Cost-conscious health care facilities are embracing repair and maintenance as an alternative to costly probe replacement.
Expanded functionality, enhanced portability, and improved performance have led to increased reliance on ultrasound technology in health care. Medicare reimbursements for musculoskeletal ultrasound studies alone more than tripled over the last decade.1 With advancing technology, the modality’s scope and usage continue to accelerate across the board, putting greater stress on both systems and transducers (probes).
“Our ultrasound volumes have increased; so has the attention being placed on these images,” said Dale Dornacker, supervisor, Imaging II Clinical Engineering at Aurora Health Care in Milwaukee. Cost-conscious organizations are seeking new strategies to handle escalating wear and tear on equipment while containing costs. In their efforts, however, they often overlook probe maintenance.
“Ultrasound probes are one of the areas in imaging that many facilities have the least control over,” said Joe Masek, transducer operations sales manager, Axess Ultrasound, in Indianapolis. “They have a hard time keeping inventory of the probes they have, much less knowing the condition of them.”
Repair, Don’t Replace
With no maintenance strategy in place, many health care organizations simply replace probes whenever they are not working properly. “They don’t realize how much money they’re losing [replacing these probes]—it’s astronomical,” said B.J. Cumbie, director of biomedical engineering, Aramark Healthcare Technologies, based in Lubbock, Tex.
In light of high replacement costs—anywhere from $7,000 to $70,000, with refurbished probes coming in at around half that price—an increasing number of health care organizations are turning to a repair-first option. Cumbie recently served as Corporate Manager, Clinical Engineering at Aurora Health Care, and played an active role in the organization’s pioneering approach to probe maintenance and repair. “There was a tremendous amount of money to be saved,” he said.
According to Axess Ultrasound’s Joe Masek, three out of four probe defects are repairable if detected and addressed early, with costs starting as low as $500 to $600 for some basic repairs. He stated that repair versus replacement can deliver cost savings as high as 50% to 75%.
How to determine the advisability of repair? “You need to weigh the cost of the repair against the cost of replacement,” said Masek. “Also, what is the history of the probe? What kind of damage has occurred, and how many times has it been repaired? A probe has a certain life expectancy, which is directly related to frequency of use and the way in which it is handled.” Masek estimates a 3- to 5-year life span as a baseline estimate for most probe types.
When weighing repair, Amanda Plumley, biomedical imaging equipment technician at Aurora, employs a cost analysis based on the nature of the repair and the age of the probe. “Common use types of repairs aren’t as significant as the cost of replacement.”
Choosing and Managing a Service Vendor
The market for ultrasound probe repair consists largely of independent vendors, although some original equipment manufacturers (OEMs) are ramping up in that direction. “Some of the OEMs are getting into the probe repair business,” said Dornacker. He recommended staying with service providers who have built up their repair expertise. “When someone is just starting out, they’ve got some things to learn, even a big OEM.”
“The OEMs have very limited, if any, repair facilities,” said Cumbie. “When they do say they have it, they are farming it out to the service organizations.”
Dale Dornacker, Supervisor, Imaging II Clinical Engineering, Aurora Health Care
When choosing a vendor for ultrasound probe repair, look for good communication. “What’s important is developing a relationship; knowing what they can and can’t do,” said Cumbie. “When you build that relationship, it turns into a true partnership.”
No one vendor can answer all maintenance needs for the vast range of probes currently in use. “There’s no one outside company that can provide everything,” said Dornacker. For facilities that are moving from a replace to repair strategy, Dave Dallaire, director of sales at MedPro Imaging of Waukesha, Wis, recommended choosing a vendor that can help end users feel comfortable with the change. “Look for a focus on customer service; someone who has the experience for taking those assets and developing an overall probe maintenance strategy.”
Cumbie advised sharing information on your inventory with vendors to determine the level of service they can provide. He emphasized that the level of service available is important. “There are so many types of probes out there that, if someone tells you they can do it all, they’re lying. Repair processes for certain probes, like 3D and 4D probes, are still developing.”
Dallaire emphasized the importance of broad repair expertise. “Hospitals have a wide variety of probes, so you want vendors who can repair a wide variety.” He also recommended looking for quality assurances through International Organization for Standardization (ISO) certification, particularly ISO 13485, which is specific to the design and manufacture of medical devices.
Masek advised obtaining verification that the vendor actually accomplishes repair in-house. “There are a lot of organizations that promote probe repair, but there’s a very small handful of companies that actually do it,” he observed. “Some companies subcontract their repairs to people like us.” If possible, he recommended doing a site visit to tour the repair facility.
Masek also cautioned against putting too much emphasis on loaner availability and pricing. “Your decision really should be based on what’s my problem, and who’s best suited to fix it,” he said. “Don’t assume that all repair vendors and the repair processes they employ are the same.”
Proactive Approach
Repair is just the first step. Leading-edge organizations are taking probe management further with a proactive approach to maintenance, ranging from regular inspection and diagnostics to planned replacement. “With an aggressive program,” said Cumbie, “we can find problems when they cost less.”
Determining the cost benefits of an effective maintenance strategy starts with a full inventory. “You need to get your arms around what you have so you can develop a baseline for expenses,” said Dallaire. Most hospitals will inventory ultrasound machines, but not probes. “That was our first step,” agreed Dornacker, “determining how many probes we had—what manufacturers, what models.”
Joe Masek, Transducer Operations Sales Manager, Axess Ultrasound
As any biomedical engineering department will tell you, that is no small task. “It’s amazing how people can hide probes,” said Cumbie. “Doing a complete inventory means some individual has to go around and locate every one of them.”
It’s an upfront time investment that pays off in the long run, particularly for large organizations like Aurora, which saw immediate ROI after implementing a probe maintenance strategy a few years ago. “In our first month, we had cost avoidance of over $250,000,” said Cumbie. Dornacker reported that Aurora’s cost-to-service analysis of probe maintenance spending showed that cost of ownership has been decreasing over time.
Cumbie pointed out an added benefit of establishing a probe inventory. “When new equipment comes in, you can baseline the condition, and near the end of a warranty period you can evaluate the probe. If it’s not effective, you can go back to the OEM with quantifiable data.”
In addition to repair or replacement expenses, when a probe goes down, there are soft costs that are hard to quantify—such as rescheduled patients, lost referrals, and rush shipping, observed Masek. “If health care organizations schedule probes for evaluation and repair little problems rather than reacting when the probe finally does go down, they’ll save money, and they’ll also improve patient flow and reduce the risk to the patient,” he said. He added that with scheduled downtime, loaner probes can be made available in a timelier manner to assist uninterrupted patient flow.
With the introduction of its new Probe P.R.E.P.™ program, Axess Ultrasound provides a structured approach to probe maintenance. The program works with health care organizations through the full cycle of a probe’s life, including repair and planned replacement. The primary goal is to find little problems before they start negatively impacting patient outcomes. “Small problems don’t resolve themselves, they just continue to get worse,” said Masek. “Probe P.R.E.P. is all about partnering with facilities to help manage that asset to keep probe repairs minimal, so they can provide better patient care and lower their costs.”
Some organizations also are making investments in on-site diagnostic tools such as Unisyn’s FirstCall™ high-speed probe testing device as part of their maintenance program. “We inspect our probes every 6 months,” said Plumley. “Every little wire and every crystal is tested.”
In the Field
Proper probe maintenance depends on proper handling. Educating technicians on the delicate infrastructure at the core of each device is an important component of an effective overall strategy.
“We have a kit that has probes that are opened up, so you can see the crystals, see all the wires and circuit boards inside,” Dornacker said. “In many cases, the end users think that’s a really robust, thick cord. But if I show them that there are 240 or more hair-like wires inside, they’re much more careful every time they carry that probe. We have departments that treat them like babies now.”
“Our organization as a whole is good at communicating the costs of the equipment,” said Plumley. “If a probe has to be sent out for damage, I show the technician.”
Aurora also took the step of billing costs for repair or replacement due to accidental damage back to each individual department. “By putting the onus on the departments, the care they put into the probes increases,” said Dornacker. “One department that saw their costs increasing just contacted us to do more educational programs for their team.”
One of the biggest challenges to staff training and compliance is lack of time. “Techs are so busy with their primary probes, they have a hard time letting them go for preventive maintenance or minor repairs,” explained Masek. “They keep using them until the image quality gets so bad, or they quit working altogether.”
Cumbie agreed that taking probes out of service for minor repair is an obstacle for busy technicians. “Check it now, or you can check it when you don’t have a working probe,” he said. “A minor repair versus a major overhaul is a big difference. You can either pay now or pay later, but you’re definitely going to pay.”
Plumley advised education, communication, and documentation to gain staff compliance. “If you keep really great documentation over time, it will show a payoff in the long run, and it’s a great way to educate the staff,” she explained. “The more numbers you can provide to the departments that you’re servicing, the better they understand.”
Next Generation StrategiesAs more health care organizations implement probe repair and maintenance, the next step could be to bring some repairs in-house. “Sixty percent of all probe repairs are what we call basic repairs: lens replacements, strain release, cable patches,” said Dallaire. “Instead of going to the probe repair company, facilities can do these repairs themselves, and cut down on time and save money.” MedPro introduced the ProbeLabs in 2011 to help facilities accomplish this.
“ProbeLab packages provide materials and training that allow a hospital to perform routine repair and maintenance internally,” said Dallaire. “The practice has been adopted on other modalities, like endoscopes; this is very similar to that.”
The program has been successfully implemented overseas; a US pilot program is being rolled out this year with five facilities. “Going forward, we’ll add more,” said Dallaire. “Doing small repairs in-house prevents more costly repairs that really drive up budgets. The idea is to find it, repair tonight, put it back into service tomorrow.”
Plumley believed probe repair in-house would be instrumental, but had some concerns. “My only reservation would be how much upfront time for training there would be,” she said. “But after the learning curve, I think it would be a great asset.”
Bottom Line Impact
Whether doing repairs in house or outsourcing the service, the bottom line is that a proactive probe repair and maintenance strategy makes sense for health care facilities that are working to hold down costs, with the added benefit of minimizing downtime and maintaining image quality. “The faster we can get those probes back into the users’ hands,” said Plumley, “the better off everybody is.”
Dara O’Brien is a contributing writer for Axis Imaging News.
Reference
- Sharpe RE, Nazarian LN, Parker L, Rao VM, Levin DC. Dramatically increased musculoskeletal ultrasound utilization from 2000 to 2009, especially by podiatrists in private offices. J Am Coll Radiol. 2012;9(2):141-6.
