By Jim Fedele
The recent barrage of regulation changes and proposals to medical equipment maintenance has certainly been unprecedented in my tenure as an HTM professional. In the past four years, we have had multiple CMS regulation changes and the FDA is also looking at how medical equipment is serviced and reported. Some industry leaders suspect that this is OEM driven, stating the OEM is claiming that it is trying to protect the patient from poor maintenance practices. As I think about the situation, I wonder what happens if they get what they want. What happens if the OEMs are deemed the only people able to service medical equipment? I feel like that is the goal. I would like to share those thoughts with you.
The first thing I think about is cost when I imagine an industry that only permits the OEM to service equipment. Most of us spend a lot of time evaluating which service contract to purchase based on our own ability to service the equipment and its likelihood of an expensive failure. We know that OEM service is typically the most expensive option when managing medical equipment. If the OEM was doing all the service would the price be less? Economics tells us that when there isn’t any competition prices are generally not less. My experience has been that OEM service is typically 50 to 100 percent more than a competing Independent Service Organization (ISO) price. Given that we frequently hear and read about that we as a nation need to reduce health care cost relying singularly on the OEM would be contradictory to that initiative.
Another issue I think about is response time in an OEM-only environment. Many hospitals do not have enough of a single brand or type of equipment to warrant a dedicated on-site technician. Frankly it is what we, the onsite team, do best. We are in the facility and able to respond instantly. What currently happens with equipment on service contracts with the OEM is that my team is frequently asked to look at a stat problem to try to prevent patients from being rescheduled. If the OEM is the only method permitted for service it will most likely cause delays in patient care. This will not improve patient care. This will put patients at risk or at least force them to go to another facility for service.
The final situation I think about is the human resource. Where will OEMs get the technicians to handle the increased business? Logically, they would recruit them from in-house programs or even ISOs. I find this interesting as aren’t these the same people they are trying to protect the patient from? Again this happens now except in reverse, ISO and in-house programs recruit technicians from the OEM. Many of our third-party repair companies were born from OEM technicians that decided to start a business on their own. Even with the remote diagnostics there will still be a need for a person to replace the part or calibrate the machine; technicians will still be necessary. A larger looming issue is the “graying” of our industry, meaning that many technicians are reaching retirement age and new ones are starting to be hard to find. We also know that many in the workforce want a work life balance which means that being an on-the-road technician is not nearly as appealing as being an on-site technician.
I can understand how people not close to this situation could feel like the OEM is the best repair solution. It is easy to surmise that the OEM would have the best training and knowledge of their device. However, at the end of the day, a human performs the duties. I have had great OEM technicians come to my hospitals and I have had really bad ones that I wouldn’t let work on a wooden box. The same is true for onsite technicians as well. I don’t say this to be derogatory. It is just a fact of life. How the OEM makes up for bad technicians is that they are able to throw parts at a problem until it is fixed, the in-house team has to be a bit more frugal.
However, in my opinion, for equipment service to be legislated away from a free market solution will not make patients safer. The fact remains that medical equipment is becoming more reliable; most problems occur at the user interface. If hospitals are forced to use OEMs, they will need to reduce the in-house staff to cover an increased service cost. I feel like this will negatively impact the relationship between servicer and user that is necessary today to solve problems with equipment. I stated equipment has gotten reliable, but it has also gotten more complicated. Users need a high level of interaction to maintain their competence in the use of equipment today. I just don’t see how OEM-only service would ever accomplish a safer outcome for patients.
Jim Fedele, CBET, has been with Medical Dealer magazine for more than 12 years. He is currently the director of clinical engineering for Susquehanna Health Systems in Williamsport, Pa. He can be reached for questions and/or comments by email at email@example.com.