Halo system costs: replies
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Title:
Halo system costs: replies
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Thanks to those who responded!!
The posted question:
Can anyone explain why Halo orthoses are so expensive? Is it the liability
exposure, the cost of quality control, sterilization, cost of the materials,
the relatively low volume of sales, the 24 hour emergency availability, the
cost of the materials, the cost of assembly, the cost of R&D to design and
develop? Any ideas, or is there just good mark up on them for the
manufacturers?
To practitioners:
What brands have you found to have the quality required, convenience of
application and adjustability and a more reasonable cost? Do you consider
cost? Please don't respond if you have a vested interest in the brand you use
unless you disclose it.
I'll post responses.
Randy McFarland, CPO
Fullerton,CA
The responses, each separated by a blank line:
(names included if permisson was given)
The first halo system I used was Ace. This was because the
neurosurgeon that just opened her practice came from a school that used Ace.
This was about 1983. I did not consider anything else except that's what
the doc wanted to use.
In 1994, I started to work at a different hospital that used Bremer. Again,
that's what was in inventory.
After more than 200 halo's, if I was to start from scratch, I would suggest
a hybrid. The Trippe-Wells crown from Ace and the vest from Bremer.
My reasons: the Trippe Wells from Ace provides a more cosmetic placement of
the pins (usually in the hair line) and I had no one come free of the pins.
The down side, it comes over the head so you just increased the person's
height by up to 1 1/2 inches. Bremer's crown works well, but I have had
more than one patient pull loose from the pins. I believe that the patients
forehead angle was to severe to get the 2 pins above the eyebrows
perpendicular to the skull with the Bremer. Bremer's crown works best with
a square forehead.
The Ace vest was sized every two inches. I needed to stock from a 30 inch
to a 60 inch vest. And then, about 40% needed the trim lines cut during
application, especially the larger sizes. With Bremer, two sizes fits all.
Except for two patients I had to recontour the posterior panels to match
their kyphosis and one that I had to attach to a TLSO, the Bremer fit well.
I do not know if the hybrid system will work as I never tried it. (Or what
your insurance company will say if you do)
I have looked at several other systems, but never got the OK from the docs
to try/change. I do know that, in my opinion, I do not believe that the PMT
system is a wise cosmetic choice. It looks the bulkiest.
I have not done a halo in the past year and a half. I know I offered
several suggestions to improve both systems. I do not know what changes
have been made since late 1998.
You have permission to post using my name.
Ed Roman, Orthotist/CP
I think that the main reason why halos cost so much is because of the limited
companies
that are willing to make them. There are two that I am aware of PMTand BREMER
I think there is another company but cannot recall the name. PMT seems to be
the best made and easy to use with minimal effort. Application time can be as
little as 15 minutes. Of course thats just my observation for what its worth.
CO
Probably all of the above, but you forgot... limited number of manufacturers.
I wonder if that tells you anything about the points you have previously
listed. Bruce CO
With that said it is all of the above and more. It has been several
years
since I have done a Halo but when I was doing them (Probable 4-7 a weak) we
used Bremers. They were the least invasive during application and we would
actually applied them in the hosp. rooms on the neuro floor. Drs saw no
reason to bill for surg. sweets. You also had a minimum of tools required
and process took about 30-45 mins with the pt. awake the whole time. Please
understand this was the majority of cases not all.
As for the cost. Halo's as far as I am concerned are a high maintenance
Item. I would follow the pt. throughout the healing process on an average
of once a weak and also as needed. Not only would I address the medical
condition but also the psychological condition. Like I've said to many
people No one ever told me that a broken neck would be fun .
As far as the overall cost and reimbursement goes, I don't know about you
but I have a group of employees that like to be paid for the hr's they work.
I have yet to talk to an Ins. Employee who is willing to not be paid by the
ins. co. they work for. I have offered many Ins. people a job with the only
condition being that they wouldn't get paid for at least 3 months and once
the months were up I would then decide what they were worth and maybe pay
them or possibly ask for more documentation. I don't know if this was the
direction you were going in but I hope it helps. CPO
We use Jerome, which is more expensive. However, everything is
conveniently sterile, which to us is a time saver.
We have not had a failure, however we changed to mechanical rotary torque
wrenches as we found the clickers to be inconsistant. John Hattingh CP
Just a comment on quality and ease of use.
I have found that PMT is a good quality product and is the easiest to use.
The superstructure and componants are easy to use and adjust. Unfortunately,
they are not cheap. Probably one of the more expensive alternatives. They
are MRI compatable,so that helps.
Steve Fletcher, CPO
I'd say that's a pretty good summary. I'd leave out sterilization since
most institutions won't rely on the manufacturer's sterilization and will
gas them again anyway. Their marketing expenses are also quite high,
having rep's all over the country on commission, visiting hospitals, etc.
I've used several manufacturer's products over the years and favor Ace.
The service is about as important as the product since it's an emergency
type of item and frequently needs scaring up at the last minute. Having
someone around 24 hours is kind of essential for this service.
Good luck,
Aryeh
In answer to your question about halo costs and why the charge is as high as
it is, you must first understand that the cost of the product, the service ,
the insurance and the availability are the basis for the original pricing
done by ACE and later Bremer and PMT. The second factor was materials and the
change from surgical stainless to aluminum and titanium and eventually the
carbon grafites.
When pricing a product like the halo the first price that we as practitioners
see is the price from the manufacturer currently about $ 950 to $1350 for the
base unit. These units are then customized by different attachments and head
blocks as well as accessories that are used for positioning and application.
The next factor is liability insurance, in each state the procedure for
application of a halo is governed by the rules of that states health
department and how the procedure is identified. As a surgical procedure the
surgeon is responsible for the actual application of pins and the halo , in
some states the orthotist may assist and in others there are no specific
rules, therefore the insurance level might be different. Finally the followup
and what other services might be included such as the use of other cervical
orthoses as the patient is removed is sometimes included (philly collar etc.)
When you factor in 24 hour service , shipping by next day air , followup for
retightening and office visits the prices can start to fall into the ranges
you've obviously seen. On the otherhand there are practitioners and companies
that sell the halos and never provide any additional services , just delivery
of the product to the hospital and never see the patient to provide care, I n
that case the charges are high. There are other times when the company is
required to do all of the followup with the surgeon but never actually
applies the halo. The expression time is money still holds true.
Hope this information helps.
Carey
I'm a prosthetisit /orthotist not a sales rep. In addition the 24 hour
service has more to do with the trauma hospitals my company serviced not the
shipping from a central location. Finally in 22 years I have only heard of a
few instances where a doctor or practitioner ran into major liability
problems and in those cases they deserved the penalties they received for
they were not qualified to do the procedure.
In retrospect the cost of the product is still only one part of the
accounting process. I think it might help if you were to refer to the aopa
accounting methods packet that was available a few years ago. It showed you
exactly how your to develop product pricing. This does not mean that one
could not discount from the figures but it might give you a better idea as to
how much P&O products really cost for you as a practitioner to deliver.
Carey
The posted question:
Can anyone explain why Halo orthoses are so expensive? Is it the liability
exposure, the cost of quality control, sterilization, cost of the materials,
the relatively low volume of sales, the 24 hour emergency availability, the
cost of the materials, the cost of assembly, the cost of R&D to design and
develop? Any ideas, or is there just good mark up on them for the
manufacturers?
To practitioners:
What brands have you found to have the quality required, convenience of
application and adjustability and a more reasonable cost? Do you consider
cost? Please don't respond if you have a vested interest in the brand you use
unless you disclose it.
I'll post responses.
Randy McFarland, CPO
Fullerton,CA
The responses, each separated by a blank line:
(names included if permisson was given)
The first halo system I used was Ace. This was because the
neurosurgeon that just opened her practice came from a school that used Ace.
This was about 1983. I did not consider anything else except that's what
the doc wanted to use.
In 1994, I started to work at a different hospital that used Bremer. Again,
that's what was in inventory.
After more than 200 halo's, if I was to start from scratch, I would suggest
a hybrid. The Trippe-Wells crown from Ace and the vest from Bremer.
My reasons: the Trippe Wells from Ace provides a more cosmetic placement of
the pins (usually in the hair line) and I had no one come free of the pins.
The down side, it comes over the head so you just increased the person's
height by up to 1 1/2 inches. Bremer's crown works well, but I have had
more than one patient pull loose from the pins. I believe that the patients
forehead angle was to severe to get the 2 pins above the eyebrows
perpendicular to the skull with the Bremer. Bremer's crown works best with
a square forehead.
The Ace vest was sized every two inches. I needed to stock from a 30 inch
to a 60 inch vest. And then, about 40% needed the trim lines cut during
application, especially the larger sizes. With Bremer, two sizes fits all.
Except for two patients I had to recontour the posterior panels to match
their kyphosis and one that I had to attach to a TLSO, the Bremer fit well.
I do not know if the hybrid system will work as I never tried it. (Or what
your insurance company will say if you do)
I have looked at several other systems, but never got the OK from the docs
to try/change. I do know that, in my opinion, I do not believe that the PMT
system is a wise cosmetic choice. It looks the bulkiest.
I have not done a halo in the past year and a half. I know I offered
several suggestions to improve both systems. I do not know what changes
have been made since late 1998.
You have permission to post using my name.
Ed Roman, Orthotist/CP
I think that the main reason why halos cost so much is because of the limited
companies
that are willing to make them. There are two that I am aware of PMTand BREMER
I think there is another company but cannot recall the name. PMT seems to be
the best made and easy to use with minimal effort. Application time can be as
little as 15 minutes. Of course thats just my observation for what its worth.
CO
Probably all of the above, but you forgot... limited number of manufacturers.
I wonder if that tells you anything about the points you have previously
listed. Bruce CO
With that said it is all of the above and more. It has been several
years
since I have done a Halo but when I was doing them (Probable 4-7 a weak) we
used Bremers. They were the least invasive during application and we would
actually applied them in the hosp. rooms on the neuro floor. Drs saw no
reason to bill for surg. sweets. You also had a minimum of tools required
and process took about 30-45 mins with the pt. awake the whole time. Please
understand this was the majority of cases not all.
As for the cost. Halo's as far as I am concerned are a high maintenance
Item. I would follow the pt. throughout the healing process on an average
of once a weak and also as needed. Not only would I address the medical
condition but also the psychological condition. Like I've said to many
people No one ever told me that a broken neck would be fun .
As far as the overall cost and reimbursement goes, I don't know about you
but I have a group of employees that like to be paid for the hr's they work.
I have yet to talk to an Ins. Employee who is willing to not be paid by the
ins. co. they work for. I have offered many Ins. people a job with the only
condition being that they wouldn't get paid for at least 3 months and once
the months were up I would then decide what they were worth and maybe pay
them or possibly ask for more documentation. I don't know if this was the
direction you were going in but I hope it helps. CPO
We use Jerome, which is more expensive. However, everything is
conveniently sterile, which to us is a time saver.
We have not had a failure, however we changed to mechanical rotary torque
wrenches as we found the clickers to be inconsistant. John Hattingh CP
Just a comment on quality and ease of use.
I have found that PMT is a good quality product and is the easiest to use.
The superstructure and componants are easy to use and adjust. Unfortunately,
they are not cheap. Probably one of the more expensive alternatives. They
are MRI compatable,so that helps.
Steve Fletcher, CPO
I'd say that's a pretty good summary. I'd leave out sterilization since
most institutions won't rely on the manufacturer's sterilization and will
gas them again anyway. Their marketing expenses are also quite high,
having rep's all over the country on commission, visiting hospitals, etc.
I've used several manufacturer's products over the years and favor Ace.
The service is about as important as the product since it's an emergency
type of item and frequently needs scaring up at the last minute. Having
someone around 24 hours is kind of essential for this service.
Good luck,
Aryeh
In answer to your question about halo costs and why the charge is as high as
it is, you must first understand that the cost of the product, the service ,
the insurance and the availability are the basis for the original pricing
done by ACE and later Bremer and PMT. The second factor was materials and the
change from surgical stainless to aluminum and titanium and eventually the
carbon grafites.
When pricing a product like the halo the first price that we as practitioners
see is the price from the manufacturer currently about $ 950 to $1350 for the
base unit. These units are then customized by different attachments and head
blocks as well as accessories that are used for positioning and application.
The next factor is liability insurance, in each state the procedure for
application of a halo is governed by the rules of that states health
department and how the procedure is identified. As a surgical procedure the
surgeon is responsible for the actual application of pins and the halo , in
some states the orthotist may assist and in others there are no specific
rules, therefore the insurance level might be different. Finally the followup
and what other services might be included such as the use of other cervical
orthoses as the patient is removed is sometimes included (philly collar etc.)
When you factor in 24 hour service , shipping by next day air , followup for
retightening and office visits the prices can start to fall into the ranges
you've obviously seen. On the otherhand there are practitioners and companies
that sell the halos and never provide any additional services , just delivery
of the product to the hospital and never see the patient to provide care, I n
that case the charges are high. There are other times when the company is
required to do all of the followup with the surgeon but never actually
applies the halo. The expression time is money still holds true.
Hope this information helps.
Carey
I'm a prosthetisit /orthotist not a sales rep. In addition the 24 hour
service has more to do with the trauma hospitals my company serviced not the
shipping from a central location. Finally in 22 years I have only heard of a
few instances where a doctor or practitioner ran into major liability
problems and in those cases they deserved the penalties they received for
they were not qualified to do the procedure.
In retrospect the cost of the product is still only one part of the
accounting process. I think it might help if you were to refer to the aopa
accounting methods packet that was available a few years ago. It showed you
exactly how your to develop product pricing. This does not mean that one
could not discount from the figures but it might give you a better idea as to
how much P&O products really cost for you as a practitioner to deliver.
Carey
Citation
“Halo system costs: replies,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 7, 2024, https://library.drfop.org/items/show/213659.
