Youve Decided to Bring Imaging Service In-House: Where do you
Start? Patrick K. Lynch CBET, CCE, CPHIMS, HIT Pro/PW Global
Medical Imaging Slide 2 Think of every item of equipment as a
sponge. The size of the sponge represents the cost of the item.
Slide 3 The entire Hospital... Slide 4 Your world in Imaging...
Slide 5 The amount of water the sponge holds represents the annual
cost of maintaining the item. Slide 6 Our job: Squeeze the excess
water (dollars) out of the sponges. Slide 7 Phenomenom Annual cost
of service is proportional to the purchase price Amazingly
consistent throughout the economy Look at Extended Warranties for
Office Products (Best Buy, Office Depot, etc.) 2 nd year warranty =
10% to 25% of purchase price The same with Medical Devices. Slide 8
In Medical, it is called Cost of Service Ratio It works for: a
single item or a group of items. Slide 9 Cost Profile for Various
Imaging Service Scenarios Type of Service % of Price per $1M FFS
OEM (unmonitored)12% - 20%$130,000 Contracts OEM12% - 15%$120,000
FFS OEM (monitored) 9% - 12%$ 90,000 Contract (3 rd Party) 8% -
10%$ 80,000 FFS (3 rd Party) 6% - 12%$ 60,000 InHouse 4% - 8%$
40,000 9 Slide 10 Heres an Exercise... Slide 11 Slide 12 A typical
scenario... Slide 13 If Biomed did not exist... Slide 14 If Biomed
did EVERYTHING... Slide 15 To Save Money: Move as many sponges as
possible as far to the RIGHT as possible. Slide 16 Slide 17 Step 1
Think about ALL of your modalities Slide 18 Step 2 - Where are you
in the service of each modality? Warranty? Manufacturer Service
Contracts? 3 rd Party Contracts? Insurance-type products? In-House?
Multi-Vendor Agreements? Time and Materials? Slide 19 Step 3 - Why
do you want to change the present service? Savings for the
hospital? I hate those *#!&$% manufacturers. I am having
service issues with my present provider. Upward career path (and
$$$) for me. Slide 20 Where do you want to go with each modality?
Keep it as it is now. Let a vendor do the work, Ill manage the
vendor. Well do PMs. Let a vendor do repairs. First response and
fix 60% of all calls. Seek out opportunities, go as far as
possible. Become totally in-house (95 of all work). Slide 21 How to
determine if you have a shot at an in-house program..... Where in
the organization do you report? If Biomed reports to a plant
engineer not much chance. If Biomed reports to a Vice- President or
higher, chances are good. Evaluating an existing Biomed department
Slide 22 How to determine if you have a shot at an inhouse
program..... Do you know the managers of the various sections of
Radiology? If they dont know you, they are going to be reluctant to
trust you with their service. Slide 23 How to determine if you have
a shot at an inhouse program..... Do you currently service any
Imaging Equipment? Chances are better if you already have some
interaction with Imaging. You know vendors, equipment, etc. You
know customers expectations. You know the service reps. Slide 24
How to determine if you have a shot at an inhouse program..... Hows
your track record with Administration? Do you deliver what you
promise? Does Administration believe that you can be successful in
this venture? Slide 25 How to determine if you have a shot at an
inhouse program..... Hows your reputation throughout the rest of
the hospital? Do your current customers think you are EXCELLENT or
just mediocre? Imaging is MUCH more intense than monitoring. Your
game has to be 100%. Slide 26 How to determine if you have a shot
at an inhouse program..... Can you attract and retain highly
technical employees? Since youll be spending large dollars on
training, it is important to be able to keep good Imaging
Engineers. BTW, does your hospital believe in lots of technical
training? Slide 27 Key Factors for Success: Communication Proven
Track Record Access to Information Adequate Test Equipment
Quick-on-the-trigger to call for outside help Administrations
Support Technical Expertise Slide 28 Obstacles to Starting an
Inhouse Program Human Resources Manufacturers (passwords, manuals
and parts) Repair Engineers Training Imaging Managers Test
Equipment Diagnostics / Software / Passwords Administration Slide
29 How to Sell to Administration Look how good we are in the rest
of the hospital Slide 30 How to Sell to Administration The risk of
failure of this new program is low. Slide 31 How to Sell to
Administration We can actually decrease downtime by having on-site
support. Slide 32 How to Sell to Administration I have planned for
every eventuality. Escalation Plan Status Reports (email, SMS,
phone) Communication Plan Multiple Failure Plan Slide 33 How to
Sell to Administration We wont hesitate to call in outside help if
we should need it. Slide 34 How to Sell to Administration I wont
embarrass you or let you down. Slide 35 How to Sell to
Administration Lets look at the tremendous savings to the
organization. Slide 36 How to Sell to Imaging Department Managers
Know their Business What are their metrics. What keeps them up at
night. What stresses them. Know their vocabulary. What
administration expects of them. Slide 37 How to Sell to Department
Managers Help them be more successful. Save Money. Keep their rooms
up. Keep their doctors happy. Help them meet their budget by
assuming the financial risks. Slide 38 How to Sell to Department
Managers Help them find more time. Clinical Engineering will be
managing service, relieving them of staff responsibilities. Manage
the PMs. Manage the Service Calls. Manage the bills and costs.
Manage regulatory issues. Slide 39 How to Sell to Department
Managers I have planned for every eventuality. Escalation Plan
Status Reports Communication Plan Multiple failure Plan Slide 40
How to Sell to Department Managers I have a plan for
communications. One phone call to report issues. A combination
email/SMS/telephone/status board plan for status reports to
Imaging. Slide 41 How to Sell to Department Managers We have a
track record. We have been doing this for the rest of the hospital,
we are just extending our services to Imaging. Slide 42 Problems
you WILL Have.... Manufacturers will tell customers they will be
PUSHED TO THE BOTTOM OF THE LIST when requesting service if they
dont have a contract. Slide 43 Problems you WILL Have.... Old
Vendors will talk bad about you. You do poor PMs. You cant do
upgrades. You dont have any backup. You dont have the knowledge of
experience. Slide 44 Problems you WILL Have.... Diagnostic Software
Even if you lease it from the manufacturer, it will be disabled
every time they touch a machine. Slide 45 Problems you WILL
Have.... Error Codes If you cant decipher them, the manufacturer
will be glad to do it...... for a fee. Slide 46 Problems you WILL
Have.... Rad techs on Weekends will call the number on the sticker
placed there by the manufacturer. Slide 47 Problems you WILL
Have.... General BMETs Will be angry because Imaging Engineers earn
more money than them. Slide 48 Problems you WILL Have.... Doctors
Some will resent moving away from their favorite manufacturers for
service. Slide 49 Problems you WILL Have.... Dial-in or VPN by
Manufacturers Manufacturers will make changes without telling
anyone, often disabling diagnostic software. Slide 50 Problems you
WILL Have.... Service Literature and Software Will mysteriously
disappear. Replacement manuals will be either unavailable, very
expensive, or incomplete. Slide 51 Problems you WILL Have....
Department Managers Some wont like the loss of control. Slide 52
Problems you WILL Have.... Perception Manufacturers nurture the
perception that they offer Cadillac Service and that in-house
service is just a poor, cheap substitute. Reality: In-house service
is often better equipped, more knowledgeable and quicker to respond
than the manufacturer. Slide 53 Where to find technical people
Manufacturers Hire the service engineers that you (and the
customers) like. They are already trained. They know your
equipment. They ease the transition away from the manufacturer.
Slide 54 Where to find technical people Grow your own. Does not
work for the first person in Imaging Service. You need an
experienced heavy hitter. Good Career path for BMETs. Must make
sure job grades match up. Slide 55 Where to find technical people
Military There are a number of good engineers retiring from the
military. Slide 56 Where to find technical people Recruiters
Jenifer Brown Doug Stephens Slide 57 Where to find technical people
Personal Network of contacts and associates Local area National
meetings State association Training entities DITEC RSTI Slide 58
Where to find technical people Listservs and the Internet
TechNation BiomedTalk ImageTalk Monster Slide 59 Where to find
technical people Associations AAMI Local Association Slide 60 Costs
of an Inhouse Program Salary and Overtime (10% to 15%) Test
Equipment On-Call Costs Diagnostic Software Technical Training
Contracts (youll always have some) Manufacturer Support (5% to 40%
of calls) Slide 61 Savings from an In-house Program Reduced or no
Travel Time Increased Uptime from onsite personnel & parts
Savings on X-ray Tubes No premium rate for after-hours PMs Ability
to use second source Parts Ability to use alternate (and cheaper)
service providers Ready access to dedicated engineers Slide 62
Where do I start? Start with what you know. Develop a COMPLETE
inventory. Get copies of ALL contracts. Get financial control of
all service. Collect service information. Begin talking with
potential service engineers. Pick the low hanging fruit (easy to
service or problematic current service). Slide 63 Preapproval
preparations Inventory all items. Financial Control of all service.
Copies of all contracts. Join AHRA Get any training you can. Join
ImageTalk. Slide 64 Preapproval Preparations Know alternate
providers of service, parts, tube, training, support. Begin regular
meeting with Imaging Supervisors. Start conversations with
potential employees. Develop job descriptions and pay grades with
HR. Learn about the Radiology Business the player, the money, the
issues, etc. Slide 65 What if I dont get permission? Dont give up
it will happen sooner or later. Money will get tighter. Their
favorite service engineer will retire. The company will be bought.
Service will deteriorate. Slide 66 You will get the business if you
are prepared with the correct: Reputation Information Resources
Financial Resources Communications Skills Knowledge Test Equipment
Attitude. Slide 67 Takeaways: Prepare thoroughly. Be committed for
the long haul. Persist. Find a high-powered technical expert in
imaging service. Nurture your relationships with Imaging
leadership. Slide 68 Questions and discussion
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