Decisions, decisions; every day is fraught with them. There are often multiple considerations involved in making a decision and most of the ones related to health care today are overshadowed by budget concerns. It’s never a cut and dry choice.
Like everything in the information age, there is a boatload of data available to go into the decision-making process. That fact has not skipped over the question of parts, the procurement process and who makes decisions. With multiple options comes lots of questions in order to make an informed decision.
Who is involved and responsible for parts purchases? Is it biomed? Is it a parts procurement division or person? How are facilities using CMMS software to manage and keep inventory? How can this help with parts purchasing options?
There are also concerns about how you compare the quality of parts and judging quality versus price. Do you let the biomeds do repairs and have somebody else buy parts and take care of acquisition? What are the pros and cons of having a dedicated parts procurement specialist versus having an HTM professional handle this task?
“Repair parts for medical equipment can be costly. But equipment downtime and the additional labor from installing bad parts can be even more costly,” says Patrick Lynch, CCE, CBET, fACCE, CHTS-PW, CPHIMS, Biomedical Support Specialist with Global Medical Imaging (GMI).
“There are several strategies for parts acquisition. None is perfect. None of them meets all of the goals of lowest price; highest quality; speedy delivery; tech support and liberal return policy,” Lynch adds.
Lynch’s observation explains the conundrum that many HTM professionals face; achieving several objectives that might be impossible to deliver on. Some may even be mutually exclusive.
In some HTM departments, within larger institutions, a specialist handles the many considerations of procuring parts.
“At ProHealth Care, I’m the Biomed Procurement Specialist who sources parts for availability, quality, price, issues the purchase orders, tracks delivery, handles returns of exchanges and/or incorrect parts, and enters all this detail into work orders for all our techs,” says Mickie Wong, RN. “We also have a Biomed Department Assistant, Rosa Dunton, who provides similar service for no charge/warranty/service contract parts.”
Within departments that can have a person dedicated to this function, it alleviates the question about how much time the HTM professional has to spend reviewing all the considerations involved.
“At ProHealth Care, Rob Bundick, our Biomed Manager, stresses the importance of our technicians ‘turning a wrench,’ understanding that the tech’s time is best spent focused on corrective and preventive maintenance versus time spent on the phone/computer performing clerical functions involved in obtaining parts/service that can be performed by myself and/or our office support staff,” she says.
One of the considerations that a procurement specialist or an HTM professional is faced with is whether or not buying parts from the OEM is the way to go. There are clearly arguments on both sides of this approach. Cost is generally at the top of the list.
Buying from the OEM
“In my mind there are two strategies; buying all of the parts from the OEM, or a mixed approach, buying from the OEM and selected third parties, as there are some parts only available from the OEM,” says Ken Maddock, BSEET, who co-taught a course titled “Device Supportability: The Dos and Don’ts of Using Replacement Parts” at the 2015 AAMI Conference and Expo.
“The pros of buying from the OEM is that theoretically you should be getting the best quality parts that are almost guaranteed to work with your device. Although this is theoretical, it is a very high probability,” Maddock says.
“Buying parts from the OEM is the path of least resistance, and typically, is the most efficient when you consider the amount of work your organization has to do to purchase parts, especially if you consider technician time,” he adds. “You also promote a strong relationship with the OEM by using only their parts.”
Maddock says that on the flip side is that you “typically pay a higher cost than other options and you can generate complacency on the part of the OEM if they think you aren’t open to other options.”
He also points out that there are times when the OEM may have a part on back order that is available immediately from an alternate vendor.
According to Wong, some of the pros of using OEM parts include: the OEM provides updated info on the latest rev level, there is tech phone support to confirm which part/rev level is needed, a comfort in knowing/avoiding [the] fear factor that you will receive the same replacement part and the OEM typically has a larger inventory when parts are needed quickly.
Like Maddock, Wong cites higher costs as a con, along with “resistance to provide support if an ISO’s part is used.”
When the downside is price, the HTM professional is faced with one of those conundrums mentioned.
“This is the hardest component of our role in my opinion. The role of a HTM professional is to ensure the medical equipment for which they are responsible for is available and working properly so it is ready for use,” says Dave Francoeur, regional vice president at Compass HealthCare Technology Solutions.
“There is a constant balance between cost and quality, and while an organization you collect a paycheck from may feel one way about that, the organization that you are providing the services for may feel another,” he adds.
Francoeur says that there are very complicated algorithms that “take into consideration price, usage, failure rates, life cycle cost and life expectancies.”
“Then you need to layer on factors associated with what makes best sense for your organization. Balancing price, customer satisfaction, and as always; risk. My personal perspective is that over time, it usually equals out ‘pay me now or pay me later.’ When one attempts to cut corners, assuming all things being equal, eventually you will make up the difference in cost in some manner. Frequency of failures, customer satisfaction, down time/lost revenue, risk/adverse outcome,” Francoeur says.
The price/quality equation seems to be central to any debate about using OEM sourced parts. It begs the question; how do you balance price versus quality?
“There is no absolute answer to this question. It depends on your organization’s philosophy on where it prefers to live on the risk curve,” Maddock says. “Some organizations are willing to take little risk where quality is concerned, but more and more are willing to live with more risk if it potentially involves significant cost-savings. For the HTM leader, in my opinion, you have to use typical risk assessment strategies. You evaluate the possibility of a negative impact along with the potential outcome. If the possibility of a negative impact is low and the potential cost-savings great, it is an easy decision.”
But Maddock points out that most decisions aren’t easy. He suggests that it is better to err on the side of the negative impact because of the potential impact on patient outcomes and patient safety.
“If the potential savings aren’t significant, I believe you select the choice with the lowest potential for a negative impact. Again, you have to understand your organization’s philosophy on risk and use that to assist you with the tough decisions. Sometimes you just have to make a tough choice and be willing to live with the outcome,” he says.
From a parts procurement specialist vantage point, the price/quality issue has clearly delineated borders.
“Price is not an issue when our uptime on a hard down situation — with no backup equipment — will always take priority. However, when we’ve worked with ISOs long enough, we gain a trust in their refurbishing capabilities for quality,” Wong explains. “For those situations, when we can only obtain a used or refurbished part from an unknown vendor, then higher price is desirable over questionable quality.”
Using an ISO
“Obviously cost is always the major factor in attempting to secure parts for devices needing preventative or correct maintenance. The balance needs to come from finding the appropriate partner(s) that can provide the right price, right quality, and in the appropriate time frame,” Francoeur says.
“These three criteria are paramount to the success of any good progressive organization that wants to make a positive difference,” he adds. The value of partnering with an independent service organization are the scales of economies. As an ISO, it allows for acquiring large quantities of products, driving maximization of value, as well as the leverage of driving change.”
Wong adds that there are typically lower costs with an ISO and they bring an increased availability of parts for older equipment. This provides the additional benefit of not having to upgrade or replace obsolete equipment when parts are still available on the secondary market.
She says that another positive for using an ISO is “greater negotiating power for lower prices, warranties, and/or keeping exchange parts.”
Maddock says hospitals have an additional option when a procurement specialist, or another person in the HTM department isn’t assigned to this task.
“Many organizations use their supply chain department to purchase parts for the HTM team. The advantage of this is that you are utilizing existing personnel trained for the purpose and it should be more efficient if managed properly with an appropriate mechanism for acquiring parts on an emergency basis,” he says.
“There are also some organizations that will reach an agreement for a third-party to purchase all HTM parts if they feel there is a financial advantage and have done all of the background checking to verify proper controls and the viability of the third-party organization,” he adds. “I am not aware of any organization that allows the HTM department to acquire medical equipment other than items below the capital limit that are used for spares.”
“I truly believe in the old adage – What got you here today, may not be what gets you there tomorrow,” says Francoeur. “We should continually challenge ourselves to make sure what has worked in the past is still the best solution today. Within the ISO world, having dedicated resources and maximizing on that benefit absolutely nets the best results, and we are provided with data continually we can use to challenge and prove that point.”
Francoeur says that changes will be made whenever an opportunity for improvement is found. He says that resources dedicated to procurement will intentionally and randomly vet certain services and purchases to validate that the price, quality and delivery that they are receiving, are the best they can be.
“The biggest factor for both OEMs or ISOs is knowing the vendor and asking: is [the] part new, refurbished, or used/as-is; who is the OEM of that part — since it’s often-times not the manufacturer themselves — do they refurbish themselves, [and] if so, what is their experience, where are parts manufactured – oversees, etcetera, and the age of our equipment,” Wong says.
HTM Does it All
When the decision falls to an HTM professional, as it so often does, then let the HTM pro own it lock, stock and barrel.
“Let the BMET find the part and choose the vendor – this works very well, as the BMET is responsible for the complete repair and will choose the best overall parts vendor,” Lynch says.
On the flip side, Lynch says that there can be a problem, with an increased workload. A BMET is an expensive person to have chasing down parts. He says that there is always the possibility also that they may be aware of only the older, established vendors and not in touch with newer, more innovative providers.
“Probably the best overall scenario to meet the complex needs of the hospital is to allow the hospital HTM administration to select preferred vendors, negotiating deals, discounts, training, etcetera, and then let the individual BMET place orders and manage the transactional events,” Lynch says.
Whichever strategy is employed, a balance between quality parts, availability and a budgetary focus must be found. Thin budgets paired with patient safety makes for challenging times and more complex decisions.
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