To Biomed or Not to Biomed

 Who’s Watching Contract and Non-Contract Vendors
The high cost of replacement parts for medical equipment is just one of the many factors contributing to the ever-increasing cost of health care.

Over the past 3 or 4 years I have consulted several hospitals regarding the process of starting a biomedical electronics department or to determine what clinical engineering support they need. Many hospitals have outside contractors perform equipment checks, preventive maintenance (PM), and some minor repairs under contracts costing anywhere from $95,000 to $250,000 a year, depending on the amount of equipment and/or services requested.

After 18 years with a large metropolitan hospital and some 7 years in my own business, I’ve been asked on several occasions, “Why is it more expensive to keep a medical device up and running without a service contract on it?” Until about 3 or 4 years ago, this question seemed quite simple, although I now know a little more about what is really going on when you call an outside service company to repair your medical equipment.

Each and every piece of medical equipment has to stay in use for as long as possible during its first 2 or 3 years, according to its capital equipment request, which includes a return-on-investment table, often computed by the facility’s chief financial officer. This allows the device to pay for itself in the prescribed amount of time.

Most small hospitals (fewer than 100 beds) today have had to cut costs, downsize, and do more with less, and, therefore, most do not have full-time biomedical tech support. Instead they have outside vendors come in 1 or 2 days per week. Let’s say that an IV pump acts funny or for some reason just does not seem to be working the way it should. It is marked “not working” and set on a shelf for the biomed vendor to check. Five days later the biomed checks the device and finds nothing wrong. The device is returned to service. That is 5 days of lost revenue, times four or five other devices. All of that equipment can add up to a lot of money lost to the hospital for lack of a full-time BMET.

Or, what if the biomed vendor finds that there is something wrong and has to order parts? The device could be down a lot longer than 4 or 5 days, adding to the lost-revenue factor or decreasing the yearly input of capital monies.

Three years ago I started offering “total asset management” to my accounts. I would monitor all contracts and service personnel, including any service person performing repair/and or maintenance on facility medical equipment. This type of service necessitates a full-time biomed.

Some service companies will jump through hoops to get more money from a hospital when a medical device is not on a service contract. The following are just a few examples:

A nuclear-medicine device needed servicing. A service engineer came in to determine the nature of the repair, and, after 1 hour, stated that he would have to replace the $6,000 control board because a wire had come loose. When I asked if he could solder the wire back on, he said, “We were told not to carry a soldering irons.” I asked if my soldering the wire back onto the board under his auspices would void the 90-day service warranty. He didn’t see why it would. Total cost: $780.

In other words, if this facility did not have a full-time biomed, the service call and parts would have been well over $7,000—all because of a solder connection.

In another instance, we called a service rep to troubleshoot a mammography unit. During the initial phone call, I was asked if the 5-V power supply was working. I found that it was not. The service vendor offered to drop ship the power supply and have a field engineer there within 24 hours at a cost of $4,600.

“What is all that for?” I asked.

“Well, $2,000 for the power supply and $2,600 for travel, hookup, and recalibration.”

I called the unit’s manufacturer and asked the price for the 5-V power supply. The manufacturer told me it was $497.43. What a mark up.

I ordered the power supply and installed it. Then I called the service vendor to request a PM and recall. Total price: $1,200.

The above are just a few of the many ways a full-time biomeds/clinical engineers can save a facility money. (On December 30, 2003, I turned in a year-end monies-saved report to the CEO of one of my hospitals. It totaled a little more than $47,000.)

Until service vendors understand what their actions, or lack thereof, do for the health care industry, they will always be seen as interested in just “making a profit.” As true as this may be, sometime in the near future they will have to apply a “partner relationship” methodology to their business practices, which just might justify their existence.

Scottie R. DeWolfe, CE, BMET, is the sole proprietor of B-METS Corp in Dothan, Ala.