Through an awareness of procedures, biomeds can add value to negotiations

From one hospital to another, the level of a biomed department’s involvement in making decisions on adding new equipment can vary from none to active. By understanding a medical facility’s equipment-acquisition process and contributing to it, biomeds can add value to their organization and better serve patients.

At Catawba Valley Medical Center (CVMC of Hickory, NC), a thoroughly integrated team approach to acquiring equipment yields the best results for the organization and the community it serves, according to Jonathan Holman, who coordinates CVMC’s seven-person clinical technology department.

“It’s a streamlined process,” Holman says, and one that relies on communication and teamwork, beginning with a commitment from administration and middle management to risk management, materials management, organizational learning, and end-users. “Equipment acquisition layers over into so many departments that to make this work it involves everyone,” Holman adds.

At the start of CVMC’s process, end-users meet with vendors to see and discuss products. After seeing options, a purchase recommendation based on a thorough review by the evaluating committee is made.

The clinical technology department then works with a preassessment committee to review and discuss the proposed purchases. Discussions address budgeted and unbudgeted equipment requests, return on investment, requests for proposal (RFP), and certificate of need, as well as the impact on a department or all clinical areas. Also discussed is any group purchase organization (GPO) power the hospital has through a provider such as Novation, which might offer better pricing on the purchase.

Next, clinical technology sends the manufacturer a prepurchase evaluation form, which covers items including the basics of vendor name, equipment manufacturer, model number, and approximate price, as well as delivery and installation information, equipment requirements and safety standards, software and manuals, training, service, and warranty.

Seven Tips for an Effective RFP
“If done correctly, the request for proposal (RFP) becomes part of the process carrying you through installation, service, warranty, etc,” says Myron Hartman, MS, SASHE, CCE, CRES, CBET, program coordinator of biomedical engineering technology at Penn State New Kensington (Upper Burrell, Pa).

Boyd Campbell, CBET, CRES, cofounder of Southeastern Biomedical Associates Inc (Hudson, NC), adds, “Don’t think this is like buying a car; price is always an important issue, but not the most important. First and foremost is patient safety.”
How do you create an effective RFP? Hartman and Campbell offer the following tips:
• Make it a team effort by involving all the appropriate players.
• Define needs and prioritize goals; work through requirements (don’t forget the obvious) versus the wish list.
• Ask for sites where the equipment is in use and which can be used for a site visit at vendor expense.
• Address all power aspects from adequacy and surge protection to requirements.
• Cover all points of installation, such as unloading, testing, workers’ comp for installers, number of installers, conformance with ordinances, etc.
• Provide the number of on-site training days, follow-up training, ongoing training for software/hardware upgrades, certification, etc.
• Provide biomedical training information, such as availability of training identical to manufacturer’s service personnel. —MF

The prepurchase evaluation is then reviewed upon return from the vendor. When a decision is made to order equipment, clinical technology will begin working with the organizational learning department to coordinate with the vendor training for users, be it a department or hospitalwide. These two departments work closely to ensure that all training requirements are met.

The process is well-documented throughout so that at any point anyone can look at the status. “The paper trail goes through seven or eight hands, so the buy-in is there,” Holman says.

Always striving for continual improvement, the process, Holman adds, “is a work in progress.” But ultimately, he says, “We try to stay leading-edge in all equipment, and we buy what fits our patient needs.”

A Biomed’s Contribution
Boyd Campbell, CBET, CRES, cofounder of Southeastern Biomedical Associates Inc (Hudson, NC), echoes the importance of a team in going through the equipment-acquisition and negotiating process. “It’s very important to pull a team together,” he says. “If it’s not doable, a team can figure this out quickly.”

Campbell, who helps hospitals develop their biomedical departments, believes a successful acquisition demands a team that involves the biomeds, be it for large or small facilities. But Campbell says there still are many organizations where biomeds are not yet part of the purchasing process. Sometimes a biomed’s first awareness of new equipment is when it is too late to negotiate and plan for the new addition because the equipment is literally on the doorstep, according to Campbell.

For those organizations, this presents a terrific opportunity to involve biomeds who can demonstrate the value they can add.

“You never want to go in and say, ‘I want to be the point of contact,’” Campbell says. The biomed really is an “assist role.” As a contributor to a team effort, the biomed and each team member have particular knowledge and skills to contribute. For example, the clinical staff can address the question of, “Will this work for our patients?” And biomeds will be the strongest staff members for evaluating the technical considerations of the equipment and finer engineering points. The biomedical department’s understanding of what equipment a facility has can contribute to standardizing equipment, which increases patient safety, and to the ease of keeping machines in service.

Biomeds also bring valuable input to the logistical side of the equation, such as how to get large equipment into the facility; planning for space requirements, electrical, plumbing, and air; and determining the transition time needed for moving old equipment out and the new in. As well, Campbell says, “The biomedical department can usually schedule to get the new equipment into service quicker with a little notice.”

Offering assistance with a smaller acquisition may be one way for biomeds not involved to get more engaged. Campbell suggests this is a path that may help a hospital get more comfortable with “another finger in the pie.”

Campbell says he has worked in situations too where “we just stuck our noses in when things went wrong” to point out where the input of the biomed group would have made a positive difference. Eventually, administration began to see the value of the additional input.

Negotiate Training
Working with the IT area, biomeds can offer input and exert influence on the software side of the equation too during equipment negotiations. It is important to anticipate what issues might arise related to the software and service side while the purchase order for a $500,000 piece of equipment, for example, is still in-house, as obviously any leverage is gone once the check is cut.

As an example, a particular piece of equipment may have password protection on a service-area menu for which only the manufacturer service representative has access. If the representative is 4 hours away, this may cause unnecessary downtime. Had the purchase contract stipulated the same training for the facility’s technicians as the service representative and provided service-menu access, the equipment downtime would have been minimized.

On training, as well, evaluate what is being included, who is being covered, and if the training is of sufficient length to address all concerns. If materials are available only on CD, consider negotiating hard-copy manuals and determine the number needed.

“I believe in negotiating on all points of need whether large or small,” Campbell says. “Many times, due to GPO contracts, the vendor may not be able to change price, but may be able to provide more training, extended warranties, or disposal supplies, for example.”

Look too at compliance issues in the evaluation stage. For instance, does the software for the product under consideration produce an audit trail? If not, is there a software interface to provide this that can be negotiated into the purchase price?

Get In the Game
Myron Hartman, MS, SASHE, CCE, CRES, CBET, who is the program coordinator of biomedical engineering technology at Penn State New Kensington (Upper Burrell, Pa), says that where biomeds can best contribute to the equipment-acquisition process is in development of the RFP.

A well-conceived RFP (Sidebar, page 41) is the basis for determining what is the best product for the facility. It should address everything from general bidding information, power requirements, clinical training for staff, training for biomedical staff, service and repair, and technical specifications. Within those categories, Hartman says, the hospital should define its needs and ask how the vendor will meet the specifications. And if the vendor cannot meet the specifications, the vendor should be able to document what can be provided.

Not all purchases may require an RFP, and this may be driven by a facility’s procedures and the complexity of the transaction. “A prepurchase evaluation form is a great way to go for purchases, such as IV pumps, defibrillators, and EKG machines,” Campbell says. This essentially is a more compact document that still covers all the must-know information.

Even before the RFP or prepurchase evaluation, the biomed might be able to assist with a generic request before specifications are even drawn up to contact vendors or an independent source, such as ECRI, to identify broadly what options are available.

Hartman says biomeds further their value to the process by developing an awareness of the bigger picture. This includes everything from understanding how the fiscal year and new product launches impact the timing of purchases to having an awareness of the short- and long-term planning requirements of the facility or contributing to a comprehensive review of all the impacts of a changeover, for instance with a machine that necessitates a move from film to digital.

One of the weaknesses in the biomed field, Campbell believes, is in showing value through documentation. Manage-ment wants to see it in “black and white.” Outline scenarios to present to administration to show how things would have rolled out differently with biomed involvement. This will help increase the perception of professionalism of the biomeds and their ability to offer more.

“Get in the process in an assist role,” Campbell says, by serving on a capital equipment committee or ensuring that you get to see medical equipment requests. “Prove your worth up front.”

Maria Fotopoulos is a contributing writer for 24×7.