We are starting a series of comments aiming to illustrates the impact and the contribution of technology to health care efficiency with an initial note on maintenance strategies for specialized medical equipment.
Activity-based financing
Already established for several years in Quebec in targeted sectors (imaging, oncology, etc.), the activity-based financing approach has brought some changes on the way to manage and to account for the maintenance of biomedical equipment. In fact, since the implementation of this new financing method, costs of service contracts are now reported to the relevant business segments in the annual financial reports (AS-471) to establish an overall cost of doing business that is consistent across the province.
Our institutional BME services have always made informed choices about maintenance strategies for specialized medical equipment, combining in-house service with input from manufacturers and service providers on several criteria: technology complexity and access to maintenance training, financial and clinical risk, equipment criticality. Despite the change in accounting approach, the contribution of the BME in direct maintenance or in the establishment of maintenance strategies is not expected to be withdrawn. It will be important to ensure that the BME is not disempowered from the contract management and renewal process.
Consider the actual utilization rate
Activity-based financing must push institutions to take into consideration a factor sometimes forgotten or taken for granted in the past, the actual utilization rate of technologies. Our BME services know equipment fleet well, both in terms of inventory (cost and date of purchase, maintenance history, anticipated life expectancy) and clinical contribution (criticality, impact on care delivery, etc.), except in a few exceptions, the actual volume activity (expressed in number of cases) is rarely a factor considered to establish maintenance strategy or to determine a reasonable cost of service.
Thus, it will be possible to subscribe to complete or shared maintenance contracts for an imaging modality based on the value of the device and the challenge that it represents for the technical team (availability and cost of parts, availability of maintenance training) without, however, considering that this device might not be used to its full capacity. In the activity-based financing context, the measurement of performance for an institution is the ratio between the total of all expenses and the amount of procedures executed. The cost of maintenance for an under-used device negatively affects this ratio.
Maintenance strategies modulated according to the rate of use
The institution will thus consider the actual utilization rate in establishing the maintenance strategy for service equipment targeted by the activity-based financing and anticipate which service will be covered next by this type of financing.*
Do we need a complete service contract for an under-used device? Are other devices available in case of failure to distribute the clinical task in case of failure? If it is a fleet or multiple devices, it would be convenient to negotiate shared coverage with the service provider: for example, shared coverage for radiogenic tubes, detectors or major components on several devices (example: one or two tubes per year for 2 or 3 devices). In every case, sharing service agreements for a supplier, exploring solutions with multivendors or sharing resources with other institutions will help reduce the total cost of maintenance.
Ideally, the institution aims at auto sufficiency, but the low availability of labor, expertise and training or even the risk represent an obstacle to complete independence.
CIM Conseil has the technical and strategic expertise to help you review your maintenance approach while considering the criticality of the device towards the clinical mission, the actual rate of use and the resources at your disposal.
