In fact, I have never bundled Xpress-It
with any hardware so it technically qualifies under the Medicare regulation. AAC
is all Xpress-It knows about. However, software requires hardware, and that’s
historically been the problem. Today, you can get a $300 netbook that will
happily run Xpress-It. The average user might need external speakers, but that’s
about it. Still, I simply don’t have the financial resources to put Xpress-It
on Medicare’s radar. That process takes a willing doctor, a subject, and
If you think other companies would
line up to buy Xpress-It, remember the dedicated machine environment that’s
in vogue. Also remember that they have products already to look after.
Xpress-It has been a good idea, but
it presumes the buyer really wants the user to be able to do more than talk. I agree
that’s a cynical description, but it’s also darn accurate. The
situation won’t change until someone the buyers have to listen to tells
them that computers are all-around enablers. The more ways a person can use a
computer, the less disabled he or she is.
From: Scott Royall
Sent: Wednesday, September 23, 2009 5:06 PM
To: Scott Royall
Subject: RE: FW: Dig this crap!
No doubt I didn’t express
myself clearly either.
In a dedicated environment,
there are other products out now that can objectively argue to be as good as
Xpress-It. I would counter that Xpress-It still maintains some minor
advantages, but I would have to concede the point that I’m an one-man
operation. That’s a real concern to large buyers. Even when we speak
about the non-Medicare market, the fact is still that buyers use similar criteria
of dedicated use to curb fraud. I’m not good enough as a programmer to
surpass the decade of R&D other companies have spent to catch up. At
present, I no longer have a clear advantage in a dedicated machine, because
Xpress-It was always meant and designed to offer dedicated-machine performance
on a general purpose system. It never was meant to beat that performance
This may seem to be defeatism,
but even the most tenacious fighter has to know the rules of the fight
he’s in. I have always wondered why the AAC market wasn’t crowded
with products like Xpress-It. It certainly isn’t magical, and mimicking
its strengths wouldn’t be difficult. Well, I finally have an answer to
why Xpress-It still stands alone. As the audio segment that started this
discussion points out, Medicare has no problem paying $8,000 for a dedicated
AAC device (probably a Dynavox), but will not buy a $2,000 general purpose
computer. This despite the fact that the “patients” (a word I have
come to loathe) in the two cases mentioned found even the rudimentary
text-to-speech software that comes with a GPC to be more helpful than the
$8,000 device! Is it any wonder why I get more conservative every second?
No, Medicare isn’t the
only payer (yet), but who really thinks private insurance uses purchasing
regulations that are more liberal than the government’s? Of course they
don’t, because their job requires them to minimize the risk of fraud. If
the government still only believes in dedicated devices, why should insurance
companies stick their necks out? The audio mentions that at least one AAC
company does sell a “dedicated device” through Medicare that end
users can then pay the same company $50 to convert it back into a general
purpose computer. I wonder how long it will be before Medicare declares that
practice to be fraudulent!
To me, this Medicare purchasing
regulation is only one brick in the Great Wall that largely separates the
Disabled from society. Other “bricks” in that wall extend as far as
our most basic instincts that govern who we associate with so I really cannot
foresee the Disabled (and yes, I am over-generalizing) becoming a valued
segment of society soon.
On the other matter, who do you
think I know at Dell with that much clout? I haven’t heard from Michael
Dell since about 1990! Besides, I haven’t done anything that recruiters
have found interesting in almost eight years. I regret to say my working days
Sent: Tuesday, September 22, 2009 10:02 PM
Subject: Re: FW: Dig this crap!
It didn’t come through in the short time I had to write, and it’s
probably a lousy strategy to be expedient and not long-term focused however, if
the dollars are with a dumb product then you can make your product the smartest
of the dumb. Somewhere in the future, you can make it behave like the
well mannered, machine sharing, smart thing that it is. Or, market two
models: The dumb for purchase with Medicare dollars as an integrated machine hog
and the smart for sale to people who have their own machine.
If Medicare won’t pay for it as it is and Medicare are the only dollars
you can see out there, then the task is to either 1) change Medicare, 2) have
Medicare buy only the software and whatever additional hardware (perhaps
none) that it needs to function in a ‘real’ environment (for e.g. your
amplifier and speakers) that can’t be used for something else, and let the
patient use his own computer to run it, 3) find another market, or 4) be left
out of the market.
I don’t see No. 1 happening anytime soon as the potential for
"fraud!!" and "abuse!!" and other political hacks will
drown out whatever benefit the software brings if it runs on a computer that
Medicare buys that can also be used for (bad example, but Maaaarvin Zindler
guaranteed to play on the TV news) porno pictures.
No. 2 opens your patient to having to buy a computer .. No easy task for
a person / family struggling to pay bills associated with medical care of the
patient needing it.
No. 3 will take some imagination
No. 4 is already happening.
Let me switch subjects .. The news today has Dell buying Perot Systems,
who, if memory serves me correctly after working around them for four years,
make some 40% of their dollars in health care related consulting
services. I don’t know if you can bend this onto your painter and pull,
but if you have a way to be referred out of Dell to Perot and a product to
bring with you, there might be some consulting opportunities. Just a
thought – though it was triggered by how well you know your stuff about Dell
gear and your product.
Scott Royall wrote:
The competitive advantage of
Xpress-It is exactly that it is a good team player in a GP world.