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> the device will be priced through a subscription model at $199 monthly for five patients or $399 monthly for unlimited use. Is this normal in the medical ind

> the device will be priced through a subscription model at $199 monthly for five patients or $399 monthly for unlimited use. Is this normal in the medical industry? It seems a little absurd to me but I know nothing about medical tech.

m_a_g 3y ago
It’s B2B so I’d say it’s normal.
pixl97 3y ago
In general med tech = so expensive your eyes bleed and your brain melts. I'm assuming they've dropped in price a pretty good amount now, but digital x-ray machines with the require software were near hundred thousand price range and typically tied around some windows operating system. So if the controller came with XP, never expect to go to a new operating system. The companies general answers were, oh, you need a controller with a new OS, spend another $100k for the next gen, which unless you're pumping out huge numbers of xrays was just not going to happen.
- parl_match 3y ago
  >So if the controller came with XP, never expect to go to a new operating system. That's not necessarily a bad thing! In our industry, the idea of something using XP is ridiculous. Applying our experience to the medical field is a bad idea! It's an appliance. It doesn't really matter what OS it runs as long as its stable and certified to do. It spits out imagery which you can then process and view on any compatible device - often a reasonably modern computer running some sort of health informatics platform. For what it's worth, the "XP" OS is often licensed and supported for well longer than a consumer SKU. IIRC microsoft provided support and security updates for embedded/appliance applications until 2019! These devices are often not openly networked, or if they are, they are through some sort of gateway that's appropriately locked down and updated.
  - pc86 3y ago
    It's an appliance with huge gaping security flaws that its very creator says you should use under approximately no circumstances. > For what it's worth, the "XP" OS is often licensed and supported for well longer than a consumer SKU. IIRC microsoft provided support and security updates for embedded/appliance applications until 2019! You're 100% right but that still means the thing has been sitting around for half a decade with no security updates whatsoever. There is a fine line between stability and simply being a miser and refusing to update things within a reasonable period of time. Healthcare, especially corporate healthcare run by people other than physicians, is far to much on the miser end of the spectrum.
    - 5440 3y ago
      I recommend you all read the 2023 FDA cybersecurity expectations before commenting. https://www.fda.gov/media/119933/download https://www.fda.gov/media/119933/download
  - pixl97 3y ago
    >These devices are often not openly networked, or if they are, they are through some sort of gateway that's appropriately locked down and updated. Possibly in major hospitals with large large IT teams... But I've worked in a lot of smaller clinics and the term 'often' changes to 'almost never'.
  - OJFord 3y ago
    > In our industry, the idea of something using XP is ridiculous. Only because of the lack of (security, drivers) updates though right? If I couldn't use Linux or macOS I'd rather use XP (if it were current) than anything that's come since. (I also don't need accessibility features which I'm sure have come a long way.)
parl_match 3y ago
$400 a month, in a reasonably busy dermatologists office, would probably come to about $20 "per use". A lot less if you have multiple patients use it a day.
- deleted 3y ago
  [deleted]
- wrycoder 3y ago
  Which will probably be billed at $200, if my long experience with dermatologists is any guide.
- adrr 3y ago
  Primary use case would be PCPs who aren’t trained to diagnose skin cancer. There will be cost saving because the patient won’t have to visit a derm. Also it opens it up beyond dermatologists so it could be a PA or NP. That means in theory you could go to could go to a CVS minute clinic if you have suspicious mole.
  - husarcik 3y ago
    I wonder what the liability will be if the machine misses a cancer and the PCP didn't refer them to a skin expert (eg, dermatologist).
- deleted 3y ago
  [deleted]
candiddevmike 3y ago
It's normal in the US. Outside the US things are more competitive as companies chase fewer buyers/dollars and have to sell things cheaper. Sometimes this makes certain countries worthless in the eyes of a medical device manufacturer
pkaye 3y ago
> The FDA approval was based on results from a multicenter clinical trial led by the Mayo Clinic involving over 1,000 patients across 22 clinics. Medical tech often requires clinical trials so there is some cost to that. And it can also limit how quickly competitors can create a competing device. But $399 monthly for unlimited use doesn't see so bad when a dermatology clinic might see hundreds of patients a month.
- NeuroCoder 3y ago
  Dermatologists probably aren't going to use this. Primary care in rural areas is the best application for this.
supertrope 3y ago
In theory this lowers the barrier to entry. A small clinic can buy in at the limited use subscription and they can pay to remove the limit as they grow. Having one hardware SKU for everyone and selling feature unlock licenses simplifies manufacturing. Price discrimination, intellectual "property" enforcement, and DRM are nothing new in the medical industry.
sciclaw 3y ago
Being in the medtech/AI industry (our company, Eyenuk, created the 2nd autonomous AI approved by the FDA), nothing seems too strange here. I've seen subscriptions supported, and the pricing doesn't seem alarming. If you look at any medical bill that includes lab work, or anything medical related, this is really cheap comparatively. The cost of everything is required to lure companies into the space. The cost of research, running a clinical trial, the FDA approval, certifications (SOC2, etc.), insurance, etc. still push many companies away. In fact, in the EU, where the cost is lower, the approval process is getting harder (MDR) and many companies are leaving the market.
- hereme888 3y ago
  Why can't companies just charge X price, once, since it's already FDA approved (hence I assume models are validated), and in the future any upgrades cost Y? It comes across as predatory that users be charged subscriptions for something that seems like it should be fixed. Aren't other medical devices and drugs sold for a fixed price, regardless of all the FDA approval and marketing they had to go through? Like, no one pays a subscription fee for an X-ray machine, or a subscription for a course of antibiotics.
  - icegreentea2 3y ago
    Antibiotics are consumables - in a B2B context (it's a medical service provider who is paying the subscription fee), antibiotics are basically a subscription. Many (most?) diagnostic devices have consumables which is where companies make the bulk of their revenue. Failing that, service contracts are usually in place to lock in some sort of sustained reoccuring revenue. There is no fundamental reason why a company couldn't do your proposed model, but upgrades are definitely challenging - if you make your model better, or you improve your hardware, or basically do anything that isn't a bug fix or an ancillary upgrade (like I dunno, you made the thing boot up 25% faster), will likely require additional testing and approval from the FDA.
    - NoZebra120vClip 3y ago
      One of the genius medical marketing tactics was to create disposable condoms for thermometers, ear probes, etc., so that you can use one up for each patient and then purchase a whole big box of them on a subscription basis, rather than going through a simple bottle of sanitizer that could clean anything and everything that needs it. (And then of course, nobody cleans the probe underneath, as it just gets slightly grodier with each use.)
iancmceachern 3y ago
Yes, it's very common

m_a_g 3y ago

It’s B2B so I’d say it’s normal.

pixl97 3y ago

In general med tech = so expensive your eyes bleed and your brain melts. I'm assuming they've dropped in price a pretty good amount now, but digital x-ray machines with the require software were near hundred thousand price range and typically tied around some windows operating system. So if the controller came with XP, never expect to go to a new operating system. The companies general answers were, oh, you need a controller with a new OS, spend another $100k for the next gen, which unless you're pumping out huge numbers of xrays was just not going to happen.

parl_match 3y ago
>So if the controller came with XP, never expect to go to a new operating system. That's not necessarily a bad thing! In our industry, the idea of something using XP is ridiculous. Applying our experience to the medical field is a bad idea! It's an appliance. It doesn't really matter what OS it runs as long as its stable and certified to do. It spits out imagery which you can then process and view on any compatible device - often a reasonably modern computer running some sort of health informatics platform. For what it's worth, the "XP" OS is often licensed and supported for well longer than a consumer SKU. IIRC microsoft provided support and security updates for embedded/appliance applications until 2019! These devices are often not openly networked, or if they are, they are through some sort of gateway that's appropriately locked down and updated.
- pc86 3y ago
  It's an appliance with huge gaping security flaws that its very creator says you should use under approximately no circumstances. > For what it's worth, the "XP" OS is often licensed and supported for well longer than a consumer SKU. IIRC microsoft provided support and security updates for embedded/appliance applications until 2019! You're 100% right but that still means the thing has been sitting around for half a decade with no security updates whatsoever. There is a fine line between stability and simply being a miser and refusing to update things within a reasonable period of time. Healthcare, especially corporate healthcare run by people other than physicians, is far to much on the miser end of the spectrum.
  - 5440 3y ago
    I recommend you all read the 2023 FDA cybersecurity expectations before commenting. https://www.fda.gov/media/119933/download https://www.fda.gov/media/119933/download
- pixl97 3y ago
  >These devices are often not openly networked, or if they are, they are through some sort of gateway that's appropriately locked down and updated. Possibly in major hospitals with large large IT teams... But I've worked in a lot of smaller clinics and the term 'often' changes to 'almost never'.
- OJFord 3y ago
  > In our industry, the idea of something using XP is ridiculous. Only because of the lack of (security, drivers) updates though right? If I couldn't use Linux or macOS I'd rather use XP (if it were current) than anything that's come since. (I also don't need accessibility features which I'm sure have come a long way.)

parl_match 3y ago

$400 a month, in a reasonably busy dermatologists office, would probably come to about $20 "per use". A lot less if you have multiple patients use it a day.

deleted 3y ago
[deleted]
wrycoder 3y ago
Which will probably be billed at $200, if my long experience with dermatologists is any guide.
adrr 3y ago
Primary use case would be PCPs who aren’t trained to diagnose skin cancer. There will be cost saving because the patient won’t have to visit a derm. Also it opens it up beyond dermatologists so it could be a PA or NP. That means in theory you could go to could go to a CVS minute clinic if you have suspicious mole.
- husarcik 3y ago
  I wonder what the liability will be if the machine misses a cancer and the PCP didn't refer them to a skin expert (eg, dermatologist).
deleted 3y ago
[deleted]

candiddevmike 3y ago

It's normal in the US. Outside the US things are more competitive as companies chase fewer buyers/dollars and have to sell things cheaper. Sometimes this makes certain countries worthless in the eyes of a medical device manufacturer

pkaye 3y ago

> The FDA approval was based on results from a multicenter clinical trial led by the Mayo Clinic involving over 1,000 patients across 22 clinics. Medical tech often requires clinical trials so there is some cost to that. And it can also limit how quickly competitors can create a competing device. But $399 monthly for unlimited use doesn't see so bad when a dermatology clinic might see hundreds of patients a month.

NeuroCoder 3y ago
Dermatologists probably aren't going to use this. Primary care in rural areas is the best application for this.

supertrope 3y ago

In theory this lowers the barrier to entry. A small clinic can buy in at the limited use subscription and they can pay to remove the limit as they grow. Having one hardware SKU for everyone and selling feature unlock licenses simplifies manufacturing. Price discrimination, intellectual "property" enforcement, and DRM are nothing new in the medical industry.

sciclaw 3y ago

Being in the medtech/AI industry (our company, Eyenuk, created the 2nd autonomous AI approved by the FDA), nothing seems too strange here. I've seen subscriptions supported, and the pricing doesn't seem alarming. If you look at any medical bill that includes lab work, or anything medical related, this is really cheap comparatively. The cost of everything is required to lure companies into the space. The cost of research, running a clinical trial, the FDA approval, certifications (SOC2, etc.), insurance, etc. still push many companies away. In fact, in the EU, where the cost is lower, the approval process is getting harder (MDR) and many companies are leaving the market.

hereme888 3y ago
Why can't companies just charge X price, once, since it's already FDA approved (hence I assume models are validated), and in the future any upgrades cost Y? It comes across as predatory that users be charged subscriptions for something that seems like it should be fixed. Aren't other medical devices and drugs sold for a fixed price, regardless of all the FDA approval and marketing they had to go through? Like, no one pays a subscription fee for an X-ray machine, or a subscription for a course of antibiotics.
- icegreentea2 3y ago
  Antibiotics are consumables - in a B2B context (it's a medical service provider who is paying the subscription fee), antibiotics are basically a subscription. Many (most?) diagnostic devices have consumables which is where companies make the bulk of their revenue. Failing that, service contracts are usually in place to lock in some sort of sustained reoccuring revenue. There is no fundamental reason why a company couldn't do your proposed model, but upgrades are definitely challenging - if you make your model better, or you improve your hardware, or basically do anything that isn't a bug fix or an ancillary upgrade (like I dunno, you made the thing boot up 25% faster), will likely require additional testing and approval from the FDA.
  - NoZebra120vClip 3y ago
    One of the genius medical marketing tactics was to create disposable condoms for thermometers, ear probes, etc., so that you can use one up for each patient and then purchase a whole big box of them on a subscription basis, rather than going through a simple bottle of sanitizer that could clean anything and everything that needs it. (And then of course, nobody cleans the probe underneath, as it just gets slightly grodier with each use.)

iancmceachern 3y ago

Yes, it's very common