In a message dated 10/3/2003, I posed the following questions along with a
sob story about our difficulties with unreliable Otto Bock/TEC Harmony PRS
pumps. After my synopsis and commentary are the replies to my original posting.
> Two Questions:
> 1. Should prosthetic offices charge patients and/or their insurance carriers
> for their labor associated with repair or replacement of manufacturer’s
> components that fail while on warranty?
> 2. Or should the manufacturer reimburse the prosthetic office for the labor
> required to remove defective components that are still on the mfr’s warranty
> as well as the labor to install interim loaner units, and the labor to then
>
In reading the following responses, you will discover that there is a general
outcry re. the labor costs incurred by P & O offices when components fail
that are still on manufacturer’s warranties. The general assumption seems to be
that, if a component is still covered by a mfr.’s warranty, the P & O office
does not typically charge for the labor required to remove the defective part,
install a loaner unit and replace the repaired/replacement unit. Many cited
the risks associated with trying new technology and gave that as a reason for
not doing so. If manufacturers wonder why there is hesitation in O & P
community to using “cutting edge technology”, this fact may offer some explanation.
I believe the most intriguing response was by a practitioner who claimed that
he often negotiates with manufacturers to compensate him for his labor costs
associated with removing and reinstalling the mfr.’s failed components that
are still on warranty. What a concept! It would be interesting to hear from
any others of you who have done the same. I was surprised when the Otto Bock
customer satisfaction rep. hinted at just such an arrangement when I recently
gave her an accounting of my labor costs incurred while dealing with defective
Harmony pumps.
It seems, from some of the comments, there is a concern that manufacturers
would charge more for their components if they were required to compensate for
labor costs associated with replacing failed components still on warranty. If
so, it would be a better way for practitioners to assess the true cost of
choosing a particular component than the built-in “surprise-waiting-to-happen”
that was not originally factored into the equation.
Perhaps, AOPA (since it represents both suppliers and O & P businesses)
should sponsor a program whereby manufacturers/suppliers who belong to AOPA must
agree to compensate O & P practices for their labor costs that are incurred
removing and replacing failed components (as well as loaner units) that are still
on warranty. Such a program, of course, would include parameters such as the
practitioner or tech that performs the labor must have attended the mfr.’s
instructional course, if applicable.
Compensation to the O & P practice for labor costs does not address the cost
of time, frustration, and inconvenience to the patient. Clearly, only better
testing and more dependable components can avoid the losses for the patient.
Perhaps, AOPA should establish a clearinghouse to whom manufacturers are
required to report component failure frequency. Patients could then be informed of
the reliability of a given component that is proposed for their new devices.
Currently, practitioners can only inform patients of their own office’s
experience with the component’s dependability.
What is AOPA’s official response to these suggestions? While we are asking,
what are the manufacturers’ position on this question? They all have been
very silent on this issue in this LISTSERV. For starters, Otto Bock, Ossur and
Endolite are cited in the replies as having had reliability problems with one
or more components.
As the replies to my original posting demonstrate below, I am not alone in my
frustration regarding this issue. I don’t doubt that each practitioner
reading these will identify as well with many of the sentiments expressed.
David Varnau, LPO, CPO
******************************************************************************
*******************
I was the one that commented that manufacturers should cover our costs should
this be a failure under warranty. What this will do is force manufacturers to
pay closer attention to quality control and the condition of their loaner
units.
The loaner units are working harder then ever and should be serviced before
they are sent out. What the manufacturers need to consider is the fact that
our
patients want the same comfort and level of function that they experience
with their own components. The fact that their unit failed under warranty does
not mean that we and the patients have to put up with inferior products while
the problem is being addressed.
I am personally getting really tired of being the manufacturers testing site
without agreeing to it. Whenever a new product gets to the market place with a
huge price tag, we are told that it’s so expensive because of the R&D
$-factor associated with the product. Well how come we are still field
testing it?
******************************************************************************
********************
Terrific question. It is a question we have discussed at length within the
Veterans Affairs Medical Center, where our practitioners have decided to limit
our patient’s component choices to those that do not give us repeated problems.
Perhaps the manufactures should consider a warranty or insurance policy that
reimburses prosthetic labs for the time spent resolving problems with their
products. It would certainly give the manufactures more information and feed
back about the reliability of their products, while also becoming a financial
incentive to resolve their own problems.
Might we see manufacturers being held to a greater level of accountability
for their products? I am in favor of it. Might we begin seeing more recalls or
are we more likely to see manufacturers weighing the chances of mechanical
failure with the statistical chance of legal costs and repercussions?
******************************************************************************
********************
David, we went through a similar exercise several years back with Endolite,
back when it was still in Florida. We had several high activity patients
using their ESK and were subjected to constant repair demands due to noise.
After several such issues we gave up and stopped using the componentry. I do
agree that it is time that the manufacturers deal with the warranty labor
costs. In the Endolite case we resorted to sending them the entire
prosthesis and letting their central fab do the warranty repairs, albeit at
a significant inconvenience to the patients (most did have back up limbs).
Any suggestions on generating a concerted industry wide effort to force the
manufacturers to reimburse our labor costs would be interesting. The back
lash however will be that they increase their material cost to us to cover
the costs anyway.
******************************************************************************
********************
I agree with you. The problems that occur under a 3 month warranty
unconditional if you provide one should be no charge. If it is the manufacturer
warranty I think you are right that the manufacturer should pay for our labor if the
product still under their warranty. Seriously the components are not cheap,
and neither is our time, to realign, install, lock tight, etc., or as you say
the patients time off from work, or lifestyle inconvenience, etc.. Why should
we cover the manufacturers promises? After the warranty is over then the
patients can pay.
******************************************************************************
********************
I understand your problems totally….I have had
nothing but problems with Springlite Feet (mainly for myself, and every one
that I have fitted on a patient, catastrophic failures, even after Otto Bock
swears that there are no more problems), and have heard nothing but
nightmare stories about the Harmony systems….
The bottom line is that I won’t use products that are prone to failure. I
won’t ever steer my patients that direction. I am very open and honest with
the patients, and even encouraged a couple of patients to go to the ACA
conference this past summer to see what is out there. They came back with
lots of questions, comments, wanting all this new stuff, and then I talked
to them about it. I am very much up to date on stuff, but don’t get into
all the stuff that has bad road records.
I would definitely quit using the TEC units until they get them fixed.
There is really no way to bill for the repairs and all the time involved.
The Chevy dealerships that do all the warranty work on vehicles are
franchised dealers of Chevy. They do get reimbursed by Chevy for the work
they do, but the mom-n-pop mechanics don’t get paid for doing warranty work.
So if Otto Bock had “dealerships” or patient care facilities, then they
would pay for the repairs done, maybe. Actually, Otto Bock would go
bankrupt paying practitioners and technicians a salary for doing nothing but
repairing and replacing the bad product they are producing. They should
have factory recalls on the units.
As you can tell, you hit a sore spot with me on this….
******************************************************************************
********************
I appreciated your post. I had two Mauch knees and two other ossur components
fail on the same pt. Aside from losing his confidence, it was certainly a
waste of his and my time. I do think the Fr should be responsible for more than
component replacement.
It was interesting to hear you comments about the VASS system. I haven’t
tried it yet simply because I have been hearing about the unreliability factor. I
usually jump in quickly and end up becoming a Beta tester myself, but I am
getting tired of that!
******************************************************************************
********************
I am with you on this one. My chief complaint is the inability of the [TEC]
service
department to repair a leaking unit. I have a bilateral amputee wearing
the system. The vacuum system seems to work fine but the shock absorber
system is crap. When I receive a rebuilt unit back it already leaks. I’ve
spoken with “Steve” the service technician who refuses to believe that
there is anything wrong them their testing procedure because “that’s the
way TEC told us to do it”. Clearly it doesn’t work. I’ve even had the
good fortune of having the units leak in front of OB’s Harmony “expert”
Gary Hooks. I still cannot get a repaired unit that holds air. We’re in
the process of getting approval for a new pair of non-Harmory prostheses,
but we’re getting resistance due to the short interval since the previous
Harmony prostheses. I did manage to get them to send me one beta test unit
for a unilateral amputee with the same problem but them won’t do it for my
bilateral.
******************************************************************************
********************
Very good letter, we are having the same problems with the TEC. I find the
pathfinder set up has far less problems. My question to you, if it is past the
warranty period for Mcare, can we just fill for a new pump if it is replaced
with new?
******************************************************************************
*******************
Good question David. Do you remember when there was the problem of
loctite affecting the new plastic on the 5R1=2? I can’t remember how
many of those blocks I had to transfer out… I believe we did get a
credit for the block however….
******************************************************************************
********************
This is another reason why I am hesitant to put new components on
patients. I don’t really think it is fair to any of us
(patient,prosthetists,customer service reps)…
******************************************************************************
********************
…if the manufacturers were held to reimburse the labor at flat rate
schedules then they might spend more time testing before release. They would charge
more for the item if this became reality too. No easy solution. I think we
should send the manufacturers a bill.
******************************************************************************
********************
The manufacturer should pay. We usually try to negotiate a credit
equivalent in value to the labor charge that can be used for successive
orders. Most manufacturers do not like to reimburse cash. Credits are an
easy way out for them.
