Technology: Up and Running

Whether it’s as portable as a mobile PET scanner or as massive (and expensive) as an MRI machine, your equipment is useless to you if it doesn’t function properly.

“If you are not scanning on that machine, you are not making any revenue off it,” says Richard Morin, who is chair of the American College of Radiology Safety Committee and in practice at the Mayo Clinic in Jacksonville, Fla.

But the inner workings of such equipment are complicated, to say the least. Short of getting a degree in engineering, how can you make sure your equipment is in working condition so it can continue to work for you?

Changing tech challenges

First point of order: This is not your father’s radiology equipment.

In reality, a software programmer, a physicist, a technician from the equipment vendor to unlock the software, and even different sorts of engineers to provide service for different brands of equipment would all come in handy to help you maintain what used to be a largely mechanical domain. “It used to be all about circuit boards, x-ray tubes, relay switches, power supplies, and things like that,” explains Morin. “Now it could be a problem with a directory that filled up and the software can’t negotiate its way around to do the next patient.”

But smaller radiology practices certainly can’t afford to keep engineers on the payroll. Even bigger organizations find it difficult to keep large numbers of support staff for imaging equipment. So how do you keep up to date with the constantly changing - and increasing complex - technology? Software updates for equipment seem to roll out continuously, and new models of equipment appear so frequently that many radiology practices simply lease their imaging equipment so they can stay in front of the upgrades.

Even if you’re inspired to keep up, you might not get the chance. Vendors usually teach the classes that engineers need in order to work on new imaging equipment, and space in those classes is very limited. “Obviously there is a motivation for the vendor to make sure their engineers are trained before private or third-party institutions are trained,” says Morin.

You don’t have to D-I-Y

The good news is your practice doesn’t need to hire a half-dozen people to keep your equipment running. In fact, most practices don’t need inhouse service personnel at all, thanks to vendor-offered service contracts and third-party service providers. Depending on whether you own or lease your equipment, you should be able to find a service and maintenance contract that fits your budget.

Almost every piece of imaging equipment comes with a one-year warranty - regardless of whether you buy or lease it - which should protect you. Unlike a standard warranty for your car, which only covers certain major repairs and pre-existing problems, the initial one-year equipment warranty covers everything from preventive maintenance to corrective maintenance. It will cover both hardware and software problems and often includes software upgrades during that period. “In the car analogy, this would be like bumper-to-bumper coverage,” says Morin.

Time and materials

The question is what to do after that warranty expires. The time to ask this question is before you bring any piece of equipment into your practice.

For smaller pieces of equipment (such as a portable ultrasound machine) that receive fewer software upgrades, you could decide to go without a service contract. This is sometimes called a “time and materials” arrangement, which means that if something breaks, then the practice pays out of pocket for any labor and parts needed to complete repairs.

Note that the equipment manufacturer will usually provide minor upgrades and software patches at no charge, but you’ll have to pay for any upgrade that brings new, major features. The problem is that many practices put off upgrades because of limited cash flow or other reasons. “[When] you are two upgrades behind, it becomes very expensive to do it,” says Morin. “Almost as expensive as changing out the equipment sometimes.”

Note that equipment is more likely to break after it passes the 12-month mark. Think long and hard before simply crossing your fingers with a “time and materials” arrangement, especially for expensive equipment.

Equipment vendors vs. third parties

If you want to guarantee someone will always be available to service your imaging equipment, you’ll need to secure a service agreement. Expect to sign a three- to five-year contract.

You’ll have to decide whether to have the equipment manufacturer or a third-party provide service. Although it’s generally true that service contracts with vendors are more expensive than contracts with third-party providers, the choice isn’t only about cost.

If you are leasing the equipment, then the choice is made for you: vendors don’t allow outside providers to service leased equipment. In fact, regular maintenance and service costs are usually built into the leasing agreement. However, make sure you are clear on exactly which parts of the equipment are covered. For example, many MRI vendors cover their own equipment, but not ancillary equipment, such as a chiller. You may need a separate maintenance agreement with an HVAC company for that.

One of the most important considerations when purchasing a service agreement should be the quality of the service, says Geoffrey Smith, MD, a partner at Casper Medical Imaging in Casper, Wyo. The six-physician practice has equipment that runs the gamut, from mobile PET scanners to CT/MR and ultrasound. Because Casper is a smaller town of only 50,000, not every equipment vendor has in-town service personnel. That can mean waiting up to 24 hours before a service technician shows up to address a problem - not the four-hour turnaround typically enjoyed by practices in larger cities. People who live in major metropolitan areas take such response times for granted, says Smith.

Nor is all service created equal. Find out if the company you’re considering has immediate access to all of the replacement parts your machine needs. Will it get those parts out to you right away, or is your practice low on its list of priorities? Will the provider show up within the promised timeframe, or will your equipment be out of service for another day?

Michael Harris, assistant administrator for 23 years in the radiology, physics, and engineering department at The Johns Hopkins Hospital in Baltimore, Md., agrees about the importance of service. “The last five years, it’s pretty much been a financial objective of ours to have the service agreement quoted along with the purchase of a device,” says Harris. “Our overall costs not only include the purchase price of a system but also a five-year service cost of that particular device.”

Morin recommends talking to colleagues about a vendor’s or third-party’s track record before signing a contract. And keep in mind that a highly recommended vendor in New York might not receive the same positive reviews in Minnesota. “It is not true that all vendors or all third-party service folks are the same everywhere in the country.”

If you decide to contract with a third-party service provider, be sure the company is able to service software as well as hardware. “The problem is they may not be able to open all the files they need to open because there is a key that is not available to third-party people,” says Morin. Even with a third-party service agreement, you could find yourself in a situation where you have to go back to the vendor for some services. That can get expensive quickly.

The final factor to consider is prevention. “Over the years, the ability to get the preventive maintenance in and discover anything that is wrong with the machine before it actually went wrong is probably one of the most valuable things,” says Morin. Different pieces of equipment have different preventive maintenance schedules. Make sure the service agreement includes provisions for preventive maintenance, and clarify when that maintenance will take place. It’s best to schedule such maintenance outside of business hours so it doesn’t interfere with patient appointments.

Surely, all of this takes time to set up and then monitor - no arguments there. But it’s time well spent, because keeping equipment running optimally will keep your practice up and running as well.

Robert Anthony, a former associate editor for Physicians Practice, has written for the healthcare and practice management industries for six years. His work has appeared in Physicians Practice, edge, Humana’sYour Practice, and Publisher’s Weekly. He is based in Baltimore, Md. He can be reached via physicianspractice@cmpmedica.com.

This article originally appeared in the December 2008 issue of Your Best Practice.