By Nina Silberstein
With everyone concerned about the bottom line these days, there is a huge push to keep medical devices running instead of buying new ones. With a goal of keeping equipment in good working order for as long as possible, maintaining and repairing current medical equipment in a department’s inventory is as important as ever.
“There’s a lot of pressure for cost savings, reducing staff, and coming up with ways of doing more with less,” says Arthur Bartosch, BS, CBET, director, biomedical engineering services, Westchester Medical Center in Valhalla, NY. “We’ve lost technicians over the years, yet our program responsibilities have expanded.”
So what does a department do to bring in those cost savings, and what does it look for as far as resources? “If we have training funds available, where’s the best place to put those training dollars to reduce the number of third-party contracts, OEMs, or ISOs who are doing work for us?” Bartosch asks. “It becomes a balancing act, because you want to find out what works best. You have to ask, what makes my program be able to meet the needs of the customer, yet be fiscally responsible, [how do you] find quality repair, and be sure that the risk of that person doing the work on my equipment is reduced to the best it can be?”
Clinical/biomedical engineering departments follow different avenues when it comes to servicing their equipment. The hospital department may have an in-house team that services all devices, or at least some of them. It may contract with the original equipment manufacturer (OEM) for complete service, or have a shared service agreement or a time and materials contract. It could also have a first look agreement with the OEM where the department takes a look at a problem first, and if it cannot fix it, it will call upon the OEM. Alternatively, biomed departments can often save money and time by having a third-party vendor service equipment and/or supply the parts it may need.
Due to the critical nature of the devices, there are questions to consider before hiring a third party, such as how does a department find a qualified third-party vendor, and what makes them qualified? What guarantee do they offer to ensure quality parts and service? What should a tech look for in a third-party vendor to guarantee it is an experienced one that will provide either parts or service that will maintain quality and safety?
Dan DeMaria, manager of the biomedical engineering department at the Olathe Medical Center in Olathe, Kan, uses third parties in various capacities for parts and service. “As a general rule, we look at a couple of things,” he says. “One is, if it is cheaper to do so, do we get more bang for our buck?” DeMaria says that he sees budgets tightening, and vendors have increased their costs. While he cannot always get parts that are less expensive, the third party tends to be accommodating. “The other thing we look at is if the service is quicker. Sometimes it’s just a manner of timing,” he says.
When Bartosch and his team have a device that needs service, he asks, “Can it be serviced in-house? Do we go to the OEM or the ISO? Where do we get the parts from—an independent vendor, or do we go to the OEM?” If he determines he needs service or parts from an outside vendor, he stresses that the process of finding the right one is not trial and error. “It’s establishing relationships with vendors who can meet your needs and understand what you’re trying to do,” he says.
To select the right vendor, he considers the following important attributes of a company: its responsiveness, quality, timeliness of getting the part or service, and how quickly the company follows up if there is a problem.
Reputation is also a critical thing. “We belong to the local biomed society, and we are in contact with our peers,” DeMaria says. “There are listservs out there that provide a wealth of information, and reputation quickly spreads, good or bad.”
In looking at the pros and cons of some of the third parties a department might consider, one real pro is the relationship a department has established with them. “We try to build good working relationships with our vendors and ISOs,” DeMaria says, who previously worked for an OEM and a third-party vendor. “We find that a lot of times, the ISOs are more flexible and able to meet a unique situation.”
Critical and Complex
“With critical equipment, I will ask more questions about where the technicians have obtained their training and what certificates they may hold to work on the equipment,” says Keith Waters, CBET, clinical technology department, Oregon Health & Science University (OHSU), Portland. “We look for quality, timely, honest service at a reasonable price.” Important questions to ask include how the repair technicians are trained and how they maintain their skills to be able to repair your equipment.
DeMaria notes that his department does not ask for repair help too often, unless it is a very specialized piece of equipment for which they do not have the training to handle in-house. In that case, training of the technicians at an ISO for more complex devices is especially important. DeMaria recommends verifying that a true biomedical engineer is part of the service staff. “A lot of third parties are started up by the sales people,” he says.
Biomeds may also want to find out if the qualified vendor is authorized by the manufacturer(s) of the equipment needing service. Keep in mind that some third-party vendors do not always have the expertise to perform all repairs and have to go to subcontractors themselves. This might affect quality control down the road if the work was substandard, which could ultimately lead to product failure.
When it comes to parts, Waters says, “Here at OHSU, we try to stay with OEM parts as much as possible. Personally, I would try to stay away from third-party companies that manufacture their own parts. Although they may be very close to the manufacturer’s parts, I don’t know how they were tested and verified.” On the other hand, can the repair company prove it does not use inferior parts and materials? Ask if a company reuses parts or tries to replace costly parts that should not be replaced in the first place.
For DeMaria, used parts are fine when a particular part is hard to obtain, such as for equipment that is older. “Sometimes these parts are guaranteed. Sometimes the third-party vendor will even improve on a part that has a high failure rate and is very expensive to get from the OEM,” he says. “In that case, we’re a little more careful and only purchase one and evaluate it. Is it really good or better? We ask if there’s a warranty or guarantee.”
As a director, Bartosch not only oversees 10 in-house technicians, he also monitors anyone who provides services to the institution, depending on the type of equipment—from the manufacturer’s manager, a sterilization expert to a radiology expert and outside manager—so he can see how they all operate. Since the medical center has sophisticated equipment, he asks, “Who’s going to maintain the high-end equipment? Who has the knowledge base to do it? I’d be very hesitant to give business to a third party who doesn’t have the experience on these devices.”
Another thing to consider, according to Bartosch, is that a lot of new, high-end equipment has been in the marketplace for a relatively short period of time, so the knowledge base has not been established for a third party to come aboard. “You may also have applications that may have to be updated or changed and you need the ability to get into them with software codes.” Bartosch says. “When the system is down, we have to get it up and running, and I can’t wait for a third party to figure out how to get it done.” He adds that he would also be hesitant to bring some high-end, new equipment service in-house. “You have to look at if the vendor is willing to train you on it,” he says. “Many are not and don’t want to give you the software keys to get into it.”
A department may also use an outside source when specialty training on a device or test equipment is too expensive to justify. In addition, if a warranty does not cover user damage, or no possibility of warranty coverage exists, a third-party vendor may provide a competitive bid for repairs.
Turning it Around
Many third-party vendors do offer a shorter turnaround time and, in many cases, at a lower cost. This might be considered a higher level of service, but the overall services of the third-party vendor need to be considered, not just how quickly it can repair a device or supply parts. “Some OEMs still have wonderful customer service, but usually a smaller third party will be more personable and customer-oriented to make sure that you are happy,” Waters says.
Turnaround time also depends on what sort of equipment you have. Some third-party vendors come on-site, some mainly provide depot repair, and a few do provide loaner equipment. “In some cases, they come on-site,” DeMaria says. “One vendor we work with will hand deliver a part the same day, and that can be a really nice thing for us. And, yes, some are likely to offer loaner equipment.”
When a third party returns the equipment it has serviced, the company should include a detailed service report of what was tested, repaired, or calibrated. “If not, you really don’t know what, if anything, has been done with your equipment,” Waters says. “This should be very similar to the documentation the OEM would leave when the job was completed.”
A good third-party vendor will provide quantitative evidence of the repair. Quantitative inspection methods ensure patient safety and cost savings.
Contracting with a third-party vendor based on price only without analyzing the repair-quality methods, procedures, and processes, could be a costly mistake. Choosing the lowest bidder can compromise quality. The best advice is to partner with the third-party vendor to identify and then, ultimately, reduce repairs that could have been avoided early on. Asking for references is always a good idea.
Nina Silberstein is a contributing writer for 24×7. For more information, contact.