A Holistic Approach To Equipment Service Cost

PART ONE – By Tom O’Brien

The fact that hospital executives are working feverishly to drive down costs isn’t exactly a revelation.  The winners in the race to cut costs, however, will be those who are able to identify the best opportunities to quickly reduce operating costs and create healthier bottom lines, while maintaining patient’s access to quality care.  By now, most hospitals have tackled the “low hanging fruit” in an effort to achieve efficiencies, but there are still considerable opportunities to shape up the bottom line by taking careful stock of the money spent on servicing clinical equipment, and by managing those costs more actively. 

We have found that annual clinical equipment service costs are typically between $5,000 and $7,000 per year per bed.   Clinical equipment includes the capital assets used in providing patient care, such as biomedical, laboratory, monitoring, life support and diagnostic imaging equipment.   It goes without saying that after skilled and caring clinicians, patient care depends on available and fully functional equipment.  And this means that equipment servicing and maintenance are a necessary and value-added cost of doing business.   Over the last several years, some hospitals have chosen to shoulder higher service costs on some equipment and reduce or even drop service contract coverage on other equipment, all in an effort to shrink overall service cost. 
Equipment service costs can be significant and it is essential that hospital executives thoroughly understand what they are spending on service and actively manage that portion of the budget.   An accurate measure of all service costs will likely identify opportunities to lower costs within the hospital’s existing service delivery model, or it could provide new insights that would allow a hospital to change the overall service model.   My suggestion is that a full understanding of clinical equipment service costs lays the groundwork for the hospital to reduce these costs and optimize associated vendor and outsourcing arrangements.  These outcomes could provide significant wins with savings accruing directly to the bottom line.  The new approach may even improve patient hospital experience if equipment is always ready and performing as needed.

In this first blog I am advocating for a holistic view and approach to managing service cost.  Unfortunately, most hospital cost accounting systems and practices simply are not up to the task of accurately measuring service costs.

CLICK HERE  to read the original article.

 

Top 3 White Papers from ECRI Institute

ECRI Institute’s Top 10 C-Suite Watch List:
Hospital Technology Issues for 2012

ECRI Institute experts compiled a Top 10 list of important technologies and technology-related issues that hospital and health system leaders should pay close attention to this year.

Themes emerging on our 2012 list reflect ongoing impacts of healthcare reform initiatives and new technology developments that emphasize patient-centered care, including safety improvements, interconnectedness of technology, personalized medicine tailored to individual care needs and preferences, and ever-increasing cost pressures.

CLICK HERE  to request the full 32 page PDF file report.

ECRI Institute’s 2012 Top 10 Health Technology Hazards

This is the 2012 Top 10 Health Technology Hazards from ECRI Institute’s Health Devices System.  This annual list helps to identify potential sources of danger we believe warrant the greatest attention in the coming year.  For prioritizing your patient safety efforts, this is a good place to start.

CLICK HERE  to request this listing.

Spending Scarce Resources on the Wrong Capital Budget Requests
Not in My Hospital!

Juggling competing wish lists is a daunting task for today’s hospital administrators.  In an environment where every dollar counts, how do you prioritize capital budget requests, distinguishing between necessary and nice-to-have technology?  And how can you be sure the data supporting
your budget is accurate, reliable, and objective?

This guideline outlines some initial steps for ensuring a smoother planning process and more cost-effective budget.  

CLICK HERE  to request this white paper.

 

Invitation To Attend Advisory Committee Meeting

 

Hello Everyone in Cleveland, Youngstown, and Toledo Areas:

Rasoul Esfahani , Associate Dean, College of Engineering and Information Science for DeVry University Columbus Metro, is cordially inviting you to attend an Industrial Advisory Committee (IAC) meeting for our Biomedical Engineering Technology (BMET) program at 11 am – 1 pm on Tuesday, February 7, 2012 .  The meeting will be held in our campus at 4141 Rockside Road., Seven Hills, Ohio.  This BMET program will be offered at our campus in Seven Hills.  We want to make sure the skill set of our graduates in this program will fulfill the needs of the regional industries and we also wish to establish professional relationships with industry and hospital representatives since students in the last term need to do practicum in their field.

Your attendance would be greatly appreciated.  Please let me know by Wednesday, Feb. 1, 2012.  If you are not able to attend  please send the appropriate person.   If you have any questions , please feel free to contact me.

Thank you in advance,
Rasoul Esfahani, Ph.D., Associate Dean
College of Engineering and Information Sciences
DeVry University
1350 Alum Creek Drive
Columbus, Ohio 43209-2705
Phone: (614) 257-5035
Email: resfahani@devry.edu
Website: http://www.devry.edu/

 

EMRs, Biomed-IT, 2012, and Beyond

By Demetrius Dillard and Marcus Harris

As a biomed, health care IT can be looked upon as a threat, a necessity, and as the unknown.  With the passing of the 2009 stimulus package, it has confirmed what we all knew—health care IT is here to stay.  The majority of health care organizations without electronic medical records (EMRs) have implemented, or will soon implement, them to take advantage of higher incentives for Medicare and Medicaid reimbursement.  If they don’t, they will be penalized after 2015 with lower reimbursements.  With that in mind, it’s safe to say an EMR will pop up at a hospital near you. Health care organizations are changing the process of delivering health care, with the voluntary/involuntary implementation of an EMR. As a biomed, you may have come in contact with numerous vendors promoting “vendor neutral systems” or “interoperability.”  The idea is that the implementation of the EMR should be high on the biomed’s list of responsibilities to stay paced with changing times.

CLICK HERE  to read the rest of the article
from the January 2012 issue of 24×7 Magazine.

 

Maybe We Should Think About Y2014

By David Harrington

What is Y2014, and why should we think about it?  The year 2014 (Y2014) is the starting date for some of the new rules that are part of the health care legislation passed in 2010 by our friends in Washington, DC.  The prediction is that Y2014 will make Y2K look like no big deal, and we all know that even with all the overreaction there was a tremendous amount of work put in to locate and prevent potential problems from happening.  They spent so much time and effort on pleasing the various special interest groups that no efforts were made to be sure that what was proposed would work and could be implemented in a timely fashion at a reasonable cost.  The only good part about this problem (Y2014) is that Congress will push back dates and throw money at certain groups that either don’t need it or should not get any in an effort to make the transition smooth.

CLICK HERE  to read the entire article
from the December 2011 issue of 24×7 Magazine.

 

Let’s Make a Deal

Negotiating Service Contracts In 2012
By: Matthew N. Skoufalos

One of the most difficult processes for any biomed department is the negotiation of service contracts.  With so many masters to serve, decision-makers often get hogtied by any number of stakeholders—clinical, purchasing, the C-suite and vendor reps, to name a few.  Without a clear exit strategy, the entire exercise can be downright impossible to navigate.  This month, (January 2012) Medical Dealer Magazine consulted with a handful of veteran table talkers to find out the key areas on which to focus when structuring a win-win contract.

CLICK HERE  to read the entire article.
PDF File download is also available.

 

AAMI Accepting Comments On CMS Maintenance Announcement

An informal coalition of concerned parties has formed to discuss a recent U.S. Centers for Medicare and Medicaid Services (CMS) announcement that manufacturer-recommended maintenance frequencies are required for all equipment critical to patient health and safety.  The Dec. 2 CMS announcement, which was greeted with dismay by many hospital-based biomeds, also calls for hospitals to follow manufacturer-recommended maintenance frequencies on any new equipment until a sufficient amount of maintenance history for that equipment has been acquired.

The coalition includes various medical equipment users and others, including representatives from The Joint Commission (TJC), AAMI, ECRI Institute, and healthcare facilities.  To help the group determine its next steps, AAMI is now accepting comments and recommendations from all interested parties about the CMS announcement.  AAMI would like to know how affected parties would be impacted, with specific data and/or examples encouraged.

CLICK HERE  to participate and submit comments. 

CLICK HERE  to view/download the full CMS memorandum as a PDF file.

The CMS memo, distributed to state survey agency directors, is described as a “clarification of hospital equipment maintenance requirements” and comes more than a year after TJC, the largest healthcare accrediting organization in the country, had announced that a change was coming.  At that time, TJC indicated that it had persuaded CMS to grant healthcare facilities more latitude in setting PM schedules.  The new guidance is more restrictive than what TJC initially described.

According to CMS, biomeds and clinical engineers can adjust the PM schedule for noncritical equipment by using strategies different from what the manufacturer recommends.  But the hospital must create an evidence-based assessment that shows “the frequency adjustment will not adversely affect patient or staff health and safety.”  And CMS says that hospitals can’t deviate from the maintenance methods recommended by the manufacturer.

 CLICK HERE  to view the original AAMI News article.

 

CMS Survey Insights

We just completed a full blown article 28 survey this past week. Things  to know and be aware of:

* The surveyors will visit different units at different times and then go back.  Just because an area has been surveyed does not mean they will not revisit.

* INSTRUMENTATION MUST BE CLEAN.  We were asked WHO cleans the patient cables on monitors and any low level disinfection policy for unit based equipment.  In the cath lab they looked UNDER the table!

* EMPLOYEE FILES.  Be sure you have department orientation, any hospital based educational requirement records like HIPPA training,  fire safety,  health clearance,  annual assessments, manufacturer training records and competencies.  Surveyors requested personnel files from about 20 different  departments.

* BIOMED SHOP.  No doors propped open, no food at the bench and NO UNLABELED fluids in containers anywhere.  Be ready to prove and show how you dispose of batteries and waste fluids (Oils, glycols, etc).  Hospital will be asked to show hazardous waste program.  If you have sample tubing or fluids to be used for  testing…be sure they are not expired.  There is a potential these items can  find there way back into the hospital system.

* RECORDS RECORDS RECORDS – CT/ MRI /ULTRASOUND – HOOD CERTIFICATIONS and HEPA FILTER TESTING.  Know your testing intervals and the  records MUST match.   Semi -annual…better be two inspections in the records  for the year.

* PRESENT THE DATA IN AN ORGANIZED FORMAT.  Make it easy for the  surveyor to understand your data!   We highlighted PM work orders in  yellow and alerts and recalls in orange.

* BLANKET AND FLUID WARMER TEMPERATURES clearly marked on the units. (With tolerances and policy).

* FREEZER AND REFRIGERATOR MAINTENANCE LOGS with temperature documentation. (Especially tissue and labs types of units).

As far as computerized maintenance management software…..most are just a databases with fields.  I have had the opportunity to see and work with  various CMMS programs over time.  Some do better job then others when it comes to report generation. What I have found works best is a data dump into excel. A few headers, hospital logo, inventory with tabs and select history works pretty good. The surveyors liked the presentation.

One caution !!!  PRACTICE REPORT GENERATION BEFORE ANY REGULATORY AGENCY ARRIVES. The survey process is done with a team. You may get multiple requests for data to produce in a SHORT TIME FRAME. The longer you take to compile, the more suspicious the surveyor becomes.  KNOW that radiology, life support, vents are on the hit list. It is part of the surveyors checklist.  Don’t wait to the last minute to be adding work requests and PM information when you are on the firing line to produce data !!!  PRIOR TO SUBMISSION>>>>>READ DATA OVER 3X TO BE SURE EVERYTHING ALIGNS  WITH YOUR PROGRAM. They will call you out on any discrepancies and continue  to dig deeper.

* DETERMINATION  OF INTERVAL,  We were asked to show manufacturers PM recommendation on an IE 33 and how our program (Risk based)  matched up to that requirement -  Filter cleaning every 6 months (Minor) with an  annual PM (Major).  Be ready to explain strategy.

* ENVIRONMENT OF CARE.   This is huge.  They will pull ceiling  tiles..look for penetrations,fire stops,  HYDROSTATIC testing of fire  extinguishers,  PM Labels,  blocked pull stations AND CLUTTER !!!!   THEY WILL  request electrical closets and rooms be opened.

* EXPIRED MEDS AND SUPPLIES.  They will pull boxes off the shelves in supply rooms and pull from the back of the boxes.

* CLEAN AND DIRTY.  Where does the broken equipment get stored?   Is it labeled “Defective” and does the staff know the process of who to call and for what items?   Mixing of items in the clean and soiled utility rooms is huge.

Surveys are stressful for all.  During the exit survey with  administration you DON”T want to be the department mentioned. The realization is  if you have an organized program, doing what you say you are doing and have confidence in your data all will be good. BE AWARE…once a surveyor finds a flaw in your data or process..it opens a door to the  entire program review.  Unless there is a total breakdown in your program which  would STOP a survey, you may get a conditional. The facility will  get a report from CMS and must respond back with a corrective plan of  action in a small window of time. If you are cited the expectation will be  a corrective action plan to be submitted. CMS WILL COME BACK AND WILL GO AFTER  THE DEFICIENCY TO BE SURE THE CORRECTIVE ACTION HAS BEEN  DONE>>>>NO JOKE !

I hope some of this insight is helpful.  Good luck!

Contributed by:  Art Bartosch BS, CBET

 

ACCE Teleconference – Thursday, January 19th

Radiation Protection/CT Dose Management
Thursday, January 19, 2012 @ 12:00 Noon EST
Brought to you by the ACCE Education Committee

This session will cover a review of current radiation protection issues including new advances in CT dose management.

Speakers:

Jason Launders
Senior Project Officer/Medical Physicist
ECRI Institute, Plymouth Meeting, Pennsylvania
With 20 years’ experience working with medical imaging technology he is responsible for x-ray and MR imaging comparative evaluation projects and accident investigations conducted by ECRI Institute and also covers many related technologies, such as IT.  The primary focus of ECRI Institute’s evaluations is safety, so CT dose has been a major topic over the last few years.  As a result, Mr. Launders has followed the issue closely, evaluated the new technologies, and authored a number of reports.

Rohit Inamdar
Medical Physicist
ECRI Institute, Plymouth Meeting, Pennsylvania
With 25 years of experience in healthcare technology assessment and healthcare facility needs consulting and his background in medical physics, he takes the lead and provides guidance on all medical imaging and radiation oncology projects in the Applied Solutions Group.

CLICK HERE  to view/download the registration form.

CLICK HERE  to visit the ACCE Website homepage.

 

Clinical Engineer Touts Benefits of Benchmarking

Ted Cohen has always embraced benchmarking, and in fact sees it as a vital tool for healthcare technology management departments.  In this issue of AAMI News, Cohen—who is manager of clinical engineering at University of California, Davis Medical Center in Sacramento, CA, and one of the subject matter experts who created AAMI’s Benchmarking Solution—shares his thoughts on benchmarking, interoperability, and building an education program.

CLICK HERE  to read the rest of this article
from AAMI News January 2012 issue.