You Don’t Bring a Knife to a Gunfight

HarringtonThat line or something very close to it, was delivered by Sean Connery in the movie “The Untouchables.” That line is so very true to all of us who support technology in healthcare.

We, in our chosen field, are under ever-increasing pressure to cut costs and do things better, quicker and with ever-dwindling resources available to us. We have groups like Leapfrog, a group of large-scale employers who are working together to get lower health insurance costs, pushing for low costs in hospitals. Many of these companies have recently increased their charges to hospitals for service on devices that they sold. It is not unusual to see service rates of $500 per hour, plus travel, plus parts priced several times higher than what we can find them for from other sources.

When we buy new devices the software to calibrate the devices is conveniently on “back order,” and when we do get it, if ever, it is several revisions out of date. We are provided warranties that have more holes in them then Swiss cheese, with “user abuse” as the catchall phrase for charging under warranty for regular repairs. Almost without fail, once the unit is out of warranty we hear of an “upgrade or update” that we can buy. Why wasn’t that done under warranty?
We have “buying groups” that claim they can get steep discounts on devices from manufacturers. I recently saw two quotes from the same vendor for the same eight-bed telemetry system at two different hospitals. The hospital in the buying group was to get 15 percent off the list price while the one not in the buying group got a 24 percent discount. I asked the materials manager about the cost difference and got a blank stare. Some of the 9 percent difference could have been used for training and parts. But it wasn’t, as usual.

Another problem that we have to look out for is the extended warranty on a device. I have seen hospitals forget that the device has an extended warranty and pay for work on the unit from the same company that provided the device. That “oversight” was picked up during an audit of the account and it took months to get a “service credit” — not a refund, but a credit.

What is the biomed to do? We need to get our “jungle network” working where we share our experiences with others. We need to watch our suppliers and other service organizations to be sure that the work is done right the first time. We need to get on the FDA to enforce the provisions in the Safe Medical Device of 1976 that we must be provided accurate documentation to service and calibrate the device. I know that there have been several suits over service documentation, but they involved someone selling service, not doing it for a hospital that owns the device. But there may be a bright side to this whole mess.

With more and more large companies having to “restate” their earnings and cut some of the management perks, they just may become a little more customer/biomed friendly. These companies may actually have to support the biomeds and listen to them on devices. These companies may have to look at themselves as a major contributor to the rising healthcare costs and make some changes in charges and support.

We might have brought only a knife — and a dull one at that — to this gunfight, but we are close to scoring some very decisive points in the ongoing struggle to contain technology costs in healthcare. Keep up the good work, and we can get control of the costs, at least on technology.

Dave Harrington, director of special projects for Technology in Medicine Inc. (Holliston, Mass.), is a veteran educator/clinical engineer/technology manager and 24×7 contributing editor.