Skorup also notes that now more than ever hospitals are feeling pressure from a number of different points when new products come to market.
For starters, there are members of the medical team who tend to push for the latest and greatest new devices, he says. But the push for the most up-to-date technology isnt limited to physicians or technicians. Pharmacists, nurses and even nonclinical staff all want the latest products.
Hopefully, theyll make informed decisions, Skorup says.
But other pressures abound in the process as well. For hospitals, competition is often the driver. Whether its competing for the best staff or simply competing with another hospital, the urge to spend has never been greater, says Carol Davis-Smith, a senior consultant for Premier Consulting Solutions, a unit of the Premier healthcare alliance, and a purchasing adviser to a number of hospitals across the country.
What weve talked about for a number of years is taking a balanced approach, Davis-Smith says.
As an illustration, at Yale-New Haven, Lee was only marginally involved in the hospitals decision to purchase its CAD system. Initially, she says, she was reluctant to support the purchase, but says that the hospital was moved more by public demand rather than internal pressures to make the buy.
We werent too keen on it, she says of the radiologists in her department. But the public had been swayed by television and print ads that touted the new systems, and as a result, the aggressive marketing from the manufacturers had driven consumer demand, she says.
Lee, who was on the committee to choose a system, says they looked at the studies that were available at the timeall very glowingand double- and-triple-checked the vendors claims.
Still, the decisionmaking process can vary widely from facility to facility, even among hospitals within the same system. Theres not a consistency across healthcare in how these decisions are made, Davis-Smith says.
She says that she advises her clients to vet any big-ticket requests by looking at the equipments clinical, business and technical aspects. Think of them as interconnected rings, she says. The spot in the middle, thats the sweet spot.
When considering the business perspective of a new purchase, its wise to factor in such things as whether you have the staffing resources available to operate the new system. From the executives perspective, the questions to ask are whether the facility has the capacity or the culture to take on new and often higher-end equipment, Davis-Smith says.
Harder to calculate, she says, is what kind of financial return a hospital can expect from a new system, such as the latest imaging technology. Over the years, the process to determine the return on investment has become much more sophisticated, moving away from looking at how the use of a new device or procedure would be reimbursed and instead determining what the cost of owning a piece of equipment would be throughout its life cycle.
Costs to implement an electronic medical-record system, for instance, vary widely, according to a recent report from the American Hospital Association. Among hospitals surveyed in 2006, the median capital spending per bed for health information technology was just over $5,500 annually, according to the AHA. But that doesnt factor in full spending projections for multiyear upgrades and other operating costs. Once those other expenses come to light, an average 200-bed hospital would have invested $1.1 million in capital for health IT and spent another $2.4 million on related operating costs, according to the AHAs report.