By Eliezer Kotapuri, PEng, CCE
There is a huge uproar in the clinical engineering community about the latest directive issued by the CMS regarding hospital equipment maintenance requirements. This commotion comes in different shapes, sizes, and forms: Hospitals will be hit with hiring additional employees, departments will have to replace test equipment with what is recommended by the original equipment manufacturers (OEMs), it is too difficult to follow the OEM’s recommended PM procedures, the PM frequencies and procedures don’t make any sense, even OEMs do not follow their own procedures and/or schedules—and the list continues, concluding that health care delivery costs will be higher. Many clinical engineering professionals working for hospitals, independent service organizations (ISOs), and regulatory and nonprofit bodies have taken time to quantify the impact in terms of cost. These numbers looked very interesting and surprising. With all these impact estimates and projected higher health care delivery costs, there are advantages this directive may bring to the clinical engineering field in particular, and the health care industry as a whole.
Underbidding: How low can you go? This is a question often asked by many administrators, financial liaisons, purchasing groups, Six Sigma, and quality experts with little or no knowledge about clinical engineering. This directive may impede those executives requesting and/or ISOs soliciting quotes with less than acceptable/recommended maintenance schedules or procedures for maintaining equipment. Sometimes, it seems it is only the cost that matters and not the quality or the specifics of the agreement. Some hospitals, and not an exaggeration, are a revolving door for ISOs. It is not uncommon to see technicians and managers (once in-house employees) continue to provide services to the hospital when they were rehired as employees with lower pay (reapply, re-interview—you know what I mean) by the new clinical engineering service provider. What has really changed? Sure, the annual contract amount is lower, and maybe the quality too. However, morale among the clinical engineering employees is always on a downward trend at these hospitals. Taking a lower bid is not always the way to go.
The accuracy and quality of data will improve, as hospitals will be forced to collect/review data before making decisions to alter maintenance schedules.
The directive may breed consistency and continuity with clinical engineering services in hospitals. Clinical engineering service providers will have to bid or submit proposals for the same inventory with the same schedules and intervals, and adhere to set standards. This also expedites a need to establish a yardstick that can measure the quality of service and delivery by service providers, both internal and external. There is a greater need for this now as more and more organizations, whose core is not clinical engineering (ie, housekeeping, EVS, dietary and nutrition, journalism, insurance, Six Sigma, etc), are transitioning or diversifying into the field as service providers, and/or it is managed by those with no background in clinical engineering. This will create a sense of trust and quality among the clinical staff where quality will take the driver’s seat with a consciousness to cost.
Data collection: Evidence-based maintenance driving evidence-based medicine. Hospitals will be forced to collect/review data before making decisions to alter any maintenance schedules for non-life support equipment. How many of the organizations use data to make decisions? Departments shut off PMs and change PM schedules with no rhyme or rhythm. Some of the terms used in the work orders include—but are not limited to—performed a quick PM, visual inspection only, performed an electrical safety PM, PM performed to OEM specs (without knowing them), and PM passed. Do these terms sound familiar?
Accuracy and quality of data in clinical engineering departments will improve: The hospitals that are a revolving door to clinical engineering service providers generally have the least accurate data or no data since the outgoing/ousted provider often does not leave any history, or only some history, or leaves inaccurate inventory/history information for the incoming lowest bidder/provider.
Critical equipment: How many hospitals have this list? At least this directive will force hospitals and their clinical engineering departments, internal or external, to come up with a list. This list can vary from hospital to hospital and is not service-provider specific.
Capital acquisitions: Since the maintenance costs are expected to increase substantially, would it discourage hospitals and user departments from buying more or extra equipment, “just in case”? It is our responsibility to communicate this directive and its impact thereof to the C-suite.
OEM work and its recommended schedules and procedures: Clinical engineering departments, internal and external, will more frequently question and scrutinize the work performed by OEM service technicians visiting their facility.
OEM protocols: OEMs will be made to put forth more effort, thought, and attention before releasing/publishing equipment manuals, and may be questioned at greater lengths about the PM schedules and procedures before receiving a 510(k) clearance.
While most in the clinical engineering community may view this directive as a burden on the health care organizations and their maintaining departments, internal and/or external, this directive, on the other hand, seems to have the right potential to revolutionize the clinical engineering field and its service delivery ideology and methodology. 24×7 Soapbox, November 2012
Eliezer Kotapuri, PEng, CCE, is the director, clinical technology planning, ISS Solutions (A Geisinger Company), Danville, Pa. The suggestions and views expressed in this article are of the author and do not represent the views of ISS Solutions. For more information, contact the editor.