Advanced Mobility by Kentucky
Trailer's GE Discovery IQ

The mobile medical imaging market is expanding amid hospital budget pressures

December 09, 2016
by Lisa Chamoff, Contributing Reporter
As hospitals look to update and replace older equipment and expand imaging programs while facing budget pressures, mobile imaging solutions have filled the gap, and companies that provide these solutions see a market that continues to expand. Like many industries, the mobile imaging market took a slight hit after the 2008 financial crisis, says Mark Koers, an account executive at Modular Devices Inc., but the market for mobile medical labs has expanded in recent years.

“Hospitals have been updating and replacing older equipment and we’ve seen imaging program startups and expansions begin to pick up,” Koers says. Bob Bachman, president of Advanced Mobility by Kentucky Trailer, says aging equipment is a big driver of market expansion. “The existing fleet is old and getting older,” Bachman says. “The average age, 15 to 20 years old, has never been higher.” The mobile CT business is also growing, in large part, because of the XR-29 legislation, Bachman says.

Dale Hockel, chief operating officer of Alliance HealthCare Radiology, says the company’s suppliers of mobile imaging equipment have begun expanding their offerings, pointing to GE’s impending release of the SIGNA Voyager 1.5T wide-bore MRI. Bachman says GE and Siemens have also invested in mobilizing new MRI and PET/CT modalities, including GE’s Discovery IQ PET/CT and Siemens’ Biograph mCT.

Mobile imaging, and sharing mobile devices among several facilities, is a growing trend particularly in rural areas, says Beth Schmidt, director of marketing for DMS Health Technologies, which has been working with the Veterans Administration and Indian Health Service to facilitate getting clinics into rural areas. “Many patients who live far off the grid don’t come into a hospital until their symptoms become unbearable,” Schmidt says. “Positive medical outcomes are statistically much better when an illness can be treated early in its progression.”

A mobile trailer from
Alliance HealthCare Radiology

Smaller investment
Mobile imaging is a budget-saving option for hospitals that are unable to invest in expensive new equipment. The market is being driven by continuing reimbursement reduction pressures and hospital consolidations, those in the industry say. “Some hospitals don’t have the patient volume necessary to justify the cost of in-house imaging equipment, or access to the capital necessary to purchase the equipment up front,” Hockel says. “So having a mobile solution enables the hospital to bring quality, short- or long-term, cost-effective and convenient imaging solutions to their patients that would not be possible otherwise.”

Koers says he’s recently seen an increase in the number of cardiovascular groups interested in taking their business away from the hospital setting and starting up independent imaging centers. “In these situations, our interim cath labs are an integral part of their plans, an interim solution that can be delivered and operational within weeks, with the ability to start seeing patients, and producing a revenue stream, while plans are being made to budget for and install a permanent in-house lab at a later date,” Koers says.

Schmidt says expansion in the market comes from a combination of fiscal constraints as well as the need for capacity and access. “For instance, if a facility needs women’s health, maybe they don’t have the time or the budget to build a completely new clinic,” Schmidt says. “DMS Health Technologies can assist by providing a trailer with a complete women’s health facility — everything from laboratory services to behavioral counseling, to bone density screenings. And if we can share the trailer with other facilities in the area, we can offer women’s health services to a whole community, in local neighborhoods, for a fraction of the cost of building a fixed site. We can bring the clinic to the patient, creating a standard of care that is both comfortable and convenient.”

Dave Stewart, vice president of sales and marketing for Shared Imaging, says the market is fairly equally divided among CT and MR, with a slight increase in the utilization of PET/CT. “Health care providers are required to function in a rapidly changing environment,” Stewart says. “Some of our clients look at mobile imaging technology as an alternative to the traditional cash purchase model, while others look at it as a complement to the systems they have installed inside their facilities.”

Varied solutions
Some facilities rent only the equipment, but the mobile imaging companies can also provide technologists, patient coordinators and drivers to move the equipment. “Most hospitals and groups we work with simply rent the mobile lab and staff it on their own,” Koers says. “Occasionally, we’ll partner with a startup in a remote area that needs help finding staff, and for these folks we’ll put them in touch with one of our industry partners who specializes in technical staff.”

Business is split between short-term rentals, when a facility is undergoing a construction project or is upgrading systems, and long-term arrangements of a few years or more. Hockel and Stewart say the majority of their clients use a long-term solution, while Koers says his company’s business is split 50/50 between short- and long-term rentals. “Our mobile lab trailers — cath, angio, CT — are short-term and are best suited for a few months during an equipment changeout,” Koers says. “For long-term solutions, we offer a larger modular lab that is a minimum of 50 percent larger than a mobile trailer with direct ground-level entry that can easily be connected to a facility.”

High interest in current Technology
While there is a demand for current technology in a mobile environment, equipment providers say facilities do need to work around budgetary constraints. “For CTs, we don’t provide anything less than a 16-slice count system,” Koers says. “We’ve found a 16-slice system is still adequate for most short-term projects, while the lower slice count systems are outdated.

While the OEMs are offering new systems with higher and higher slice counts, the mobile CT market tops out at around the 64-slice count level, as a 64-slice count system is still adequate for most trauma centers and other facilities that need a high slice count system in a mobile lab. NEMA XR-29 compliant systems are also in high demand, to meet the new dose reduction standards.” Jim Varcarolis, senior vice president and general manager of the mobile division at Insight Health Corporation, says the industry offers a mix of technology, operating with the most current software applications available from the OEMs, to meet the various needs of its customers.

“It’s important to have a mix of products available to suit the needs of the customer according to what services and specialties the customer provides, from small rural facilities to large teaching hospitals, to systems involved in research grants,” Varcarolis says. Mobile equipment companies also allow facilities to test out equipment before purchasing, but Varcarolis says “rent to buy” is not currently a big trend. “Rent-to-buy may become more prevalent in the upcoming years, as customers look to upgrade technology in cost-effective ways, and as technology ‘leaps’ slow down in certain modalities,” Varcarolis says.

Mobile GE Innova 3100

Prepping and environmental Issues
Hospitals need to make sure they make the correct preparations for delivery of the mobile equipment, and that it’s protected from environmental issues, and the equipment companies can help with that. Prepping a site is largely dependent on what is being delivered, says Schmidt of DMS. “Generally, a flat, stable surface is required,” Schmidt says. “It’s helpful to have access to power and water, but not necessary. In many cases, there needs to be easy access to the hospital or facility that we’re there to serve.”

At Insight Health Corp., prepping a facility for a mobile unit includes performing a detailed site survey to find out what may be needed prior to a system being delivered, such as a pad, power, communications and access, Varcarolis says. It is also important to mitigate the effects of extreme heat or cold on image quality and patient outcomes, he says.

“We have monitoring systems on board, as well as procedures in place to ensure the integrity of our assets in the field,” Varcarolis says.

“This includes vigorous maintenance programs such as OEM service, system inspections and physicist reviews. We also incorporate policies and procedures to deal with severe weather issues such as hurricanes, snow and other such events which could potentially create safety issues and be disruptive to the service and patients who are scheduled for exams.”

Bachman says hospitals need to take regular precautions. “For the most part, the onus of weather is on the owner/operator,” Bachman says. “In hot climates, HVAC maintenance needs to be done on a more frequent basis. Filters and coils need to be replaced frequently. And the useful life of the HVAC may be shorter.”