Photo courtesy of
Shared Imaging
Shared Imaging
Special report: Mobile service providers
December 19, 2011
by Joanna Padovano, Reporter
This report originally appeared in the December 2011 issue of DOTmed Business News
When being able to provide a service can literally mean the difference between life and death, downtime can be a big concern. Even downtime on less critical services can be an issue because of the possible financial impact. Fortunately, hospitals can obtain temporary solutions to meet their needs and the needs of their patients. Mobile service providers offer facilities flexibility and coverage with a wide range of imaging modalities such as MR, CT, PET, cath/angio, mammography and ultrasound.
So whether a hospital is in the process of upgrading existing equipment and needs to maintain patient throughput, is under construction, or has needed equipment unavailable for any reason, if they have a spot to host a trailer, they have a solution. In some cases, it just may be more economically viable for a facility to have a mobile service provider deliver services periodically instead of purchasing equipment.
“If CFOs are having a hard time justifying a million-dollar acquisition of a piece of equipment because of the uncertainty of how it’s going to be utilized, maybe they should look to a company that can help supply flexible capacity,” says Ray Stachowiak, president of Shared Imaging. “If they have two MRs today and they’re trying to justify a third, what would be better? Having a third MR that in two years is only 40 percent utilized? Or maybe keep those two MRs and add two days of service a week on a mobile MR route, this way you’re increasing your capacity by 40 percent, and it’s 100 percent utilized.”
Mobile services may also be enlisted to help with outreach programs. “It’s a way [to provide] an enhanced, add-on service,” says Chad Smith, marketing director of Medical Coaches. Smith speaks from experience—his company has a mobile mammography clinic that travels around a community as an extension of the local hospital’s cancer center.
Although mobile outreach programs may prove to be a more long-term situation, in general, most mobile services are used for a finite period of time. “The majority of the business is what we call interim, which would be in that two weeks to two months range,” says Rich Dishman, executive vice president of MPX Sales and Service. “Two to eight weeks is where I would say 75 to 80 percent of the business happens.” Occasionally, it will last one to two years, he adds.
According to Smith, a typical mobile services trailer in the United States is approximately 48 feet long. The average length of a European medical coach is about six feet less, he says. Aside from the gantry area—where the scanner is located—the interior of each trailer typically also contains a control room and an injection area.
Depending on the company and the customers’ needs, some mobile service providers offer trained technologists as a package deal with equipment rentals.
Business is good for some, challenging for others
Speaking with more than a half dozen mobile service providers, DOTmed News received mixed responses regarding how business has been for the sector.
Smith reports that the domestic business of Medical Coaches—a manufacturer of numerous mobile services, including MRI, PET/CT and mammography, among others—has been on the decline. On the other hand, their international sales, which comprise 35 to 40 percent of their business, have been increasing.
For Assured Imaging Women’s Wellness, a provider of mobile mammography, ultrasound and bone density scanning, business has been good, according to Joseph Shafe, the company’s vice president of sales. Shafe mentions that his company recently expanded into Washington, Oregon and California. “Our goal in the next five years is to be in 15 states, all on the West Coast,” he says.
Meanwhile, business for Shared Imaging has been an ongoing challenge, according to Stachowiak, who blames the uncertainty surrounding the economy and health care system in the United States. Shared Imaging provides mobile services in CT, MRI and PET/CT.
“Our mobile services business has done extremely well,” says Steve Richter, executive vice president of sales for DMS Health Technologies, which offers mobile services for PET/CT, MR, CT, digital mammography and nuclear medicine. “Our utilization rates are very high in both our mobile imaging fleet as well as in our interim rental business. The economy I think has actually helped our business quite a bit.”
Similarly, Dishman reports that his company’s sales have been trending upward over the past year. He suspects the reason is due to the fact that hospitals waiting on equipment upgrades after the recession began are now able to purchase new systems and are therefore requiring the use of mobile services. “Our business is linked to the volume of new equipment sales that are going on in the general marketplace . . . so there’s this natural niche to be filled for temporary coverage,” he says.
“We saw an uptick in the first three quarters, and now things are kind of notching back a little bit,” reports John Vartanian, president of Medical Imaging Resources, a mobile service provider of MR, CT, Cath/Angio, nuclear medicine and PET/CT. “We see a lot of people pushing their projects off. Projects that were scheduled for the third and fourth quarter [of 2011] are getting pushed into first, second, or third quarter of 2012.”
Jim Varcarolis, vice president and general manager of operations for Insight Health, a provider of mobile MR and PET/CT, says that his company has noticed the needs of customers have been changing. “Depending on who the customer is, some of it is due to customer growth—expanding their services—and some of it is due to technology changes,” he says.
Mobile services across the border
Aside from Canada and Mexico, it’s uncommon for mobile service providers in the United States to conduct business internationally.
“We’re pretty much limited to where there are roads,” says Dishman, noting that he has been approached a few times by potential customers who wanted him to ship a trailer overseas for a project. “It’s never happened because the real cost of doing that is so high, it’s just cost-prohibitive . . . I would say that’s a much smaller niche to approach.”
Medical Imaging Resources, on the other hand, does sell their mobile units outside of North America, but only on rare occasions. When this occurs, the trailer is placed on a roll-on/roll-off ship—designed to transport wheeled cargo—and then sailed to its overseas destination.
Reimbursement, repairs and regulations
Reimbursement rates for mobile services are no different than those of fixed units, since the equipment is no different than what is located inside hospitals and imaging facilities.
Repairs are generally the same too, with one major difference. “The added dimension is the trailer,” explains Dishman. “There are some people that will say that any kind of medical equipment in a mobile environment is more prone to repairs, but I haven’t really found that to be true. What is going to be prone to repairs is the mobile that you’ve got it housed in.” He adds, “My experience over the years has been that as long as you’re doing preventive maintenance and you pay attention to things right away when they pop up, you don’t have more problems than you would have at a typical fixed site.”
As is the case with reimbursement, regulations for the equipment inside mobile service trailers are the same as they are for fixed systems. There are, however, rules that apply specifically to the vehicle. “There are some state regulations regarding things like radiation safety, as far as making sure that the structure of the trailer is lead-lined properly so there’s no leaking radiation, so that none of the staff or anybody walking around the trailer could accidently get a dose of stray radiation,” explains Dishman.
Mobile service providers are also responsible for meeting whatever requirements are enforced by the Department of Transportation regarding delivering the trailer to the facility in need. This means routes need to be carefully planned, making sure any bridges or roadways used are approved to handle the weight of the truck and trailer.
Market trends of mobile modalities
It’s hard to pinpoint which type of imaging equipment is currently the most popular in a mobile setting. Different companies are experiencing different trends regarding which modality customers are seeking out the most.
For Medical Coaches, it seems that there has been decreased interest in mobile MRI and PET/CT units recently.
It’s a different story for Shared Imaging’s Stachowiak, who says PET/CT has been seeing good growth rates. “MRI is still growing, but less so, and CT is maintaining itself,” he adds.
“I would say that we’ve seen MR definitely stabilized, maybe a slight uptick, but probably our biggest uptick is in PET/CT,” reports Richter on behalf of DMS Health Technologies.
“I’d say CT is down quite a bit,” says Vartanian. “I think that hospitals are trying to do projects quicker, faster, and more efficiently. CT, the modality is easier to install now than it has been in the past, and I think that’s just one of those things where if someone says, ‘OK I’m going to be without a CAT scanner for four days, five days, let’s go without a mobile,’ or a lot of hospitals may have redundant capabilities, so they’ll just add two shifts to deal with their needs for short term.”
Bumps in the road
Due to the economy and health care reform, price matters more than ever. “Everybody wants more for less,” says Vartanian. “The second thing that comes out of the customer during a conversation after ‘Hello?’ is ‘I need a better price.’”
“There’s a lot of uncertainty out there, people aren’t sure what to do or they’re not pulling the trigger as much as they used to,” says Smith, who mentions that the economy is really affecting specialty vehicle manufacturers in a negative way. “People are reluctant to buy a brand new coach as opposed to a used or refurbished-type coach,” he says, estimating that a new customized trailer costs between $300,000 and $400,000.
Dishman has observed that the technological trends of the sector seem to follow a cyclical pattern. “Wherever you’re at on the technology ladder, each type of system has a product life cycle—you just have to observe that and be sensitive to it,” he says. “At some point there will be a demand for the next higher-rung technology, and then you just have to tailor your fleet to be responsive to what’s being asked for. That’s kind of like a repeating cycle.”
One challenge that is more unique to mobile service providers—as opposed to the medical imaging sector in general—is the price of gasoline. No matter what the cost of fuel, medical trailers always need to fill up their tanks in order to drive from point A to point B. “Some of the fuel prices have come down for now, but as the fuel prices go up, it definitely erodes the margin as we’re moving these assets around the United States,” explains Richter.
Additionally, the unpredictability of nature is a constant challenge that creates hazardous driving conditions and makes it difficult for mobile service providers to maintain a perfect on-time delivery record. “We recently just went through a hurricane hitting the North East and a snow storm,” says Varcarolis, mentioning that there are a lot of logistics involved in the transportation of medical trailers.
Further down the road
“I think a lot of people thought it was only going to be a short-term type thing, but I think mobile’s going to be around for a very long time,” predicts Richter.
“This year’s RSNA will probably tell a lot,” Smith tells DOTmed News in late October, a month before the Radiological Society of North America’s annual meeting. “We’ll find out what kind of modalities are out there right now, what they’re developing, what’s going to be mobilized, and what customers [will] want to take advantage of.”
Vartanian forecasts that there will always be a need for mobile service providers, but it is unclear how much the sector will be able to grow due to so many factors at play in the market today, from fuel prices to health care reform and its potential impact on imaging systems to come. “Some people say it could be positive, some people say it could be negative,” he says. “We don’t have the crystal ball.”
Names in boldface are Premium Listings.
Domestic
Ron Averitt, Imaging Equipment Technologies, AL
Sonia Karnes, Sharpe Financial Network, AZ
Jay Schermer, Apex Imaging Corporation, CA
Shea Berreckman, Catalina Imaging, CA
Matt Lieberman, VIP Imaging, CA
Chris Ash, Scanworks, CO
Christine Holland, Parker Medical, Inc., CT
Jim Marsh, TGM2, FL
Melissa Roy, Genesis Medical Imaging, Inc. , IL
DOTmed 100
Todd King, KING Equipment Services, Inc, IL
DOTmed Certified
DOTmed 100
Michael Glynn, Mylin Medical Systems Inc, IL
DOTmed 100
Ron Smith, Brown Specialty Vehicles, KS
Eric Smith, SOS Medical Imaging, NC
DOTmed Certified
DOTmed 100
Christi Kukes, DMS Health Technologies, ND
DOTmed 100
Marc Fessler, Independence Cryogenic Engineering, NJ
Marshall Shannon, Image Technology Consulting, LLC, TX
DOTmed Certified
DOTmed 100
Donnie Ozenne, Nuclear Imaging Services, LLC, TX
John Daniels, Radon Medical Imaging Corp-WV, WV
DOTmed 100
International
Mads Vittrup, AGITO Medical, Denmark
DOTmed 100
Vahit Ayazoglu, AnkaRad Medical Imaging Systems, Turkey
Jelly van der Werf, Intermedical, Netherlands
Efzan Robert Malique , VCResources, Malaysia
When being able to provide a service can literally mean the difference between life and death, downtime can be a big concern. Even downtime on less critical services can be an issue because of the possible financial impact. Fortunately, hospitals can obtain temporary solutions to meet their needs and the needs of their patients. Mobile service providers offer facilities flexibility and coverage with a wide range of imaging modalities such as MR, CT, PET, cath/angio, mammography and ultrasound.
So whether a hospital is in the process of upgrading existing equipment and needs to maintain patient throughput, is under construction, or has needed equipment unavailable for any reason, if they have a spot to host a trailer, they have a solution. In some cases, it just may be more economically viable for a facility to have a mobile service provider deliver services periodically instead of purchasing equipment.
“If CFOs are having a hard time justifying a million-dollar acquisition of a piece of equipment because of the uncertainty of how it’s going to be utilized, maybe they should look to a company that can help supply flexible capacity,” says Ray Stachowiak, president of Shared Imaging. “If they have two MRs today and they’re trying to justify a third, what would be better? Having a third MR that in two years is only 40 percent utilized? Or maybe keep those two MRs and add two days of service a week on a mobile MR route, this way you’re increasing your capacity by 40 percent, and it’s 100 percent utilized.”
Mobile services may also be enlisted to help with outreach programs. “It’s a way [to provide] an enhanced, add-on service,” says Chad Smith, marketing director of Medical Coaches. Smith speaks from experience—his company has a mobile mammography clinic that travels around a community as an extension of the local hospital’s cancer center.
Although mobile outreach programs may prove to be a more long-term situation, in general, most mobile services are used for a finite period of time. “The majority of the business is what we call interim, which would be in that two weeks to two months range,” says Rich Dishman, executive vice president of MPX Sales and Service. “Two to eight weeks is where I would say 75 to 80 percent of the business happens.” Occasionally, it will last one to two years, he adds.
According to Smith, a typical mobile services trailer in the United States is approximately 48 feet long. The average length of a European medical coach is about six feet less, he says. Aside from the gantry area—where the scanner is located—the interior of each trailer typically also contains a control room and an injection area.
Depending on the company and the customers’ needs, some mobile service providers offer trained technologists as a package deal with equipment rentals.
Business is good for some, challenging for others
Speaking with more than a half dozen mobile service providers, DOTmed News received mixed responses regarding how business has been for the sector.
Smith reports that the domestic business of Medical Coaches—a manufacturer of numerous mobile services, including MRI, PET/CT and mammography, among others—has been on the decline. On the other hand, their international sales, which comprise 35 to 40 percent of their business, have been increasing.
Photo courtesy of Medical Imaging Resources
For Assured Imaging Women’s Wellness, a provider of mobile mammography, ultrasound and bone density scanning, business has been good, according to Joseph Shafe, the company’s vice president of sales. Shafe mentions that his company recently expanded into Washington, Oregon and California. “Our goal in the next five years is to be in 15 states, all on the West Coast,” he says.
Meanwhile, business for Shared Imaging has been an ongoing challenge, according to Stachowiak, who blames the uncertainty surrounding the economy and health care system in the United States. Shared Imaging provides mobile services in CT, MRI and PET/CT.
“Our mobile services business has done extremely well,” says Steve Richter, executive vice president of sales for DMS Health Technologies, which offers mobile services for PET/CT, MR, CT, digital mammography and nuclear medicine. “Our utilization rates are very high in both our mobile imaging fleet as well as in our interim rental business. The economy I think has actually helped our business quite a bit.”
Similarly, Dishman reports that his company’s sales have been trending upward over the past year. He suspects the reason is due to the fact that hospitals waiting on equipment upgrades after the recession began are now able to purchase new systems and are therefore requiring the use of mobile services. “Our business is linked to the volume of new equipment sales that are going on in the general marketplace . . . so there’s this natural niche to be filled for temporary coverage,” he says.
“We saw an uptick in the first three quarters, and now things are kind of notching back a little bit,” reports John Vartanian, president of Medical Imaging Resources, a mobile service provider of MR, CT, Cath/Angio, nuclear medicine and PET/CT. “We see a lot of people pushing their projects off. Projects that were scheduled for the third and fourth quarter [of 2011] are getting pushed into first, second, or third quarter of 2012.”
Jim Varcarolis, vice president and general manager of operations for Insight Health, a provider of mobile MR and PET/CT, says that his company has noticed the needs of customers have been changing. “Depending on who the customer is, some of it is due to customer growth—expanding their services—and some of it is due to technology changes,” he says.
Mobile services across the border
Aside from Canada and Mexico, it’s uncommon for mobile service providers in the United States to conduct business internationally.
“We’re pretty much limited to where there are roads,” says Dishman, noting that he has been approached a few times by potential customers who wanted him to ship a trailer overseas for a project. “It’s never happened because the real cost of doing that is so high, it’s just cost-prohibitive . . . I would say that’s a much smaller niche to approach.”
Medical Imaging Resources, on the other hand, does sell their mobile units outside of North America, but only on rare occasions. When this occurs, the trailer is placed on a roll-on/roll-off ship—designed to transport wheeled cargo—and then sailed to its overseas destination.
Photo courtesy of
Medical Coaches
Medical Coaches
Reimbursement, repairs and regulations
Reimbursement rates for mobile services are no different than those of fixed units, since the equipment is no different than what is located inside hospitals and imaging facilities.
Repairs are generally the same too, with one major difference. “The added dimension is the trailer,” explains Dishman. “There are some people that will say that any kind of medical equipment in a mobile environment is more prone to repairs, but I haven’t really found that to be true. What is going to be prone to repairs is the mobile that you’ve got it housed in.” He adds, “My experience over the years has been that as long as you’re doing preventive maintenance and you pay attention to things right away when they pop up, you don’t have more problems than you would have at a typical fixed site.”
As is the case with reimbursement, regulations for the equipment inside mobile service trailers are the same as they are for fixed systems. There are, however, rules that apply specifically to the vehicle. “There are some state regulations regarding things like radiation safety, as far as making sure that the structure of the trailer is lead-lined properly so there’s no leaking radiation, so that none of the staff or anybody walking around the trailer could accidently get a dose of stray radiation,” explains Dishman.
Mobile service providers are also responsible for meeting whatever requirements are enforced by the Department of Transportation regarding delivering the trailer to the facility in need. This means routes need to be carefully planned, making sure any bridges or roadways used are approved to handle the weight of the truck and trailer.
Market trends of mobile modalities
It’s hard to pinpoint which type of imaging equipment is currently the most popular in a mobile setting. Different companies are experiencing different trends regarding which modality customers are seeking out the most.
For Medical Coaches, it seems that there has been decreased interest in mobile MRI and PET/CT units recently.
It’s a different story for Shared Imaging’s Stachowiak, who says PET/CT has been seeing good growth rates. “MRI is still growing, but less so, and CT is maintaining itself,” he adds.
“I would say that we’ve seen MR definitely stabilized, maybe a slight uptick, but probably our biggest uptick is in PET/CT,” reports Richter on behalf of DMS Health Technologies.
“I’d say CT is down quite a bit,” says Vartanian. “I think that hospitals are trying to do projects quicker, faster, and more efficiently. CT, the modality is easier to install now than it has been in the past, and I think that’s just one of those things where if someone says, ‘OK I’m going to be without a CAT scanner for four days, five days, let’s go without a mobile,’ or a lot of hospitals may have redundant capabilities, so they’ll just add two shifts to deal with their needs for short term.”
Bumps in the road
Due to the economy and health care reform, price matters more than ever. “Everybody wants more for less,” says Vartanian. “The second thing that comes out of the customer during a conversation after ‘Hello?’ is ‘I need a better price.’”
“There’s a lot of uncertainty out there, people aren’t sure what to do or they’re not pulling the trigger as much as they used to,” says Smith, who mentions that the economy is really affecting specialty vehicle manufacturers in a negative way. “People are reluctant to buy a brand new coach as opposed to a used or refurbished-type coach,” he says, estimating that a new customized trailer costs between $300,000 and $400,000.
Dishman has observed that the technological trends of the sector seem to follow a cyclical pattern. “Wherever you’re at on the technology ladder, each type of system has a product life cycle—you just have to observe that and be sensitive to it,” he says. “At some point there will be a demand for the next higher-rung technology, and then you just have to tailor your fleet to be responsive to what’s being asked for. That’s kind of like a repeating cycle.”
One challenge that is more unique to mobile service providers—as opposed to the medical imaging sector in general—is the price of gasoline. No matter what the cost of fuel, medical trailers always need to fill up their tanks in order to drive from point A to point B. “Some of the fuel prices have come down for now, but as the fuel prices go up, it definitely erodes the margin as we’re moving these assets around the United States,” explains Richter.
Additionally, the unpredictability of nature is a constant challenge that creates hazardous driving conditions and makes it difficult for mobile service providers to maintain a perfect on-time delivery record. “We recently just went through a hurricane hitting the North East and a snow storm,” says Varcarolis, mentioning that there are a lot of logistics involved in the transportation of medical trailers.
Further down the road
“I think a lot of people thought it was only going to be a short-term type thing, but I think mobile’s going to be around for a very long time,” predicts Richter.
Photo courtesy of
DMS Health Technologies
DMS Health Technologies
“This year’s RSNA will probably tell a lot,” Smith tells DOTmed News in late October, a month before the Radiological Society of North America’s annual meeting. “We’ll find out what kind of modalities are out there right now, what they’re developing, what’s going to be mobilized, and what customers [will] want to take advantage of.”
Vartanian forecasts that there will always be a need for mobile service providers, but it is unclear how much the sector will be able to grow due to so many factors at play in the market today, from fuel prices to health care reform and its potential impact on imaging systems to come. “Some people say it could be positive, some people say it could be negative,” he says. “We don’t have the crystal ball.”
DOTmed Registered DMBN December 2011 - Mobile Service Providers - MR, CT, PET Companies
Names in boldface are Premium Listings.
Domestic
Ron Averitt, Imaging Equipment Technologies, AL
Sonia Karnes, Sharpe Financial Network, AZ
Jay Schermer, Apex Imaging Corporation, CA
Shea Berreckman, Catalina Imaging, CA
Matt Lieberman, VIP Imaging, CA
Chris Ash, Scanworks, CO
Christine Holland, Parker Medical, Inc., CT
Jim Marsh, TGM2, FL
Melissa Roy, Genesis Medical Imaging, Inc. , IL
DOTmed 100
Todd King, KING Equipment Services, Inc, IL
DOTmed Certified
DOTmed 100
Michael Glynn, Mylin Medical Systems Inc, IL
DOTmed 100
Ron Smith, Brown Specialty Vehicles, KS
Eric Smith, SOS Medical Imaging, NC
DOTmed Certified
DOTmed 100
Christi Kukes, DMS Health Technologies, ND
DOTmed 100
Marc Fessler, Independence Cryogenic Engineering, NJ
Marshall Shannon, Image Technology Consulting, LLC, TX
DOTmed Certified
DOTmed 100
Donnie Ozenne, Nuclear Imaging Services, LLC, TX
John Daniels, Radon Medical Imaging Corp-WV, WV
DOTmed 100
International
Mads Vittrup, AGITO Medical, Denmark
DOTmed 100
Vahit Ayazoglu, AnkaRad Medical Imaging Systems, Turkey
Jelly van der Werf, Intermedical, Netherlands
Efzan Robert Malique , VCResources, Malaysia