Reviews and News on Medical Equipment

When purchasing new medical equipment, the warranty terms are typically up for negotiation. There is no need to take just what is offered. A cookie cutter warranty may not fit the special needs of your practice and patients. Here are a few things to look for in your warranty, and to ask for if they are not offered.

* Scheduled maintenance – To maintain the warranty, you will typically have to agree to and perform regular scheduled maintenance on the machinery or medical equipment. You will need to know exactly what must be done and at what frequency. Is the frequency based on number of uses, or is it a function of time? Does maintenance include replacement of certain supplies or materials, or even components? These are all usually technical matters and many are not subject to negotiation. But the number or cost of professional maintenance calls you will receive can be a point of discussion. As long as you are doing your part to keep the equipment running well, you want your vendor and/or manufacturer to be supporting you in that as well.
* Training – If your purchase contract doesn’t specify training for your staff regarding use, care, and maintenance of the machine or equipment, make sure it is spelled out in your warranty.
* Cost of replacement parts – Find out if the vendor will share some of the cost of parts, especially ones that are prone to wearing out. Obviously anything found to be defective should be replaced at no cost to you
* Length of warranty – When it comes to warranty length, the longer the better, or the higher volume the better. It will depend on the type of instrument and test volume, but you want coverage to last as long, or for as many tests, as possible.
* Voiding of Warranty – Make the vendor go over what will void your warranty and make sure that any staff member who operates the machine understands this too. This important point is often overlooked. Most vendors are fairly straight-forward about the actions and conditions that will void a warranty—unauthorized repairs, or failure to use specified supplies, for example—so make sure they are terms you understand fully.
* Response time – Get signed documentation as to how long the vendor can take to respond to a call. Know under what conditions a technician will be sent to your site as opposed to doing troubleshooting by telephone. Know where the people answering help line calls are located and what days/hours they are available. Learn what will trigger a on site call versus a help desk call.
* Replacement costs – Under what terms does the vendor offer a replacement for the instrument and how much of that cost will you have to pick up? What kind of insurance arrangement does the vendor require?

A warranty is not an incidental thing. It can mean the difference between your machine being a profitable asset and your medical equipment becoming a endless pit for your money. The warranty should be one of the first things that you bring up with a vendor and should, for the most part, be open for negotiation. If you find a company that is resistant to talking about terms – take your money elsewhere.

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Once you have picked your medical equipment out, installed it, and have it operational, your job is not over. Now you have to insure your equipment against any long term damage. You can purchase insurance that will pay for damage to or even the replacement of your medical equipment, but you must carefully consider how much you want to spend and what you want and need the insurance to cover.

The first thing to consider is whether or not your machine is new enough to be under warranty. In that case, all insurance questions may be moot. Check the language of the warranty. Look for the terms “replacement cost” or “extreme damage.” There should be a clause about replacement in the event of a disaster – fire, flood, and the like. The terms should be fairly straight forward. Be sure to check to see if the contract refers to another policy or demands that you take out additional insurance.

If it does, or if the manufacturer can’t or won’t give terms on replacement, it is time to get an insurance agent. Call them and schedule a visit. When they come by, go over your existing policy. See if it covers the costs of replacement for the equipment in question, in addition to any other losses you may sustain. Most insurance policies have maximum limits; make sure your insurance coverage actually covers everything you need replaced.

When discussing your needs with an insurance agent, be sure to mention whether or not the medical equipment is vital to the operation of the business. This will be a key phrase that the agent can use to write the policy and find a carrier to underwrite the cost. They will need the amount of the replacement cost. That is very different from the amount that you paid for the instrument, especially if you bought it used. See what the vendors will charge for a new piece of equipment similar to the one that you have. That is the price to quote to the insurance agent.

Be sure that the terms are also appropriate for your area. A clause including damage from earthquakes might not be so vital in an area that has not experiences a quake in living memory, but in Southern California, it would definitely be considered essential.

Insuring you instrumentation is an important concern. It can be the difference between recovery from a disaster and shutting down an ongoing medical concern.

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Although it may be counter intuitive, there is a time when it would be cheaper to get a newer or upgraded medical equipment than keep the older equipment you already have. These are just a few of the reason to give serious consideration to moving to a new machine.

* Down time – How often is the old machine not producing for you? A medical office should be run like a old time family farm. If something is not producing for you, you get rid of it. It an instrument is fragile due to age, it may be time to get upgrade.
* Accuracy – Has there been a change in the accuracy of the instrument? Bad clinical data can not only harm the patients, but cost the practice a great deal in malpractice and lawsuits.
* Supply costs – What is the difference between new supplies and the old ones the instrument needs? Take the case of an x-ray machine: the cost of film is fairly stable, given the number of manufactures out there. But with a chemical analyzer, there may be only a few places to get reagents and that might tie you down
* Repair costs – How many service calls have you had in the past six months? Each visit from a repairman costs, and that has to be considered into the expense of keeping the old instrument. Any new instrument will have service calls included as part of the warranty.
* Turnaround time – Has a clinical situation arose that means you need results faster? An older machine can mean a longer time to get those needed results. Has time become an asset you are looking to manage more closely? If so, that upgraded machine is beginning to look better and better.
* Daily maintenance – Are you doing additional maintenance for an additional cost? And be sure to consider time cost as well as monetary cost. Longer start up time can mean longer turn around time. And has that one simple part that you need to keep running become a regular thing?

Taking all of these into consideration, you should be able to make a decision between the old machine and a newer piece of medical equipment.

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You have made a change in your instrumentation. But now you have an old piece of medical equipment that you no longer need. What do you do with it? Here are some options that you should know about and some things that you should keep in mind.

If the machine is still under warranty, and you are getting a new machine to upgrade the old one, these questions may be moot. The methods of disposal may already be spelled out in your contracts.

The first place that you should look to for disposal options is the very vendor that you bought the medical equipment from in the first place. They may have several reclamation programs that will take the instrument right off your hands.

Is the instrument still accurate and serviceable? Then you should consider selling it. There are several online auctions that have used medical equipment. This way, you will recoup some of the cost of your new instrument. There are also several companies who will buy the machine. They will take it, repair it and resell it.

Another option for a workable piece of medical equipment is donation to medical service foundation. That piece of older model that you cannot use anymore may become the centerpiece of a clinic somewhere.

But let’s say that you have a used medical equipment that is not under warranty and there was no vendor to give you customer service. Call the manufacture directly. They should have some suggestions about you disposal options. If they are unwilling or unable to help, there are some suggestions that may be helpful.

If there are no bio-hazard issues, see what disposal options the local authorities have for the disposal of electronics. Your instrument may fit into that category of waste very nicely. If there are bio-hazard concerns, call a company who disposes of medical waste. They will be able to direct you. If there are reagents involved that must be disposed of, either the aforementioned bio-hazard disposal company will be able to help you, or they will be able to direct you to someone who can.

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The first consideration you need to make is the nature of the population you are going to serve. Are the demographics shifted older rather than younger? In that case you may need more assistance devices than holders for educational material. More young women than older ones? Look into lower cost pregnancy tests.

Now consider the nature of your practice. An orthopedic surgeon cannot function without an x-ray machine, and the best one he can afford. A small family practice may have limited used for a x-ray machine and a smaller, lower volume machine may serve very well.

Accessibility is the next consideration. Is the practice that you are equipping in a major urban area, with all the associated support? In that case having a number of a good medical supply companies close at hand may help you control the costs of maintaining your instruments. On the other hand, an extremely rural area may force you to stock up on expendable supplies much more than a practice in the big city.

Turn around time is another consideration. How fast does your practice need the results? Take lab tests for an example. There are several national laboratory companies that will have expedited times for several tests. This, or a relationship with the local hospital, may supersede the need to have an in house chemistry analyzer. But if you are running any kind of urgent care facility, a twenty four hour turn around time may be unacceptable. And your instrumentation has to reflect that need.

Changes within your profession may influence these decisions. Are there new innovations on the horizon that will deepen the services that you offer? If so, those might be the only consideration that you need to make. But if an existing piece of instrumentation will serve your clinical need that may be an option.

Of course, an overriding concern is cost. Various vendors offer several financing options, and used medical equipment cannot be overlooked in this economic climate. These can be the hardest questions to answer, but the cost cannot become the sole determination in your medical equipment purchase decision. Taking all these factors into account will help you to pick out the best instrumentation for your practice.

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There is a belief that the newest is the best that innovation is the key to advancement, and medical science can be no different. The newest medical equipment has to be better than last years device, and the drive to get that new, improved, better than ever thing can consume us all.

But this might not be the best way to look at your medical equipment. Yes, a new fresh solution may be needed. Here may be a persistent problem that can be solved only with the newest and best piece of equipment. And in that lies the secret: need.

Before you replace or even upgrade that piece of instrumentation, there are a few things that you need to ask.

• Has a new problem come up? Age of an instrument should not be the overriding factor in whether or not to replace a piece of medical equipment. If your needs have changed or there is a new challenge, then a new piece of instrumentation might be in order
• Have the operational cost changed? If it is now more expensive to run your machine than it was last year, a change might be in order. But before looking at a whole scale refit, a change in supplier might solve the problem.
• Have the diagnostic needs changed? If your patient population has changed, and changed dramatically, that new instrument may be collecting dust. Your instrumentation has to be able to adapt to your patients. If a new piece of equipment is necessary to provide the best standard of care for your patients, you may need to upgrade regardless of the age and condition of your current equipment.
• Has the instrument’s accuracy changed? Check your control numbers for a set period. If there is a trend away from the set norm, some kind of correction will be needed. Question the manufacturer’s technical people, and don’t rely only on the salesmen.
• Is the warranty on your machines expired, or about to expire? You need to ask yourself how often you used the warranty. If service calls were frequent and necessary to keep it running, see if you can extend the warranty without replacing the machine. On the other hand, did all those calls interfere with the production of results? If it did, replacement might be the best option.

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Now that you have your new, or new to you, piece of medical equipment, it has to be used. For that, there are the chemicals that are needed for operation. There are specific guidelines that have to be followed, but within those guidelines you will have a bit of wiggle room.

Hopefully, the initial work was done before you purchased the instrument. Assume that the cost per test has already been figured and you have that firmly in mind. It will be the basis for the operational costs for your equipment.

Now think, what does your instrument utilize the most? An X-ray machine will use film, and use a lot of it. Chemical analyzers will use reagents and cleaning solutions. A piece of durable equipment, say a exam table, will have little or no supply cost.

How often is this instrument going to be used? Consider our x-ray machine again. A general medical practice will not see the volume of x-rays that an orthopedic office will see. That is the other half of the total test cost.

How stable are the supplies? Bulk buying is a good way to save money, but only if the supply is stable over a long period. Chemical reagents have a great deal of variation when it comes to expiration dates. Check them closely before buying a large amount. Going back to our hypothetical x ray, buying film in bulk can be a good idea generally. Simple x-ray film lasts a long time when stored properly.

Do you have more than one supplier? This is almost never the case with a chemical analyzer. In fact, you can get some fantastic deals on an analyzer because the company will make its money selling you the necessary reagents. Be sure to crunch the numbers before making that large a purchase.

Check the warranty. In the first blush, the warranty may seem uninvolved with supply costs, but it may be the largest determining factor. Especially in the case of a new machine, the warranty may be voided if you use another kind of supply that the ones suggested by the manufacturer. If that is the case, your hands are tied.

Document, Document, Document. Keep meticulous records before and after there is any change in the supplies, especially in the case of chemical reagents. The regular running of controls will tell you about the accuracy of the medical equipment and if the change has effected the instrument negatively. Any level of savings is unimportant if the clinical accuracy of the data is compromised.

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When it comes to maintaining and cleaning your medical equipment, the first question you must answer is, “Is the equipment covered under a manufacturer’s warranty?”

If the equipment is not covered under warranty, then you have several options to choose from. You can use the recommended cleaning and maintenance schedule and products, or you can choose something different. For example, you might wish to make your own cleaning solution for the outside of the equipment. A common solution is 15% bleach in water. For isotonic solutions for the equipment’s interior, again you have some latitude. If you believe you can get better accuracy or service from your machine by using a variation on the manufacturer’s recommended reagents or cleaners, you can set up an experiment and document the results accordingly. You can also purchase your materials from any vendor who meets your price and quality requirements.

Essentially, if the equipment is no longer under warranty, you may do with the machine as you wish, balancing your responsibility to get the maximum utility from your equipment against the best use of your staff and resources.

If the equipment is still under manufacturer’s warranty, however, the situation is completely different, and very simple. Follow the manufacturer’s specifications to the letter. Period. It does not matter that you might be able to save time or money by using a different chemical or adhering to a different schedule or method. It does not matter that you might be able to save time or money by purchasing supplies from an unauthorized vendor or of a different brand, even if the supplies are essentially the same. The terms of the manufacturer’s warranty are generally very strict, and not negotiable.

Any deviation at all from the manufacturer’s specifications will void your warranty. If, for example, the manufacturer’s warranty calls for the machine to be cleaned every 8 hours and you clean it every 12 hours instead, you have just voided your warranty. If, for example, you use a different brand of reagent from what the manufacturer specifies, or you use the specified product in a different amount or concentration, you have just voided your warranty.

In addition to using the manufacturer’s specified cleaning and maintenance protocols, you have to be able to produce proper documentation that can show that you have followed the manufacturer’s specifications.

The time to deal with these warranty issues, of course, is before you purchase the medical equipment, not after. Make sure you and your staff completely understands what is expected of you in terms of cleaning and maintenance to keep your warranty in effect. Generally when you purchase new equipment, the purchase price includes training (and travel as necessary) for a negotiated number of your employees to learn exactly how the machine should be cared for. If you are purchasing an expensive or sensitive piece of equipment, a blood analyzer for example, make sure that travel and training are included with the purchase price.

Manufacturer’s understand, of course, that not everyone has the budget to purchase new equipment. When you purchased used medical equipment, most manufacturers are happy to provide you with a copy of the owner’s manual and will be happy to make recommendations on cleaning and maintenance according to what they have determined will get you the maximum utility from your equipment.

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When you purchase medical equipment, there are a few considerations you must make when determining the proper location for that equipment. Of course, size of the equipment will be a primary concern. If the instrument is small, say the size of a bread box, or something you can lift on your own, in general you will just need a clean place for the instrument. If the instrument is larger on the other hand, particularly something that would require help to move or install, the correct location must be chosen and prepared first.

Some of these questions will require you to consult the manufacturer’s owners manual. Most manufacturers have made these available online for easy access.

Here are some steps in choosing and preparing a place for your medical equipment.

* Electromagnetic environment: Some machinery and equipment cannot be located near x-ray machines or other equipment that produces a strong electromagnetic field. This may eliminate certain areas of your building or office as possible locations for the new equipment.
* Electrical needs: Does the equipment have special electrical needs? Your new equipment may need a different type of outlet or grounding from what you currently have available. The owners’ manual will give instructions regarding electrical needs. Be sure to see our earlier blog entry “Power Supply Needs for Medical Equipment” for more information on this topic.
* Climate: Does the instrument or equipment generate heat or moisture? If so, it may need additional space around it for optimal functioning. There are some pieces of equipment which require a constant temperature of a certain level for best functioning, but generally most equipment will work well in any environment comfortable for you and your staff.
* Level: Some equipment requires the floor to be absolutely level. Chemical analyzers in particular require a level floor. Most floors aren’t perfectly level. To have your floor evaluated, contact a contractor who can assess the floor and make any necessary corrections.
* Weight: Can the floor support the weight of the equipment you are considering installing?
* Materials storage: Is there sufficient storage space for materials used by and needed for maintenance and cleaning of the equipment? How close to the instrument do these materials need to be? How quickly will you need to access them? Do the materials themselves have particular storage needs, e.g. refrigeration or climate, that must be considered?
* Work flow and patient flow: How will the equipment be used? Will it be used by one person at a time, or will more than one person need access to the equipment? In an emergency room setting, for example, several people may need access to the equipment, whereas for standard laboratory tests, one staff member may be sufficient. Consider how patients flow through the space and consider how the location of the machine or equipment will affect their care.
* Maintenance and Cleaning: How much access to the machine, particularly the rear of the machine, is needed for cleaning and maintenance? How often is maintenance required? There may be maintenance and cleaning that are required hourly, several times a day, daily, quarterly or even annually.

Spend a little time choosing the best location for your equipment, and you will save your self a lot of time and effort in the long run.

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As a purchaser of medical equipment, you need to negotiate the best pricing structure that you can. There are various ones out there and they are usually tied to the kind of equipment that you are buying.

In the case of most used medical equipment, it is a case of one time cash up front, especially if you are buying in an online auction. This may be a way to save a little on the front end, but there will be little or any support for training and repairs. Additionally, you are receiving the equipment “as is,” typically with no warranty or guarantees as to serviceability. So be wary.

On the other end is a payment structure for a new piece of medical equipment. This can be a payment plan spread over a set time period, or a credit arrangement between you and the company. The advantage of this is that the warranty and all support begin as soon as the first payment is made or even as delivery is taken on the equipment. This is one thing that comes with the price of a new piece of medical equipment.

Between these two extremes is a whole host of payment options that may depend on your skills in negotiation and the type of medical equipment you are obtaining. Even on a used piece, there may be a warranty option and the possibility of a payment plan. This is another reason to buy from an established and well-reviewed vendor.

There is another option that exists: leasing. Some people think that they are the same thing as a payment plan, but they have different structure and details. For one thing the original owner still owns the piece of medical equipment. That means that they are responsible for any upgrades and listed repairs. This makes a lease a good choice for a high volume instrument or a new, cutting edge piece of equipment that may be quickly outdated. Another thing to realize is that a lease may have some form of interest attached to the payments. And given that the prices of some instrumentation can go into the low six figures, interest can become substantial very fast.

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