Let's face it--we all are under pressures to reduce costs and do more with less, all the while increasing patient safety, uptime, reliability and dependability of imaging equipment. You may not know it, but you have some free resources at hand to help with these tasks.

All hospitals have one or more people who repair medical equipment throughout the hospital--the heart monitors, infusion pumps, thermometers, and so forth. Even if you are not using these people to repair your imaging equipment, they can
still be a help to you.

Called "biomeds," clinical engineers, BMETs or even imaging engineers, these specialists are trained in the repair and maintenance of electronic medical devices. They were trained in the military, a technical school or a university. If their specialty training is in the medical field, they will know a good bit about anatomy and physiology and have enough accounting and finance knowledge to be able to evaluate the economy of various service options.

It would be a good idea for you to meet these guys (and gals). They probably "live in the basement" and may be in an independent department or report through a facilities or materials manager or to the IT department. Here would be my plan
for getting familiar with these resources in my hospital.

1. Call the main hospital phone number. Ask for the "biomedical" department. If the operator is clueless, ask for the people who fix the broken heart monitors.

2. When you have the correct department (which may take a couple of calls), ask for the director or manager.

3. When you get them on the phone, explain who you are and ask for a meeting to discuss their department, their staff, their capabilities and their resources. They will be VERY excited, because the ultimate goal of every biomedical department is to be the servicer of the hospital's imaging equipment. Your call just made their day.

4. When the meeting occurs, ask the following questions:

• What is your background, training and education? (You should expect at least a bachelor's degree, 5 to 10 years of experience in the maintenance of medical equipment, a lot of service schools, and experience in hospitals and/or with
  manufacturers. Focus on relevant experience related to imaging equipment.)
• How long have you been at this hospital? What was your last job?
• What is the size of the department?  How many people?  Their backgrounds?  Their current job duties?
• Who employs the director/manager and all of the employees? Whose name is on their paycheck?  They may be hospital
  employees, but they may be contracted from an outside company. This wouldn't be bad, but you should be aware of it.
• Who does the director/manager report to the hospital? Is it an administrator? A vice president? The CFO? The facilities engineer? This is important because you will need to speak with that person in order to assess your organization's willingness and ability to explore the expansion of the department to help you out.
• Ask about record keeping. What software do they use? Do they document 100 percent of their work performed? How do they schedule and complete preventive maintenance? What sort of preventive maintenance completion rate do they achieve every month? The answers to these questions should be direct, firm and given without hesitation. If the director/manager
  stumbles around or doesn't know, this is a bad sign.
• Ask about their training budget. How many dollars are spent by the hospital annually to train the biomed staff?  (A good rule of thumb is approximately $10,000 per employee). Has the amount gone up or down significantly in the past five years?  The training budget is the investment in the future. If a hospital doesn't train its technical staff, they cannot possibly keep up with new and future technology.
• Ask to get a copy of their policy and procedure manual. If you should decide to use their services, this will be the rule book from which they operate. It can tell you a lot about their practices. Read it and question anything that seems lax or inadequate.
• As a means of assessment, ask for some sample reports that they would provide if they did work for your department. Ask for a copy of a month's activities for an existing customer, e.g., intensive care. Every hospital has an ICU, which has lots of equipment and usually is not so large that the report size will be too great. Scan this, looking for good documentation and complete entries. Pay special attention to your ability to understand the entries written. If they are too abbreviated or cryptic, they will be of little use.
• Ask to see the last report they gave to their hospital boss. It is important to check out their writing style, the appropriateness of their communications and the clarity of the report.

5. If, after these questions and discussions, you feel comfortable with the competence of the in-house biomed staff, you then may embark upon a discussion of your situation. Let them take the lead. They should inquire about your current service arrangements, service providers, your satisfaction with them, and your motivation for seeking alternate services. If they don't seem to know what to ask, be wary of their abilities.

6. If you would like to test commitment and abilities, ask them to provide service suggestions or to take over maintenance of some low-risk equipment. Be sure to let them know that you are just trying them out and that your ultimate decision will be based upon your satisfaction with the work that you are having them do.

In-house resources can be a great help if they are educated, funded, motivated, and eager. But if they are afraid, under-educated or not supported by administration, you may be better off developing your own imaging services program as a part of the radiology department rather than using general services provided by biomedical staff.

First, it subsidizes the purchase by helping the manufacturer recoup some of the money that they had to give up in capital equipment discounts. Purchasing discounted equipment allows the buyer (the radiology manager or materials management or the GPO (group purchasing organization) to brag about how their keen negotiations and relentless pressure on the manufacturer saved the hospital double-digit discounts.

WRONG. You see, in order to win your business, every equipment manufacturer deeply discounts their equipment. Nobody pays list price for anything. Competing for your capital dollar necessitates that medical devices are grossly overpriced, so that huge discounts can be given to the "ruthless hospital negotiator."  These discounts do cut into the corporate profits, so manufacturers try very hard to make them up by selling service agreements which span many years and cover parts, labor and some other (nod, nod, wink, wink) normally uncovered costs like software updates.

Second, selling service at the time of sale leaves a major player out of the loop--the hospital's clinical engineering manager or director. (Previously called biomed, medical equipment maintenance, imaging engineering or some variation thereof, the profession recently adopted a new name which you may be seeing more: healthcare technology management, or HTM. Designed to encompass all aspects of medical device maintenance, repair and management, HTM slowly will replace the other names and provide a uniform name for a desperately fragmented profession.) 

Signing a full service agreement without the input of the hospital's professional service manager at the table is a great way for manufacturers to get hospitals to agree to unneeded and expensive add-ons or coverages that guarantee extra charges for premium service. I liken it to going to a divorce and relying on your spouse's lawyer to write an agreement that is best for you. It just won't happen. And if you sign it, you cannot back out because it only allows cancellation for "cause," a term that does not include incomplete coverage or vague language.

Third, it guarantees a cash flow for the manufacturer. They say that the multiyear contract protects the hospital from rate increases. Well, it does lock in the price. But as a specific model of equipment is in use longer, the costs of maintaining it actually goes down. As competition, parts and repair knowledge become more widely available, competition drives down costs. Those buyers who signed a multiyear contact actually spend more than if they had elected to follow another maintenance strategy.

Fourth, it limits your availability to alternate service remedies. The manufacturer is not always the best source of repair and maintenance resources. Parts, techniques and repair strategies available from third parties and your own inhouse HTM engineers often surpass the original manufacturer's abilities. After all who can get to the operating room quicker--someone stationed in your hospital, or someone dispatched from 80 miles away?

The bottom line: never sign a service agreement at the time of equipment purchase. The cards are stacked in the seller's favor and you will pay more in the long run--and may be less satisfied overall.