This article is from in the December 2007 issue of DOTmed Business News. A list of registered users that provide sales & service can be found at the end.

In retailing, everyone knows its location, location, and location.

But in shipping, whether by land, sea or air, it's communication, communication, and communication.

Or as Russell Waterhouse of the American Companies, a full service freight forwarder based in Texas puts it, "details, details, and details."

However one chooses to characterize the art of shipping sensitive and expensive medical equipment, especially such big ticket items as MRIs, CT Scanners or Mobile MRIs, it is complex, labor intensive and fraught with potential pitfalls. Often what starts as a smallish, almost innocuous hiccup ends in a witch's brew of trouble. So it's obviously best to be as proactive and detail obsessive as possible when transportation's the issue on the table.

"Communication is absolutely essential so that all the parties know exactly what's expected," says Todd Partridge, a principal with the Iowa based logistics firm, the CTS Companies. How valuable is the shipment, any special packing and handling requirements, what is the physical situation at origin and destination, need a forklift, which company's handling the rigging, any impediments to loading and unloading? That's just a scant few of the countless number of questions that must be addressed at the outset. More important, all the answers should be spelled out and double-checked long before the de-installation, packing and crating process begins.




"Establishing clear cut guidelines, getting them all in writing and then following the instructions" makes the process of shipping much more customer friendly, Partridge says. Still as everyone who talked to DOTmed Business News readily admits, given the nature of transportation and the variety of "force majeure" factors that are inherent to it, there will always be an element of uncertainty.

"A trucker's job is simple, transportation from point A to point B with no damage," says JFK Trucking, Hudson, OH, principal Joseph Kilfoyle. "But you can't control road conditions or if a tire blows."

So until the truck pulls in to offload the shipment, no one breathes easy.
And, in fact, not even then.
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As Bob Ryan of Berger Transportation Solutions, Minneapolis, MN, reminds, "what happens when the truck pulls in but there's no Masonite to lay down on the floors to roll the equipment over?" Or, perhaps, it's time to calibrate an instrument before final lockdown and there's no cadre of technicians around to do it. What then? The answer usually is charges keep mounting.

Moving Medical Equipment a Complex Equation

Moving any substantial or valuable amount of goods either domestically or internationally is a complex equation involving a buyer, a seller and an infrastructure of companies that actually execute the transit, unless, of course, buyer and seller decide to handle it themselves.




Certainly there are fairly straightforward occasions involving a single package, under one hundred pounds, that can easily be handled by one of the integrated shippers like FedEx, UPS or DHL. For somewhat larger crates--up to the dimensions of 4'x 4'x 5'-- an experienced motor carrier could probably truck it from New York to Los Angeles for something in the neighborhood of $500-750.

But for multiple piece shipments weighing tons, heavyweight and delicate MRIs or CTs, moving such expensive objects can be so intricate that "you could write an entire book about it," says Erik Cruz of the New Jersey based logistics company, Logical Solution Services, Inc. And those very complexities are the main reason why logistics firms, full service companies that oversee all aspects of transportation, are thriving.

Growth has been spurred by the increasing globalization of the medical equipment business, and since transportation in the 21st century is beset with security, regulation, customs and tax challenges, the turnkey services provided by specialist logistics companies is an attractive alternative to coordinating the job in-house. Retaining logistics providers often makes as much sense on the domestic side too

Though it's particularly difficult to arrive at accurate industry averages due to the nature of the business and all the interlocking parts, moving medical equipment can cost as little as $100 at Fedex or as much as $70,000 plus for a complex international, sea/air/truck operation.

Of course, the OEM's that prevail in medical equipment research, development and manufacture usually outsource the task of moving new equipment from the plant to the hospital, oftentimes to such logistics firms.

For example, Philips has an exclusive distribution arrangement with Berger Transportation, which has its own in-house special products division, concentrating solely on moving medical equipment. GE's been another big customer as well, just as GE's struck up exclusive deals with other regional powerhouses like Berwick, PA based Pilot Freight Services. Such partnerships are the norm at the industry's top rungs.




Meanwhile, an overseas manufacturer like Ziehm, Inc. has retained Clinical Engineering Consultants, which bills itself as a sales, service and logistics operation, to distribute its C-arms throughout the Midwest, at the same time selling and servicing them. That's a unique arrangement to be sure, but distributing medical equipment is a business dominated by multi-company arrangements, outsourcing, creativity, long-standing partnerships, and durability.

"Companies have come in and out of the business but it's pretty much the same players," says California based Sage Point Transit president Lee Bernier, "We've tripped and stumbled but we've all learned."

And that includes the customer too, who as they've become more sophisticated and cost conscious, has opted to work with logistics companies, experts, who design, create and execute the entire transportation scenario.

"Trucking companies truck, ocean companies move via ocean and airfreight companies fly shipments," says Ward Peterson, regional director, Transgroup, an Ohio based logistics company with a division, TransMedequip devoted solely to moving medical equipment nationally and globally.

"However, by using a logistics provider like Transgroup, which delivers complete solutions, our customers can do what they do best, grow their business," he says. Logistics solutions companies like TransGroup and all the others mentioned in this article are also able to negotiate and obtain rates that simply are not available to the occasional shipper, no small consideration.

Step by Step

Though procedures vary depending on exactly what is being shipped and where, (and anything with hazardous material as a component precipitates additional levels of due diligence into the process), there generally is a series of "starter" steps that transpire before the equipment ever goes to or from a hospital, clinic, private office or other specialized medical center.

DOTmed Certified companies plus many others who specialize in moving equipment initiate the process with a series of phone calls to establish all the particulars. Sometimes site surveys take place. It's not just a question of what's being shipped but how many accessories are part of the shipment and what are the special packaging and crating requirements, who is handling de-installation, where does it fit in a hospital's schedule so as to prove least disruptive, when is the shipment due at destination, which company is handling reinstallation, any particular physical challenges at the offloading site, what are the special demands that accompany the reinstallation procedure.

And that's just for starters. There's myriad other questions about insurance, the dialog between the number of outside vendors involved and, of course time sensitivity. Though it's clear that there's never anything absolutely set in stone when moving valuable medical equipment, Frieda Ambrose, of PA based F. Ambrose Moving & Rigging, estimates that from start to finish, such moves "take anywhere from 8-12 weeks" to complete.

Another example of timing being everything might involve, for example, a magnet that's being shipped via water. Generally such expensive magnets are packaged in helium, which has a shelf life of 21 days. But what happens when the ship encounters turbulent weather at sea or, upon arrival at port, encounters a wildcat work stoppage. The stakes are enormous, particularly when a buyer is faced with the loss of a $40,000 magnet and didn't know enough to purchase all the necessary marine cargo insurance on top of the routine risk management policies already in place.

"Marine law is very antiquated," says Mark Fromm of Fromm America, a New Jersey logistics company. Moreover, Fromm cautions that in such complicated insurance situations, "the big print giveth while the small print taketh away." There's the added fillip that when shipping used medical equipment over water obtaining reasonable insurance is an adventure.

"It gets very, very tricky, " says Pilot's Duff Law, especially when relatively small operations are involved at both ends of the transaction. "Two sets of inexperienced parties are trouble," he says.

"The medical community just doesn't handle these kinds of situations on a daily basis," says Travis Nipper, a principal with Clinical Engineering Consultants Inc., a company based in Kentucky but considered part of the greater Cincinnati metropolitan area. "Medicine's clients are the public and their role is to oversee patient care. They are not expected to be experts at our business."

International Another Layer of Complexity

As challenging as a US only move can be, introducing an overseas element to the equation raises the ante considerably. With international shipping comes customs brokering, an endless stream of documentation, knowledge of which steamship lines sail which trade lanes, an ability to calculate the economic merits of shipping either by water or air, adhering to a profusion of import and export regulations, tax laws, complying with FDA guidelines. Again, the list is one long and winding road, and clearly calls for a level of navigational experience not found in any but the largest of hospitals or biggest of manufacturers.

Thus, as medical equipment increasingly becomes a global enterprise, international logistics companies like Calhoun, GA based M&S Logistics have found themselves in the midst of highly favorable business conditions. Many companies like M&S also offer warehousing during transit time, as well as serving as licensed customs brokers.

M&S principal Demetri Miltiades urges anyone eyeing the overseas market, either as importer or exporter, to "get price quotes from various sources and pick the logistics company that offers competitive pricing along with professional and experienced service."

Whether medical equipment is moving halfway around the world or cross city, industry advice to the buyers and sellers is not unlike that in any other line of business, when you wander out of your area of expertise, call in the experts whose area it is.

DOTmed Fact

Those firms currently in the medical equipment business might look to the export market for big returns. While demand for equipment is strong, the sagging US dollar is also playing right into exporters hands.

"The last 3-6 months has been unbelievably busy," says Erik Cruz of Logical Solution Services. "The dollar is so weak that there's huge advantages for buyers from overseas." And Cruz says overseas buyers are taking full advantage as medical equipment exports are soaring.

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DOTmed Registered Medical Equipment Trucking, Ocean & Air Freight Sales and Service Companies
Names in boldface are Premium Listings.

Domestic
E. Lee Bernier, Sage Point Transport, LLC, CA
Demetri Miltiades, M&S Logistics, Inc., GA
Todd Partridge, Computer Transportation Services, IA
DOTmed Certified
Travis Nipper, Clinical Engineering Consultants, Inc., KY
Bob Ryan, Allied Van Lines - Berger Transportation Solutions, MN
Roger Miesner, A-Mrazek Moving, Storage and Transportation Systems, Inc., MO
Victor Cruz, Logical Solution Services, Inc., NJ
Joseph Kilfoyle, J.F.K. Trucking, Inc., OH
Ward Peterson, Transgroup Worldwide Logistics, OH
Fran Ambrose, Ambrose Rigging, PA
Russell Waterhouse, American Shipping Co., Inc., TX

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