Buying Refurbished Equipment for Surgery Centers: Q&A With Bunny Twiford of Twiford Consulting
Bunny Twiford, RN, is president of Twiford Consulting in Warminster, Pa.
Q: What types of refurbished equipment should an ambulatory surgery center consider?
Bunny Twiford: Buying refurbished medical equipment should be limited to support equipment that would not significantly impede surgery center operations if it broke down. Of the hundreds of pieces of equipment commonly used in an ASC, many of them can be bought used. Examples include IV poles, kick buckets, back tables, anesthesia chairs, three-tiered carts and emergency carts.
Another area for refurbished equipment is backup equipment that would be used if something breaks down. For example, a surgery center might purchase a refurbished portable light source that would be used if one of the permanent light sources in a room failed. Refurbished medical instruments might make sense for some specialties.
Q: What types of equipment should be bought brand-new?
BT: Equipment you want to be sure won't break down. Devices that should be bought brand-new include scopes, computers and cameras. Using a scope is so intensive that you don't want any surprises. Since the surgeon depends on a camera for all the visualization, you cannot have a fuzzy picture. Although new is no absolute guarantee of 100 percent reliability, it should provide the base of your capital equipment items in many specialties.
Q: Refurbishing companies advertise savings of 30-55 percent. Is that what an ASC can typically expect?
BT: I don't want to name a specific number. The price must be compared with a wide variety of factors — above all, with the quality of the equipment. You don't want to buy the cheapest product available and have it break down, which is a risk when you are considering refurbished equipment. Call the manufacturer or your medical supply vendor to get a baseline price. Discounts may be higher if you order multiple pieces of equipment.
If you shop around, you'll often see discounts above 10-15 percent. You'll see a wide range of prices. When I went on the Internet looking for an automated external defibrillator, I found a new Zoll AED Plus for prices between $1,491 and $1,729. I found a factory re-certified model at $1,095. With that kind of price range, you'd want to know more about each offer before going any further. Don't just look at the price; look at the condition and other factors.
Q: Speaking of the equipment's condition, what do refurbishing companies typically do to improve the condition?
BT: There is a wide range of things the company could have done, and these factor directly into the price. For example, the price can be incredibly low because all the company did was put on a new coat of paint. On the other hand, a higher price may mean the company painstakingly disassembled the piece and rebuilt it to the specifications of the original equipment manufacturer, replacing parts where needed.
There are different terms for the condition of the equipment. "Remanufactured" is the highest level, meaning the piece was rebuilt to OEM specifications. "Refurbished" may mean less was done, and "visually refurbished" means only superficial upgrades were made, such as the new coat of paint. But definitions of these terms vary among companies, so it is important to ask precisely what was done when researching a product.
Q: Besides condition and price, what other factors should be considered when buying refurbished equipment?
BT: You should ask whether the product comes with a warranty. How long does the warranty last and how extensive is it? A lengthy warranty means the company can vouch for the quality. On the other hand, a short warranty of 60 days or less does not give you much time to determine if the equipment works properly and meets physicians' needs.
Another concern is whether all the ancillary pieces are included. In the case of a patient monitor, for example, are the blood pressure cuffs and EKG leads included? If they are not, not only will you have extra costs, but locating the exact pieces that fit this specific equipment might be challenging.
Also, are replacement parts still available? Even when a piece of equipment is no longer manufactured, you can often still get parts for it. But if there are no replacement parts, you will not be able to get the equipment fixed if it breaks down.
Finally, what is the return policy? What can be done if the surgeons don't like the equipment? And what if the package was damaged in shipping?
Q: How do you go about locating refurbished equipment?
BT: Go online and check company websites. Some of the popular websites are Didage Sales Co., eMed America, Foremost Medical Equipment, MedWOW and World Medical Equipment. When you go to the company website, limit your search to a specific product and don't get distracted by other products. If you are searching for a patient monitor, don't start looking at C-arms. You can waste a lot of time on a website.
Q: What sort of information on the company website should you be looking for?
BT: Look for such things as the price, available discounts, warranty information, the service agreement, return policy and the availability of parts. The website might say, "Call for price," which may mean there is some flexibility on price.
What I would do is record all the information on a spreadsheet so that you can compare products side-by-side. Putting down the essential facts on a spreadsheet helps you filter out extraneous influences, such as the vendor was pleasant on the phone or was abrupt with you. Maybe the person who was abrupt had three phone calls on hold. To make sure you come up with an objective decision, have someone else look at the information with you. Each of us has prejudices. Someone else may have a different view and then you can discuss that.
Q: Should you contact the company?
BT: After finding out all the information you can from the website, call up the company. It is better to call than to email. On the phone I can ask such things as, "What does 'fully refurbished' mean?" If the warranty is too short, you can ask if it could be extended. Some websites don't have a phone number to call, which is a problem. You really should talk to someone.
Q: Are there other ways to check out the quality of an item before buying it?
BT: Ask your biomed vendor about the model's repair record. What devices are constantly being repaired? What models should be avoided? Also, contact managers at other ASCs and ask what their experiences have been with refurbished equipment.
Collect a wide range of information. Anticipate the questions your board will ask when you propose purchasing the item. You don't want to go back to your sources after the meeting and look for more answers. If your facility has never bought refurbished items before, the board will have a lot questions. To prepare for this, you might want to share the information on your spreadsheet with the medical director beforehand. He can help you anticipate the questions the board might ask.
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