This month, TechNation asks the experts about purchasing and servicing ultrasound equipment. Responders include Bob Broschart, Director of Technical Services for Axess Ultrasound; Keith Rubenstein, Senior Vice President of Sales and Marketing for MedPro Imaging, Inc. and Matt Tomory, Regional Account Executive for Conquest Imaging.

WHAT ARE THE BIGGEST TRENDS RIGHT NOW IN THE ULTRASOUND EQUIPMENT MARKET?

BOB BROSCHART: One of the larger trends is the increased demand for portable systems. The technology has dramatically improved over the last five years. While it is still not at the level of mainframe systems, the majority of clinical scans can be achieved quite well with the new portable units. The demand increases year over year. I don’t see portables replacing mainframe systems any time soon, but they are improving the ability to get needed ultrasound studies to a larger percent of the population.

KEITH RUBENSTEIN: The biggest trend that we see today is to offer ultrasound services into newer clinical markets. MSK, Musculoskeletal Imaging is rapidly expanding in the marketplace. It is a great, more cost-effective way to diagnose patient problems with joints, bones, tissue, etc. Miniturization too is occurring. The manufacturers are putting a large focus on the portable or laptop models, while decreasing the sizes of their premium platforms. 3D/4D is still considered to be a great technology and more and more labs and offices are acquiring this.

MATT TOMORY: Due to the present climate of the economy, and with reimbursements going down, people are holding onto their existing equipment a lot longer and doing everything they can to get some additional mileage out of it. People are reinvesting in their existing equipment; instead of five to seven years, people are looking to get maybe 10 years out of a piece of gear. For Conquest, that’s a good thing because our business objective is to support people in keeping their existing equipment running better longer. We partner with biomeds to try and get them more proficient at servicing the various pieces of equipment out there. We have an expansive train-
ing program where all the different manufacturers’ platforms we can teach people how to maintain their own equipment. If we can teach somebody to maintain their own equipment they don’t have to call in the manufacturer or an ISO.

HOW WILL THE MARKET FOR ULTRASOUND EQUIPMENT EVOLVE IN THE NEXT FIVE YEARS?

BROSCHART: All the research I have seen points to the ultrasound market increasing over the next five years. This includes the U.S. and Europe, as well as China and India.

The continued growth and use of ultrasound into new clinical applications is also occurring. Musculoskeletal, 3D/4D, etc., are two of the expanded clinical uses of ultrasound. Since ultrasound is also more cost-effective to use and maintain (as well as lower Medicare reimbursement rates), I see ultrasound being used more frequently and developing into ever-newer clinical areas. Refurbished systems also may see an increase as hospitals and doctors’ offices try to reduce costs and still maintain a high level of service to their patients.

From a service perspective, I think you will see technicians who repair ultrasound needing to go into previously unknown areas. Orthopedic surgeons, Oncology, Breast Centers, etc., will be the new home of ultrasound systems. This means repair technicians will need to learn a whole new list of clinical terminology and clinical environments to better understand their customers’ needs and issues. These new clinical areas come with a whole new set of problems and needs that will need addressed slightly different than the older radiology and cardiology areas.

Servicing of the refurbished market will require technicians who have a wide knowledge of a variety of ultrasound systems and models/manufacturers. Obviously, supporting the refurbished equipment will mean identifying reliable parts, probes and service support providers. The quality of refurbished systems must also be closely monitored by the buyers. What may appear a good deal can very often go wrong if the seller does not have the proper support functions in place to maintain and support the equipment.

RUBENSTEIN: How will that affect service of the equipment? I see this market continuing to grow. According to Dr. Harvey Klein and his annual ultrasound report, last year ultrasound sales worldwide exceeded 5 billion dollars. That is a lot of ultrasound. With the downturn in the economy over the past few years we have seen at MedPro a tremendous increase in refurbished ultrasound purchases. We see this continuing to grow. In regards to service, we opened two transducer repair facilities to accommodate the growing focus of hospitals to do more repairs either on their own, or with more third parts to offset the OEM pricing structure. Our business has grown 62 percent this year over last with the ability to help hospitals save money and repair their transducers.

TOMORY: A lot of that depends on what happens with Obamacare. It looks like that’s going to bubble up to the Supreme Court, and we’ll see how much of that is going to be implemented. I think a lot of people are holding back on purchasing new equipment to see what’s going to happen to that. The other side of the coin is reimbursements – whether they’re going to stabilize or continue to go down. If they continue to go down, there’s going to be a push toward maintaining existing equipment. Clinical departments are going to have to show ROI – how a new machine will increase productivity or revenue.
With productivity, can you get more throughput or more revenue in the sense of “Does this have new capabilities where we can build for additional types of exams?” In the market for new equipment, where we’re seeing a lot of advance in technology is in productivity. A lot of the newest pieces of equipment operate faster and get better images, so sonographers don’t have to try as hard to get the correct views. They also store raw data, which speeds processes. Everybody’s using PACS now, so where the technology is increasing now is increasing throughput and productivity and not so much capability.

WHAT ARE SOME OF THE BIGGEST CHALLENGES OF PURCHASING AND SERVICING ULTRASOUND EQUIPMENT TODAY?

BROSCHART: All the OEMs have a wide variety of platforms now. (Sometimes as many as 15 different products in production for every known clinical and market application.) Couple that with the even larger range of refurbished equipment available, and customers can become very confused on what to buy. I believe the buyer needs to perform a very detailed needs analysis and determine exactly what clinical needs are required for their application. Sometimes, new is the best way to go. If you have several models of a particular system and need to expand, I recommend looking at refurbished. It all depends on what you are trying to accomplish clinically and budgetary constraints.

Servicing the newer ultrasound systems has evolved into more software-based solutions. All of the newer models are software driven. This has required repair technicians to become much more proficient in Windows and other software programs. I see this trend as doing nothing more than growing over the next few years. Gone are the days of simple hardware replacement. While that still occurs, re-loading software, de-fragging hard drives, etc., with special emphasis on patient data in compliance with HIPAA is now the norm. Technicians will need to continue to develop strong software skills in the future.

RUBENSTEIN: For a hospital I would have to say that there is a lot of parody in the premium ultrasound market. Is there truly a difference in one brand’s compounding imaging technology and another’s? Is the 4D truly that much better? Is the probe technology worth the extra $15,000? Sometimes it comes down to what other modalities are being purchased by the facility. A CT, MR, X-ray and ultrasound would probably provide a greater discount than buying a single ultrasound system or two. Bundling is happening with the big four companies more and more in 2011.

TOMORY: We can look at it both ways. The challenges of servicing the older equipment – parts and technical support are fallible on older equipment. Can you get support? Yes, because of companies like Conquest, who specialize in parts and technical support for these older pieces of gear. Where the challenges lie on the newer pieces of equipment, in some cases, is in software and technical data, as well as passwords on some of the diagnostics for these newer pieces of equipment. There are new pieces of equipment coming out where there are software and password obstacles that have to be overcome in order to service the equipment.

PLEASE SHARE YOUR ADVICE FOR PEOPLE IN HOSPITALS THAT ARE FACED WITH THESE CHALLENGES.

BROSCHART: Training, training and more training! It doesn’t matter if it’s training your buyers to look at the detail needs before buying a new system or training your technicians to properly repair and support the equipment. The support is out there
to help with buying decisions and service support. Even some of the service companies can be excellent advisors for buying equipment. With no bias toward any one OEM, they can give you objective answers to equipment questions. The service companies are also a great solution to provide training and support for in-house technicians who can repair and support the equipment in your facility. No one can respond faster to a problem than your in-house technician. You just need to get them trained.

RUBENSTEIN: My advice really is to always try and keep up with the latest technology and speak with your peers about what they are doing. Be open to refurbished systems as many good companies out there are providing quality products and services for a fraction of the manufactures prices. This will allow you to potentially acquire more modalities and more technology. I would have hospitals explore working with good third party service providers. Many of them are trained and have response times that are unrivaled by OEMs.

TOMORY: We advise the biomed department to be a part of the purchasing process, and during that process, to make sure they get training included with purchase, and that they make sure the manufacturer will include the operating software, as well as service manuals. It’s important that the biomeds are part of the purchase process while it’s going on so they can persuade the manufacturer to include what they’ll need to service the equipment.

WHAT ELSE DO YOU WANT TECHNATION READERS TO KNOW ABOUT PURCHASING AND SERVICING ULTRASOUND EQUIPMENT?

BROSCHART: Do your due diligence before selecting a provider or support organization. The same applies to buying equipment. I see an awful lot of Internet selection of companies and that can be very dangerous. Call around, check references and, whenever possible, visit companies. Seeing is a believing.

Again, I would say: Get your technicians trained properly and consistently. Help is available in the marketplace if they get stuck on an issue. But if they are fully trained and kept fresh on that training, nothing but lower costs and improved patient care and throughput is achieved.

RUBENSTEIN: MedPro would like them to know that if you want to do in house ultrasound probe repairs and not send the repairs out, MedPro has the technology to allow you to do that, thus saving hundreds of thousands of dollars and more importantly downtime in the departments. If you are servicing your ultrasound systems now with biomed departments, move on and repair the transducers too.

TOMORY: I would reiterate the importance of being part of the purchasing process, and say that the equipment can be maintained well beyond the manufacturer’s end of life period. Biomeds just have to partner with the right ISO and get the right training.