ASC physicians and staff are bombarded often with news of new surgical technology that will soon make their current equipment obsolete. How ASCs keep up is key for not only attracting or keeping physicians, but patients as well. SurgiStrategies asked different members of the industry for some pointers on evaluating new equipment, the economy’s effects and more.
The following is a roundtable discussion with that includes Jim Wetzel, director of marketing and corporate accounts Berchtold Corp.; Bill Merkle of MD Technologies Inc.; Kristy Knack, senior director of customercare and improvement at STERIS Corp.; and Robert Edelstein, president of Millennium Surgical Corp.
In this tough economy with capital equipment purchasing dwindling, what can ASCs and surgical hospitals do to meet their equipment needs and still remain fiscally viable?
Wetzel: I think the best thing that facilities can do to meet equipment needs during these tough economic times is to engage in a good preventative maintenance program. Most surgical equipment manufacturers have their own direct service organizations. Company-owned/employed service organizations deliver the most in value for a facility. They know the equipment best and what service points were designed into the product during development. In most cases they will not be the least expensive, however, over the long run; your expensive equipment will be maintained most effectively.
Merkle: With interest rates being at historically low levels, it may be an excellent opportunity for an ASC or surgical hospital to allocate a portion of current expenditures toward a piece of capital equipment that can be financed for the same monthly expense as a disposable product or service being purchased today. There are many equipment leasing, lease-to-own and financing options available for capital equipment. Suppliers may also be interested in offering financing or purchasing arrangements to foster a partnership that ultimately increases sales.
Besides the current state of the economy, what other new trends, techniques, etc., are garnering attention in surgical technology today?
Knack: The primary issue surgical centers currently face, after the economy, is maximizing surgical throughput. Performing more cases at a lower cost is the single biggest influence on an ASC’s ability to achieve and maintain profitability. Instrument management is one of the most important components of surgical throughput. Instrument management entails having the right instruments in the right operating room when they are needed for surgery. There are many factors that affect instrument availability, such as reprocessing efficiency, sterilizer cycle times, instrument inventory management and staffing, to name a few. Another major factor is reducing non-operative time. Advanced technologies are all designed to help reduce non-operative time. They allow surgical staff to quickly and easily transfer patients, information and equipment within, and in some cases outside the facility, and devote more time to procedures.
Edelstein: The biggest challenge facing many centers, even ones who are expanding case volume, is doing more with less or the multiple hat-wearer scenarios each of us face in the workplace. Often the person who is responsible for buying surgical instruments, technologies and supplies at an ASC will not have the time to do it right or to become an educated consumer.
Along with performance, what type of things should physician owners and administrators look at when evaluating new surgical technologies potentially for purchase and why?
Edelstein: Along with performance of new surgical technologies, physician owners and administrators at new or expanding centers need to consider startup costs and how to control them. This can be accomplished by carefully selecting surgical instruments or technologies and working with surgeons to get a true expectation of case volume. Scrutiny of “surgeon preference” items is important. We have helped centers get retractor systems, minimally invasive port systems and instruments at cost sometimes 50 percent less than the name brand without any effect on patient outcomes or surgeon satisfaction.
Establishing real expectations of case volume is also important. For example, a patient who needs spine surgery may not be the perfect patient for outpatient spine surgery, or the surgeon may be reluctant to book cases at an ASC versus a hospital. From our experience, just looking at the surgeons’ monthly volume of cases will not be a true indicator of the volume the surgeon will bring to the center.
Knack: They should investigate the service and support offered by the vendor. Many facilities purchase products without considering support after the sale. ASCs with limited staff and equipment need to make sure their equipment supplier will be there not only during the sale, but also once the doors open and procedures start. Service programs and warranty conversion programs can also extend the life of equipment and ensure that equipment is kept to manufacturer standards, protecting the ASC investment.
With budgets for many facilities’ capital purchases down, should ASCs and physician-owned hospitals invest in upgrading to new surgical technologies?
Knack: Yes, there are many new technologies that will help ASCs reduce cost, increase productivity, reduce infection rates, and/or improve patient or staff safety. These are always wise investments. For instance, LED lighting technology has quickly become the standard for surgical lighting and has transformed this product category. LED technology provides a better quality of light, emits less heat over the surgeon and the patient, and is more cost effective than traditional halogen lights, which need to be replaced every 100 hours. Another fast-growing category is audio/visual integration. The various signal and integration technologies allow ASC staff to quickly access and send information into and out of the OR, integrate images into a patient’s electronic medical record, and easily share data with the lab, consulting physician or technician. There are a wide variety of integration systems on the market today. In order to be cost-effective, ASCs need to ensure they are buying a system that provides all the functionality they need, but not more than they will use.
Edelstein: Yes, particularly with regard to ophthalmic and orthopedic surgery. There have been huge advances in these areas that have prompted the opening and expansion of surgery centers specializing in these procedures.
As a supplier of specialty surgical instruments, Millennium Surgical works closely with eye surgery centers, delivering ophthalmic surgical instruments and supplies. We have assisted over five centers this year in adding retina surgery to their centers. Although the start up expense is high, with proper oversight and commitment from the surgeons, retina surgery can help increase revenue and profits. Recently payments for retina surgery have increased due to advances in procedures that have allowed for a less invasive procedure.
Starting in 2007, we have seen a trend in both the new centers we help open and existing surgical centers; the addition of spine surgery. Surgical instrumentation and techniques have become less invasive and more cases can be performed as an outpatient procedure.