everyone support the medical industry schemers via "Obamacare", etc. Oh yeah, then there is the medical industry hobby of having their on-staff lawyers sue anyone into oblivion that has the misfortune to not be carrying insurance with an agreement to not be sued for the overcharges.

                        Comment


                        • #13
                          Originally posted by pfcs49 View Post
                          Shit! I offered ca$h to my DME, when I got my (3rd chair in 23 years!) aluminum Medicare chair, for him to also order me a titanium frame of the same dimensions too. I have all the accoutrements to take from my 2005 chair that cracked and create a new (for me) Ti chair.
                          WTF! Wouldn't even quote q price!

                          Why can't I buy this??
                          This is distressing. As a teenager, my vehicle was vandalized (side window broken to gain entry). I called local glass company looking to get the window replaced, ASAP (winter in New England is not the time of year you want to be driving around with an open window!).

                          The nice young lady wanted to know if I had glass coverage. "I don't know (I surely don't want to run around chasing down an insurance policy before I can arrange to have my window CLOSED!)"

                          She wouldn't give me a price. Exasperated, I finally said, "Which is cheaper: with or without insurance coverage?"

                          "Without."

                          "Great! Then I don't have coverage. Now, how much is it going to cost me?"

                          There needs to be an TENTH circle of Hell for these folks!

                          Comment


                          • #14
                            Originally posted by automation View Post
                            This is distressing. As a teenager, my vehicle was vandalized (side window broken to gain entry). I called local glass company looking to get the window replaced, ASAP (winter in New England is not the time of year you want to be driving around with an open window!).

                            The nice young lady wanted to know if I had glass coverage. "I don't know (I surely don't want to run around chasing down an insurance policy before I can arrange to have my window CLOSED!)"

                            She wouldn't give me a price. Exasperated, I finally said, "Which is cheaper: with or without insurance coverage?"

                            "Without."

                            "Great! Then I don't have coverage. Now, how much is it going to cost me?"

                            There needs to be an TENTH circle of Hell for these folks!
                            Took me a while but with help with big words I gots it all read up today!
                            Hear ya on window. Had been to dentist in middle of ice/snow storm a few winters back for a root canal.
                            Mama had tried to clear passenger front window by rolling it down. Well no one usually up tp passenger side in van hence window usually never opened. As soon as she hit power down button a pop and window fell in door frame.
                            Stopped first glass shop. Not fix unless replace motor and track that it comes in a complete unit at cost with install over $1,000. Plus it had to be ordered and be at least a week before they could get one from warehouse. I ask them to just get glass back in place and block it closed since we have no garage that a Sprinter SHR van will fit inside.
                            This shop said could not do that, it was not safe and insurance didn't cover that type of work. I told him not interested in insurance, just wanted closed so no snow piled up inside. BTW" We had glass replacement/repair on insurance but he never ask.

                            Second shop told guy up front not interested in anything but window blocked closed to keep weather out. He said no problem that in this weather he completely understood. He charged $25 and said he noticed while had door opened up that was just a piece of plastic that held track to arm on motor. He said he unplugged power to both passenger and driver side control buttons to prevent accidental accidents.
                            He ask if like him to look up cost of replacement of that part it needed so know when weather cleared up to get it fixed. He looked it up and seemed surprised could not get just that plastic roller connector but had buy whole unit including motor, but cost for whole unit with installed be $325.
                            Been a few years ago, still never got unit replaced. No one sits over there, so see no need for it.

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                            • #15
                              My independent DME just got bought up by National Seating and Mobility about 6 months ago.
                              Art

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