CT is the most desired modality this year, with 64-detector units strongly favored despite budget challenges
Axis Imaging News’ readers were surveyed in April 2007 at this website, where 124 respondents answered 23 questions about their plans for acquiring capital equipment and the methods that they will use to purchase it. In addition, they provided details concerning the difficulties that they must overcome in seeing that their equipment needs are met, along with predictions of the procedural volumes that they will have to handle.
Survey respondents were working primarily as radiology administrators (32%), with many physicians (16%) also providing survey data. Other respondents included picture archiving and communications system administrators (13%); CEOs, CFOs, CIOs, and COOs (6%); radiologic technologists (6%); and practice administrators (5%), as well as medical physicists (2%). Other titles were held by 21% of respondents, who reported working in various consulting, engineering, informatics, and quality-assurance positions.
Hospitals were the work or practice setting for most respondents (50%). Freestanding imaging centers were the workplaces of 22%, and 16% were employed by health systems. Employers were located in the United States for 82% of respondents and elsewhere for 3%, with the remaining 15% preferring not to supply their addresses. Among US respondents, the South Atlantic (24%), East North Central (18%), Pacific (14%), West South Central (13%), and Middle Atlantic (12%) regions were the most frequently reported employer locations; smaller numbers of respondents represented the Mountain (8%), West North Central (8%), New England (4%), and East South Central (1%) regions.
Changing budgets
Budgets for capital equipment are, of course, tied loosely to procedural volumes, and Figures 1 and 2 indicate the broad range of variation in both areas. Most respondents (27%) reported that their facilities had procedural volumes of fewer than 25,000 studies per year, and most (28%) had budgets of $1 million to $5 million for capital equipment in radiology.
Figure 1. How many imaging exams/procedures are performed by your facility/practice each year? Total is less than 100% due to rounding.
Fewer than 25,000………………………….27% More than 250,000:…………………………24% 50,000 to 100,000:…………………………19% 100,000 to 250,000:………………………..15% 25,000 to 50,000:…………………………..14%
Figure 2. What is your current capital budget for radiology? Total exceeds 100% due to rounding.
Less than $100,000:………………………..17% $100,000 to $500,000:……………………..13% $500,000 to $1 million:………………………13% $1 million to $5 million:……………………….28% More than $5 million:………………………..17% Don’t know:………………………………….13%
Since fiscal year 2006, capital-equipment budgets have been unchanged for 24% of respondents (Figure 3). Budget decreases were indicated by (23%), with (72%) of those affected by budget reductions reporting cuts of more than 10%, (8%) reporting more modest decreases of 7% to 10%, and (20%) reporting relatively mild decreases of less than 6%.
Figure 3. Has your budget changed since last year?
Increased…………………………….43% Did not change:………………………24% Decreased:…………………………..23% Don’t know:…………………………..10%
Positive changes in capital-equipment budgets were somewhat more prevalent than might have been expected, given the effects of widespread reimbursement reductions (including those tied to the Deficit Reduction Act). Increased budgets were reported by 43%, and of these, 47% saw budget growth of more than 10%. Another 35% of respondents with budget improvements reported increases of 7% to 10%, 14% reported increases of 3% to 6%, and 5% reported increases of less than 3%.
Planned additions
During fiscal 2007–2008, 86% of survey respondents noted that they plan to acquire capital equipment for radiology. CT is the modality that most respondents (41%) indicated that they would purchase (Figure 4). Within the group planning to buy MRI systems (31%), field strengths of 1T are not being sought by any respondents; field strengths of 1.5T are wanted by 57%, and of 3T, by 32%. Open magnets will be bought by 11%.
Figure 4. What capital equipment for radiology do you plan to purchase this year?
Total exceeds 100% because many respondents will purchase multiple modalities; write-in responses in the “Other” category included ultrasound, nuclear medicine, scintigraphy, film-based radiography, single-photon emission computed tomography, breast coils for MRI, and upgrades.
CT:………………………………………………….41% Digital mammography:………………………………31% MRI:…………………………………………………31% Picture archiving and communications system:……..27% Other:……………………………………………….24% Digital radiography:…………………………………22% Three-dimensional software:……………………….22% Digital fluoroscopy:…………………………………19% MRI software:………………………………………19% Computed radiography:…………………………….15% Gamma camera:…………………………………….15% Positron-emission tomography/CT:…………………15% Radiology information system:……………………..14% Nothing:…………………………………………….14%
Most buyers of CT systems (63%) will look for systems with 64 detectors, but another 4% want 32 detectors, 23% want 16 detectors, 2% want eight detectors, and 9% intend to buy systems having fewer than eight detectors.
Survey respondents who were practicing in or employed by freestanding imaging centers were asked to assess the impact of the Deficit Reduction Act on their plans to acquire capital equipment. The revenue lost as a result of the act will cause some respondents to decrease their planned purchases, but others expect to substitute less sophisticated equipment or buy refurbished units. Some indicated no changes in their plans, and some have put purchases on hold until they can complete the financial analyses needed to assess the impact of reimbursement changes. A few noted that they will compensate by extending their operating hours or otherwise increasing procedural volumes.
Acquisition mechanisms
The facilities represented by 79% of respondents belonged to buying groups. These groups were used for 75% to 100% of purchases by 32% of respondents whose employers had memberships, with an additional 27% of members using buying groups for 50% to 75% of purchases and 15% making 25% to 50% of purchases through the groups. Buying groups were used for fewer than 25% of purchases by 9% of respondents who had memberships (Figure 5).
Figure 5. What percentage of purchases do you make through your buying group?
75% to 100%:…………………………32% 50% to 75%:…………………………..27% 25% to 50%:…………………………..15% Up to 50%:………………………………9% Don’t know:…………………………….17%
Imaging modalities were acquired through the facility’s preferred vendor by 45% of respondents (Figure 6), although the same vendor was not used for all modalities in most cases, with only 16% reporting that degree of purchasing consolidation. The equipment vendor was selected with the participation of the radiology administrator in the facilities of 100% of respondents, with participation also reported for the hospital CFO (66%), the radiology chair (65%), the operations/materials manager (50%), the chief technologist (46%), the CIO or another person responsible for the facility’s information technology (28%), and the medical physicist (20%).
Figure 6. Does your hospital have a preferred vendor for modality purchases?
Preferred vendors were chosen with some constraint due to contractual obligations, although 85% of respondents indicated that vendor overrides were possible under certain circumstances. Vendor contracts covered a period of 1 to 2 years for 15% of respondents, 2 to 4 years for 44%, 5 years for 24%, and 6 or more years for 6%. Some facilities still seek proposals from competing vendors, even though they have preferred-vendor contracts in place, because a significantly less expensive offer can be enough to trigger an override of the contractual purchasing arrangement.
The technology-acquisition process was highly variable, with some respondents using formal technology teams to specify equipment and choose suppliers, and others relying on the decisions of senior management alone. The radiology administrator was involved in technology acquisition in the facilities of 74% of respondents; the chair of radiology, in 53%; subspecialty radiologists, in 42%, the practice president, in 18%; and senior executives (CEOs, CFOs, CIOS, and/or COOs), in 5%.
The time needed to complete the technology-acquisition cycle, defined as beginning with a request for proposal and ending with a purchase, took more than 2 years for 5% of respondents, 1 to 2 years for 23%, 6 months to a year for 54%, and less than 6 months for the most agile 18% of facilities.
Hospital radiology departments face not only the acquisition delays and budget constraints that plague much of the radiology community, but an additional barrier to obtaining capital equipment: competition from other departments and services for scarce capital. The most serious competitors for capital dollars were named by 97% of hospital-based respondents as cardiology departments, by 27% as vascular-surgery departments, and by 24% as oncology departments, with an additional 27% stating that departments that do not focus primarily on imaging (such as emergency, laboratory, surgical, information, and orthopedic services) were their main competitors.
The generous sharing of their time and insight by survey respondents is appreciated by Axis Imaging News.
Kris Kyes is the technical editor of Axis Imaging News. For more information, contact
Comparing 2006
Although the individuals who responded to the 2006 and 2007 editions of the purchasing survey were not identical, making direct comparisons invalid, certain results may reflect general changes in the needs of the imaging community. Two years’ data cannot constitute a long-term trend, of course, but there were 41% more survey respondents for 2007, perhaps adding to the reliability of the information. Among the notable differences between years:
Fewer respondents plan to purchase capital equipment, with 98% for 2006 decreasing to 86% for 2007.
Major technology purchases are planned by fewer facilities, with CT acquisitions dropping from 50% for 2006 to 41% for 2007 and MRI decreasing from 44% to 31%.
Multidisciplinary involvement in vendor selection seems to have grown dramatically, with an increase from 55% for 2006 to 100% for 2007 reported for radiology administrators and other large gains seen for radiology chairs, CFOs, operations/materials managers, chief technologists, and CIOs.
Facilities appear to be signing longer preferred-vendor contracts, with contracts lasting 2 or more years reported by 41% of respondents for 2006, but 74% for 2007.
The ability to respond to market changes quickly may have decreased; in 2006, 29% of respondents reported a technology-acquisition cycle lasting less than 6 months, but only 18% could act that rapidly in 2007.
The perceived threat of cardiology’s ability to compete for capital has grown. While 79% of respondents named cardiology departments as major budget competition for 2006, nearly all (97%) did so for 2007. Competition for equipment-acquisition funds from departments that do not focus on imaging was also felt to increase, from 14% to 27%.
