Reviews and News on Medical Equipment

The implementation of cost-cutting rules for Medicare has been advanced by the Obama administration, allowing Medicare to use competitive bidding strategies to purchase medical equipment such as power wheelchairs and walkers. The administration said it supports competition among companies vying for the right to supply medical products such as oxygen to the homes of elderly patients. After complaints from The Centers for Medicare and Medicaid Services (CMS) about excessively high medical equipment prices that can often have price tags that are thousands of dollars higher than advertised Web vendors, the administration elected to allow Medicare to choose several low bidding companies within a specific geographic location. Because this program will require the government to pay for medical equipment from only approved suppliers, it has the potential to save the government $1 billion per year.

The new program was implemented despite last minute lobbying efforts by both Congress and the home-care industry. The White House received a total of 84 written requests from Congressional lawmakers requesting that the government drop the proposed plan. In addition, Congress received similar letters from 28 home-care agencies. In a news release, the groups claimed that the bidding program will result in decreased quality and limited access to care for both senior citizens and people with disabilities by forcing up to 90% of small business medical operators out of the market. Opponents of the plan claim that both CMS and senior citizens will be the ones to feel the brunt of the plan by cutting back on quality providers of medical equipment.

The plan, proposed in 2003 and later blocked by Congress was passed by President Obama who expressed a desire to do away with waste in the health care industry while improving the quality of health care for senior citizens. The plan will go into effect on 2011; however CMS will begin accepting bids in 2010.

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Whenever you select and purchase electrical medical equipment, the first step in installation is to consider the electrical needs and power source for that piece of equipment.

First assess the power needs of your medical equipment. Power needs will vary greatly. X-ray machines, for example, use a great deal of power and require special wiring and outlets that only a professional licensed electrician will be able to install and certify as meeting all code requirements. The manufacturer’s website and/or equipment manuals will have electrical specifications spelled out in detail. Share the specifications with your electrician and ensure that you and your electrician follow them to the letter. An incorrect power set up will ruin your investment in an instant, not to mention potentially causing harm to your office and/or staff.

If your purchased equipment can run off of standard current, there are still considerations which need to be made. The majority of instrumentation, especially medical equipment, has internal circuitry that is like a computer; in fact, some analyzers exceed the computing capacity of some home computers. So your equipment will need at least the same level of protection as a computer. Regular domestic current is anything but regular and steady. There are fluctuations and waves in the electricity, and too little current can be as troublesome and dangerous as too much.

The first and most basic of types of protection needed is a surge protector. If you think of the electric power as a wave, the surge protector will cut off the tops of a wave and let through electricity that falls under a certain level. Do not, however, fall into the trap of “one surge protector is as good as another.” Make sure you spend the money to buy a quality surge protector.

Even with a surge protector in place, you may not have enough protection. You see, waves that can go up (power surges), can go down (brown outs), and one can be as damaging as the other. If the electricity falls, the instrument, sensitive to changes in electricity, will “open itself,” if you will, to get as much of the electricity as it can. So, when the power comes back to normal levels, it can hit the medical supply almost as hard as a real power surge. This surge may be well below the absolute limit of the surge protector, but the circuitry in your piece of medical equipment will be fried all the same. Additionally, equipment that tries to run on inadequate current will burn itself out, much like a car that tries to drive 70 mph in first gear.

The device that can protect you from both surges and brown outs is called a power conditioner, or line conditioner. This cleans the highs and lows off of the electricity, “conditioning” the electrical power and keeping the level constant. This is the safest way to protect your new piece of medical equipment.

The other piece of equipment you may wish to consider is an un-interruptible power supply. This piece of equipment functions much like a combination surge protector and battery back-up, and can keep your equipment running for a period of time even in the event of a power failure. This can be especially important for equipment like office computers, where critical data can be lost during a power failure, or to keep medical equipment on which your patients depend running until it may be switched over to an alternative power source.

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For the small office, medical equipment tracking is really a non issue. The diversity of your instrumentation is at such a level that inventory and tracking is a matter of looking around and saying, “There it is.” And that fits your needs exactly.

But in larger, more diverse facilities, medical equipment tracking can be a headache at best, and a nightmare at worst. Different floors of a hospital or different offices in a clinic have constantly shifting needs. And someone has to keep track of each machine that will answer each need.

There have always been paper tracking sheets – sign in/sign out logs. They form a basic system, but they are dependent on how well they are maintained. And the learning curve can vary so much between personnel that it is difficult to keep the consistency needed for the paper based system. And there has to be a person to check the log against where the instrument actually is.

Bar code tracking was the next step in inventory control. More information was able to be coded onto the bar code, but there was still the problem of the staff’s familiarity with the system, and the adherence of the staff to the inventory protocols.

It is not always a matter of staff resistance but of clinical necessity. The ER is a major consumer of inventory, but when do they have the time to track a piece of medical equipment?

Fortunately, a new system tags each piece of medical equipment with a ultrasound tag that is picked up by a localized receiver that is Wifi enabled. The ultrasound signal, invisible to humans, transmits all identifiers to the receiver which then goes into the computer system. All information is then ready to review in real time.

A state has been reached that will allow real time inventory to be preformed by the instruments themselves. No more chasing down that infusion pump. The pump will tell you where it is and who has it checked out. This is light years over the old paper and pencil tracking systems and a real step forward in making equipment even more user-friendly.

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Eventually, every piece of medical equipment needs servicing. If the equipment is under warranty, most service issues are clearly spelled out for you. But what do you do if the equipment is out of warranty? As with many pieces of equipment, the first consideration is where you got the machine. There are two different approaches whether or not you purchased the machine from a vendor or non-vendor source.

Most vendors have a professional association with the various manufacturers. It is not exactly the same relationship as between an auto dealership and an a auto manufacturer, but there are important similarities. As with a car, an associated medical vendor has a pipeline to the newest service options, and a good vendor will contact you with these options long before the expiration of the warranty. These options may cost you an additional fee, but they will save you a great deal in both down time and repair costs.

The vendor may also offer you a replacement machine instead of an warranty extension. Don’t discount this offer, but don’t immediately jump at it either. Look at the supply and maintenance costs to see if which would be more economical, the new machine or keeping the old model operational. Review the repair logs, and look for an increase in the number of calls, or a repetition in the reason for the calls. In either case, retiring the old machine may be a better option in the long run. These types of warranty negotiations are a perfect time to address this with your vendor.

If your medical equipment was purchased used, you are not out of options. If you haven’t already, contact the manufacturer of your instrument. They will be glad to tell you about the service options they offer for used medical equipment. Then you can begin negotiations as you would for a new machine.

Now, if you run into a dead end from the manufacturer, and the option of a new instrument is beyond you right now, it’s time to talk to your technicians and become creative. Assess what is exactly wrong. If it is a catastrophic failure, it may be time to retire the old machine. But if the quality of the results has not been greatly compromised, or there is a way to work with the problem, then you might be able to let the old machine continue on. You should institute a monitoring program with complete documentation, of course, but the old work horse may be able to give you a bit more service before she is put out to pasture.

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Most medical equipment and instruments are not designed to be mobile. Much of the equipment is large and bulky, and some, such as chemical analyzers, has specific requirements like a perfectly level service. However, there are some types of equipment that you can include in a mobile unit. Generally this calls for special handling and documentation.

If you are considering providing mobile patient care, the first step is to determine what you need to provide versus what you want to provide. If the stated purpose of the mobile unit is to provide a specific service, such as mobile mammography or mobile imaging, you will have a clear picture from the beginning of what you need. After you know what you need, you are pretty much limited to what the vendors have available that will meet your needs. On the positive side, purchasing this type of equipment will generally mean new medical equipment that comes with manufacturer support, and technical and educational support. The negative side is that you had better bring your check book: this will be expensive.

In the case of a mobile medical facility designed to provide general care, your equipment and instrumentation needs will be dictated by the population you are seeking to serve. There is equipment and instrumentation that has been designed for use in a moving vehicle, even equipment and instrumentation designed for use on moving hospital ships in high seas. If you want this kind of set up, be prepared to bring your check book: this will also be quite expensive.

On the other hand, there are some pieces of equipment that are either already imminently transportable, or available in hand-held forms. Consider infusion pumps, defibrillators, blood sugar monitoring equipment, or anything else that might be included in an ambulance or transport vehicle. Most of this equipment is good for immediate care situations, but not necessarily good for gathering diagnostic information.

If you need diagnostic information, you will probably have better luck using your mobile unit into a collection site for lab or other services, and transporting the samples to a hospital or private lab.

Mobile medical centers are generally very expensive, and require community involvement, either at the local or even the state level, to become realized. A better way to serve an under served or rural population would be to either invest money into a good transport system for getting patients to already existing care facilities, or to build a care facility in the area to which patients can come.

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So you’ve decided to purchase a new or new-to-you piece of medical equipment, and you have it installed. Your next hurdle is getting your staff trained in using the medical equipment.

There are three primary ways for staff to learn how to work new equipment or instrumentation: through the vendor, through training by experienced personnel, or through self-tutorial. Which choice is best for you is as much a factor of the instrument or medical equipment itself as the nature of your practice.

To determine which of these ways will be optimal for your particular situation, find out if training is addressed in the warranty for your equipment or instrumentation. If it is, and chances are it will be for new equipment, training decisions have already been made for you; your job is now to follow those directives to the letter. Oddly enough, this type of training can be the least expensive, because the training, including the expenses for travel to the corporate headquarters of the manufacturer for that training, is typically included in the purchase price of your new equipment.

If you have a machine that has no warranty, or you have a machine that is very simple to operate, already experienced staff can train other staff in proper use of the equipment. The key difference here is that in this kind of knowledge exchange, you may obtain perfectly fine operational skills, but you will not receive any kind of certification. If a manufacturer trains you to use their equipment, you usually receive a statement of certification from the manufacturer. Your question here is then whether or not certification is required by law or another rule making body. Does your profession require certification? If so, what kind, or how much? The answer to these questions will vary depending on the nature of your practice and the equipment being used.

The last category is self-tutorial. In this instance your staff will study all available documentation and manuals for the equipment in question. Manuals and documentation are generally available through the manufacturer, often at no cost through the manufacturer’s website. Self-tutorial is an effective educational and training option only for simple medical equipment and experienced staff.

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If you are in the business of purchasing medical equipment, you will chiefly see three different types: new, used and refurbished. While the term “new” is pretty self-evident, what is the difference between used and refurbished medical equipment?

Used medical equipment has been previously owned and operated. The quality and condition of used equipment can vary. Used equipment can be a good value if it the equipment in condition is still serviceable, and the materials and supplies needed for operation of the equipment are still available.

Used medical equipment may be sold “as is” with no warranty and no assertions given as to whether or not or how well the equipment will function, or it may come with a warranty. The warranty will generally be given by the seller of the equipment as opposed to the manufacturer. Remember that warranties are typically negotiable; see if the terms offered work for you and your medical practice, and what is available for negotiation.

Refurbished equipment, on the other hand, is equipment that has been previously owned and operated, but which has been repaired and serviced and is typically offered as being of the same general quality and condition as new equipment. Refurbished medical equipment is often new equipment that was returned to the manufacturer either as defective at purchase or during the warranty period. The equipment was then serviced to be restored to “like new” condition, with repairs and replacement parts being used as needed. There is no industry standardization for the terms “refurbished” or “reconditioned,” so it is up to the buyer to understand exactly what is being offered for sale. Refurbished equipment generally comes with a warranty given by the manufacturer, although the warranty may not offer the same terms as the warranty for that same equipment when it was new.

Speaking of new, just how “new” is new? If you are buying new medical equipment, are you expecting to get equipment that is brand-new, just out of the box, never used by anyone before? Does it matter to you if someone else had a trial of the equipment before it came to you? These are questions worth asking yourself. Think of it this way: if you’re buying a new car, do you want the odometer to read less than 10 miles when you take your first drive, or is it OK if the odometer reads less than 500?

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