By C.A. Wolski<\/p>\n
Purchasing should take into account the entire lifecycle of a piece of equipment\u2014including how and when it will be disposed of. Biomeds should be part of the disposal conversation beginning with the purchasing process.<\/p>\n
There\u2019s one certainty facing every biomedical department. Today\u2019s new, state-of-the-art equipment is destined to become tomorrow\u2019s obsolete burden that will have to be disposed of. The question facing many healthcare enterprises is how to handle this disposal.<\/p>\n
The days of thoughtlessly dropping non-hazardous medical equipment in landfills are over. There are other options from reselling to recycling to donation. Not exploring one of these options will leave money on the table for many healthcare organizations. These alternatives provide an opportunity to increase equipment ROI, limit the amount of stored equipment that needs to be tracked, and to demonstrate how the organization is a good corporate citizen by implementing a sustainable disposal program.<\/p>\n
But whatever the disposition decision, it takes planning, and, ideally, involving the biomedical department even before an order is placed for the new asset. Unfortunately, many healthcare enterprises wait until they need to dispose of equipment to address their options. This may mean that the enterprise won\u2019t be able to recoup any of its investment and\/or be left with few or any options\u2014other than a landfill.<\/p>\n
With a bit of foresight and clear communication and cooperation between departments, disposition can result in numerous benefits for the enterprise inside and beyond its walls.<\/p>\n
Options, Options, Options<\/p>\n
Broadly there are five options for disposing of equipment:<\/p>\n
Throw it away.
\nRecycle it.
\nResell it.
\nDonate it.
\nTrade it in to the OEM.<\/p>\n
Jeff Dalton, CEO of reLink Medical, a company that specializes in the sustainable and safe removal and repurposing of out-of-service medical equipment, further elaborates on these options, saying effectiveness is tied to who is doing the disposing, with some of the options described as \u201cnot safe.\u201d<\/p>\n
\u201cHealthcare enterprises can do it themselves\u2014either throw away, sell, or repurpose the equipment,\u201d he says. \u201cThey can just donate the equipment or attempt to use a local resource to dispose of it. Or they can use a proven sustainable solution that provides the highest returns and documented risk management.\u201d<\/p>\n
The one option that Dalton says is the least viable and the highest risk for healthcare organizations is throwing away or repurposing with the wrong company, he says, adding that this avenue, by analogy, is comparable to having your test equipment calibrated by a consumer electronics store.<\/p>\n
Joel Anderson, medical program director for MATTER, a Minneapolis-based NGO, notes that disposing of equipment to other organizations not only keeps material out of landfills, but it also frees up expensive storage space, possibly even shrinking the overall storage footprint\u2014saving the enterprise those costs.<\/p>\n
\u201cHospitals storing old equipment \u2018for later use\u2019 in paid warehouse space can be a slow financial drip,\u201d he says. \u201cAnalysis of equipment coming out of service should be evaluated not only on functionality but on feasible use within the hospital system. Warehouse storage costs can quickly outpace the FMV of certain types of equipment if it is stored more than a few months.\u201d<\/p>\n
While an argument could be made for redundancy or that this stored equipment could be used for parts or as a \u2018backup,\u2019 in the era of ongoing advancements in technology underpinned with planned obsolescence, it is doubtful that these stored pieces of equipment will ever be used again once they\u2019re unplugged.<\/p>\n
There certainly are opportunities today for healthcare enterprises to realize a return on investment for end-of-life equipment, but that takes planning, communication, and a change of mindset.<\/p>\n
Planning Ahead<\/p>\n
It\u2019s not enough to find the right outlet. Healthcare entrprises must also figure lifecycle planning and risk management into the purchase equation. For example, Dalton notes that organizations typically \u201cbuy\u201d a piece of equipment three times. The first is the purchase price, the second is the service contract, and the third consists of parts and other maintenance costs. \u201cIt\u2019s not just the line item, but all the sub-line items you have to look at,\u201d he says.<\/p>\n
In most cases, healthcare enterprises aren\u2019t designed to plan for equipment disposition; their expertise is patient care. This is where companies like reLink Medical come in. They can help healthcare organizations use data to develop disposition plans that work best for that enterprise\u2014returning maximum ROI and risk mitigation at the end of the equipment\u2019s useful (for that organization\u2019s) life. First there needs to be a fundamental shift in the organization\u2019s mindset, according to Dalton. \u201cOur reLink 360 platform lives by the adage of moving organizations from reactive to proactive to predictive,\u201d he says.<\/p>\n
Reactive organizations are characterized by waiting until there\u2019s an equipment crisis. They will have few options, and certainly will likely recoup very little of their investment. To become proactive, according to Dalton, organizations have to build disposition and risk management planning into their budgets\u2014in other words, have a strong lifecycle planning process in place that is followed throughout the equipment\u2019s use by the organization.<\/p>\n
Organizations with a predictive mindset have a holistic approach to their equipment programs. For example, they take into account depreciation, risk management, and other financial factors with equipment uptime. \u201cYou need to integrate these factors\u2014financial, risk management, and operational\u2014and understand that the longer you hold onto a piece of equipment the less you\u2019ll get back,\u201d says Dalton.<\/p>\n
For example, if a healthcare enterprise has a fleet of monitors that have reached the end of their lives for the organization or are scheduled to be cycled out based on the pre-determined replacement parameters\u2014and are still in high demand in the market\u2014there is an opportunity to recover a maximum return on the equipment.<\/p>\n
However, timing is everything. Every month that an organization waits to cycle out its equipment will see that value tumble. This is not a decision that\u2019s left to guesswork. It is informed by a host of datasets that can be used to determine the optimal moment to cycle that piece of equipment. For example, Dalton notes the reLink 360 platform provides the kind of actionable data that allows the organization to move to that predictive mindset.<\/p>\n
Enter the Biomeds<\/p>\n
Perhaps the biggest secret weapon that any organization has in making their disposal decisions is one they don\u2019t often use\u2014their on-staff biomeds. \u201cThere\u2019s a tremendous disconnect on this point,\u201d says Dalton. \u201cHTMs need to be part of the capital planning and disposition process.\u201d<\/p>\n
Dalton notes that HTM professionals bring three key perspectives to the planning and disposition conversation:<\/p>\n
Can the department repair the device that\u2019s being purchased?
\nWhat are the expected repair costs\u2014including parts, downtime, etc.?
\nCould the value of the existing device cover the cost of the training for the device being purchased, compared to the new one?
\nClear lines of communication need to be established during the planning process so stakeholders across the organization can make the most informed decision possible, including the end-of-life disposal of the equipment.<\/p>\n
Implementing Best Practices<\/p>\n
Planning is one thing; making sure that equipment is properly disposed of is another. Whether an organization decides to handle the disposal itself\u2014which could be time consuming and costly\u2014or hand it over to a third party, there are several key elements that need to be considered.<\/p>\n
The equipment needs to be triaged. What value does it have? Can it be resold, and to whom (U.S. acute care, subacute care, aftermarket, or international market)? This can be a tricky determination\u2014for example, Dalton estimates about 40% of the equipment his company handles is recycled for its components and valuable materials.<\/p>\n
By comparison, with its ability to accept more equipment for functional use, the international market has a significantly lower amount of recycled equipment. For the MATTER 360 program the rate is only 5% with just 0.6% ending up in landfills, according to Anderson.<\/p>\n
Once the equipment has been triaged then a new set of determinations need to be made. Does it need to be cleaned? Has all the identifying material\u2014software, patient information, identification tags, etc.\u2014been removed? Have all the proper documents been created and distributed to the finance department?<\/p>\n
The complexity of the process points to the reason why healthcare enterprises may want to turn to organizations like reLink Medical. They can handle every aspect of the disposal process. But just because an organization says it can handle disposal, it may not be quite the right fit for the enterprise.<\/p>\n
Dalton offers some tips to guide healthcare enterprises during the vetting process:<\/p>\n
Ask the supplier what types of equipment they don\u2019t handle. Look for a provider that is holistic and not modality specific.
\nFind out how the disposal vendor handles government compliance reporting.
\nAsk how hazardous materials are handled\u2014including both biologic and non-biologic material.
\nWhat data will the vendor be providing the enterprise\u2014including records of disposal, release of liability, and other records the healthcare enterprise\u2019s finance department needs?
\nFind out about the logistics of the pickup process. Who does the pickup? Is it the disposal company itself? Is it subcontracted? Is the healthcare organization responsible for loading the equipment? How often are pickups made?
\nAnd, of course, involving all stakeholders in the entire process is critical to ensuring that the disposal process is handled according to both federal compliance regulations and the enterprise\u2019s own rules.<\/p>\n
Avoiding the Landfill<\/p>\n
No matter what avenue an organization takes to dispose of its equipment, in today\u2019s sustainability-conscious business environment, avoiding the landfill is critical. It is not only a potentially untapped area of revenue that many organizations may be leaving on the table, but a way to do good for the environment and a way to demonstrate good corporate citizenship.<\/p>\n
Anderson vividly notes how medical equipment that might not be suitable for the U.S. market, but is given a second life in Africa can make a real difference in patients\u2019 overall health and their experience receiving care.<\/p>\n
\u201cEnd-of-life of medical equipment should be thought of in most cases as \u2018end-of-U.S. life,\u2019\u201d he says. \u201cThis old equipment, while out of date with U.S. standards, is highly sought after and needed in most African countries. Take for instance a hospital maternity bed. After five years of use, it may be cycled out of the system. It may have a few patches on the mattress, scratches on the frame, and one of the control buttons may not work right. This equipment may be simply recycled for scrap or disposed of another way.<\/p>\n
\u201cNow juxtapose this situation with what a rural hospital in Liberia or Congo may have for a mother giving birth,\u201d he continues. \u201cTheir birthing experience will most likely be on the floor, lying on cardboard. If a mom is fortunate enough, she may give birth on a spring bed with carboard as the mattress. This stark contrast can be seen with many types of medical equipment and medical supplies. A slightly expired catheter is better than no catheter. A 15-year-old infant warmer is better than a 100-watt bulb. Expired surgical gloves are better than bare-handed surgery.\u201d<\/p>\n
Whatever the reason, goal, or method a healthcare organization uses to make its disposal decisions, moving from a reactive posture to a proactive or predictive mindset takes a willingness to tap internal and external expertise and to plan for the device\u2019s lifecycle holistically.<\/p>\n
And chief among that predictive, holistic shift is involving HTM professionals every step of the way.<\/p>\n
Los Angeles-based freelance writer C.A. Wolski is a regular contributor to 24\u00d77. Questions and comments can be directed to chief editor Keri Forsythe-Stephens at editor@24x7mag.com.<\/p>\n