Third-party providers step up to offer cost-savings
By Elaine Sanchez Wilson
When it comes to servicing the MRI segment, providers are managing a dynamic modality that is seemingly in a constant state of evolution. Biomeds and other healthcare professionals not only must be familiar with the technology’s multitude of components—from field gradients and radio waves, to cryogenic fluids and compressors—but they also need to know when to turn to more specialized servicers when issues arise.
“The MRI equipment segment is the most technically complex modality to service,” explains Jim Spearman, president and CEO of Cary, Ill.-based Consensys Imaging Service Inc.
“The manufacturers have a history of frequently changing software platforms, clinical applications, and overall technological methods of generating images and/or operational processes. MRI is also the most dangerous equipment from a proximity perspective, due to cryogenic fluids, high voltage, and high magnetic fields that can cause heavy metal objects to go airborne at high-speeds when they approach the magnetic field.”
Kara Bowman, MVS inside sales and technical support specialist at Whippany, N.J.-based Bayer MVS, suggests a multipronged approach to service. “MRI equipment is oftentimes looked at holistically, but when facilities are seeking coverage, repairs, and maintenance, it is best to see if multiple companies can service your needs better than just one provider,” she says.
“The magnet and software, the MRI coils, and even the monitors and injectors should be examined for repairs by separate service organizations. It may be the best option for minimal downtime, lowered costs, and making sure quality patient care comes first.”
One example of a matter requiring more specialized attention exists within the cooling chain, says Simeon Lowe, director of service at Block Imaging in Holt, Mich. “If you have a super-conducting magnet—which is much more common—the vessel will be cooled by liquid helium, or cryogens,” Lowe says. Multiple components are at work to reduce helium boil-off, he adds, such as cold-head, compressor, and chiller.
“While all crucial to the operation of a super-conducting magnet, these subsystems generally are serviced separately from the MRI system itself,” he says. “More often than not, you will need specialized engineers to handle the service of the coldhead/compressor and an HVAC engineer to work on the chiller.”
Barriers to Utilization
Because MRI is such a complex technology that incorporates a marriage of systems, Lowe says his company encounters a wide spectrum of challenges. “They vary a lot, especially when looking across different manufacturers and models,” he continues, adding that the most common issues include artifacts or ghosting in images, HVAC or cooling-chain-related failures, and system boot-up failures, especially related to the workstation failure or software issues.
Over at Consensys, the most frequent service challenges the team deals with are improper power and grounding, and poor routine maintenance, according to Spearman. “Consensys is truly an alternative to OEM-service, and as a result, we often win accounts from OEMs and find a history of poor maintenance as a root-cause of poor system performance,” he says.
“Consensys has a vast library of proprietary tools and programs.” As a result, he says, company officials often identify root-causes that have existed for months—even years—after inspecting units that have undergone OEM service.
On the other hand, Bowman says the biggest challenge her team faces is the absence of information, specifically with regard to the “problems the end user is experiencing with their equipment,” she says. “In order to provide the fastest and most comprehensive repairs, proper communication needs to be given to the repair providers.
“These repairs are really no different than taking your vehicle to be serviced at the dealership,” she explains. “We do not just drop off our vehicles and say, ‘It’s noisy.’ We need to be more specific in order to have the problems addressed. As a coil service provider, we need to ask what the issue is and receive a detailed explanation of when it’s happening. This ensures we are servicing to the best of our abilities.”
A lack of information also leads to another challenge the Bayer MVS team encounters, this time with customers not fully understanding their OEM coverage.
“For example, customers often think they are covered for MRI coils when the magnet is covered, but MRI coil coverage is typically an extension to the contract that costs facilities extra,” Bowman says. As a result, she encourages facilities to do their homework before signing on the dotted line since there’s typically an option to separate the MRI coils.
All things considered, Bowman says, facilities can save significant capital by partnering with a strong third-party repair company—without sacrificing the quality they expect of the OEM.
It’s no surprise that a change in the country’s administration and an uncertain future healthcare landscape has impacted imaging departments’ budgetary decisions. In many cases, providers are reconsidering the OEM service path and turning to third-party partners, or even looking within their own organization.
According to Lowe, an increasing number of healthcare networks and hospitals are bringing their imaging equipment service and maintenance in-house. “By this I mean that traditionally the majority of service performed on diagnostic imaging equipment was done under a full-service agreement by the [OEM],” he says.
“Due to financial cutbacks that many health providers are being forced to make, service contracts are one of the first things to go. Many have also realized that training up a staff of clinical engineers and using third-party parts providers, like Block Imaging, to support their imaging equipment can be much more cost-effective.”
Spearman adds that customers have demonstrated a desire to take more financial risk on the service of their imaging assets, including MRI. “Service contracts are a large cost dollar-item in any budget, but what customers miss is the rest of the equation: revenue minus cost equals profit,” he says.
“There is a disproportionate focus on cost to service the units versus how much downtime, lost patient revenue, planned-maintenance defects, and regulatory/safety liability can more than justify a 10%–20% difference in the cost to service a unit. Consensys has serviced global market-leading MRI platforms under full-service without one single hour of down-time over a three-year period.”
Amidst these financial considerations, another trend in the MRI segment involves the demand for superior image quality. “As manufacturers strive to obtain the highest image quality, the more complex the MRI coil design tends to be, which means more complex and expensive coil repairs,” Bowman says. She adds that access to proprietary components and software may become an issue with some repair providers.
“When sending an MRI coil in for service, biomeds should confirm the problem with the site imaging center, and provide HIPAA-compliant images if possible,” Bowman suggests. Attention to detail, however, is paramount, she says. The more detail that’s provided, the sooner the technician can resolve the issue.
Weighing the Options
When figuring out whether to bring service in-house or seeking out a third-party partner, healthcare providers can take certain steps to reduce their risk.
“Biomeds, clinical engineers, and their managers can do quite a bit to at least start going down the road of in-house service without fully taking all [the] risk,” Lowe says. “One way to do this is by moving some of the smaller modalities in-house first. [Bone mineral densitometry], general [radiology], and ultrasound are much more baseline systems to get training on without exposing yourself to the disaster of a quenched MRI magnet, blown CT tube, or failing cath lab detector.”
Lowe adds that partnering with a third-party service provider, such as Block Imaging, on a step-down service program is another option. In this scenario, HTM professionals can undergo service training on specific equipment and then still receive expert help, when needed. “This can be done on a time and materials service basis, or just moving to a less expensive third-party contract with the intent to eventually move out on your own entirely,” he adds.
Spearman, for his part, says biomeds often face a “no-win” scenario because “they can rarely impact the revenue side of the equation and are thus forced to focus on cost-only solutions.” He says, “This typically results in trial and error over several years, with marginal results in the majority of cases as it relates to high-end imaging equipment service.”
Consensys, he reveals, offers an empowerment service contract, in which in-house and biomed teams have been trained to service imaging assets at first look and full-service levels. “This is just one of many best-practices available to address this issue,” he adds, commenting that there are many scenarios where in-house service is the best option and others where it is not.
Moreover, customers with OEM service contracts in place can also feel empowered to challenge their existing coverage to maximize their cost savings.
“When looking to save costs in a facility that is covered by the OEM, challenge the OEM coverage and identify if there are options for saving money by separating your MRI coils,” Bowman advises. “If you’re not covered and/or you’re seeking a quality third-party repair provider, know what to look for when choosing these companies.”
Make sure, for instance, that the company is International Organization for Standardization (ISO)-13485 certified, she says. “Beware, though,” Bowman adds, “because some third-party companies say they follow ISO 13485 standards, but they’re not actually certified.” And for intricate MR systems, it’s a distinction that matters.
In the end, healthcare organizations can follow best practices to ensure that their equipment is running at optimized efficiency. “MRI coils are really no different than a vehicle—the more miles on the vehicle, the more service it is going to need,” Bowman says.
She encourages HTM professionals to proactively run quality assurance testing, as well as visually inspect the equipment on a daily basis. “Proper care and handling is another factor in extending your MRI coil life,” Bowman says. “Impact damage and improper use are often the reason for MRI coil service, which is why she advises biomeds to play close attention to MR systems.
Moreover, Lowe stresses that all equipment should be on a documented preventative maintenance schedule, adding that the OEM-recommended frequency will vary based on modality and manufacturer. “In many cases,” he says, “preventative maintenance can catch issues before they put a system fully down—and, if nothing else, make sure that it is operating at optimal effectiveness.”
He encourages providers to ask the following questions when setting up systems to manage in-house service:
- “Are you documenting past repairs and system maintenance history?”
- “Are you evaluating equipment lifecycle expectations and making decisions to keep or replace devices based on these measurements?”
- “What metrics is your team using to evaluate the effectiveness of your clinical engineering teams, outside of dollars saved?”
Joining in on the conversation, Spearman adds that it’s important to bear in mind that imaging equipment is constantly evolving. After all, he reveals, some of today’s technologies are vastly different than those of even five or 10 years ago. That’s why Spearman advises healthcare facilities to “think long-term” when developing a service program—with the ability to train to new imaging platforms considered a non-negotiable.
“Leverage experienced partners like Consensys Imaging Service or others who can assist with known challenges while helping to create lasting, long-term, cost-effective solutions.” Because in today’s MRI environment, such a scenario is key.
Elaine Sanchez Wilson is associate editor of 24×7. For more information, contact [email protected].