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Special report: Mobile medical services allow for seamless business

December 31, 2013
by Nancy Ryerson, Staff Writer
Mobile medical trailers make life easier. They provide service when a hospital is replacing equipment, give facilities a chance to test out a new modality before making a purchase and help out rural hospitals that lack the capital for a permanent set-up.

But if mismanaged, mobiles can cause trouble, too. Improper site planning or IT mess-ups can turn what should be a positive experience into a disaster. Knowing the best way to approach mobile service is important, especially since more and more hospitals require it as budgets finally allow for new purchases.

“We’ve actually had several cases where we simply didn’t have a system available — couldn’t even call a colleague and find something because their units were all out, too,” says Rich Dishman, vice president of MPX Sales and Service, LLC. “In 2009, 2010, that was almost unheard of because everything was so slow at that point.”

To help you keep everything moving, mobile medical service professionals talked with DOTmed Business News about the most popular modalities, creative ways to use mobile service and the best ways to prepare your parking lot for the mobile’s arrival — including the tricky IT side of things.

Making the connection
Though trailers are usually temporary, facilities must take into account all of the details involved in a regular room set-up, including wireless connectivity and other IT concerns. Making the connection is the responsibility of the mobile service provider, but hospitals should have their IT teams on hand to work with the mobile side when the trailer pulls in.

“Ours is pretty plug and play,” says Mark Koers, account executive at Modular Devices Inc. “In general, with our systems we provide a really open network that can connect with any hospital network. It can be split off into multiple data decks in a very easy way to extend into the hospital. That’s something we’ve done a lot the last couple years.”

Mobile companies also assure hospitals that their systems can export to a wide variety of PACS systems, though it’s important to double-check.

Larry Siebs, president/CEO of Shared Imaging, says that customers sometimes have concerns about patient data security when his team wants to perform remote diagnostics on a piece of equipment in the trailer.

“The hospital is concerned that the data will be somehow leaked out in some way, but when you look at the remote diagnostic capabilities, all patient data is stripped out of that,” says Siebs.

Pat Buchholz, vice president of Shared Medical Services, confirms that many customers ask about patient data security.

“We have a specialist that works specifically on image transfer and data transfer for mobiles,” says Buchholz. “We’ve come a long way in that regard, and obviously security is a big issue that we’ve worked with.”

Trailer companies are also perfectly comfortable navigating the various rules and regulations that accompany patient data, including HIPAA.

“We utilize a business associates’ agreement with all of the hospitals we engage with. It’s probably five pages long and filled with the dos and the don’t for patient data,” says John Vartanian, president of Medical Imaging Resources, Inc. “Whenever we send a vendor on to do a new work, even if we send someone to do the HVAC system, that vendor still signs the BAA agreement saying that if they notice any problems with patient data security they’re to report it.”

On the low-tech side, site planning is a problem that never gets old. In general, be sure to leave enough space for the large trailers to park, and for the sake of patient comfort, try to keep the trailer as close to the hospital as possible.

“You don’t want to be taking someone 100 yards away from the hospital, especially when the weather is terrible or cold. They try to work it out so they go right from the door into the patient lift,” says MPX’s Dishman.

New modalities on the move
Are you curious about how your facility’s upgrades compare to the national trends? Mobile companies say that PET/CT has been their most popular trailer, especially in urban areas.

“You’re really seeing more of the urban community hospitals looking to have PET/CT as a service where they haven’t had it before,” says Shared Imaging’s Siebs. “The volume on the PET/CT has been picking up as far as the number of scans, so we really have great adoption.”

PET/CT is expected to grow by 22 percent over the next five years and by 55 percent over the next 10 years, according to a report from Technology Insights. MR and digital mammography have also continued to grow on the mobile side, says Shared Medical Services’ Buchholz.

Modular Devices’ Mark Koers the first company to offer mobile cath/angio labs, says that his company’s signature item has seen a bit of a decline in favor of newer rooms, such as electrophysiology rooms, which are better suited to the company’s modular solutions because they require more space.

“For EP and peripheral vascular procedures, you need to have an anesthesiologist in the room and some more involved equipment, so the modular labs lend themselves much better to those kinds of procedures,” says Koers.

Besides keeping services going when a new install is taking place, mobiles and modular solutions can also be used to test the waters with a new modality before making a large purchase.

“A hospital will have a doctor who promises to come and bring a lot of business, says Koers. “Adding on a new cath lab, for example, could cost of millions of dollars, with the hope that the doctor will deliver on his promises. With a trailer or modular solution, they can get some traction before installing a larger in-house lab.”

Hospitals also test patient load on a second or third scanner before deciding to install it, or can use a mobile to accommodate patient overflow during busy periods.

“If they’re on the brink of a second or third scanner, rather than doing the improvements for a second CT or MR, they’re bringing the [mobile] in to catch the volumes up and see if they really have the need for a second scanner,” says Shared Med’s Buchholz.

CT to go?
While CT mobile routes were once popular, especially in rural areas, mobile providers now report that most facilities require a more permanent scanner, especially for emergency rooms.

“It’s one of those tools now that’s a necessity, so the mobiles don’t really fit that,” says Buchholz.

But there may be a new life for mobile CT, in light of the U.S. Task Force decision to recommend low-dose CT screenings for smokers at a high risk of developing lung cancer. One mobile services company, Imaging Solutions, Inc., teamed up with the low-dose CT company, SmartCT, to provide mobile low-dose CT in rural shopping centers in the Upper Midwest.

Because Medicare and Medicaid don’t cover the procedure, keeping it affordable was a priority. The mobile in question was equipped with a GE Lightspeed 16 CT. However, GE’s dose reduction solution, called ASIR, doesn’t support Lightspeed 16, and replacing the scanner proved to be prohibitively expensive for a mobile installation. SafeCT, Medic Visions’ iterative reconstruction product, ended up being a fit because the technology is compatible with older systems. The scanner only had to be shut down for one day to install the program.

Eyal Aharon, CEO of Medic Vision Ltd. imagines that more low-dose scanners will be installed in mobiles in the future.

“Most of the CT scanners in the mobile units are of models not supported by the OEM’s dose reduction solutions, so the operators need to replace the existing CT with a new one in order to comply with low-dose initiatives,” he says.

While the need for low-dose CT scans is always growing, some commentators aren’t sure that offering the service in a parking lot is the best approach.

“Early detection of lung cancers is serious business and while in theory one could pre-screen and educate patients at a mall as well as anywhere else, I find the practical logistics of doing so hard to imagine,” Lena Kauffman, a contributor at ImagingBiz, wrote in June. “A more likely scenario is for the patient to be handed materials on the risks and benefits of screening along with a screening questionnaire. […]The need for an accreditation program for CT lung cancer screening could not be more urgent.”

Shared Imaging’s Siebs feels that CMS reimbursement for low-dose lung CT scans will need to be in place before lung cancer screenings in mobiles could really become popular.

“The amount that the patient or even a payer would be willing to pay for that, versus the cost you would have to provide that at, makes it a difficult one to have any margin associated with. I don’t see that taking off,” says Siebs.

A more flexible future
In a way, mobile services have found a way to do well in a variety of economies, whether they’re providing service for facilities that can’t afford a long-term install in troubled times, or helping out hospitals that are in the process of upgrading in more prosperous seasons. Companies are optimistic about the way the Affordable Care Act will impact their segment, as well.

With the stronger emphasis on patient care over financial goals, Siebs predicts that some facilities may even opt for permanently flexible solutions.

“They’re going to be looking at their satellite services, looking for the right services to support their patients,” says Siebs. “Bolting them down doesn’t always make sense. With the changes that are going on in health care, it’s going to be probable that I’ll have to move that asset within my network. Putting them in a trailer, putting them in a modular building is going to make sense.”

DOTmed Registered Mobile Service Providers - December 2013 Companies

Names in boldface are Premium Listings.
Frank Smisek, Field MRI Services, Inc, GA
Michael Hardesty, Advanced Mobility Specialty Vehicles, IL
DOTmed Certified
Todd King, KING Equipment Services, Inc, IL
DOTmed Certified
Wes Solmos, Creative Foam Medical Systems, IN
DOTmed Certified
Mark Koers, Modular Devices Inc., IN
Paul Zahn, Shared Medical Services, Inc., WI
DOTmed Certified
DOTmed 100

Giuseppe Bettini, Radiological Service srl, Italy
Abdulatif Shlash, Shlash Medico, Syria