In addition to navigating ever-changing government regulations and managed-care rules, medical executives increasingly are responsible for the acquisition and maintenance of the pricey, high-tech equipment necessary to deliver top-quality care.
But with the growth of independent providers of technological support and service, help -- in the form of outsourcing -- may be on the way.
Between now and 2010, outsourcing of healthcare technology services is expected to increase significantly, say management consultants Donald F. Blumberg and his son, Michael R. Blumberg, president and vice president respectively of d.f. Blumberg Associates, of Fort Washington, Pa. The option to outsource will provide physicians with the support and training necessary to keep current in a dynamic field, they say.
Blumberg believes many factors will contribute to the growth in technological outsourcing:
- Mergers and consolidations have turned hospitals into profit centers run by experienced financial executives whose primary focus often is profitability, not state-of-the-art medical care.
- All major hospitals have purchased physician practices to gain control in their markets and to increase outreach.
- Tomorrow's hospital likely will not be comprised of one or two buildings on a single campus. Instead, it may include a network of hundreds of physician offices and several clinics, all of which will require technological service and support.
- As the baby-boomer population comes of age, consumers are increasingly demanding state-of-the-art medical treatment, which contributes to the rush for the latest technology.
Full service from outside support would include a broad base of technical capabilities, such as coordinating and supporting a central network. Such support is available from both equipment manufacturers and third-party organizations that outsource their services.
Physicist Gary A. Ezzell carries the burden of making sure medical equipment is functioning properly for Harper Hospital's Karmanos Cancer Institute at Wayne State University. As coordinator of medical physics, he oversees the maintenance of the radiation oncology equipment, including the medical linear accelerators, at the Detroit Medical Center.
"The physicians want the equipment to work reliably and . . . (they become) very unhappy if a (piece of equipment) goes down and patient treatments need to be canceled or postponed. A certain amount of downtime is expected -- 3% or so -- but repeated incidents on one machine create a lot of grief," Ezzell says.
Getting access to the equipment to do preventive maintenance is not as easy as it used to be, Ezzell says, because the number of patients on each machine has increased over the years. The maintenance staff used to have access to the machines for a few hours once a month, but now they are expected to do repairs outside of normal working hours (7 a.m. to about 7:30 p.m.), which means they must work late or on weekends.
As a result, the institute has begun to use third-party service organizations for about half of its service contracts for medical linear accelerators. Ezzell says he turns to independent organizations "when they're qualified and less expensive than the manufacturer's service."
Joseph Acosta of the Detroit Medical Center says physician executives affiliated with the center don't have to be concerned about the service and support of high-technology medical equipment because "we provide them -- at all eight DMC (medical center) units -- with complete preventive maintenance and corrective maintenance 24 hours a day." Acosta serves as high-technology medical equipment manager for the eight institutions that operate under the umbrella of the center. Quarterly surveys at the medical center determine any necessary changes.
Since July, when a program combining in-house service with vendor maintenance was implemented, the medical center has saved more than $1 million, Acosta says.
Vendors such as GE Medical Systems, Milwaukee; COHR of Los Angeles; Toshiba of New York City and Tustin, Calif.; and others, are consulted on an "as needed" basis, Acosta says.
Blumberg says equipment manufacturers with nationwide service organizations are establishing their own strategic directions. Long-time manufacturers, such as GE Medical and Picker, will continue to meet hospitals' service needs, while organizations coming primarily out of the data-processing market, such as Unisys, Olivetti and Wang, have begun to penetrate the service and support market.
Donald Blumberg says new networking technology, including new products that use off-the-shelf microprocessors and work-station technology, will be available at an increasingly rapid pace.
He advises physician executives to choose a provider who can service and support the full array of technology designed for hospitals and physicians' offices.
Jeff Hayes, vice president for service development and outsourcing at Irving, Texas-based VHA, says physician executives often function essentially as chief operating officers and primarily are concerned with the cost of servicing and supporting biomedical and clinical equipment.
Their second concern, he says, is "having technicians available to do technical repairs at short notice."
VHA operates a national network of more than 1,650 community-owned healthcare organizations and provides services to an additional 2,000 nonacute-care facilities that are affiliated with VHA's members.
VHA is a cooperative, so its member organizations earn cash and equity each time they purchase a product or service through VHA. In 1997, VHA members and purchasing affiliates bought $8.6 billion in supplies and services.
In identifying service and support providers, Hayes says VHA tries to find those firms that can handle a wide range of services for a wide range of products.
Among the organizations that have offered preferred terms to VHA members are GE Medical and DecisionOne of Frazer, Pa., which have partnered with other firms to provide service and support.
Blumberg contends that outside organizations that provide service and support will thrive as they begin to offer real cost reductions and improved service.
Herb Drill contributes to the Philadelphia Inquirer and several other publications. He lives in Bucks County, Pa.