By Nancy Vacante

Tighter purse strings resulting from pressures to improve margins, combined with complex purchasing processes, can make investing in new equipment a challenge. As more health care facilities hold onto endoscopy equipment longer, maintenance costs often associated with aging equipment also continue to rise. Facilities may argue preventive maintenance in the form of a service plan is an unnecessary upfront cost — especially when staring at shiny new equipment — but maintaining a maintenance regimen is important for extending the life of a facility’s workhorse equipment.

Intermittent servicing or ignoring seemingly harmless issues may only cause additional downtime and higher repair costs as these issues worsen. Increased downtime resulting from frequent equipment repairs can lead to a loss of revenue due to canceled procedures, and loss of patient referrals if cancellations become frequent. Patient satisfaction scores may even take a hit if procedures are canceled. Through preventive maintenance, health care facilities can benefit from improved uptime, capitated repair cost and priority service, if on contract, reducing the service spend overall for aging equipment.



When deciding on a service contract, be sure to consult the equipment’s “Instructions for Use” for guidance on repairs. Using the OEM for preventive maintenance and repair service for proprietary equipment parts is tied to infection control. Parts and materials both play a role in everything from the equipment’s precise rotation and flexibility during a procedure, to withstanding precise temperatures and chemical compounds during reprocessing.

Also, don’t hesitate to request a tour of your service provider’s repair center to see the process and the team that supports your facility’s endoscopy equipment. See firsthand the repair methods, tools and technology used to return your device to OEM standards. Other factors to consider when deciding on a service contract include:

• The service level of the contract:What are the agreed-upon terms outlining service performance? Do they include the specified time frame for when the service provider would repair a device or respond to your calls?
• The price of the contract:What repair/ maintenance services are included in the contract? What does the fine print say? What does the contract exclude?
• How will service under the contract affect future renewal rates? Let's say your facility has a solid preventive maintenance plan in place and you want to justify an investment in new equipment. How do you know whether an endoscope is a candidate for continued use, or is past its prime and ready for replacement? When determining whether to replace your equipment or hang on a little longer, it is important to evaluate the new technology features and advantages, as well as several relevant factors, including: your facility type, the number of procedure rooms, case volume projections and procedural mix, equipment age, utilization rates and repair histories. The number and frequency of procedure-start delays and cancellations resulting from unavailable equipment, as well as reprocessing capacity limitations, should also figure into your calculations.

Here are a few tips to assess your facility’s needs and make your case stronger:
• Perform an equipment inventory and an aging and repair history analysis: Assess your inventory needs today and your projection for three to five years down the road. To get a clear picture of your current endoscope assets, perform a hands-on inventory to locate all endoscopes accountable to your unit. Your inventory log should contain data that includes equipment models, serial numbers, purchase dates, scope age (in years) and appropriate comments or descriptions. Some OEMs can provide medical device histories for endoscopes repaired through their facilities.

• Refer to your scope repair histories to help you trend the data and identify opportunities to reduce repairs.Repair logs can help identify problem scopes, or isolate areas of handling and repair protocols that need attention. Repair logs also are useful for calculating an instrument’s downtime. For instance, if a colonoscope is out of commission a total of 23 working days for repair work, based on a 240-working-day calendar, this colonoscope was not available for service about 10 percent of the time. Not only is the downtime an inconvenience, but when this scope is out of commission, it places more wear and tear on the facility’s remaining inventory to keep up with procedural demand.

You also can use the repair logs to calculate your annual repair expenditures and compare them against applicable national benchmarks. If your costs are higher than national averages for peer facilities, you probably need to re-evaluate your scope inventory mix and repair protocols. Benchmark data is usually broken down in a number of ways, so it is important to use current trending data by scope type since specialty scopes typically have higher repair cost per case averages than standard workhorse endoscopes.

• Calculate your facility’s utilization. Endoscopes with the highest utilization rates often require the most frequent repairs because of general wear and tear, and repeat exposure to harsh reprocessing chemicals. Aging workhorse endoscopes with low utilization rates may have fallen out of favor with physicians, so they may need to be removed or replaced. Endoscope utilization rates often indicate whether a facility’s inventory mix meets procedural and technology demands. At the sample facility highlighted in the chart on page 60, 45 percent of the facility’s scope inventory is used to perform 67 percent of its total case volume. To calculate endoscope utilization, you can document the utilization rate of individual scopes or the overall endoscope inventory by type, as shown in the example. Automated endoscope reprocessor logs offer one simple way to accurately calculate scope utilization data, or you can retrieve this information from procedure note documentation.

• Perform an outcomes analysis. This will help you understand how your endoscope equipment factors into all aspects of your facility’s operation. Ask physicians, staff and other stakeholders for input:
• Does the facility anticipate an increase or decrease in case volume or changes in case mix over the next three to five years?
• Have cases ever been lost, delayed or canceled as a result of equipment shortages?
• Does the endoscope mix per procedure room meet the facility’s and physicians’ needs?
• Do requests for infrequently used technology interfere with a realistic budget allocation?
• Does the ratio of AERs to procedure rooms still make sense? (The number of AERs may impact optimal scope turnaround times. An inadequate inventory of AERs also can spike overtime costs used to compensate staff that stays late to reprocess scopes at the end of the day.)
• Have repair costs increased for no apparent reason?
• Is there a new physician using the equipment?
• Have procedure volumes spiked?
• Are a few preferred new scopes being utilized constantly while other equipment collects dust, having reached the end of its usable life?
• Have reprocessing protocols or staff changed? (Non-dedicated reprocessing personnel can adversely impact the type and frequency of repairs. So can a rushed reprocessing staff that hurries through reprocessing steps to accelerate scope turnover.)

Once you have all the data collected, your proactive maintenance regimen comes into play to help budget for new equipment. By proactively implementing a repair reduction plan, you can improve handling protocols and reduce reprocessing-related issues. The savings you experience in repair reductions can be earmarked to augment your budget for inventory purchases. Armed with a dedicated analysis specific to your facility’s inventory and with the help of the right data, the result of this effort should be what helps convince your administration to fund the acquisition of new equipment.

Nancy Vacante is the director, professional services at Olympus Corporation of the Americas.