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Attachment for Manual Wheelchair that Converts to Powered Wheelchair

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    #46
    I think it's mostly sustainability. The number of people using an ultra-light manual wheelchair, who would also want some power assist, is a fraction of the ~300,000-350,000 people living with SCI in the US (less than 1/2 of those are paraplegic who are far less likely to already be using a fully powered chair). Sales volume alone isn't enough in this industry, IMO. Gotta price to make enough to sustain with relatively low volume of sales. On top of all the other price pressures, I think it's mostly necessity driving prices.

    (There certainly are other mobility related disabilities that drive people into wheelchairs, but I'd be surprised if the ultra-light wheelchair market serves them in great numbers.)







    Originally posted by ProPulse View Post
    Do you think that the crazy prices for the kits are simply to keep the bushiness afloat or taking advantage of a system where they know that they can charge high prices since that's what 'everyone does'? (by system I mean the healthcare system)
    "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

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      #47
      [Look at the history of DME businesses "struggling" -- despite "outrageous" (?) prices for the kit they sell.]

      Originally posted by ProPulse View Post
      Do you think that the crazy prices for the kits are simply to keep the bushiness afloat or taking advantage of a system where they know that they can charge high prices since that's what 'everyone does'? (by system I mean the healthcare system)
      Sorry, by "kit" I mean "equipment/stuff" -- not "kits that you can assemble".

      I don't think they're "getting rich" with the prices they charge. Rather, I think the COSTS of selling into this market are just considerably higher than "commodity products".

      Kurzweil's Reading Machine had a ~$50K price tag. Surely, the (direct!) parts+labor (DM+DL) didn't cost that much. But, very few sales. And, each sale required a PERSON to travel with the device (the size of a washing machine) to get it set up and running. SOMEONE had to pay for that travel, hotel, meals, etc.!

      Why are hearing aids so expensive? I can buy a whole TV for less than the price of ONE hearing aid! Surely there's a decent sales volume -- and the cost of manufacturing can't be that high. OTOH, I don't need any "fitting" or "tuning" or "after-sale-adjustments" when I buy a TV whereas the hearing aid has lots of that sort of "support" factored into the price of the sale. (someone has got to pay for that time)

      [This is the point I am trying to make; there's a lot of "overhead" associated with a sale that isn't present for "more mainstream" (whatever that means) products.]

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        #48
        Originally posted by ProPulse View Post
        @nonoise Do you think it would be better to have the joystick totally separated from the chair? By totally separated I mean, the joystick can come with a wheelchair mount where it is "stored". But during use, the user just holds the joystick in a single hand to control the chair(the joystick is relatively small). This would eliminate the disruption from any mounting arms that would have to be installed. The alternative is exactly what you said, a collapsible joystick mount with hinge or quick release. We could also include both as options and the user can choose what they prefer depending on convenience and motor skills.
        Options would be the best IMO. I'm not seeing how one would use a the joystick in a single hand unless it gets some kind of a mount. But one could hold it in one hand and operate it with the other. The main thing is that it is not in the way during transfers.
        I have had periodic paralysis all my life. I lost my ability to walk in 2011 beginning with a spinal block, which was used for a hip fracture caused by periodic paralysis.

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          #49
          Originally posted by Oddity View Post
          Sales volume alone isn't enough in this industry, IMO. Gotta price to make enough to sustain with relatively low volume of sales. On top of all the other price pressures, I think it's mostly necessity driving prices.
          It's not just the low volumes but, also, the higher costs associated with each sale.

          My other half just bought some instructional DVDs -- direct from the "author". I'm sure the author just burned the originals onto DVD-R media and printed labels on them. Then, stuffed them in a padded envelope and affixed "standard postage" to the envelope and the sale was complete. The author didn't have to answer any questions (everyone knows how to play a DVD; and the customer self-selects whether they want to "learn" about what's covered on THAT particular DVD). Author was free to check their web site for new orders whenever it was convenient for them (e.g., could do so after their regular 9-to-5!). No phone calls to handle, etc.

          So, it's easy to figure out what your costs are in such a business and what your selling price needs to be to remain profitable. The only wild card is if something gets lost (or damaged) in the mail.Most DME isn't that cut and dry. There's more hand-holding, questions to be answered, options available, paperwork to handle, variable delivery costs, repairs, warranty replacements, etc.

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            #50
            Originally posted by nonoise View Post
            Options would be the best IMO. I'm not seeing how one would use a the joystick in a single hand unless it gets some kind of a mount. But one could hold it in one hand and operate it with the other. The main thing is that it is not in the way during transfers.
            There are small joysticks (as well as trackballs) that you wear like a "ring" (on your finger) and actuate with your thumb. Check some of the links I posted, up-thread.


            If it's wireless, you just set it down "someplace convenient" (and, can then use it to remotely drive the chair to a "parking place" while not in use)

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              #51
              Originally posted by automation View Post
              There are small joysticks (as well as trackballs) that you wear like a "ring" (on your finger) and actuate with your thumb. Check some of the links I posted, up-thread...
              I saw them and they may work *if* the joystick is tall (long) enough, which is especially questionable in the thumb example. In simple terms to try to explain, the joystick becomes gas pedal and steering wheel. It seems to me I would need better stability and finer tuning. Full power chairs are set up the way they are for a reason.
              Last edited by nonoise; 4 Apr 2019, 2:57 AM.
              I have had periodic paralysis all my life. I lost my ability to walk in 2011 beginning with a spinal block, which was used for a hip fracture caused by periodic paralysis.

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                #52
                Originally posted by nonoise View Post
                I saw them and they may work *if* the joystick is tall (long) enough, which is especially questionable in the thumb example.
                The "thumb example" is intended to be operated BY the thumb -- i.e., one-handed.







                [Of course, assuming the driver has the digital dexterity required -- but, that's a given with ANY control!]

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                  #53
                  Yeah well I've flipped my hacked smartdrive wheelchair which was setup with a lever short stroke throttle (instead of push to go). I would not use one of those that is even less than what sent me to ER. I was fine that time but I had a nasty bump on my head.
                  Last edited by nonoise; 4 Apr 2019, 3:25 AM.
                  I have had periodic paralysis all my life. I lost my ability to walk in 2011 beginning with a spinal block, which was used for a hip fracture caused by periodic paralysis.

                  Comment


                    #54
                    Originally posted by ProPulse View Post
                    Quick thank you to everyone participating or even just taking the time to read through this thread. I truly appreciate how helpful the community has been. It's exciting to hear about everyone's input on how this product can make lives even just a bit better Edit: *Keep giving me all the advice you've got! I don't want it to seem like I wanted the thread to end lol*
                    Lots of good discussion in this thread. I’ll throw in a bit of an engineering query....

                    You’ve said that you’ll only be using one powered wheel. That’s fine, the SmartDrive only has one, and has a lot of torque and can get up relatively steep hills. However it does not have a brake, users need to use the wheelchair wheels themselves to stop. And there would be no point in having a brake on the SD as the wheel would just slide, particularly when going downhill, and/or in the wet.

                    Other power assists (and powered chairs) do have brakes on the unit itself, but they are significantly heavier, and/or have at least two wheels for traction (and steering).

                    So how are you intending to keep the user safe (ie by braking safely), without making the unit so heavy that it can’t be lifted?
                    Gordon, father of son who became t6 paraplegic at the age of 4 in 2007 as a result of surgery to remove a spinal tumour.

                    Comment


                      #55
                      My $.02 regarding price/billing
                      If you code it K0108 you might as well kiss the billing side of the business good bye. Dealers hate billing that code. Most funding sources make it very very difficult to bill and collect that code. Some funding sources only pay 20% of MSRP on K0108. If you can code it E0986 (power assist) then you want to price it as close to the "allowable" as possible. For example: In California (USA) the allowable for E0986 is $5200. You want your MSRP to be that or higher, with dealer cost being half of the allowable. Be careful how you set up your distribution. You can't have a "cash" price and a "billing funding" price. Medicare monitors the web and if a manufacture sells a "coded" product below the allowable then they will lower what dealers get reimbursed for that product.

                      That all said, I would either develop and market a product for the cash only pay or billing only. If you did the billing only, you can still sell for cash but not the other way around.

                      Good luck!

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                        #56
                        In order to qualify for the E0986 HCPCS code the device needs to be activated by the user engaging the push-rim in a push stroke. K0108, being carried priced, is indeed more difficult, and inconsistent, from one carrier to the next.

                        Regardless, I totally agree with the notion it should be priced whatever the payer market (mostly Medicare) will bear, not what individuals are willing to pay out of pocket. Scant few of us can afford much of anything. ~30% of households with an SCI member earn less than $15,000 a year, and only ~16% of us work.
                        "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

                        Comment


                          #57
                          Originally posted by nonoise View Post
                          Yeah well I've flipped my hacked smartdrive wheelchair which was setup with a lever short stroke throttle (instead of push to go). I would not use one of those that is even less than what sent me to ER. I was fine that time but I had a nasty bump on my head.
                          The "thumb joystick" operates identically to a "regular" joystick. Take your thumb off and the chair stops -- just like taking your hand off a regular joystick stops a chair.

                          I've a spare m300 from which I've removed the "store bought" electronics (except the motors) and replaced them with my own. I "fit" various types of controls to it in an attempt to see what works, what doesn't and sort out WHY each has the benefits/shortcomings that it does. I've fitted "steering wheels", trackballs, Spaceballs (a 6 DoF joystick), gyromice, "Joust buttons", mushrooms (imagine a joystick that is covered with a hemispheric globe, operated with your palm), pen mice, touchpad, etc. -- most of these salvaged from game consoles or PC workstations. (I've even tried a dual lever control similar to how a tank is steered -- control the speed and direction of the drive motors INDIVIDUALLY)

                          Next on the list is a "space pilot" (another 6 DoF joystick):



                          (twist knob to turn chair, push forward/back to move -- deliberately ignoring the more conventional "joystick" mode of application). I then (informally) evaluate them from the perspective of a rider as well as an attendant (there is often a difference in their usability based on the role of the operator) by auditioning them, myself, and inviting friends/neighbors/colleagues to take a spin, as well (I set up a little "obstacle course" for them to navigate).

                          The most difficult UI that I've found (personally) to use is the trackball -- because its hard to tune the control to "forget" at the right rate (the ball doesn't return to center so that has to be implemented in software -- it's not an intuitive relationship that you can easily develop with the control). The most responsive is the touchpad -- very little effort required (but not suited to anyone with ET, Parkinson's, etc.) I'd like to fabricate a non-planar version to see if that makes "homing" your finger easier -- esp if visually impaired. The most fatiguing is the "Joust buttons".

                          Curiously, most "casual users" seem to have a harder time with a joystick; they can't intuit how the chair will respond when they pull BACK on the stick and inevitably end up "changing their mind" after they find the chair going in an unexpected direction (going forwards is a piece of cake). The "steering wheel" and Spaceball seem easiest for them to relate -- likely because they are most similar to driving a car (I suspect the space pilot will also fall into this camp).

                          But, folks can usually adapt to ANY of the controls in short order (though I wouldn't want them driving through a china shop!). The harder problem is sorting out how various physical limitations impact the choice of UI, beyond the obvious.

                          Comment


                            #58
                            Originally posted by Oddity View Post
                            Regardless, I totally agree with the notion it should be priced whatever the payer market (mostly Medicare) will bear, not what individuals are willing to pay out of pocket. Scant few of us can afford much of anything. ~30% of households with an SCI member earn less than $15,000 a year, and only ~16% of us work.
                            I'd be leary to unconditionally present that as the "optimal strategy" (to the OP). Instead, I think he/she/they should look at the price that they can AFFORD to (profitably) sell the device. "Targetting" a price based on (e.g., Medicare) a particular sales mode binds them (almost perpetually!) to the other requirements that the chosen mode imposes. Having a single customer (which is what Medicare becomes, when you go that route) has perverse effects on how you operate your business. This, in turn, impacts how nimble your business can be in addressing future needs and opportunities.

                            Imagine (far-fetched example) that folks decide that powerchairs are a great alternative to owning a vehicle -- in much the same way that two-wheeled electric scooters are now perceived. But, you're locked out of that market because "folks" won't pay that sort of money for a powerchair used for a non-medically-necessary purpose! Your (non-DME) competitor comes up with a cheap powerchair and outsells you. Eventually, your "legitimate" customers discover that they can buy a non-DME chair for less money/hassle than they can buy the Medicare-coded chair from you. But, your business is still designed around that pricing and sales structure.

                            Figure out what you NEED for a selling price and then see what sorts of "customers" you can AFFORD! You might discover that selling direct is a more viable option -- esp if the middleman doesn't add any significant value to YOUR product's sale. Avoiding the paperwork and extra level of "profit" might make what would have been an expensive device considerably more affordable!

                            [E.g., I'm sure I can sell my car to someone who wants to pay for it using Visa/MasterCard/AMEX. But, the hassle of figuring out how to accept payment in that form -- as well as understanding what hidden legal obligations might attach to that sort of sale -- would likely rule out that buyer in favor of someone with cash, even if considerably LESS!]

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                              #59
                              Fair point. I wouldn't suggest my post as optimal, just something to think about. Leaving potential profit on the table, by potentially pricing less than the payer ~85% of the SCI community uses is willing to pay, just because they can, might not be optimal either. It's not a horrible idea to plan for the reality of where the money comes from for most of these devices. Medicare typically requires certain certifications (RESNA/ATP/OT/PT, etc...several of which require Phd education) as a requirement of a business filing these claims. Selling assistive medical tech direct isn't necessarily possible for a manufacturing company.
                              "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

                              Comment


                                #60
                                Originally posted by Oddity View Post
                                Fair point. I wouldn't suggest my post as optimal, just something to think about.
                                Exactly -- the same applies to my comment. The OP needs to look at what their needs are and then see how well that fits with different "markets".

                                Leaving potential profit on the table, by potentially pricing less than the payer ~85% of the SCI community uses is willing to pay, just because they can, might not be optimal either. It's not a horrible idea to plan for the reality of where the money comes from for most of these devices. Medicare typically requires certain certifications (RESNA/ATP/OT/PT, etc...several of which require Phd education) as a requirement of a business filing these claims. Selling assistive medical tech direct isn't necessarily possible for a manufacturing company.
                                OTOH, OP appears to be a (engineering) student. It wouldn't be unheard of for another student with marketing abilities to be brought onboard. (As Engineers, we tend to see everything as an "engineering problem") The WWW makes a lot of things that were previously high hurdles considerably easier.

                                I watch a lot of "usable" medical kit get discarded simply because of "regulations" regarding its legitimate use (in the USA). While understanding the rationale behind those regulations, it's also not hard to see how they work against they people they are intended to protect, in many cases. (i.e., there are real costs to every "rule" -- whether they be before or after the sale)

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