The Green Issue Special Feature: the Greening of Hackensack University Medical Center Deirdre Imus and John Ferguson

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The Green Issue Special Feature: The Greening of Hackensack University Medical Center Deirdre Imus and John Ferguson

INDUSTRY SECTOR REPORTS: Ŷ CT Scanners Ŷ C-Arm Ŷ Arthroscopy Ŷ Disposables contents april 2009 features 16 DOTmed Clean Sweep Even hospitals can do some spring cleaning. 46 31 Greening Hackensack University Medical Center What’s big, green and doesn’t smell like a hospital? 42 Recycling Used Equipment It’s more involved yet more profitable than your household recycling. 45 Green Construction Green construction can lead to green in the bank.

17 CT Sales and Service Check on the health of this segment of the industry. 27 Disposables Even though they’re disposable, they’re still indispensable. 37 arthroscopy Sales and Service DOTmed makes an exploratory report. 46 C-Arm Sales and Service C-arms continue to flex some muscle. 17

departments

2 Letter from the Editor 14 In the Next Issue 54 People & Companies 4 Feedback 14 Focus on Performance 57 Law & Order 6 Hospital & Health News 41 Spotlight on Service 60 Old Into Gold 10 Healthcare Chronicles 44 Shows & Conferences 62 Marketplace & Classifieds 12 What’s New 53 This Month in Medical History 68 Blue Book Price Guide letter from the editor April 2009 Green isn’t just for St. Paddy’s Day Publisher Our April issue of DOTmed introduces a number of things DOTmed.com, Inc. I’m excited about. First, it’s our “Green Themed” issue. President Philip F. Jacobus That means many of the features and even some of the In- Executive Editor dustry Sector Reports have been approached in a way that Robert Garment highlights aspects dealing with the environment. You may 212-742-1200 Ext. 243 be surprised how much health care and the environment [email protected] do go hand-in-hand. Editor-in-Chief Sean Ruck The second exciting event is hinted at on the cover. 212-742-1200 Ext. 218 DOTmed was invited by Deirdre Imus of the Deirdre Imus Environmental [email protected] Center for Pediatric Oncology at Hackensack University Medical Center and Associate Editor Barbara Kram John Ferguson, president and CEO of Hackensack to visit the hospital and 212-742-1200 Ext. 251 discover how they went about “greening” their facility. We bring that meeting [email protected] to you in this issue. Creative Editor As promised last issue, there is more information about the Association Bradley Rose 212-742-1200 Ext. 226 of Medical Service Providers (AMSP) and more will follow in the future. [email protected] This group offers a lot of benefits to those they do business with and it pays Copy Editor to learn about them. Joan Trombetti This issue also introduces a new regular feature called “Spotlight on Ser- Editorial Coordinator vice.” We hope to hear from you on what direction you would like to see this Kathy Mahdoubi Design Director feature go so we can continue to improve upon the content we offer. Stephanie Biddle I hope you enjoy our first “Green” issue and keep an eye out for next Contributing Writers month’s themed issue “Women’s Health.” Daniel Callahan, Wayne Webster, As always, questions, comments and suggestions are always welcome. Keith Loria, Astrid Fiano, Mark Klincewicz, BME Please email me at [email protected] Advertising Until next issue! Sales Director: David Blumenthal 212-742-1200 Ext. 224 Sean Ruck [email protected] Editor-in-Chief Account Executive: Mitch Aguirre DOTmed Business News 212-742-1200 Ext. 238 [email protected] Please outline the content of the article Account Executive: Sean Collins Call for 212-742-1200 Ext. 288 and provide a brief description of your [email protected] qualifications as an authority Submissions and Account Executive: Sandy Jablonski in your field. 212-742-1200 Ext. 214 White Papers [email protected] SM By email to: DOTmed Business News Account Executive: Rigo Smith [email protected] invites all medical industry 212-742-1200 Ext. 207 professionals who have unique [email protected] By mail to: experience or knowledge in Press Releases The Editor, DOTmed Business News any clinical or business area of If you have news regarding your company submit it to: [email protected] 29 Broadway, Suite 2500 healthcare to submit an article Article and Story Consideration for publication. New York, NY 10006 If you have an article or feature story you would like the editors of DOTmed Business News to consider publishing, submit it to: On The Cover: [email protected] Deirdre Imus, philanthropist, and environmental and children’s health advocate, Letters to the Editor with John P. Ferguson, President and CEO of Hackensack University Medical Submit letters to the editors to: Center, photographed in the lobby of the Donna A. Sanzari Women’s Hospital, [email protected] part of the Sarkis and Siran Gabrellian Women’s and Children’s Pavilion — an Auctions If you want information about auctioning award-winning facility built with environmentally responsible materials. equipment on DOTmed.com, please call: 212-742-1200 Ext.296, or email us at DOTmedSM provides the DOTmed Business NewsSM to its registered users free of charge. DOTmedSM [email protected] makes no warranty, representation or guarantee as to the accuracy or timeliness of its content. DOTmed Business News is published by DOTmedSM may suspend or cancel this service at any time and for any reason without liability or obligation to any party. All trade names, trademarks and trade dress contained herein belong to DOTmed.com Inc., 29 Broadway, Suite 2500, their respective owners and are used herein with the intent to represent the goods and services New York, NY 10006 of their respective owners. If you think your trade name, trademark or trade dress is not properly Copyright 2009 DOTmed.com, Inc. represented, please contact DOTmed.com, Inc. All rights reserved.

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The strength of experience. www.nationwideimaging.com ͻ732-262-3115 Share Your Thoughts Our upcoming issue is our “Women’s Health Issue.” So we feedback want to hear your thoughts: What is the biggest challenge fac- Is FDA Creating a New Cardinal Rule? ing health care in regards to women’s health? I read your article about Cardinal Health’s consent decree [Editor’s Note: See DM 8247] and it made me wonder if you Submit responses to [email protected] or the FDA have considered what a company like this would (please include “May Feedback” in the subject line) do to guarantee their place in the market. Has anyone considered investigating whether their test procedures, processes and quality assurance procedures are developed in such a way Events for April 2009 as to yield the desired results that would guarantee them a pass with the FDA? I too could write a test case that would ARNA National Radiology Nurses Day 2009, pass under the right conditions. April 10, Nationally-U.S.A. And what’s this about an independent auditor? How could the FDA allow an “independent auditor” in-house who Health & Rehab (Assistive Technology and Care becomes like one of the staff with the same things at stake? Products) 2009, April 12-14, Fredericia, Denmark Does this auditor then exist to help them create documents 6th Annual World Health Care Congress 2009, and procedures that are solely for the benefit of getting a pass April 14-16, Washington D.C. from the FDA and maybe not to ensure that their product really works as expected by the consumer? How does the FDA AHRA (Radiology Administrators) Leadership allow this type of behavior to happen when the company has Institute Spring Conference 2009, April 14-16, obviously failed with issues that cause a recall? The FDA’s New Orleans, LA recommendations are supposed to represent the consumer not the business, and the business is not supposed to get away AONE (Nurse Executives) 44nd Annual Meeting with circumventing that in any way. and Exposition 2009, April 15-19, San Antonio, TX Sincerely, J. English Japan Radiological Society (JRS) 68th Annual Meeting 2009, April 16-19, Yokohama, Japan

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CVS Pays $2.25 Million and Toughens Climate Change Threatens Health, Practices to Settle HIPAA Privacy Case Reports Harvard Men’s Health Watch The U.S. Department of Health and Human Services (HHS) Climate change can affect health in many ways. Heat-relat- and the Federal Trade Commission (FTC) has announced that ed illnesses and deaths will increase as the earth warms up. CVS, the nation’s largest retail pharmacy chain, will pay the Hurricanes, cyclones, floods, and wildfires are expected to in- U.S. government a $2.25 million settlement and take correc- crease, causing injury and death. Many insects thrive in warm tive action to ensure it does not violate the privacy of its mil- weather, meaning potential for more insect-borne diseases, in- lions of patients when disposing of patient information such as cluding West Nile virus, viral encephalitis, and Lyme disease. identifying information on pill bottle labels. Tropical diseases such as malaria and yellow fever could also The settlement, which applies to all of CVS’s more than spread to temperate zones like the United States. 6,000 retail pharmacies, follows an extensive investigation by Climate change is already producing health problems in the HHS Office for Civil Rights (OCR) for potential violations the United States. Ozone layer depletion has increased expo- of the Health Insurance Portability and Accountability Act of sure to ultraviolet B radiation, which contributes to skin can- 1996 (HIPAA) Privacy Rule. cer and cataracts. Global warming has promoted the growth of The Privacy Rule requires health plans, health care clear- ragweed-another reason for the increase in asthma, as well as inghouses and most health care providers (covered entities), hay fever and allergies. including most pharmacies, to safeguard the privacy of patient • Online: dotmed.com/dm8335 information, including such information during its disposal. Online: dotmed.com/dm8267 • Landmark Policy Report: Many Cancers Could Be Prevented in the U.S. and Across Waiting for Biopsy Results May Adversely the Globe Affect Health A new global policy report estimates that approximately 45% Women who’ve had a breast biopsy know the anxiety of wait- of colon cancer cases and 38% of breast cancer cases in the ing for the results, but that stress may cause adverse health U.S. are preventable through diet, physical activity and weight effects, according to a new study published in the March issue maintenance. The report also sets out recommendations for of Radiology. policies to reduce the global number of cancer cases. The overall message of the report, Policy and Action for Cancer Prevention, published by World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR), is that all sections of society need to make public health, and cancer prevention in particular, a higher priority. It includes estimates on the proportion of many different types of cancer that could be prevented through diet, physical activity and weight management. In the U.S., about one third of the most common cancers could be prevented. That figure does not include smoking, which alone accounts for about a third of cancers. • Online: dotmed.com/dm8308

FDA Warns About Risk of Wearing Medicated Patches During MRIs “When women express how taxing it is to have to wait for Certain adhesive patches that deliver medication through the results, the medical establishment may dismiss their feelings as skin have been found to be a risk to patient safety. The patches, psychological,” said the study’s lead author, Elvira V. Lang, M.D., if worn while undergoing magnetic resonance imaging scans associate professor of radiology at Harvard Medical School and or MRIs, can cause skin burns, says the U.S. Food and Drug radiologist at Beth Israel Deaconess Medical Center in Boston. Administration. “We were able to show that this state of not knowing the diagno- The patches of concern include both brand name and ge- sis goes along with biochemical changes which can have adverse neric products and patches purchased over the counter without effects on wound healing and the immune system.” a prescription. • Online: dotmed.com/dm8260 • Online: dotmed.com/dm8415

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We Will Meet Or Beat Any & All Parts Quotes...Period! 866-283-4288 | magnaserv.com | 2862 S.E. Monroe St., Stuart, FL 34997 HHS Announces New Health Reform Website FDA Recalls Selected Pediatric The Department of Health and Human Services (HHS) has an- Tracheostomy Tubes nounced the implementation of a new web site dedicated to A class 1 recall is being issued on selected lots of pediatric health care reform, www.healthreform.gov. In an HHS press tracheostomy tubes (Shiley 3.0PED Cuffless Pediatric Tra- release, HHS Spokeswoman Jenny Backus stated that the web cheostomy Tubes, Covidien Inc) manufactured from July 7, site and a new report on the web site, Americans Speak on 2008, through December 9, 2008, and distributed from July Health Reform: Report on Health Care Community Discus- 24, 2008, through December 23, 2008, the FDA says. sions, would “ensure that when we discuss health reform, the The recall is necessary due to complaints received about American people will have an equal stake in the health reform the difficulty of inserting two instruments: the device used to efforts.” Ms. Backus also stated, “Sky-rocketing health care place the tracheostomy tube into the windpipe (the obturator) costs are creating enormous pressure on families, on business- and the catheter suction tube, which is inserted into the tra- es and our fiscal future. The Obama Administration is commit- cheostomy tube. ted to taking action this year on health reform and is calling on The company issued an urgent alert letter to customers government, business, health care stakeholders and everyday on January 14, 2009; a second letter issued on March 6, 2009, Americans to come together to make it happen.” recommends that healthcare professionals remove all remain- On the web site, visitors can access the video of the recent ing affected products and return them to the manufacturer for White House Health Forum (reported in DM 8381) and the replacement or credit. The manufacturer may be contacted by event blog of the Forum. They can also submit an electronic telephone at 1-800-635-5267. statement of support for health reform, submit questions for • Online: dotmed.com/dm8434 Regional Health Forums scheduled for across the country in the coming months, watch videos of Americans explaining why they believe health care reform is needed, and review Metal Devices for Joint Replacement Are details of the HHS budget. Visitors can also comment on the Loosened by Immune System issues in the web site. Researchers at Rush University Medical Center have identi- • Online: dotmed.com/dm8430 fied a key immunological defense reaction to the metals in

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joint replacement devices, which leads to loosening of the components and device failure. Over 600,000 total joint replacements are performed in the United States each year. The majority are successful and last well over 10 years. Healthcare But in up to 10% of patients, the metal components loosen, requiring the pa- Chronicles tient to undergo a second surgery. The loosening is often caused by Prescription for the Future: More Knowledge localized inflammation, an immune reaction to tiny particles of debris from By Dr. Henry Wagner the components themselves as they he health care system is likely to change dramatically. Politicians are working rub against one another. No infection feverishly to keep their constituents from the unemployment lines and every is involved. avenue is being investigated for ways to cut government costs to free funds for “As soon as joint replacement other expenditures. Health care has long been a target of cost cutting. Those holding the purse strings are now reluctant to make big purchases at this time. devices are implanted, they begin to While it is understandable, it is also unfortunate. Few would argue that America is corrode and wear away, releasing par- T an aging society. Baby boomers, among the largest generational representation of our so- ticles and ions that ultimately signal ciety, have passed the halfway point and the demands placed on our health care system danger to the body’s immune system,” will only increase. To meet this increase, it will be necessary to allocate more funds to said Nadim Hallab, associate professor update existing technology and purchase the latest molecular imaging instruments. at Rush University Medical Center and Nuclear medicine - PET/CT, SPECT/CT together with CT and MRI represent an incred- the study author. ibly useful set of tools that can assist in providing the best possible health care that we This is the first time that research- can offer. There is, however, a downside - the equipment is very expensive. This expense ers have shown that debris and ions means it is imperative for a machine to not only prove itself in clinical practice, but also justify itself in basic economics. Even the most effective methods of identifying or treating from implants trigger this danger-sig- health problems need to be economically viable in order for them to be used in practice. naling pathway. Online: dotmed.com/dm8422 • Efficient Use Fortunately, nuclear medicine can be economically viable. The answer to the problem of Surgical Devices Coated return on investment can be found in the value of the knowledge that nuclear medicine provides. Having a team trained to use the machines to their maximum efficiency reduces the With Peptides Kill Bacteria time spent on each patient study. Plus, the knowledge will decrease the overall cost of caring Researchers at the University of Brit- for each patient. There will be decrease in the cost of care for each patient. Less time spent ish Columbia have discovered a mimic does not mean a lower quality of care. It means the time spent will be used to maximum of one of “nature’s antibiotics” that benefit. An assessment of time used will take into account such things as the span of time can be used to coat medical devices to between onset of symptoms and the care of the patient. prevent infection and rejection. The study, published in the jour- Efficient Budgeting Many of the people in control of budgets and finances for hospitals and clinics are troubled nal Chemistry and Biology, found by the thought of spending money for nuclear medicine. Right now, the big OEMs - GE, that a synthetic form, short tethered Philips and Siemens are having problems because of the hospital administrators’ worries cationic antimicrobial peptides can about the economy. Although recent sales of PET/CT and SPECT/CT have decreased, I think protect surfaces, like those of medical they will resume their growth as more people come into the health care system. devices, killing bacteria and fungi that come into contact with them. The Key to it All Medical devices such as surgi- I believe the cost per patient will decrease as equipment improves and training increases cal implants, catheters, hip replace- for professionals operating the equipment. I believe overall expenditure for hospitals will ments, and joint prostheses have the increase as well, with more equipment needed to handle the larger influx of patients. An increased number of patients with a decreased amount of time needed to give them the proper potential to become infected with care means hospitals stand to bring in revenue. bacteria, leading to many medical Further, education for professionals will lead to quicker diagnosis, better planning and problems including degeneration or monitoring of treatments and ultimately, improved patient care. Ultimately, isn’t that what rejection of the implant. Currently, we all want to provide? silver is sometimes used to coat Online: dotmed.com/dm8549 medical devices because of its anti- • Dr. Henry Wagner is an international authority on nuclear medicine. He is currently Emeritus Professor microbial properties. of Medicine and Radiology; and Professor of Environmental Health Sciences at John Hopkins Universi- • Online: dotmed.com/dm8423 ty. During his six decades with John Hopkins he has trained more than 500 radiologists. Dr. Wagner is a member of the Institute of Medicine of the National Academy of Sciences and he is an honorary member of both the British Institute of Radiology and the Radiological Society of North America.

10 DOTmedbusiness news www.dotmed.com

what’s new

Medical Imaging & Technol- The X-STOP IPD, the new proce- have been detected by colonoscopy. For ogy Alliance Statement on dure now being performed at New York asymptomatic high-risk patients and Methodist Hospital, involves placement symptomatic patients, the percentage of Obama Budget of an implant, called the X-STOP device, patients correctly identified as having The Medical Imaging & Technology Al- between two bones in the back of the colorectal polyps or cancer may be too liance (MITA) expressed its support for spine to widen the canal and alleviate the low to be useful. the health policy goals presented in the symptoms of spinal stenosis. Once the Online: dotmed.com/dm8454 President’s federal budget, and shares a • implant is in place, the bone overgrowth commitment to ensuring that all Ameri- no longer comes in contact with the cans have access to affordable, quality National Neurotechnology nerves and the symptoms are alleviated. health care. This new procedure lessens the risks of Initiative Act Introduced in However, the association said that medical complications associated with Congress the budget’s proposed reliance on ra- traditional surgery used to treat LSS and The National Neurotechnology Initia- diology benefit managers (RBMs) will can be performed in under an hour with tive (NNTI) Act was introduced into deny imaging services, and is an inef- the use of local anesthesia. both houses of Congress on March 12, fective model that undermines the doc- Online: dotmed.com/dm8377 by Rep. Patrick J. Kennedy (D-RI) in the tor-patient relationship in making health • House, and Sen. Patty Murray (D-WA) care decisions. If the Medicare program in the Senate. On her website, Sen. depends on RBMs, it will lead to further Vapor Sensor May One Day Murray said the legislation was to “help reducing seniors’ access to life-saving Whiff Disease scientists advance their understanding medical services. A future sensor may test a patient’s of the human brain and develop new • Online: dotmed.com/dm8395 breath for breast cancer, lung cancer, treatments and cures for the millions of diabetes or asthma. Americans who suffer from neurologi- NYM Offers Innovative A University of Missouri researcher cal diseases, conditions and disorders.” is developing a device that will analyze Solution to Treat Lumbar The Neurotechnology Industry breath and urine samples for volatile Organization (NIO) has applauded the Spinal Stenosis markers inside the body that indicate legislation. “The huge numbers speak A new minimally invasive surgical disease. These volatile markers, such as for themselves: There are 100 million procedure that relieves the symptoms alkanes, acetones or nitric oxide, give Americans suffering from a brain-relat- associated with lumbar spinal stenosis doctors clues about what is happening ed illness, with an enormous economic (narrowing of the spinal canal) is now inside the body and can be used as a di- burden that continues to grow as the available at New York Methodist Hos- agnostic tool. population ages,” said Zack Lynch, Ex- pital (NYM). • Online: dotmed.com/dm8494 ecutive Director of the NIO, in a press release. “For a modest investment, Con- Virtual Colonoscopies gress has the opportunity to streamline Show Value for Some research efforts, accelerate the development of new treatments, promote inno- Patients, But Polyps Will vation and job creation by small busi- Be Missed nesses and have a meaningful impact on The value of CT colonography, also the lives of those suffering from devas- called virtual colonoscopy, is under de- tating diseases and injuries.” bate as Medicare considers halting cov- • Online: dotmed.com/dm8488 erage of these procedures as a diagnostic method for detecting colorectal cancer and precancerous growths. Research Latest IMV Market Report findings from meta-analyses performed on Mammography Centers by ECRI Institute® suggest that CT Shows a 16% Decline in colonography appears most promising Mammography Procedures for screening asymptomatic, average- An estimated 36.7 million x-ray mam- risk patients; however, it will miss some mography procedures were performed important polyps and cancer that would in the United States in 2008, in 8,670

12 DOTmedbusiness news I a p r i l 2009 www.dotmed.com hospital and non-hospital sites, according to a report just released by IMV Medical Information Division. “This represents a slight 2% decline from 37.3 million procedures in 2007, which is consistent with trends observed by the CDC,” said Lorna Young, Senior Director, Market Research. “Compared to 2000, the 36.7 million procedures conducted in 2008 represents a decline of 16% from an estimated 43.9 million procedures in 2000, or about a 2% decline per year. This may be partially influenced by a 13% reduction in the number of MQSA certified sites in the United States from 9,910 sites as of May 2000 to 8,670 sites as of December 2007.” • Online: dotmed.com/dm8419 Fraud Monitoring of Electronic Medical Records Uncovers Identity Theft In the health policy arena, information technology is seen as a panacea to improve efficiency, reduce repeat testing, and save billions. While those are some expected benefits of electronic medical record-keeping, its greater money-saving potential may lie in helping to uncover fraud. puts the rate at 10%, a crippling $226 billion loss yearly. The National Health Care Anti-Fraud Association (NH- Suddenly the urgency for electronic medical record adop- CAA.org) conservatively estimates that 3 percent of all health tion is in sharp focus because the best way to spot fraud is by care spending - about $68 billion - is lost to fraud. A more using high-tech data mining tools. jaundiced, or perhaps realistic estimate by the FBI and CDC • Online: dotmed.com/dm8192

DOTmedbusiness news I a p r i l 2009 13 FOCUS ON PERFORMANCE Coming in “It’s not easy being green” May Along with his association with Miss Piggy this song made Kermit the Frog famous in the 1980’s. When Kermit was belting this one out, it really Industry Sector wasn’t so easy being green. Today, things are easier. There are ways to help the environment Reports: and your pocketbook at the same time.

For most, just reducing the carbon footprint Wayne won’t be enough incentive. To make greening Webster work in a medical imaging facility there needs to be a financial reward for changing habits. Today’s medical imaging facility can do much to reduce the use of consumables and the cost of capital goods. Imaging is transitioning to digital and as it does, the film and the chemicals for processing are greatly reduced. The dilemma faced by the facility manager is balancing the long term environmental benefit with the short- term capital budget. In any financial environment it’s difficult to justify replacing equipment just to eliminate a disposable. Today’s Ultrasound Sales uncertain economy makes it even harder. & Service A probing report at this sector. If you’re in the process of planning the replacement of old medical equipment with new, give some thought to where the old equipment will go. It’s often easier to trade-in the old equipment rather than try to sell it yourself so that’s the route many take. But, just like when you trade-in your car for a new one, you don’t know what you’re receiving for your trade-in or where it’s going. Digital Mammography Even if your equipment is still useable and in good condition, depending on age there’s a good chance that once traded-in it will Sales & Service just head for the scrap yard. With this equipment out of the inventory Mammography’s hi-tech ascent another new medical device will need to be manufactured to replace continues. it. The outcome isn’t good for the environment or your wallet.

When considering the replacement of a piece of equipment with new, contact a company that can buy your old equipment for refurbishing and resale. I work with many of these companies. They are anxious to work with you. You’ll most likely get a better Bone value for the old equipment and conserve resources by eliminating Densitometer the need to produce a new instrument to take its place. Sales & Service If you don’t know who to contact, you can use DOTmed to list Get to the meat of the matter on the equipment and the requirements you have for purchase and bone densitometers. removal. The listing is free. A company dealing in pre-owned medical equipment or someone wanting to acquire and make use of your equipment will contact you.

Taking charge of the disposition of equipment you plan to replace can help green the environment and put a little extra green into your Analog budget. Mammography Online: dotmed.com/dm8550 Sales & Service • Even when it’s not digital, it still Wayne Webster is a consultant in Medical Imaging Business proves invaluable. Development. You can send your comments or questions to [email protected].

14 DOTmedbusiness news I a p r i l 2009 www.dotmed.com

Just in time for Spring Cleaning

n this issue we have focused on Call in a DOTmed Clean Sweep Team “going green,” or at least mak- We make cleaning it all out a breeze! ing choices that are better for We’ll come pick-up all that idle medical equipment you have in storage, we’ll sell the environment and in turn, for it — and you’ll pick-up some extra cash! society. Every hospital – including yours – has plenty of equipment you can’t throw away, but One choice that meets both those I just won’t use. Now you can easily dispose of it. And make some money, too boot! goals – of helping the environment and directly helping society is to do some spring cleaning. For hospitals and Call in a DOTmed Clean Sweep Team. We’ll come to your facility, inventory, photograph, itemize, and remove all your old medical centers, spring cleaning usu- equipment that still has value. ally gets a bit more in-depth than just putting away the winter clothes and Then we’ll Auction it all on DOTmed.com. You can watch the Auction yourself. taking out the patio furniture. If you have equipment that you We’ll deduct the cost of pick-up, storage, Auction Management, crating & shipping will no longer be using and it’s just from the total Auction results, and write you a check for the balance!* taking up room in storage, do yourself, All the old equipment you have in storage can be worth thousands of dollars to you. and others a favor and dust it off and put it on the market. Medical centers Call DOTmed’s Clean Sweep Hotline. We make cleaning out your old used lacking the budget for new equipment equipment a breeze! will thank you, their patients will thank you, and those at your hospital trying 866-999-DOTmed (3686) Ext. 105 to make budgets stay in the black will *Pick-up fees may be required for rural hospitals, or hospitals with less than 10 re-sellable items. thank you. • Online: dotmed.com/dm8559

16 DOTmedbusiness news I a p r i l 2009 www.dotmed.com CT Sales & Service

The market reflects broader health care technology stressors By Barbara Kram

anuary 1, 2007 was an infamous day for the CT in- storm, uncertain federal regulatory shifts, concerns about the dustry and in many ways the beginning of a new era. overuse of medical imaging, clinical issues of radiation dose ex- That date initiated cuts in Medicare reimbursement for posure, and the potential reform of the U.S. health care system. imaging studies at free-standing radiology centers as a These factors leave hospitals and imaging centers more fo- result of the Deficit Reduction Act (DRA). Also at that cused on the bottom line than ever. Some practice models just Jtime, the reimbursement rate for cardiac computed tomogra- won’t make it. Others are postponing equipment investments. phy angiography (CTA) was slashed in half or more, depend- “The way the economy is going right now, we’re seeing ing on the rate and region. As a result U.S. sales of CT, which a trend of more small imaging centers shutting down. Small had risen dramatically, came down from a spike of about $1.8 centers don’t fall under the same Medicare reimbursement ar- billion in 2006 to just over one billion in 2008. rangements that large hospitals do,” said Larry Knight, Chief “That’s a fairly significant drop but the market was very Operating Officer, Sunrise Medical Technology, Inc., Waxa- highly accelerated before that. The stable range is probably $1.2 hachie, TX. Reimbursements that had been over $1,000 per or $1.3 billion per year,” said Doug Ryan, Senior Director, CT, study a few years ago have been trimmed to about the $300 Toshiba America Medical Systems. “You need to constantly be range. “So their entire business model was based on higher flexible and change your business. In the U.S. there has not been numbers. CT in many cases is a loss leader, a device put in the one year that is the same as another,” he observed. center not as a primary source of revenue, but as a device that This unpredictable climate is worsened by the economic must be there to maintain their status overall.”

DOTmedbusiness news I a p r i l 2009 17 Prices on new CT scanners have tector is an exchangeable unit that could come down and manufacturers have grow with future needs. iCT SP meets a come up with smaller systems that are lower price point and meets the need for more affordable, as well as with scal- a secure investment into the future so able solutions. These don’t require as the product is not outdated in two, three great an up-front investment but can be or four years.” upgraded over time. An example is the The bottom line for CT is not just Philips Brilliance iCT flagship and its its reimbursement rate but the growth offspring, the Brilliance iCT SP, priced in procedures that now top 70 mil- Trauma patient getting a about 20% lower. lion per year. While the rate of growth scan from a Brilliance CT “The major difference is a smaller has slowed to about 7% from double 64-channel scanner detector size compared to iCT,” said digits three years ago, that’s still not Peter Reimer, Vice President of Global too shabby. The OEMs told DOTmed fectiveness of CT in applications such Marketing, Philips Healthcare. “The de- Business News that they anticipate the as CT colonography, which suffered a markets should unfreeze in the second setback in February when Medicare said half of this year. it doesn’t want it covered. (Note that the Regarding access to capital, final rule was not out as of this writing.) which is a challenge of our current CT as a modality is in need of a economic crisis, it bears noting that “killer app” like virtual colonoscopy that Philips Healthcare provides financ- is routinely used for widespread screening through Philips Medical Capital, ing in the healthy population. Another a joint venture with AAA-rated Dutch example might be screening symptom- bank De Lage Landen. free smokers to spot early lung cancer. A collimator on a GE LightSpeed 16 is As for long-term trends, watch for Meanwhile, cardiac and ER remain being checked at C&G Technologies forthcoming clinical studies on the ef- important applications for CT and evidence of effectiveness is mounting.

18 DOTmedbusiness news I a p r i l 2009 www.dotmed.com

Mixed Signals on Third Party Impact Fewer new scanners are being sold, and those that are sold Tips for Hospitals from Third may suffer from a reversal of recent slice wars. “People are Party CT Service Providers being very cautious, measured and calculating,” said Greg DOTmed Business News regularly polls inde- Kramer, President, C&G Technologies, Inc., Jeffersonville, IN pendent service organizations (ISOs) about speaking of CT comparison shoppers. “People are asking - do I really need a 64-slice CT? They may say a 16-slice is just medical technology trends. Here is some advice fine.” Providers may not be able to do a cardiac exam on a from third-party companies about CT purchase 16-slice machine, but for common applications like chest or and service decisions. spine it does the job. “There are also hospitals that never considered buy- Pre-owned equipment is always going to provide a cost savings, and leasing versus buying offers the flexibility of ing refurbished equipment before and are now doing it,” upgrading your equipment sooner rather than later. This al- Kramer said. lows a facility to provide current technology without signifi- “People were waiting till after the election and to see what cant capital expenditures. happens with the economy,” said Robert Serros Jr., President -Greg Mullen, Vice President, ADM, Elmhurst, IL and CEO, Amber Diagnostics, Orlando, FL. “All industries took their foot off the accelerator. Now people are revisiting Do not sign multi-year service contracts you can’t get out of. their capital expenses and looking at refurbished equipment Look for third-party service. Keep your equipment another without a doubt because they have to.” year. Don’t let doctors make decisions about spending your Conservatively, purchasers can save 30% and often much money just because they want a new scanner. Make them more, by opting for used equipment. As an example, one inde- justify the purchase by ROI and patient care improvement. -Bill Blackford, Vice President, CTronics, Stockton, CA pendent company reported that a new 16-slice CT that goes for $500,000 can sell for $175,000 used on the open market. Hospitals and imaging centers should call their local col- “Reimbursements always play a large role in driving the leagues before doing business with any company. Before market, but the recent economic downturn has only served to buying any equipment check to find out if what you are buy- make our business model more attractive,” said Greg Mullen, ing has a proprietary X-ray tube or requires proprietary software for servicing. -Frank Pontillo, Imaging Director, Engineering & Network Sys- tems, Inc., Pembroke Pines, FL

Ask how long a third party has been in business and get referrals. Anybody can sell a piece of equipment. If you give someone a warranty and in the last week of that warranty a major part goes out, are they going to be there? Do a background check. -Robert Serros Jr., President and CEO, Amber Diagnostics, Orlando, FL

Make certain that the company you are contracting to deinstall has experience not only in the deinstallation and rigging of CT but in the specific OEM type. For instance, you may have a company with experience in Philips CTs but if you have a Siemens that needs to be deinstalled, there are specific differences and requirements. Due diligence is the rule of thumb. Identify a good dealer that has a long- standing reputation of representing what they sell. DOTmed can be a valuable resource here. -Larry Knight, Chief Operating Officer, Sunrise Medical Technology, Inc., Waxahachie, TX

Listen to more than talk. You are investing in something you will have for a number of years and is a critical component. Visit the service provider’s facility. It might take a day out of your schedule but it is a day well spent. Can they do emergency repairs? Do they stock parts? What about tracking and record keeping? Evaluate the support network. If you have a major disaster with your machine and whole gantry needs to be replaced, can they take care of it? You reputation is riding on your CT. - Greg Kramer, President, C&G Technologies, Inc., Jeffersonville, IN

20 DOTmedbusiness news I a p r i l 2009 www.dotmed.com

Vice President, ADM, Elmhurst, IL. “Our “There is a tougher time sourc- Service Dominates as a primary market originally was more rural ing. But some of the slack is taken up Priority for OEMs, ISOs areas or clinic settings but we are start- by people going out of business,” ex- In times when sales are suppressed, ser- ing to receive more attention from larger plained David Denholtz, CEO, Integ- vice becomes more important as providers hospitals in urban locations.” rity Medical Systems, Inc., Fort My- keep the installed equipment operational. Nevertheless, the economy hurts ev- ers, FL. It seems that imaging center And service of this sophisticated technol- eryone and most third party companies closings are a trend that off-sets the ogy doesn’t come cheap. report steady or somewhat slowing sales. demand for sales. “Centers are con- “The lifecycle costs over a piece of “The OEMs need to maintain a com- solidating or not replacing equipment. equipment like a CT scanner is almost petitive advantage in the marketplace Some customers with three or four half the price of a scanner. You are typi- and are dropping prices on those brand centers are going down to two or three cally selling the [new CT] in the million new CTs installed with a warranty, driv- centers. When nobody is buying new, dollar-plus range and the service con- ing prices on used equipment down even there are not as many used scanners, tracts can be $130,000 to $200,000 per lower,” Knight said. “To be competitive, but then again fewer people are buy- year,” said Ted Nemetz, Vice President a used piece of equipment must be sig- ing used scanners, so it evens out.” of Service, Toshiba America Medical nificantly lower in cost than what that “The market has slowed down Systems. “Operating costs may not meet OEM can offer in new equipment. So somewhat. Many hospitals have frozen that so we have to be more creative and the OEMs are really bringing a competi- their capital budgets for this year and flexible on the service side to wrap the tive edge into the marketplace making it maybe longer depending on what leg- deal together for the customer.” tighter for third party market groups.” islation is forthcoming. Access to pre- Toshiba, with nearly a 90% capture Another challenge for indepen- owned scanners is becoming more of rate for service contracts on its equip- dents is that, with fewer units sold, a challenge,” noted Bill Adkins, Presi- ment, enjoys an impeccable reputation fewer pre-owned scanners are coming dent, National X-Ray Corporation, in the marketplace with top rankings on the market, reducing inventory for Palmetto, FL. for service from major research firms. re-sellers. Its line of Aquilion CT scanners has not been in the market long so that few third parties are servicing them and few are available for re-sale. “We don’t have that many out there,” Nem- etz said. “It’s like a Toyota Corolla that keeps running.” While Toshiba would not tell us What’s The Right Price For This Imaging Equipment? how many service engineers it employs, it was clear that the quantity and coverage they hold, as well as its quality are big reasons for the high service ratings. But hospitals are cutting corners here, too. “Many clients are choosing to modify or reduce their service contract coverage on CT to a bare minimum and put greater focus on the [other] Call Bay Shore. And Know For Sure. modalities that generate the revenue,” Knight said. OEMs and service companies offer We Are The Largest Buyer & Seller Of Pre-Owned a range of contracts from full parts and Imaging Equipment In The U.S. service including the pricey X-ray tube, to a partnership deal where the hospital biomedical staff assumes some risk, Before you trade-in your current unit, sell 1-800-471-1189 down to a time and materials bare bones to a broker, or buy from a dealer, make one contract. more call: to Bay Shore. Preventive maintenance is critical We will provide you with a free, up-to-date Call Bay Shore. and must not be skipped. ISOs suggest market valuation and quotation for any And know for sure. that the OEM general requirement for piece of imaging equipment you wish to quarterly PM is a minimum standard. buy or sell. www.bayshore-medical.com “You MUST keep a good eye on the rotate brushes and rings. X-ray tube

22 DOTmedbusiness news I a p r i l 2009 www.dotmed.com dielectric oil must be checked; oil fans and filters cleaned. If a used in imaging equipment to block radiation, but the X-ray PM is done only four times a year as many OEMs recommend, tube in the Brilliance iCT is the industry’s first “green” glass- the mechanical systems must be inspected,” urged Sal Aidone, ware since it contains no lead. Vice President, Deccaid Services, Inc., Deer Park, N.Y.

CT: A “Green” Machine? You may not think of a CT scanner as part of the solution to the world’s environmental challenges but the industry is doing its part. Both ISOs and OEMs have programs in place. For example, ISOs pride themselves on recycling equipment back into the marketplace, an inherently conser- vative business. “Any reprocessing has a benefit,” said Ser- ros. “We also chop up machines for parts and scrap metal. A recycler separates the metals by type after we take out the major components.” But the best way to save the planet is by GE Discovery design, which the OEMs are pursuing in their CT750 HD equipment. “A lot of our heritage comes from Western Europe, which tends to be more progressive in terms of sustainability and ‘green’ initiatives. That has an impact in our product roadmap today,” said Jason Plante, Director of CT Product Marketing for Philips Healthcare. He explained that lead is a common metal

DOTmedbusiness news I a p r i l 2009 23 “We had a breakthrough in using more environmentally friendly material to safeguard the radiation inside Read More Online the X-ray tube. That is an area of focus and concern,” • Considering a portable CT? Plante said. Outside the U.S., Philips must comply with Read clinical vignettes from leading OEMs stiff global environmental standards to reduce hazard- at www.dotmed.com/news/story/8476. ous substances. “The same products will be offered in the U.S. so the U.S. will benefit from European trend-setting • Concerned about radiation dose? Calculate in environmental policy.” your patients’ exposure risk using a new web • Online: dotmed.com/dm8551 site. Read about it at www.dotmed.com/news/ story/8477.

DOTmed Registered CT Equipment Sales & Service Companies For convenient links to these companies’ DOTmed Services Directory listings, go to www.dotmed.com and enter [DM 8551] Names in boldface are Premium Listings. Name Company - Domestic City State Certified DM100 Carl Frank DBRS Medical Systems, Inc. Chino CA • Rick Stockton Atlas Medical Technologies Ontario CA • Steve Foos IMAG, Inc. Redding CA Mike Guthleben Radiology Oncology Systems San Diego CA • Bill Blackford CTronics Stockton CA • Steve Gregson Sage Point Transport, LLC Upland CA Chris Ash Scanworks Centennial CO Scott Carson Med1Online Golden CO David Denholtz Integrity Medical Systems, Inc. Fort Myers FL • • John Pereira United Medical Technologies Corp. Fort Myers FL Alex Clavijo Diagnostic Medical Equipment Solutions Miami FL Robert Serros, Jr. Amber Diagnostics Orlando FL Bill Adkins National X-Ray Corporation Palmetto FL • Frank Pontillo Engineering & Network Systems, Inc. Pembroke Pines FL Len Spooner MagnaServ, Inc. Stuart FL Heather Funk Dunlee, Inc. Aurora IL James Gallagher LG Medical Technologies, Inc. East Dundee IL Greg Mullen ADM Elmhurst IL George Webb MobileScan Imaging Kildeer IL Mike Ghazal Zetta Medical Technologies, LLC Lake Zurich IL Charles Gauthier Imaging Services Streamwood IL Ronald Moore R & D Imaging, Inc. Evansville IN Greg Kramer C&G Technologies, Inc Jeffersonville IN • • Davyn McGuire Med Exchange International, Inc. Agawam MA • • Wayne Horsman Columbia Imaging Inc Columbia MD Jeff Rogers Medical Imaging Resources, Inc. Ann Arbor MI Susie Vestevich Xoran Technologies, Inc. Ann Arbor MI • Jason Crawford Block Imaging International, Inc. Lansing MI Jim O’Rourke LJ Technologies Brick NJ Robert Manetta Nationwide Imaging Services, Inc. Brick NJ • • Joseph Jenkins International Imaging Ltd. Las Vegas NV Sal Aidone Deccaid Services Inc. Deer Park NY • John Kollegger Bay Shore Medical, LLC Ronkonkoma NY Peter Reimer Philips Healthcare Highland Heights OH Gilberto Mangual ImageTek Trujillo Alto PR • Trey McIntyre International Medical Equipment and Service, Inc. Fort Mill SC • • Marshall Shannon Image Technology Consulting, LLC DeSoto TX • • Michael Webster Legacy Medical Imaging Fort Worth TX Courtney Lane Innovative X-Ray Services, LLC Friendswood TX Larry Knight Sunrise Medical Technology, Inc. Waxahachie TX • Cliff Hess Texas Medical Mobile Services Waxahachie TX Jon DeRoost Beacon International Edmonds WA

Name Company – International City Country Certified DM100 Horacio Jose Gomez VCG Imagen SRL Buenos Aires Argentina • David Lapenat ANDA Medical, Inc. Ottawa Canada Abdelrahim Khalil Besisc Cairo Egypt • • Paulos Hailu Diverse Electromedical Addis Ababa Ethiopia Florian Dickopp Medicopex GmbH Oberasbach Germany Bippon Gupta Masters Medical Equipment Pvt Ltd. New Delhi India • Abdul Radjak PT Alkeslab Primatama Jakarta Indonesia Rami Marom ElsMed Ltd. & Relaxation, Inc. Holon Israel • • Fusako Hashimoto Fair Medical Matsudo Japan Borhan Kalash Memco Damascus Syria Imad Muati IMC Damascus Syria Ahmet Guner Ekolab Lab ve Bilgi SisTic Ltd. Ankara Turkey Ralph Childs G-Tech Medical Services Abu Dhabi United Arab Emirates Jose Morillo J Morillo Sistemas Biomedicos Cabimas Venezuela • •

24 DOTmedbusiness news I a p r i l 2009 www.dotmed.com

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COLUMBIA IMAGING, INC. the imaging specialists

Columbia Imaging, Inc. 9050 Red Branch Rd., Suite O 847.489.7056 POWER UP TO EXCELLENCE Columbia, Maryland, 21045, USA Call 888-466-SAGE (7243) www.columbiaimaging.com mobilescanimaging.com Disposable Medical Devices Painting a Greener Picture By Joan Trombetti

here is a broad range of disposable medical sustainable design considers the social and financial effect on products and devices in the health care industry. a product as well as its effect on the environment,” says Ka- With “disposable” as part of the description, it damus. From a designer or engineer’s perspective, sustainable might not seem that these medical devices and a design takes the entire product life cycle into account, from friendly “greener” environment could go hand- creation to disposal, during the initial design of the product. in-hand,T but the industry segment is moving in a greener Regulations for waste reduction and minimization or elim- direction and trying to help reduce the millions of tons of ination of hazardous substances have already been in place for medical waste generated each year — a portion of which is the European Union (EU) for several years for everything but considered biohazardous. medical devices, and it is believed that medical devices will be A report by the Hospitals for a Healthy Environment included sometime between 2010-2012 in the EU. (H2E) states that hospitals in the U.S. produce approximately These regulations include: the Waste Electrical and Elec- 6,600 tons of waste per day. As much as 80% to 85% of this tronic Equipment (WEEE); Restriction on Hazardous Sub- waste is non-hazardous solid waste like paper, cardboard, stances (RoHS); Registration, Evaluation and Authorization of food, metal, glass and plastics. H2E believes that recycling Chemicals (REACH); and the Energy Using Products (EuP) would substantially reduce waste volume. regulations. The WEEE Directive is environmental legislation that hopes to reduce the amount of waste dumped into landfills. “Green disposables” begin with the design It encourages recycling and reusing electrical and electronic Chris Kadamus, Principal Design Engineer at Cambridge Con- equipment. The RoHS applies to end-user electrical and elec- sultants, Inc, believes that with the introduction of new regula- tronic equipment (EEEE) and has in place maximum acceptable tions, rules and purchaser preferences, many of the waste dis- levels of six substances within the composition of the product posal methods of hospitals and ultimately the design decisions including lead, cadmium, mercury, hexavalent chromium, poly- of medical device manufacturers will soon be changing. “True brominated biphenyl (PBB) and polybrominated diphenyl ether

DOTmedbusiness news I a p r i l 2009 27 The American Hospital Association, The American Society for Gastrointestinal Endoscopy, and The American College of Cardiology. Among these groups, several have introduced Industry Statements that support the use of SUDs based on reports issued by the U.S. Government Account- ability Office (GAO). The GAO concluded that FDA oversight has increased since 2000, and available information does not indicate that the use of SUDS presents an elevated health risk. Brian Sullivan, President and CEO of SterilMed, Inc. says that using reprocessed devices has become a standard practice for most hospitals in the United States, as well as most of the leading teaching and research hospitals Some of the disposables in the country. “Using at least some re- offered by processed devices is a standard practice Precision in 70% of US hospitals,” says Sullivan. Surgical Supply “While over 3,000 hospitals currently have a reprocessing program, and over 93% of the US News’ “Honor Roll” (PBDE) flame retardants. the initial product planning stages. Each Hospitals use reprocessed devices, there Kadamus says that although similar stage is evaluated from the perspectives are still some hospitals that have yet to legislation does not yet exist in the U.S., of energy efficiency, environmental im- fully integrate reprocessing as a stan- there is pressure from a non-domestic pact, material usage, human effort and dard practice at their facility.” customer base that has already forced cost. “Performed correctly, product life Reprocessing medical devices many American companies to comply cycle design can lead to significant im- positively impacts the environment by with WEEE and RoHS. provements in manufacturing efficiency, maximizing the use of existing devices, “Many health care facilities are and improve time to market, risk reduc- decreasing the volume of devices that embracing sustainable practices as a tion, efficient material and energy us- are sent to landfills and reducing the smarter way to do business,” according age, safety and regulatory compliance, production of methane gas required to Kadamus. To save on spending, they and packaging and transportation costs,” to make new products. The American are purchasing and using eco-friendly says Kadamus. Designing products for Hospital Association and the U.S. En- products that are PVC-free, mercury- easy disassembly, minimizing bulky or vironmental Protection Agency have free and lead-free. This, in turn, will al- nonessential packaging, reducing part entered into a Memorandum of Agree- low the medical device industry to cut count, moderating the use of dissimilar ment which called for a number of ac- back on packing materials, design prod- injection-molded materials and eliminat- tion steps for hospitals to reduce medi- ucts for disassembly and recyclability ing toxic or hazardous materials (lead and cal waste. “Hospitals face the challenge and support end-of-life product recla- PVC, for instance) help to meet the goals of meeting the goal of a 50% reduction mation programs. for sustainable design as well as those for in medical waste volume by 2010. With Kadamus says, “many of the key efficient, low-cost design. “With respect US hospitals producing more than 6,000 tenants of sustainable product concept to disposable medical products, choosing tons of waste each day, this is a signifi- of product life cycle design stem from materials that limit environmental dam- cant challenge. Recycling is one impor- understanding and developing a product age during disposal and incineration can tant step in reducing that impact on our life cycle, not just a product.” reduce toxic air emissions and reduce environment,” says Sullivan. waste processing costs,” he says. Association of Medical Device Re- The product life cycle processors (AMDR) president Daniel design concept Reprocessing Vukelich says, “As the U.S. Govern- The concept of product life cycle design single-use-devices ment Accountability Office indicates considers all stages of product existence, Single-use-devices (SUDs) reprocessing – medical device reprocessing is strin- including concept development, material has been evaluated for safety and clean- gently regulated by FDA.” With that selection, design and engineering, man- ing efficacy by various groups within the assurance, it makes financial sense for ufacturing, packaging, transportation, health care industry including The Associ- hospitals. “Reprocessing saves hospi- sales, use and end-of-life disposal during ation of Perioperative Registered Nurses, tals millions of dollars,” says Vukelich.

28 DOTmedbusiness news I a p r i l 2009 www.dotmed.com He also pointed out that of all the disposable medical devices damage to the environment with mercury and dioxin being the available – only 2% to 3% can be considered for reprocess- main culprits. Dioxin is produced from materials like plastic ing. That brings up the question, “What happens to the 97% that react at high temperatures with materials like PVC and to 98% of the disposables that can’t be reprocessed – where chlorine. Accumulating dioxins released into the environment do they go?” have been proven to have an effect on the endocrine systems of humans and animals. The EPA has regulations to control the Recycled disposables emissions from medical waste incinerators and include stringent Vukelich explained that when the AMDR can no longer re- air emissions guidelines for states to use in developing plans to process a medical device, it is usually stripped down and its reduce air pollution from medical waste incinerators built on or components sold to third parties. For example, some plastics before June 20, 1996; and final air emission standards for medi- can be melted down and put into cinderblocks used for weath- cal waste incinerators (MWIs) built after June 20, 1996. erproofing– the aftermarket for plastic is valuable. Other The EPA’s MWI standards and guidelines have caused many components, like titanium and carbon used by orthopedics for health care facilities to use alternative technologies for treating external fix bolts – can be sold, melted down and reused in waste including microwave technologies, steam sterilization certain consumer products. “This is a very exciting time for like autoclaving, electropyrolysis and chemical mechanical the reprocessing and recycling industry,” says Vukelich. “The systems. Many states have regulations requiring medical waste AMDA and other organizations and companies are working treatment technologies to be certified, licensed or regulated and very hard to clean up and keep the environment clean.” individual states have their own requirements. Several Federal Sullivan of SterilMed explains that if a device cannot be agencies also have regulations that cover the waste stream. reprocessed, the company reclaims and recycles the metal and The Maine Hospital Association, which represents 29 plastic. During 2008, more than 20,000 pounds of material community-governed Maine area hospitals generate about was recycled at SterilMed. The reclaimed plastics and metals 190,000 pounds of waste per month. The Maine Medical were refined and used to create other products. Waste Facility utilizes 2H-1000 Hydroclase Vessels, which process 500 to 800 pounds of waste per day. The technol- Time limits on reprocessing ogy from Hydroclave Systems Corp (SC) of Canada has a Robert Copeland is a consultant in the North Carolina region patented treatment process that utilizes steam heat to sterilize with more than 25 years of experience in the industry. He says waste and subsequently shred it making it acceptable mate- that disposables fall into several categories, and if they are rial for landfill disposal. This is a positive move for the en- candidates for reprocessing, they can usually only be repro- vironment. Previously, medical waste was hauled to landfills cessed a certain amount of times – particularly those made of in unmodified form. plastic. “The sterilizing process of plastics has to be carefully managed because if the temperature is too high, or an incor- rect sterilizing method is used – chemical changes could cause damage to the composition of the plastic. “There is a time/ temperature/method relationship that must be adhered to,” says Copeland. He believes that hospitals must weigh the cost versus risk when it comes to deciding whether or not to go forward with reprocessing certain single use devices. “SterilMed limits the number of reprocessing cycles according to the specific construction and material composition characteristics of each device,” says Sullivan. To assess this, the company performs an analysis that determines the structural integrity of a device, and then performs validation testing. Based on the results of the validation testing, Sullivan says, “We will determine the number of cycles a particular device can be reprocessed. The number of reprocessing cycles for devices ranges from one to five.”

Landfills and incineration for medical disposables that cannot be reprocessed or recycled Hospitals and other health care facilities have been trying to deal with medical waste for years. Incineration is one strategy that many facilities have adopted because it reduces waste in Disposable imaging landfills and saves health care facilities money. Still, incinera- catheter testing at SterilMed tion has its drawbacks. Known emissions of organic pollutants and metals cause

DOTmedbusiness news I a p r i l 2009 29 Kate Flynn, FACHE, president of Fletcher, Associate – Policy and Programs can understand both sides of the repro- The Health Care Improvement Founda- at the Product Stewardship Institute, Inc. cessing issue. When it comes to legislation (HCIF) – a Philadelphia-based nonin Boston says that over the past year, PSI tion in the works requiring patients to profit dedicated to building partnerships has facilitated meetings with pharmaceu- be informed about reprocessed single- for better health care in Southeastern tical companies, device manufacturers, use-devices, she says, “In most cases, PA, says, “Hospitals’ commitment to the government officials, pharmacies, public patients are more comfortable knowing ‘green revolution’ is a critical objective health groups and other key stakeholders that they are getting items that have nev- for the Delaware Valley.” She says that to recommend the development and im- er been used before – especially when the 20 hospitals in her region have been plementation of a “model state program considering an invasive procedure” working together since mid-2007 to re- for Massachusetts” based on a modified Scott Townsend, owner of duce the impact on the environment by producer responsibility system, the details Townsend Surgical relates that his dis- reducing regulated medical and general of which remain to be negotiated. “The posable business has been average to waste, managing pharmaceutical and goal of the project is to maximize the safe slow and his biggest challenge has been toxic waste and developing environmen- collection and disposal of used medical finding precisely what customers want tally preferred purchasing. “A prominent sharp devices,” says Fletcher. “The proj- amongst the enormous variety of medi- achievement has been reducing the vol- ect is in-line with other PSI initiatives cal disposable devices available. He ume of infectious waste among the re- to directly involve the manufacturers of anticipates that business will continue gion’s hospitals by more than 40% in the products that create challenging waste is- as usual with “steady slow growth over aggregate,” says Flynn. “Best practices sues in creating solutions.” the next six months, especially in mar- are being compiled and, along with case kets outside of the U.S.” Townsend sells studies, will be posted on HCIF’s web DOTmed users express and repairs equipment to hospitals, sur- site as a resource for other hospitals and their opinions gery centers, clinics and dealers, nation- health care providers.” Jennifer Westbrook, CEO of Precision ally and internationally. He said that he Surgical Supply has firsthand knowl- sometimes will sell disposables outright Disposables in the home edge as a former phlebotomist of many or on consignment from a medical facil- health care environment disposables on the market. She said that ity, but he will not touch certain products Disposable needles, syringes and lancets for her company, sales of disposable that are injectable or contain liquids. represent the lion’s share of home health products have remained strong despite Another company, SONOTECH, care SUDs. It is estimated that over three current economic conditions. As far as has a product in unit dose packets that billion disposable needles and syringes the environment goes, Westbrook says, is designed to prevent cross contami- and an additional 900 million lancets (col- “I find the biggest challenge is finding nation. Marian Larson, Marketing and lectively called “medical sharps”) are used a balance between having an environ- Sales Manager at SONOTECH says, outside of health care facilities in the U.S., mental conscience and awareness with “57% less plastic waste is generated and two-thirds of these are used by those providing supplies that will be of the by the average hospital when it used managing their own (or their pet’s) health most benefit to our clinics, hospitals and Clear Image Singles rather than 250 ml care at home. Self-injectors are known to – ultimately the patients. bottles. It’s not only cost effective for discard medical sharps in trash containers Westbrook is confident that the health care facilities – it’s also kind to in homes and public places and in other SUD market will continue to grow. the environment because it reduces public settings such as hotel rooms, air- There continues to be a great need for waste.” When the ‘average’ hospital ports and toilets. These disposal methods these products,” she says. As the world performs around 20,000 scans per year, create potential dangers for the trans- market grows, so will the need for re- that waste reduction is significant. Online: dotmed.com/dm8561 mission of infectious diseases. Sierra E. processing.” Wetsbrook says that she •

DOTmed Registered Disposables Equipment Sales & Service Companies For convenient links to these companies’ DOTmed Services Directory listings, go to www.dotmed.com and enter [DM 8561] Names in boldface are Premium Listings.

Name Company - Domestic City State Certified DM100 Jenny Westbrook Precision Surgical Supply, LLC Westminster CO Dan Vukelich AMDR Washington DC Juan Cortes Sensor Medics Corp. Homestead FL Robert Copeland Consultant Winston Salem NC Ralph J. Pesant RJP International, Inc. Baldwin NY Dawn Nightshade Medequip Engineering Service, Inc. Central Point OR Scott Townsend Townsend Surgical Knoxville TN • Marian Larson Sonotech, Inc. Bellingham WA • • Name Company – International City Country Certified DM100 Jorge Martinez Laboratorio De Tecnologia Electronica En Medicina, LTEM SA DE CV Mexico City Mexico

30 DOTmedbusiness news I a p r i l 2009 www.dotmed.com How the Country’s 4th Largest Health Care Facility Became #1 In Being Green

By Robert Garment ackensack University Medical Center (HUMC) • 6,200 babies born Photography by Titus Kana is an impressive complex of 14 buildings spread • 76,000 inpatient admissions over several acres. At its heart is a 775-bed • 77,000 CT scans performed teaching and research hospital affiliated with • 105,000 visits to the emergency room the University of Medicine and Dentistry of • 5,347,000 pathology procedures performed. NewH Jersey – New Jersey Medical School. HUMC has more than 7,200 employees and an annual This award-winning facility that has just about everything budget of over $1 billion. There are more than 1,400 physi- is missing the one thing most other hospitals have in abun- cians and dentists on staff. HUMC is the largest provider of dance: that pervasive, not-so-pleasant “hospital smell.” And inpatient and outpatient services in the state of New Jersey, and for that, the patients, visitors, and staff alike have environmen- it’s a very busy place. For example, in 2008 alone at HUMC tal advocate Deirdre Imus to thank. there were more than:

DOTmedbusiness news I a p r i l 2009 31 How fast can you turn Greening The Cleaning products around an ocean liner? are so safe to To get a facility the size of HUMC to use, they’re used make any large-scale change — such inside the nursery as revamping their entire housekeeping full of newborns at process — is a daunting undertaking. the Women’s and Children’s Pavilion It’s somewhat akin to turning around an at Hackensack. ocean liner steaming at flank speed. So what kind of person would approach HUMC’s President and CEO to convince him to “green” such a bustling facility — particularly given the rigorous standards for cleanliness a hospital must maintain?

Meet Deirdre Imus, and learn what makes her tick Deirdre Imus began to take a serious interest in the correlation between variations in my diet could affect my come in contact with on the environment and an individual’s performance on the track. I paid at- a daily basis,” Mrs. Imus health when she was attending col- tention to the food I ate, and it was observed. “From what I lege at Villanova. “Because I was in- easy to extend that concept to all the learned, I became a vegetar- volved in athletics at school, I wanted things that could affect my health, ian, and have been for about to be as fit as possible. I learned how and of course, that’s everything you 25 years now.”

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32 DOTmedbusiness news I a p r i l 2009 www.dotmed.com Meanwhile, back at the Ranch… The Imus Cattle Ranch In 1992, Deirdre met Don Imus, the noted radio talk show per- sonality. The two soon married, and because they were both for Kids with Cancer committed to helping children battle cancer, they started the The Imus Ranch is an authentic, 4,000 acre cattle Imus Cattle Ranch for Kids with Cancer in 1998. ranch located near Ribera, NM, approximately 50 miles “The concept behind the Ranch was to create a pristine northeast of Santa Fe. Ten times a year for two-week environment for the children — from all-natural building sessions, the Ranch welcomes children suffering from materials, to growing our own organic food without insecti- cancer, serious blood disorders, and those who have cides. We also teach them that they’re normal children, who lost siblings to Sudden Infant Death Syndrome. The happen to be sick, and that they can do pretty much what Ranch is a 501(3)(c) charity financed by Don Imus’ any kids do, given the right environment and encourage- fundraising efforts, and by 100% of the profits from ment,” Mrs. Imus shared. “At one point during the second Deirdre Imus’ retail Greening The Cleaning (GTC) year we were at the Ranch, a question occurred to me: was product line and Imus Ranch food products. the typical hospital environment — where many of these kids spent a lot of time being treated — healthy, particular- The Imuses make sure that parents and their chil- ly since they are cleaned 24/7? That well-known ‘hospital dren understand the Ranch’s fundamental philos- smell’ made me think not, and further research proved that ophy. It is not your typical summer camp — at all. was definitely the case,” Mrs. Imus concluded. And she set Or as Don Imus, in his own eloquent, understated out to do something about it. way puts it, “This is not Camp Happy Face.” The children work from dawn to dusk doing the jobs of The moment of truth real cowboys and cowgirls. They round up horses Mrs. Imus went to the President and CEO of Hackensack and Texas Longhorns, herd and feed sheep, buffalo, University Medical Center, John Ferguson, with a thick chickens, goats and donkeys, and also learn to rope folder filled with facts documenting the toxic ingredients and tie a calf. in conventional cleaning products. She also made the case Don and Deirdre Imus personally spend each day with the children at the Ranch. They say their objective is to encourage the children to experience a sense of achievement, responsibility and self- We Buy, Sell, Service, esteem through hard work and fun, while restoring their pride and dignity. Many children are convinced and Repair All that because they are sick they are not normal, but Pathology/Histology at the Imus Ranch they quickly discover they can do anything any other kid can do. Lab Equipment.

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DOTmedbusiness news I a p r i l 2009 33 able areas. That’s a great deal of real During our tour of Hackensack, we came across a typical housekeeper’s cart, which, as Mrs. Imus proudly displays, estate. And all of it is cleaned with is full of Greening The Cleaning products. GTC products. It’s the job of Alan Lee, Administra- tive Director of Information and Guest Services, Environmental Services, and Operator Services for HUMC, to over- see housekeeping. He says, “HUMC is totally committed to the GTC program. I came on board about a year after the transition to GTC products was made and from that day to this, when you come to Hackensack University Medi- cal Center, it doesn’t smell like you’re in a hospital. To me, that is the sweet smell of success.” While most of HUMC’s buildings are cleaned by on-staff employees, some cleaning services are provided by outside contractors. “It’s stipulated in those contracts that the outside vendors must use GTC products. And not sur- prisingly, they’re happy to do so,” Mr. Lee noted.

Yes, disinfectants are used, as needed, in conjunction with the GTC Program “I want people to understand that the GTC products are not the only cleaning products we use,” Mr. Lee observed. “There are situations in the hospitals that call for the use of a disinfectant. Many hospitals use bleach-based disinfectants, which are very harsh. The one we use at HUMC is TBQ from Steris, an EPA- approved quaternary-ammonia based product. We use TBQ, as a disinfectant, that housekeeping tends to overuse oped from all-natural, non-toxic ingredi- in concert with GTC products in all pa- harsh disinfectants to clean just about ents, they were put through Hackensack’s tient rooms during terminal cleaning, everything and anything. “I was ready rigorous efficacy testing. The results of so we do both a thorough and environ- for a whole lot of skepticism on his those tests were extremely satisfying to mentally responsible job. Since HUMC part. He could have said, ‘You’re cra- me because our Greening The Cleaning has had one of the best outcome records zy, go away,’ but about five minutes (GTC) formulations not only exceeded for any hospital over the last five years, into our discussion he essentially said the necessary standards, they actually did that’s proof using GTC products does not ‘Deirdre, you’re right, these products better than many of the harsh chemical compromise our patients’ health. In fact, are noxious, and if you can deliver cleaners which were in daily use,” Mrs. GTC has helped contribute to those bet- a natural solution that’s as effective, Imus noted with pride. ter outcomes, so the products are time- then do it.’ And that’s how ‘Greening tested and proven,” Mr. Lee added. The Cleaning’ was born,” Mrs. Imus Cleaning more than 3.4 recalled. 2006 U.S. Environmental Getting the go-ahead to ‘green the million square feet on a cleaning’ was one thing. Developing a regular basis Protection Agency new line of cleaning products that would The 14 buildings on HUMC’s campus Region-2 Quality Award meet the high standards within a hospital contain approximately 3.4 million sq. HUMC has received many awards for was an even bigger challenge. “When we ft. of floor space — not to mention all excellence in healthcare. The GTC pro- came in with the formulations we devel- the windows, walls, and other clean- gram has added to that total. In 2006,

34 DOTmedbusiness news I april 2009 www.dotmed.com the regional office of the U.S. Environ- The Deirdre Imus Environmental Center mental Protection Agency recognized for Pediatric Oncology both Hackensack University Medi- The Deirdre Imus Environmental Center cal Center and The for Pediatric Oncology was founded in Deirdre Imus Envi- 2001. Its creation was inspired by Mrs. ronmental Center for Imus’ concern for children’s health and Pediatric Oncology for their the success in the greening of Hacken- contributions to environmental health. sack University Medical Center. And in April, 2008 the New Jersey In Mrs. Imus’ own words, the mission of Chapter of the U.S. Green Building the Center is, “to identify, control, and Council (USGBC) bestowed its first ultimately prevent exposure to the environmental toxins that are causing Green Product Award on the Greening children to become sick – that’s the bottom line.” the Cleaning line of non-toxic com- mercial cleaners. Deirdre and the staff strive to bring about fundamental health improvements in the lives of children today and in generations to come. Through Changing the long-held their education and outreach programs, they help disseminate information for parents and the community. They formed a task force to investi- notion of what “clean” gate the reported high incidence of autism and other learning disorders smells like among children born to teachers working at a school in New Jersey. Mrs. Imus noted that, “one of the ironic They are also leading a clinical study to investigate a pesticide-free al- challenges we face when convincing ternative to traditional head lice treatments. people they should use GTC products is that one of their greatest benefits, the The Center also has a dedicated Greening The Cleaning (GTC) Team lack of a noxious odor, goes against the that helps hospitals, schools, and other facilities transition to the award- commonly-held perception that clean- winning GTC program — which typically can be achieved in 7 to 14 days. ing products should have a bleach-like Marketing for the GTC program includes an array of new distributor and or ammonia-like odor. What ‘clean’ customer support initiatives. Their evolving network has global reach. should smell like should be the absence Towards this end, The Deirdre Imus Environmental Center has recently of odor, and not the smell that comes partnered with a number of organizations that employ the disabled, blind from harsh detergents and the other and visually impaired. These business partners provide complete cus- products we typically clean our homes tomer service and order fulfillment activities for GTC’s growing list of and businesses with,” she added. institutional clients. A facility can go green in Contact the Center to talk about environmental issues or concerns, or just 7 to 14 days inquire about the Greening The Cleaning program. Transitioning to the GTC program is quite easy. HUMC was the first HOW TO CONTACT THE CENTER: hospital to do it, and since then, ap- The Deirdre Imus Environmental Center for Pediatric Oncology proximately 500 business enterprises Hackensack University Medical Center have gone GTC green. This includes Research Building, Room 240 over 70 health care facilities, includ- 30 Prospect Avenue • Hackensack, NJ 07601 ing multiple hospital systems, more Phone: (201) 336-8071 • Fax: (201) 336-8161 than 100 schools and school systems, www.dienviro.com • Email: [email protected] and hundreds of other businesses and corporations. “Since the housekeeping person- nel are essentially replacing offending cleaners with benign GTC products, their training period is short and easy,” Mrs. Imus said. “Our GTC Team comes in to do the training. And basically, that involves showing housekeeping per- sonnel which GTC product is best for a given job.”

DOTmedbusiness news I a p r i l 2009 35 Going green can save up to 30% or more on housekeeping products “Most people today assume that ‘organic’ and ‘all-natural’ products are more expensive,” Mrs. Imus observes, “but that’s not the case with GTC products at all. Switching to GTC is at least budget-neutral, and in many situations significant savings are re- alized on an annual basis,” she adds. For instance, Ray Garcia, Director Environmental Services, Silver Hill Hospital, New Canaan, CT, said they save about 20% annually using GTC products. And Luann DeFalco, Man- ager Environmental Services, St. Vin- cent’s Hall-Brooke Behavioral Center, Sunrise Medical Bridgeport, CT, said they are realizing an annual savings of 33%.

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A safer environment and better morale for staff One of the common problems with the harshness of standard cleaning products is that housekeeping staff sometimes have allergic reactions to the products. “Since the GTC program was instituted, staff is no longer exposed to toxic chemicals that could potentially cause reactions,” says Mr. Lee, “this lets all our employees enjoy a better work environment.”

36 www.dotmed.com A micro- technology becomes a major business By Keith Loria ust about everywhere you look copy Association of North America now The Players arthroscopic procedures are on calls a billion dollar industry. While OEMs such as Stryker, CONMED rise, attributed to their mounting Advancements in endoscopes, fluid Corp, Storz and Olympus continue to scope and usage in the diagnosis management systems, cameras, pow- see sales rise yearly, companies such and treatment of ankles, elbow, ered instruments, displays, and hand as Advanced Endoscopy Devices, Inc. wrists,J hips and knees. Shoulder proce- tools are encouraging surgeons to pre- have graduated from service and refur- dures are also expected to increase with fer the use of arthroscopic devices to bish sales to manufacturing their own the introduction of advanced knotless open procedures. Some believe the ar- new arthroscopic equipment and are fixation systems by some of the OEMs. throscopy market is driven by increased seeing success. When you are dealing with the utilization in sports-related injuries, as “It’s pretty competitive out there. business of arthroscopy equipment, you a majority of orthopedic surgeons find One thing that has really helped us is need to look into more than just the ar- arthroscopic surgeries to be less risky. the fact that we don’t have many play- throscopes themselves, as a typical ar- In a recent marketing report created ers, like Storz or Stryker. We don’t have throscopy system can include camera, by Global Industry Analysts, Inc., they to do the big mark-ups so our prices camera cables, light source, sheath, cite arthroscopic visualization instru- are typically 60% below what the other color monitors, printers, fiber optic ments as representing the largest as well manufacturers sell them for,” says the cable and accessories. Accompanying as the fastest growing segment of the company President John Dawoodjee. instruments include shavers, cannulas, field in both the U.S. and abroad. In fact, “For independent distributors and peo- blades, burrs and forceps. All of these it is expected to reach more than $515 ple from other countries wanting to buy components make up what the Arthros- million in the U.S alone by next year. product, our price advantage is so much

DOTmedbusiness news I a p r i l 2009 37 Cut-away view of an arthroscope (Image courtesy of Rigid Repair Center)

greater and we have seen an increase in Refurb process $1,000. When you start comparing those sales.” Over at Knoxville, Ten.-based Townsend prices to those of a refurbished system, Then there’s the refurbished market, Surgical, owner Scott Townsend deals you understand why business has been which has also been thriving according in refurbishing all types of arthoscopic booming for most. to the companies who sell, service and equipment, from scopes to shavers to “They can save a lot of money on deal in this equipment. cameras. The amount of work needed a refurbished unit and we can duplicate “Our company sells refurbished ar- on each varies from piece to piece. the functionality and can save a surgeon throscopes from all the manufacturers “An all OEM scope that passes the more than 70% on a lot of this,” says Ti- and we’ve seen sales increase steadily function tests perfectly and survives the pei. “One Stryker shaver can be $7,000 over the years,” says Cornel Cacuci, Of- autoclave with no moisture intrusion but we can refurbish it and bring it back fice Manager for Apex Endoscopy Inc. will be re-sold without doing anything to life and sell it for under $1,000.” in Lawrenceville, Ga. “We’re refurbish- but the testing,” says Townsend. “Con- Same holds true for the cam- ing about 40 a month and we haven’t versely, a camera may be entirely rebuilt era systems which can run from seen any change with the downward including the prism and the cord.” $20,000-$50,000. A refurbished camera trend in the economy. The refurbished Danny Tipei, Owner of Skokie, IL- can go on the market for anywhere from market is still strong here.” based Inex Surgical, Inc., believes that $1,000-$10,000. Arthroscopes have evolved to bring reverse engineering the new equipment brighter, sharper images to the physician is the best way to know how to refurbish Fixer Uppers and there seems to be a “latest and great- the equipment to peak specifications. The popularity of arthroscopic proce- est” piece of new equipment coming to Arthroscopic instruments that come dures comes from a surgeon’s ability to market every other month. Of course, as in get inspected, taken apart, cleaned, examine joints through small incisions more applications evolve for using this have bearings and seals replaced, and and it is that sensitive, micro-technology equipment and the OEMs continue to put through a performance test. Then that often leads to equipment damage. roll out advancements on a regular basis they measure the motor coils, test the Tipei offers up a laundry list of to fill the need, some of the older equip- sensors, the shavers, repair the consoles, things that can go wrong with these del- ment may not hold its value. and look at the power supply. icate instruments as the miniature cam- “One of the biggest challenges is “The only blue prints we have are eras, lenses, light source and the fiber trying to gauge the future value of equip- the ones we made on our own, and we optics inside the scope are all vulner- ment that is on the secondary market. As understand how the different components able. Things are dropped, bent, sliced the OEM’s continue to bring new prod- and parts work,” Tipei says. “Everything by other instruments or they get dirty or ucts to market and with high frequency, that has to do with arthroscopy from small simply are overused and are susceptible equipment that was once in high demand shavers to video cameras to scopes we re- to normal wear and tear. can lose a large portion of its value due to pair, refurbish and service here.” “With scopes going down very fre- newer generations continually showing quently—due to, for example, a doctor up on the secondary market,” says Philip By The Numbers who doesn’t maneuver a shaver or laser Mothena, President of Simple Solutions, When you look at a new arthroscopic very well and cuts the tips off scopes or Inc., a pre-owned dealer based in Vir- system from an OEM such as Stryker a facility where they don’t have enough ginia. “Another hurdle recently has been or Olympus, you are dealing with prices scopes in inventory and resort to overus- facilities being very reluctant to spend in the tens of thousands of dollars. A ing the scopes that they have, it’s impor- the capital on upgrading their existing camera can run upwards to $50,000 by tant to have everyone prepared,” he says. equipment, or expanding their current itself, scopes average around $7,000, “My technicians know how to search arthroscopy set-ups.” while sheaths average a little under blind and repair to the component level.”

38 DOTmedbusiness news I a p r i l 2009 www.dotmed.com Michael Lay, Principal of Chesterfield, Mo.-based Life “There are way too many people doing repairs and Systems, Inc., also understands the importance of having ex- sales these days. I have been doing repair business for over perienced service people when fixing arthroscopic equipment 15 years now and have seen the cost of the repair go up to make his company stand out. and the price I can charge my customers go down,” says “For flexible scopes we have a senior technician with pre- Adam Rudinger, President of Lex-Tech, Inc., which deals vious OEM experience. We have a head technician in rigid in refurbished arthroscopes. “This is due to a glut of repair that was also previously with a major OEM. Our camera lead companies that have popped up over the past few years. The technician has 15 years camera repair experience with three new guy tries to undercut the existing guy and then a price major repair companies,” Lay says. “This is delicate equip- war ensues.” ment and you need the best people if you are going to provide This could affect the industry in the years to come. the best service.” Todd Abrams, President of Rigid Repair Center in Welling- International Market ton, Fla., repairs on average, 350-400 scopes a month. Economic growth, corresponding increase in living standard, “What we do is a-z repairs on 99.9 % of the rigid endoscopes and aging population would continue to create a greater de- that are out there,” he says. “We do a three-level system here. mand for arthroscopic procedures throughout the world. Level 1 would include a basic cleaning, opening up of the scope, Global Industry Analysts, Inc. reports that the United evaluating what’s wrong with it, replacing one rod lens, clean- States, Europe, and Japan account for more than 85% of the ing the scope and putting it back. Level 2 would be replacing the global market for arthroscopy. Meanwhile Asia-Pacific and objective lens system, the working end glass piece, which is the Latin America, each at about 10%, constitute the two fastest expensive part. Level 3 is a complete rebuild. We will replace the growing markets during the last decade. inner and outer tubing, fiber-optic bundle, and any and all parts Those numbers have opened up the eyes of Advanced En- necessary to bring it back to factory specifications. If it’s run over doscopy Devices, Inc. as they look to sell their new equipment by a bus we can fix it.” overseas. Perhaps that’s why service companies have seen their business continue to grow over the years, even in today’s economic climate. “We are doing more than usual. I am seeing the future for repairs, at least in terms of the next year or two as the economy picks back up,” says Abrams. “The hospitals are not getting the budgets they used to get so they can’t buy those new toys with the bells and whistles and need to fix their old toys, which is our niche market. Business has been very good, especially since October.”

This arthroscope’s tip was hit by a shaver during a procedure and the tip was particially shaved off. (Image courtesy of Rigid Repair Center)

But when so much business exists, that opens up the door for more businesses to try and take a stab at the market. Abrams says there are at least 275 arthoscopic rigid repair shops that he knows of, but many are operating out of their garage with little experience, no insurance and not much to stand behind their business except for slightly lower prices.

DOTmedbusiness news I a p r i l 2009 39 DOTmed Registered Arthroscopy Equipment Sales & Service Companies For convenient links to these companies’ DOTmed Services Directory listings, go to www.dotmed.com and enter [DM 8552] Names in boldface are Premium Listings. Name Company - Domestic City State Certified DM100 John Woods Advanced Endoscopy Devices, Inc. Canoga Park CA David Bello Endoscopy Replacement Parts, Inc. Newberry FL Todd Abrams Rigid Repair Center Wellington FL Cornel Cacuci Apex Endoscopy, Inc. Lawrenceville GA Danny Tipei Inex Surgical, Inc. Skokie IL • Sam Kanaan Laproman Dearborn MI • Asif Bhinder tekyard Burnsville MN Marcus Rosenberg Endoscopy Development Company LLC Bridgeton MO Michael Lay Life Systems, Inc. Chesterfield MO • Jason Eden Bio Basics Global Park Hills MO • Edward Soto SterilMed’s Scope Exchange Greensboro NC Adam Rudinger Lex-Tech, Inc. Greenwich NY Roger Katona Zoi Surgical, Inc. Chesterland OH Scott Townsend Townsend Surgical Knoxville TN • • Stephen Rousset Medical Equipment Solutions Beaumont TX Philip Mothena Simple Solutions, Inc. Blacksburg VA Robert Overmars BPI Medical, Inc. Fife WA

Name Company – International City Country Certified DM100 Kashif Saleem Ansari Medical Karachi Pakistan

“The international markets such as Asia and South Amer- says Dawoodjee. “Our international market is only 20% right ica are very much in demand for arthro equipment right now,” now but we are hoping to increase that number, because more and more countries are demanding that they get new products ERP_ad_0508:Layout 1 4/17/2008 4:08 PM Page 1 and we can supply them with what they need.” Obviously, the pre-owned equipment is attractive for for- eign markets since they don’t often have the same budgets as When it comes to U.S. hospitals. endoscopy replacement parts, Cacuci has seen his company increase refurbished equipment to places like Taiwan and Brazil, because they are inter- everyone comes to ested in getting the most for their money. Endoscopy Replacement Parts. What lies ahead In the next few years, the most obvious advancement that is starting to already come into play from the OEMS, concerns clearer imaging with HD video systems and wireless technologies being introduced. Scopes, cameras, fluid management systems and power instruments are all being seamlessly integrated into customi- zable OR systems, alongside high-definition monitors and • First to mass-produce precision aftermarket components wireless camera heads, which offer greater data capturing compatible with Stryker, Olympus, Wolf, Fujinon, Pentax, flexibility and enhanced image viewing. This helps to maxi- ACMI/Circon, Dyonics, K. Storz, Richards, Linvatec and many more mize space, reduce procedure and turnover time and enhance surgeon control. • State-of-the-art facilities “It’s a strong industry and you have to keep things state • Send us blueprints or sample parts for free evaluations of the art and have the ability to offer things that other peo- and quotes ple can’t,” Dawoodjee says. “I think a way the business will change is more and more hospitals will not want to do busi- • Over 120 years combined experience ness with people coming to them, realizing the savings of purchasing on-line.” When you have a billion dollar industry where the mo- EndoscopyERP Replacement Parts, Inc. mentum doesn’t seem to be waning, there seems to be plenty 25430 NW 8th Lane, Suite 100 Newberry, FL 32669 877-650-8909 of business out there for everyone right now. www.endoscopeparts.com Online: dotmed.com/dm8552 [email protected] •

40 DOTmedbusiness news I a p r i l 2009 www.dotmed.com re you willing to lose We will highlight the full spectrum thousands of dollars due of equipment, from the high-end to the to an unforeseen prob- low. We will offer feedback on the ser- lem? Are you willing vicing of all this equipment from the to gamble on a patient’s perspective of the Original Equipment well-being or your livelihood? Manufacturers (OEMs), to Independent A rd Most people attempt to avoid the Service Organizations (ISOs) to 3 Party types of problems that could cost them and even in-house servicing. Get the in- majorly. In the medical industry, one of formation you need to know to make the the best ways to avoid problems or to best decisions for your servicing needs. at least minimize them is to make sure Additionally, we want to hear your your equipment is being serviced in a service questions. Let us know what’s on time-efficient and cost effective way. your mind and we’ll introduce your ques- DOtmed realizes this is a concern tions to those who have the answers. for many of our readers and that is why Keep watch in upcoming issues of we will be bringing you information on DOTmed Business News for more infor- servicing equipment in future issues of mation that you can’t afford to ignore! the magazine. We will feature different modalities in each issue and spot- Have a service light service issues you may encounter Spotlight along with the expense (or savings) you related question? should anticipate depending upon how Contact us by email today. on Service you address the needs of that machine. [email protected]

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DOTmedbusiness news I a p r i l 2009 41 Green Machines Recycling Used Medical Equipment By Kathy F. Mahdoubi

verything moves in reverse at Newtech Recycling’s knives are outside his league, he says. Enter Martin Camp- computer and electronics recycling facility in Som- bell, president of Campbell Technological Resources, Inc., erset, NJ. Technicians operate in much the same way and Tommy Geske, president of Sunrise Medical Technol- as you might see in a manufacturing video played ogy, Inc. These gentlemen are versed in the “scrapping out” backwards. Each piece of equipment is processed of most of these and other types of medical equipment. and broken down: first the casing and the circuit boards, the plas- E “When we bring the equipment in we obviously take tics and metal components and the wires, until there is nothing left except the individual components used to manufacture them. a look at it and make sure that there are no surprises,” Jim Entwistle is President of Newtech Recycling, says Campbell. “CT and X-ray will have oil-fill trans- Inc. He encounters defunct diagnostic X-ray equipment formers and those will have to be segregated and handled regularly, and it’s his business to know exactly what to with great care. MRI magnets are typically very heavy -- do with it. For the most part, there is no guesswork. 6,000 to 30,000 lbs, so those require special equipment “It comes in and we take it apart,” says Entwistle. “I for handling.” am truly the end-of-life person in this process. I’m the Each piece of equipment has its own decommission- end of the line.” ing and recycling protocol. With MRI, this protocol is split A push toward environmental health and regulation even further depending upon the type of magnet used. has increased recycling across the country and much of the “There are two different kinds of MRI magnets,” world, but the business of recycling is also encouraged by explains Campbell. “Cryogenic magnets can be ramped financial opportunity. The green movement in the medi- down. You can use the resistance and the power sup- cal equipment industry is much the same as any other in- ply to pull some energy out of the magnet and allow the dustry that recycles. A technologically advanced piece of magnet to ramp down. If you have a permanent magnet, equipment like a CT or PET scanner or MRI has a rela- you must ship the magnet in a container that protects the tively long lifespan and can be bought and sold a number environment from the magnetic field.” of times before being considered officially obsolete and re- “Most MR machines have a ‘quench’ circuit, which tired from the regular medical field, but the usefulness does automatically shuts down the magnetic field,” says not end there. Some medical technologies can be used for Geske. This is a good thing, because of the cost and labor other applications, in veterinarian medicine, for instance, or issues involved in ramping down a magnet. Once a mag- converted for use in industrial applications. If equipment net is quenched there is ordinarily no remaining magne- doesn’t find a new career in one of those fields, several tism, although some kinds of steel have been known to imaging technologies, including X-ray, CT, MRI and PET retain some of the magnetic property. Proper inspection can be processed by specialized recycling companies and of the equipment ensures that it is safe to recycle. broken down into individual commodities – plastics, steel, MRI magnets themselves are a virtual metal quarry aluminum and copper, etc. – to be resold in those markets. waiting to be mined, but the present economy has de- “All of these materials will go back in as feed stock pressed commodity prices to such a degree that it is not for new manufacturing,” says Entwistle. “They go to re- nearly as profitable to scrap equipment as it was just fineries in the United States and also overseas, but it’s all twelve months ago. broken down.” “A year ago we did very well scrapping MRI and Even nuclear medicine technologies, such as linear CT, but there’s not a whole lot of activity going on with accelerators, which use depleted uranium shielding, and salvage right now,” says Geske. “We have seven mag- gamma knives, which house radioactive materials, can be nets in the warehouse that we’d love to scrap out.” rendered perfectly safe and can be recycled after being Instead of breaking down a piece of medical equip- properly processed by a licensed and trained professional ment into their respective commodities, folks like Geske for the removal of environmentally sensitive materials. are obliged to “sit on it” until prices are more palatable. Entwistle may occasionally recycle X-ray equipment, “For example, six to seven months ago aluminum but other types of equipment like CT, MR and gamma sold for a little over a dollar a pound. Today, it’s down to

42 DOTmedbusiness news I a p r i l 2009 www.dotmed.com above 15 cents a pound,” he says. “Copper hit an all-time medicine. Hebert Marquez is president of Radiation Oncolo- high of $4.15 and now it’s down to $1.12.” gy Services, Inc, a CA-based company providing worldwide Campbell continues to recycle equipment and seems installation, parts, service and removal of radiation therapy to be handling plummeting commodity prices with due equipment. Marquez says that some machines, like linear ac- patience. If the equipment is delivered to their facility, celerators, do not contain radioactive material, but do produce the elimination of transport cost keeps scrapping profit- radiation that may irradiate the machine’s depleted uranium able. When one market suffers, others may thrive. The shielding, thereby requiring special handling. resale of medical equipment for veterinarian applica- “Everything can be recycled except for the DU – the tions appears to be a robust market. With no insurance depleted uranium needs to be disposed of properly,” says reimbursement issues, selling to veterinary practices can Marquez. be far more attractive than dealing with medical prac- Philotechnics, Ltd. operates out of Tennessee and is tices that may be hindered by payer agendas. one of the relatively few companies licensed to contain “Veterinarian medicine represents an alternative for and remove radioactive materials from decommissioned a business person to get involved with because it’s a cash nuclear medicine equipment. This process is regulated in business,” explains Geske. part by the Nuclear Regulatory Commission (NRC). Other applications for resold medical equipment “Depending upon what state you live in, the Nuclear come care of the industrial sector, Geske Regulatory Commission has authorized indi- says. CT technology is often used in vidual states to administer their own rules,” non-destructive industrial applications, says Andy Armbrust, president of such as testing the structural integrity Philotechnics. “This is called the of vessels and pipelines, and more agreement state process.” specifically for testing industrial The NRC and state regulatory agen- welds. Another option for used cies license and inspect equipment medical equipment is in- Recycling involved in nuclear medicine, ternational exportation – medical such as those that require or yet another cash market. produce radioactive sources. “Perfectly functional equipment is Examples of these include equipment is oftentimes ex- still typically a blood irradiators that use ported to parts of the world better option cesium-137 sources, and where new models just cyclotrons, which are used aren’t affordable, like parts in proton therapy and can of Russia and South America,” produce a variety of proton- says Geske. Other regions, like emitting radionuclide tracers for Africa, are underserved and in use with PET scanners. Another more desperate need of important example is gamma knife technol- diagnostic equipment. In this case ogy, which pinpoints and destroys “you might have two or three CT scan- cancerous tissues by administering a high ners in a country of 15 million, and no MRI technology.” dose of radiation using cobalt-60 sources. In or- But governmental and environmental-group regula- der to be recycled these and other types of equipment need tions regarding the export of used medical equipment are to be demanufactured and the radioactive sources removed growing steadily more stringent, especially on the receiv- for the half-life, or period of decay, of the respective radio- ing end. For instance, several countries throughout the nuclide, says David McIntyre, public affairs officer for the world have implemented embargoes against importing NRC. X-ray and CT technology is not regulated, because used medical equipment. Brazil has such an embargo, while they may conduct radiation, they do not contain any and China does as well. This is partly due to the careless radioactive materials themselves. and predatory resale of nonfunctional equipment. No matter what the equipment is, there is probably “That’s why China closed its doors to the US for a method for recycling some, if not most of it. The sal- used equipment,” says Geske. “It wasn’t rebuilt or refur- vage and commodities market may not be as profitable bished and ended up being junk and never worked.” as it has been in the recent past, but recycling medical Uninformed owners of large, complex medical tech- equipment is still typically a better option than outright nologies are often in “a quandary” as to what to do with their disposal for the environment and your bottom-line. equipment, but that is not as much of an issue in nuclear • Online: dotmed.com/dm8562

DOTmedbusiness news I a p r i l 2009 43 shows & conferences ANI: Healthcare Finance Conference June 14-17, 2009 Washington State • Convention and Trade Center

ound Judgment and Fresh Thinking is what the you are facing. And choose from six CPE-eligible HFMA Educational Foundation will be promot- sessions highlighting HFMA Peer Review(RO) ing from June 14 through the 17th at the ANI: The products and services, featuring leading-edge Healthcare Finance Conference with renowned provider case studies and solutions. Experience Keynote Speakers including The Honorable Al the latest technology and innovative solutions. SGore, Patrick Nencioni and Karen Davis, Ph.D. Make plans to register and save! Go to The Healthcare Finance Conference offers more than 80 cur- www.hfma.org. rent, in-depth, expert-led sessions including “Breakthrough Fi- • Online: dotmed.com/dm8563 nancial Performance and Risk Management Practices,” “Refining Cost Management,” “Revenue Cycle Best Practices in an Uncer- tain Economy,” and “Rethinking Capital Strategies and Source.” “ANI is the meeting for healthcare finance professionals. It has the biggest attendance and the best programs of any healthcare finance conference in the industry. The interaction I’m able to have with other healthcare finance professionals at this conference is priceless,” says Dennis Doody, CPA and Managing Director Health Care Commonfund. The Honorable Al Gore will present - Thinking Green: Economic Strategy For the 21st Century. Arguing that physical changes in our plant will eventually influence our global economy, Vice President Gore encourages businesses, including health care, to consider broader issues – environmental, social and political – when planning economic strategy. Patrick Lencioni will open session with The Five Temp- tations of a Leader, explaining how leaders often fail to see that the answers to their problems are buried within the same common sense that makes them good parents, spouses or little league coaches. Lencioni captures the common pitfalls that all leaders face and provides practical ways to overcome them. Karen Davis, Ph.D., presents Moving Toward A High Performance Health System – facilitating a conversation with leaders of the country’s foremost health organizations who will share their vision and direction in advancing promising strategies for health system improvements. ANI 2009 will focus on the current economic and healthcare climate featuring numerous sessions targeted at cost savings, efficiency, revenue and capital strategies to help you lead your organization through turbulence and meet mission objectives. There will be more provider case studies and takeaways than ever before, offering a more diverse representation of hospitals and health systems, featuring case studies from the largest healthcare systems to smaller community hospitals. Interact with peers in sessions designed explicitly to generate practical take-aways and shred insights. Make contact with colleagues and learn how they are responding to some of the same issues

44 DOTmedbusiness news I a p r i l 2009 www.dotmed.com By Sean Ruck

Green Construction is a Bright Idea

ver the past few years line. Additionally, goodwill generated by struction, hardwoods may be favored but there has been more at- being responsible members of the com- the trees used for lumber are slow to grow tention paid to the en- munity helps to generate positive PR. to maturity. Meanwhile, bamboo grows vironment. With global “It’s my opinion that health care quickly. Either can be used for flooring, warming taking a center needs to take the lead in going green,” but bamboo is more sustainable. stage,O former Vice President Al Gore Schifano says. There are challenges Another material used for hospital waving the banner for nature, manufac- to face when introducing the concept. could be considered relatively friendly for turers offering “green” or at least more “Many times, we’re introduced to some- the environment – stainless steel. You’ll environmentally friendly products and one who has been running a hospital for see it everywhere. From legs on tables even a whole television channel dedi- many years they may be reluctant to and equipment to exam and lab table tops. cated to going green (Discovery Chan- change how they’ve been doing things, Stainless steel is easy to clean, requires lit- nel’s “Planet Green”), it has been a hot especially if they’ve been successful. tle maintenance (translating to less chemi- topic. President Obama even made it When we illustrate how they can make cals and waste) and is 100% recyclable. a main focus during his election cam- the change and actually save money, paign. Then the economy tanked. they usually are on board at that point.” -Health Suddenly, the environment was put The second aspect of green design isn’t on the back-burner. CEOs and presidents Two Sides to the Story as well-known, but that is beginning to who might have been considering some -Sustainability change. More information is being gath- changes to “green” their companies now If your hospital is thinking about going ered to show the correlation between said, “We’d like to be more environmen- green, it’s important to note that there materials we use to construct homes and tally responsible, but . . .” and the “but” are two key factors. The first is the one businesses. Some of that information is was the economic slowdown. Many feel that most people are familiar with – sus- troubling. Adhesive resins in plywood that the change is too costly to justify in tainability. To put it simply, sustainabil- and particle board have been shown to this time of economic uncertainty. “That ity will mean that you’re giving careful “off-gas” urea formaldehyde. The gas is not the case,” says Tony Schifano, consideration to what resources you use can cause respiratory irritation and may president and founder of Antos Environ- and how you use them. On the day-to- cause cancer. mental. “You can be environmentally re- day level, sustainability takes into ac- Other materials can be hazardous sponsible and still save money.” count how much waste is generated as well, so it pays to be informed. Better Schifano’s company has been help- by your hospital and how much of that yet, if you’re constructing a new hospi- ing hospitals and other businesses to waste is non-recycled. tal wing for tens of millions of dollars, it incorporate green sensibilities into their On a deeper level, one that can liter- wouldn’t hurt to pay an expert to make practice for more than two decades. By ally go all the way to the foundation of sure that your new wing will be the finding more and better ways to reuse and your hospital, sustainability takes into healthiest selection for the environment, recycle, costs are cut dramatically and account how renewable the resources are your employees and your patients. those savings go directly to the bottom that you’re using. For instance, in con- • Online: dotmed.com/dm8564

DOTmedbusiness news I a p r i l 2009 45 They’re Back! What the GE/OEC return means to the C-Arms market

By Keith Loria

ay 5 of 2008 was a monumental day in the C-arms world, as for the second time in as many years, GE MHealthcare and its OEC surgery business rocked the very foundation of the entire C-arms landscape. Let’s rewind back to January of 2007 when the FDA revealed that the current good manufacturing practices with the OEC C-arm were deficient at two OEC facilities, which resulted in a consent decree that effectively shut down shipments of the industry-leading OEC products, including the 9900 Elite C-Arm System, 9900 Elite NAV C-Arm System, 9800 C-ARM System, 2800 UroView System, 6800 MiniView Sys- tem, Insta-Trak 3500 NAV System and ENTrak 2500 NAV System. While this may have seemed like good news to the other OEMs, the sud- But everything changed again last In the full size C-arm market, GE re- den influx of orders created some chaos May when GE/OEC was cleared to reports high single-digit market growth and and supply problems. Philips came away lease some of its product and began the capture of more than 40% share of this with the lion’s share of the business manufacturing the popular OEC 9900 C- specific segment in 2008, climbing even thanks to their introduction of their new Arms once again. Even though they have higher in the year’s final quarter. generation of C-arms, which included still yet to get clearance for their vascular “That trend is very encouraging and the Pulsera, offering 3D imaging. or mini C-arms, their return has changed speaks to the quality and reliability our “Just when we finished developing the entire marketplace for both new and customers see in the product,” Usher says. Pulsera to the new platform, GE had the refurbished equipment once more. “In today’s economy, it is reasonable to consent decree and shut down operations “We came back in May with the OEC anticipate some pressure in the market, for 18 months,” says Scott Burkhart, Vice 9900 Elite, the most reliable product in but given C-arms are used in critical sur- President of general X-ray for Philips. our history, and sales have been great,” gical procedures and that these surgical “Three years ago we were a relatively mi- says Elizabeth Usher, Chief Marketing procedures are growing with increasing nor player and we really set about to fix Officer for GE Healthcare Surgery. “We focus on minimally invasive approaches, image quality and be world class in image see growth in the market in 2008 primar- we continue to anticipate growth.” quality, which was accomplished.” ily driven by our re-entry.” Not to say that the other OEMs are

46 DOTmedbusiness news I a p r i l 2009 www.dotmed.com hurting. Although they may have been and has a lot of loyal OEC buyers who “Since the gates have been opened caught off guard when the original stop- were willing to wait. When they are not up with OEC there’s been a good in- gap was announced, over the past two selling new, people aren’t buying; there flux of good equipment and prices have years many of them have better posi- are no trade-ins and nothing coming in come down substantially. That’s good tioned themselves into the market and on the used equipment market.” for everyone,” Serros says. even with the reemergence of GE, have Bill Adkins, President of National Russ Surratt, President of Bighorn continued to be successful. X-Ray Corporation, based in Palmetto, Biomedical Services, Inc. in Wyoming Siemens Medical Solutions had a Fla. has a 5,000 square foot warehouse isn’t so sure. While the company has done very profitable year by gaining popular- for parts, but has seen a drop in sales anywhere from 60 to 120 C-arm refur- ity with their Artis zee system, which over the past two years on equipment. bishments in the last five years, he sees uses contrast media for spatial visual- “Two years ago it was just incred- GE’s return as a bad thing for business. ization of blood vessels. Without com- ible,” Adkins says. “Before OEC had their “When OEC was down, we sold a petition from GE, Hologic picked up problem, we would get a truck load of C- whole bunch and now that they are deliv- about 90% of the mini C-arm business arms a month. At any given time I could ering again, we aren’t selling as many,” – more on that later. Meanwhile, Philips have 20 to 25 C-arms in the shop. Now, he says. “OEC is doing everything they took control of the vascular part of the we’re talking a handful. The used market can to get business so that includes price C-arms business and will soon release is still not back to where it used to be. Our and offering a much better warranty.” their new flat plate technology. volume has dropped drastically since the Surratt’s business is concentrating “Our market share skyrocketed and OEC shutdown. The amount of used C- on the vascular and mini C-arms for our reach into the market skyrocketed arms in the marketplace has been reduced now, but once GE is cleared to distrib- and we had a free run at the market for quite a bit in the past two years.” ute those, he expects another drop. 18 months. We took advantage of it and GE resuming shipment of C-arms The economic crisis has also played that made us a much better company in has increased the supply of used sys- a role in the refurbished market. You terms of operations, quality and proce- tems available, decreasing the whole- might think that people looking to save dures,” Burkhart says. “Philips has in- sale price to pre-shutdown levels. money would be good for the refurbished herited the vascular end and when we come forth with this flat plate technology, we will have not only inherited it, we will have refined it. The customers who have seen the platform and seen the images are excited about that.” At the time of the GE shutdown, industry experts pegged them as having held 70% to 80% of the market. That percentage now stands at closer to 50% to 60%; not bad for a product that has been gone for so long. “We had many customers who have been waiting for us to come back into the market and I think we have been welcomed with open arms,” Usher says. “The OEC 9900 Elite has a strong following in the U.S market and meets the surgeons’ needs in a number of surgical specialties.”

Domino Effect It’s not just the OEMs who were affected by GE/OEC, as the refurbished market for C-arms had to deal with less inventory, which was bad for business. “In the last six months to a year, the supply has been slow and the demand has been high so prices have been high for everyone—the end users, dealers, everyone involved,” says Robert Serros, Jr. President and CEO of Amber Diagnos- tics. “GE had such a large market share

DOTmedbusiness news I a p r i l 2009 47 market, which offers prices at as much as 70% cheaper than new, but the financial uncertainty has been felt by all. Philips BV Pulsera “It seems like the smaller clinics do not have the money to spend or are just unwilling to part with it,” says Adkins. “Many doctors that I know have personally lost quite a bit in the stock market; therefore they appear to not be willing to risk their remaining funds even on their own business.”

The refurb process Amber Diagnostics sold about 80 to 100 refurbished C-arms last year, and have a very stringent refurbishing process. “When it first comes in, we do proper inventory and assessment of the Columbia, has a different view than Mini C-Arms strong machine. From that point, it gets dis- many others. As noted previously, Hologic had just infected and is totally stripped down “One of the things we decided, introduced a new digital version of their with all major components taken off through our experience, is that the usual mini C-arm when the GE decree came the machine and disinfected again be- process of refurbishment, we completely down, so they inherited about 90% of cause of blood and other things,” Serros disagree with,” Horsman says. “Normal- the mini market. says. “From that point, they are sanded, ly, they get equipment at the end of life “The timing was good because we had prepped, primed, painted, re-decaled, and rewire, repaint and redo them. Our a good, solid product but the manufactur- and replacement parts are added and re- philosophy is to find the nicest, newest, ing couldn’t gear up any faster so we did assemble. We add upgrade features and best piece of equipment we can find so have a supply issue with lead times going replace worn parts and then put it back we don’t have to do all that to it.” from 30 days to as much as 90 days,” says together and we do a burn in where we At Bighorn Biomedical, the compa- Richard Keil, National Sales Manager for try to make it not work and put it under ny completely dismantles the C-arms and Hologic Fluoroscan. “We’ve been quick the most stressful circumstances. When goes through them at the component lev- learners and have gotten the lion’s share it passes that portion, we take it through el. “We put about 120 manpower hours of the business over the last two years and quality control measures.” into the unit,” Surratt says. “We replace really saw business boom.” When it comes to refurbishing the batteries that power up the unit and Since GE still hasn’t been cleared to C-arms, Wayne Horsman, VP Columbia the little batteries that run the computer ship their mini C-arms, Hologic should Imaging Inc. a C-Arms dealer based in system, which most people don’t.” continue to be the OEM leader. “The business of the mini C-arm is healthy because there’s a big demand and need for it,” Keil says. “It’s hard to get a hold of a large C-arm sometimes Anything less than perfect so when an extremity surgeon wants to do a foot or hand or ankle surgery, is not good enough. the perfect solution has been this lower cost, lower dose, mini C-arm.” Over the last few years, the biggest changes in the mini C-arms have been the switch from an analog system to digital system and from regular to flat panel monitors. 800-722-3646 One troubling trend that Keil has no- KPVGITKV[OGFEQO ticed in the last few months is that some customers are starting to be scared off by Over 19 years of uncompromising quality. the economic uncertainty in the U.S. Every new & refurbished machine we sell is 100% guaranteed. “Although the last two years have been a big boom for us, since January, the /4+Ŗ%6Ŗ7NVTCUQWPFŖ%#TOUŖ/COOQITCRJ[ 52'%6Ŗ$QPG&GPUKVQOGVGTUŖ%4&KIKVCN:4C[5QNWVKQPU opportunity for sales has dropped down and we are hearing a lot of customers say-

48 DOTmedbusiness news I a p r i l 2009 www.dotmed.com

ing they are going to hold off,” he says. on the market. They are hard to get and bring out tissue or bones and you “They aren’t saying they are not going and you can sell them as soon as you can find small fractures or hairline is- to buy, just going to hold off six to nine get them in. I could sell three or four sues that may be going on in the bone,” months to see how the financial land- today if I had them. OEC still isn’t Burkhart says. “Integration of high end scape evens-out before they purchase.” putting any out so it’s a big problem. technology into C-arms has been spec- Customers are also turning more to- People want OEC.” tacular. There are some very innovative wards the refurbished market for minis. things we are working on.” “Mini C-arms sell as fast as you Future Looks Bright Future developments also include can get your hands on them. This is Philips will soon introduce their flat using 3D in urology, seed placement a very fine example of supply and plate technology, which will provide in the lungs and using C-arms to help demand,” says Adkins. “We haven’t much better special resolution and con- pain management by finding the nerve been able to part a mini C-arm out trast resolution. bundles with better contrast resolution. for two years. Their value is so high “You can instantly adjust controls The latest generation of Siemens ARCADIS C-arm family optimizes surgical workflows through numerous improvements. Innovations, such as the new ergonomic monitor trolley and the easy user interface provide optimal user experience, while an in- telligent algorithm automatically ad- justs and optimizes the image quality in all imaging situations. Their systems are suitable for broad clinical applications in orthopedics, trauma, and neurosurgery, as well as gastro- enterology, vascular and cardiac surgery or in urology. “The next ARCADIS generation continues the pace-setting tradition of achieving a new level of clinical excellence,” says Anders Steiner, vice president, Special Systems, Siemens Medi- cal Solutions USA, Inc. “Focused on improving everyday practice and solely led by the customers’ needs, ARCADIS incorporates numerous unique to-the- point solutions. From image quality to operability, from versatility to efficiency, the groundbreaking features of our ARCADIS family set benchmarks – with outstanding functionalities that make perfect imaging a snap and an overall ergonomic concept that rede- fines clinical workflow in many fields of practice.” As for GE, they are continuing to work with the FDA on their mini and vascular models, and expect a resolution to be reached shortly. “We are working with the FDA very closely and it’s very promising,” Usher says. “Behind the scenes we are ramping up and getting ready to move forward as soon as we can.” Once that happens, expect big changes again. • Online: dotmed.com/dm8553

50 DOTmedbusiness news I a p r i l 2009 www.dotmed.com

DOTmed Registered C-Arm Equipment Sales & Service Companies For convenient links to these companies’ DOTmed Services Directory listings, go to www.dotmed.com and enter [DM 8553] Names in boldface are Premium Listings. Name Company - Domestic City State Certified DM100 John Stringer The Stringer CO Cullman AL Terry Michel Radiology Systems Engineering, Inc. Cherry Valley CA Ted Huss Medical Imaging Resources Colfax CA Rick Stockton Atlas Medical Technologies Ontario CA • Ronald Lorg Allied Resource Technology, Inc. Dunedin FL • David Denholtz Integrity Medical Systems, Inc. Fort Myers FL John Pereira United Medical Technologies Corp. Fort Myers FL • • German Filgueira PODER, Inc. Miami Beach FL Robert Serros, Jr. Amber Diagnostics Orlando FL • Bill Adkins National X-Ray Corporation Palmetto FL Ed Ruth Managed Medical Imaging Pembroke Pines FL • Deon Armes A.X.S. Medical Systems, Inc. Tampa FL Maddi Moore MED iMAGE New Lenox IL Travis Nipper Clinical Engineering Consultants, Inc. Erlanger KY Mark Ardoin Omni Imaging Service Abita Springs LA Davyn McGuire Med Exchange International, Inc. Agawam MA Richard Keil Hologic, Inc. Bedford MA • • Wayne Horsman Columbia Imaging Inc Columbia MD Jason Crawford Block Imaging International, Inc. Lansing MI Asif Bhinder Tekyard Burnsville MN William Brooks Salem Medical Electronics, Inc. Clemmons NC Robert Manetta Nationwide Imaging Services, Inc. Brick NJ Kristopher Derentz KenQuest Medical Henderson NV • • Gary Benitez Crown Medical International Beechhurst NY • Leon Gugel Metropolis International Long Island City NY • John Kollegger Bay Shore Medical, LLC Ronkonkoma NY • • John Patti NCD Medical Corporation Eastlake OH • Edward Rawley Classic Diagnostic Imaging LLC Macedonia OH Kenneth Saltrick Engineering Services Twinsburg OH Chris Popper Encore Medical International, Inc. West Chester PA • David Wingo Radiology Equipment Partners Brentwood TN Mike Jackson Combined Imaging Associates Cottontown TN Andrew Herris Herris Medical Knoxville TN Elizabeth Usher GE Healthcare Salt Lake City UT Scott Burkhart Philips Healthcare Bothell WA Russ Surratt Bighorn Biomedical Services, Inc. Moorcroft WY • Name Company – International City Country Certified DM100 Christian von Leipzig Medical Ray Salta Argentina David Lapenat ANDA Medical, Inc. Ottawa Canada Abdelrahim Khalil Besisc Cairo Egypt • • Rami Wahba Scope Care Cairo Egypt Juan Garcia Issste Pinotepa Nacional Mexico Andres Lomelli Movil Salud C.A. Valencia Venezuela

52 DOTmedbusiness news I a p r i l 2009 www.dotmed.com This Month in Medical History

Polio Vaccine is Made Public

ith the possible ex- ated a vaccine using dead viruses, which Researcher Albert Sabin felt that ception of AIDS, was able to immunize against the living Salk’s vaccine using a dead virus wasn’t there hasn’t been a virus while only creating a mild infection. as effective as a vaccine using a weak- disease in Ameri- He reported his findings to the American ened, live virus would be. Sabin con- can history causing Medical Association and nationwide test- ducted experiments using a weakened Wmore public concern than the polio epi- ing commenced, sponsored by the March form of the virus on more than 9,000 demics that would spring-up periodical- of Dimes. The results were welcome monkeys and 100 chimpanzees before ly across the country barely more than news to a frantic country. The initial tests isolating a form of the virus that would five decades ago. showed 60% to 70% prevention. But be safe to present live in a vaccine. That Polio has plagued humans for thou- the elation didn’t last long – soon, about form of the virus would reproduce in the sands of years. In fact, there are stone intestinal tract but would not do so in the engravings in Egypt referencing the central nervous system. His vaccine also paralyzing affects of the disease dating had the added benefits of not only being back three millennia. Ironically, the dis- less expensive to produce but also easier ease became a larger problem over the to take – unlike Salk’s vaccine which re- centuries as sanitation improved. With quired injection; Sabin’s vaccine could the improvement, there was less expo- be delivered by ingestion. In 1957, Sabin sure to the Polio virus, which translated began human trials, testing in the Soviet to less people building immunity. That Union and Eastern Europe. Although meant when someone did contract it, it some U.S. researchers expressed opposi- had a greater chance of being more viru- tion to Sabin’s vaccine due to its ties to lent and stood a better chance of becom- the Soviet Union, it was licensed in 1962 ing an epidemic. That was the case in and quickly supplanted Salk’s vaccine. America in the early 1900s, with repeat- In 1988, there were only 350,000 ed large outbreaks. One outbreak had cases of Polio reported worldwide. Just reports of more than 9,000 cases in New five years later, that number dropped to York City alone. During that stretch, about 100,000. China rolled out an exten- Franklin Delano Roosevelt would con- 200 cases of polio were reported as be- sive vaccination program in 1994, immu- tract the disease, a decade before being ing caused by the vaccine resulting in 11 nizing 80 million children and the entire elected President. deaths. Testing ceased until investigation Western Hemisphere was declared “polio Shortly after World War II, the Unit- traced the outbreaks to a bad batch of free.” The following year, India immu- ed States averaged more than 20,000 cas- the vaccine. Production standards were nized more than 87 million children. es a year from 1945 to 1949 with about strictly enforced and news of the suc- Although there has been a substan- 1% of the cases leading to paralysis. The cessful trials was announced at a press tial effort to totally wipe polio from the public by this time was in a panic. The conference on April 12, 1955. A national face of the planet, there is still work to National Foundation for Infantile Paraly- vaccination program was mobilized al- be done. In 2008, more than 1,600 cas- sis, now known as the March of Dimes, most immediately. es were reported worldwide with some undertook a strong fundraising effort to Just prior to the vaccination pro- previously “cured” areas experiencing provide money for researching a vaccine. gram, there were 28,985 reported cases a reintroduction of the virus. It’s fright- The money helped fund the research of of polio in the U.S. By 1957, the num- ening to imagine where we’d be today Dr. Jonas Salk. ber dropped to 5,894. Although Salk’s without the work of Salk and Sabin. Salk, building his work upon that of vaccine was proving successful, there • Online: dotmed.com/dm8554 John Enders at Harvard University, cre- were detractors among his peers.

DOTmedbusiness news I a p r i l 2009 53 people & companies

Medtronic Buys Two Heart Valve Compa- MagnaServ Enterprises Inc. Announces nies for $1.03 billion Formation of a New LLC Venture Medtronic, Inc. recently announced it is buying two privately MagnaServ Enterprises, Inc. (MagnaServ) is pleased to an- owned heart-valve companies for $1.03 billion. The compa- nounce a new venture “General Radiology Group, LLC,” nies both have transcatheter technology that enables the re- based in Stuart, Florida. The LLC team is composed of three placement of diseased aortic heart valves without the need for forward thinking, customer oriented companies, namely: Con- open heart surgery. solidated Imaging Consultants, Softwind Capital and Mag- The purchases will catapult Medtronic into this fast-grow- naServ Enterprises, Inc. ing, sought-after market, while pitting it against Edwards Life- sciences, now locked in patent litigation with CoreValve. • Online: dotmed.com/dm8253

Ohio Businessman Indicted on Fraud and Tax Charges A Federal Grand Jury in Cleveland, Ohio, returned an indictment charging Robert E. Alick with 11 counts of mail fraud, 2 counts of wire fraud, 1 count of corruptly endeavoring to obstruct and impede the Internal Revenue Service, 1 count of conspiracy to defraud the Internal Revenue Service, 6 counts of willful failure to pay over employment taxes, and 13 counts of willful failure to collect, account for and pay over employment taxes. The proceedings took place Feb. 25, 2009 the IRS informed DOTmed News. The indictment alleges that from about July of 2002 The packages will include pre-site management with through April of 2006, in the Northern District of Ohio, Al- customers’ contractors, full installation, start-up and train- ick did knowingly devise and intend to devise a scheme and ing services as well as full financing assistance, whether artifice to defraud and obtain money by means of false and it be short term, long term, fee per service, and/or cus- fraudulent pretenses, representations, and promises. As part of tomized lease-to-own arrangements. For qualified cus- the scheme Alick agreed to purchase medical equipment and tomers a full service installation and service package took possession of the medical equipment, falsely represent- can be put together with minimal upfront cash outlay. ing that he would pay for the equipment. Online: dotmed.com/dm8349 As part of the scheme, Alick took money from his cus- • tomers that was intended to be used to purchase used medical equipment and did not deliver any equipment, delivered the GE Healthcare and STERIS Corporation wrong equipment, or delivered broken equipment. Announce Collaboration Online: dotmed.com/dm8351 GE Healthcare, a global leader in healthcare technology and • devices, has entered into collaboration with STERIS Corpo- Hansen Medical, Inc. Announces Equity ration, a recognized leader in surgical technologies, to offer STERIS products in GE interventional suites. The desire to in- Investment in Advanced Cardiac Therapeu- tegrate and equip Interventional suites with leading-edge tech- tics, Inc. nologies from both companies inspired the agreement, which Hansen Medical, Inc. announced an equity investment in Ad- was announced at the Society of Interventional Radiology’s vanced Cardiac Therapeutics, Inc. (ACT), and the securing of annual meeting in San Diego. exclusive rights to certain ACT intellectual property for certain Through this collaboration, GE Healthcare will provide robotic applications. ACT, a privately held company located in specialized X-ray equipment and interventional technologies, Laguna Beach, Calif., is developing a novel technology that while STERIS will supply custom-designed HD 360° Suites is designed to accurately measure the temperature in a lesion featuring LED surgical grade lighting, video-switching and during cardiac ablation procedures. visualization systems, and equipment management solutions. • Online: dotmed.com/dm8332 • Online: dotmed.com/dm8397

54 DOTmedbusiness news I a p r i l 2009 www.dotmed.com Merck to Buy Schering-Plough for $41.1 Cardinal Health Extends Radiopharmaceu- Billion tical Network Merck said it would buy Schering-Plough for $41.1 billion in Cardinal Health, a global provider of products and services a cash and stock deal that would help it become less vulner- that improve the safety and productivity of health care, has able now that its blockbuster drug Fosamax for osteoporosis opened a new facility in Omaha, Nebraska that manufactures has gone generic and will be followed by its popular allergy radiopharmaceuticals, giving local physicians new tools that medicine, Singulair, in a few years. aid in the early diagnosis and treatment of disease. Schering’s allergy medicine, Nasonex, has a longer patent The new manufacturing facility, a cyclotron, will pro- life and Merck and Schering are already partners in the mar- duce fluorine-18 (F-18), a raw material needed to create keting of two cholesterol drugs, Vytorin and Zetia. imaging agents that, when injected into patients, are visible What’s more, Merck is a top maker of vaccines, and ac- during a Positron Emission Tomography (PET) scan. This quiring Schering-Plough will give it a pipeline of biological technique uses low levels of radiation to enable physicians drugs, due to Schering’s 2007 acquisition of Dutch biopharma- to diagnose and treat certain forms of cancer, cardiovascular ceutical company Organon Biosciences. Biologics are highly- and neurological diseases, as well as other serious medical priced and are still unable to be copied by generic drug makers, conditions, at an earlier stage of onset. The new facility has so they are seen as a white-hot area of growth for big pharma. created 30 highly skilled jobs across the areas of nuclear phar- • Online: dotmed.com/dm8419 macy, health physics and radiopharmaceutical manufacturing. • Online: dotmed.com/dm8467 Barrington CT X-ray Tube Winner Named Mark Elam, M.D. of Open MRI of Dalton (GA) is the recipi- ContextVision Continues to Bolster its X- ent of the free CT X-Ray Tube in Barrington Medical Imag- ray Division ing’s recent promotional program. ContextVision, the software imaging partner for the The prize includes a new CT Tube, shipping, installation most recognized medical imaging manufacturers world- services to OEM specifications, and manufacturer’s warranty. wide, recently announced its continued investment in its The giveaway program was held for a new CT replacement X-ray division. ContextVision added to its team of im- tube from www.dunlee.com/content.cfm/ct_tubes. age enhancement experts and announced a new ver- Entrants in the program also received a subscription to sion of its X-ray tuning software, GOPView® XR2-T. DOTmed Business News. • Online: dotmed.com/dm8502 • Online: dotmed.com/dm8433 MEDRAD Multi Vendor Service Launches TotalRepair on Select Ultrasound Probes MEDRAD Multi Vendor Service has announced the launch of TotalRepair, the first and only guaranteed repair solution on select ultrasound probes. Enabled by 100% repair capabilities, TotalRe- pair allows healthcare facilities to spend less on costly exchanges and replacements by maximizing the use of probe repair. “MVS is committed to developing new repair tech- niques that will make equipment service budgets go farther. This has immense value to healthcare systems during gru- eling economic times like these,” said Diane Watson, executive director of MEDRAD Multi Vendor Service. “With our ever-increasing repair capabilities and new offerings like TotalRepair, MVS can help hospitals and imaging centers save money by extending the life of their equipment.” • Online: dotmed.com/dm8501

DOTmedbusiness news I a p r i l 2009 55 Getting to Know the AMSP and Getting a Better Deal By Sean Ruck n February, I travelled to Puerto Rico with DOTmed president From left to right: Steve Elmendorf, Carl Hoffman, Sean Ruck, Phillip Jacobus to attend the James Massengill, Hardy Rankin, Robin West, Brian Ashby, winter meeting of the Associa- Trey Gamble, Tim Wright, Robert Probst, Tim Martin, Anthony Bodenheimer, tion of Medical Service Provid- Charles Lambert, John Snyder, Mark Schaeffer ersI (AMSP). The AMSP had invited us to give a presentation at their meeting and learn more about their association. We discovered that they were a very welcoming group of people, we also found the members to be passionate about the industry, practical in their approach and perhaps most important, a group that could potentially offer significant savings for DOTmed Business News readers. The presentation we offered wasn’t an attempt to sell anything to the AMSP. Instead, we used the time they had offered us to get to know the group better. Our presentation was technically some discussion, the consensus was Snyder of Cal-Ray, Inc. “By doing that, brief – I spoke for maybe 20 minutes. that an ideal customer would be an in- you approach potential vendors with in- Those 20 minutes were divided into the dividual or entity looking for name rec- formation you can use to help you get better part of two hours though. There ognition. Even if the service provided the most favorable prices or conditions. were questions I had and the members by an ISO is the same as an OEM for a Often though, this does lead to people in attendance were more than happy to better price, some customers are reluc- realizing we’re a good choice for them respond to them. This is how I found tant to go the non-OEM route. As one to work with so we welcome the com- out how this association could benefit AMSP member pointed out, “If some- parison shopping.” our readership. thing were to go wrong with an order, ISOs are also a good choice for To understand how you might equipment or service, it’s less likely that hospitals with limited budgets. “Any benefit, it’s important to understand a the fault will be placed on the person in customer who can define their technical little more about the AMSP, who they charge at the hospital if they were work- and clinical requirements clearly has the are, what they do and why they do it. ing with a big OEM. If they were work- potential to benefit from working with To begin with, the association is coming with a smaller company they might an ISO,” said Tim Wright, of Virtual prised of Independent Service Organi- be put on the defensive about why they Medical Sales and the 2008-2009 presi- zations (ISOs). These ISOs provide a went that route.” dent of the AMSP. vital link in the services provided to That is unfortunate though. “A cus- In order to find an ISO to work with the health care industry. ISOs, Original tomer who understands the market and do a little homework. Don’t be afraid to Equipment Manufacturers (OEMs) and is in the position to make purchasing ask some questions like, how long they smaller, third-party vendors all help to decisions can potentially save their hos- have been in business, how much and keep health care humming. Each has pital a substantial amount,” said mem- what kind of training their technicians its own strengths and weaknesses and ber Brian Ashby, Service Manager for undergo, what professional organiza- those attributes can vary even from Medical Imaging Systems. tions they belong to and most impor- company to company under one of Even if a hospital decides not to tantly, ask for references. It may take a those three umbrellas. go with an ISO, there can still be ben- little more effort but it will be time well- One of the first questions we asked efits to looking into that relationship. spent and likely, money saved. those in attendance was, “Who is the “A smart customer in any business does • Online: dotmed.com/dm8565 ideal customer for an OEM?” After some comparison shopping,” said John

56 DOTmedbusiness news I a p r i l 2009 www.dotmed.com Law & Order

By Astrid Fiano

Federal: EEOC Has Proposed Rules for Federal: FTC Approves Interim Monitor and GINA Legislation Agreement for Getinge AB/Datascope In 2008, President Bush signed the Genetic Information Non- The Federal Trade Commission FTC has announced it has ap- discrimination Act (GINA) of 2008 (see DM 6108). The Equal proved the appointment of Quantic Regulatory Services, LLC Employment Opportunity Commission (EEOC) is the feder- as the interim monitor in the matter concerning Getinge AB’s al agency required to issue regulations for Title II of GINA, acquisition of Datascope Corporation, and also has approved prohibiting the use of genetic information in employment, the related interim monitor agreement. In January, the Com- prohibiting the intentional acquisition of genetic information mission voted to accept a consent order resolving the anticom- about applicants and employees, and imposing strict confiden- petitive concerns related to the proposed acquisition. Getinge, tiality requirements. The EEOC is now proposing a rule for a company headquarted in Sweden and with a U.S. subsidiary, the implementation of GINA, and inviting public comment. is engaged in the research, development, marketing and sale of The public may submit comments by letter, fax or electronic cardiac surgery devices, including endoscopic vessel harvest- method. The complete proposed rules and details of how to ing (EVH) devices. Datascope, a Delaware corporation, also comment are available at: http://edocket.access.gpo.gov/2009/ engages in research, development, manufacturing, marketing, E9-4221.htm and sale of cardiac surgery devices, including EVH Devices. “Concerns about discrimination on the basis of genetic The FTC had previously intervened in Getinge’s acquisi- information makes many people wary about having genetic tion of Datascope, under concern that the acquisition would tests, even when those tests can help them protect their health,” give the company a near-monopoly share of the market for said Andrew Imparato, President and CEO of the American EVH devices used in coronary bypass surgeries. According to Association of People with Disabilities, speaking to DOTmed. a press release on the matter, under the terms of the decision “Strong enforcement of the new Genetic Information Non- and order, the Commission may appoint an interim monitor to Discrimination Act by the Equal Employment Opportunity ensure the respondents’ compliance with its terms. Through Commission will help protect workers and create a climate the action just announced, the Commission has exercised that where workers are more willing to use the new technology to option. The press release says Quantic’s president, R. Owen assess health risks and make decisions that can improve their Richards, is a highly qualified expert on FDA regulatory mat- health and wellbeing.” ters who has successfully served as interim monitor in previ- The proposed regulation includes definition of the statu- ous FTC matters. tory language barring actions by covered entities--including limiting, segregating, or classifying employees on the basis of National: Legislation introduced for Tax- genetic information. The EEOC proposed rule has as example: Deferred Savings Accounts for the Disabled an employer would not be allowed to reassign an employee of Representative Ander Crenshaw, (R-FL) has introduced whom the employer learned had a family medical history of H.R.1205, the Achieving a Better Life Experience (ABLE) heart disease from a job the employer believed would be too Act of 2009, legislation to amend the Internal Revenue Code stressful and might eventually lead to heart-related problems of 1986 to provide for the establishment of ABLE accounts for the employee. The proposed regulation also reiterates the for the care of family members with disabilities, and for other statutory prohibition against an employer retaliating against an purposes. The bill has been referred to House Committee on individual who has opposed any act made unlawful by GINA, Ways and Means, and in addition to the Committee on Energy and filed a charge of discrimination or assisted another in do- and Commerce. ing so, or gave testimony in connection with a charge.

DOTmedbusiness news I a p r i l 2009 57 According to Rep. Crenshaw’s web site, the ABLE Act arthritis prevention and management efforts. The bill creates “creates a tax exempt ‘ABLE Account’ that could be used for a juvenile arthritis population-based database and establishes expenses related to a disabled beneficiary including: educa- education loan repayment and career development award pro- tion, medical and dental care, community based support ser- grams to encourage more health professionals to enter the field vices, employment training and support, moving, and assistive of pediatric rheumatology. The bill has been referred to the technology.” House Committee on Energy and Commerce. “Too often persons with disabilities are caught in between the cracks in our society. The ABLE Act will provide families with a savings tool that is flexible and portable. The accounts are designed to help ease difficult financial situations and provide peace of mind to the families of individuals with disabilities,” Rep. Crenshaw says in a press release on his web site.

State: New York Legislation on Anesthesia Administration New York has new legislation under consideration, A 4509/S 1515, which allows for administration of anesthesia to a patient by certified registered nurse anesthetists (CRNAs) under the supervision of an anesthesiologist immediately available, or under the supervision of the operating physician who is physically present, or under the supervision of a dentist, oral surgeon, or podiatrist, who is physically present and autho- National: Representatives Introduce rized by law to administer anesthesia. The act also provides for Amendment to FMLA a certification process for nurse anesthetists. Congressperson Carolyn Maloney (D-NY) along with ten Another New York Bill, A 3981, would have insurance other congressperson co-sponsors, has introduced an amend- policies providing coverage for anesthesia services also in- ment to the Family Medical and Leave Act, enabling covered cluding coverage for anesthesia services provided by an in- employees to participate in or attend an activity that is spon- dependently employed certified registered nurse anesthetist; sored by a school or community organization and relates to a the law also defines “certified nurse anesthetists” as a person program of the school or organization that is attended by a son who has satisfactorily completed educational preparation for or daughter or a grandchild of the employee. The Amendment the practice of nurse anesthesia in a program accredited by also allows an employee leave to meet routine family medi- a national accrediting body recognized by the department of cal care needs, including medical and dental appointments of health. The justification of this bill, according the legislative the employee or a son, daughter, spouse, or grandchild of the web site, is the problem of New York not having recognized employee, or to attend to the care needs of elderly individuals CRNAs, and that CRNAs are often the only providers of an- who are related to the eligible employee, including visits to esthesia services in rural New York. The commentary on the nursing homes and group homes. legislation states that Insurance providers failing to reimburse The Amendment also broadens the category of covered such CRNAs have placed a tremendous financial burden on entity employers from those with 50 or more employees to the profession in the rural regions of the state. those with 25 or more. An eligible employee may choose or an employer may require the employee to substitute accrued paid National: Arthritis Prevention Bill Introduced vacation leave, personal leave, medical or sick leave, or family Reps. Anna G. Eshoo (D-CA ) and Fred Upton (R-MI) have leave of the employee for any leave under this Amendment. introduced a bill, H.R. 1210 - The Arthritis Prevention, Con- The bill has been referred to the Committee on Education and trol, and Cure Act of 2009 - in order to “address the nearly Labor, and in addition to the Committees on Oversight and one in five adults and 300,000 children in America who suffer Government Reform, and House Administration. from arthritis,” according to Rep. Eshoo’s website. “Arthritis is already the leading cause of disability in the State/National: California Man Found Guilty United States,” Rep. Eshoo said in a press release. “Many of those suffering are not receiving the care or the basic informa- of Selling Unapproved Medical Devices tion they need to manage the disease. My legislation will help United States Attorney Karen P. Hewitt of the Southern Dis- the millions of Americans with arthritis and other rheumatic trict of California has announced in a press release that James diseases by helping to treat, cure, and ultimately prevent the Folsom was found guilty after a two-week trial by a federal disease that diminishes their quality of life and affects the lives jury United States District Court in San Diego of twenty-six of their caregivers and families.” felony counts relating to sale of an unapproved medical de- According to Rep. Eshoo, the bill enhances the National vice. The trial was before the Honorable John A. Houston, Arthritis Action Plan by supporting federal, state, and private United States District Judge.

58 DOTmedbusiness news I a p r i l 2009 www.dotmed.com Sentencing is scheduled for May 11, 2009. National: House Committee Holds According to the U.S. Attorney Hewitt’s press release, Hearing on Strengthening Employer-Based the evidence presented at trial showed that from 1997 through August 11, 2008, Mr. Folsom “conspired with others to ship Health Care The Health, Employment, Labor and Pensions Subcommittee adulterated and misbranded Rife-type biofrequency devices in of the House Education and Labor Committee recently held a interstate commerce.” The press release says the device was hearing on ways to increase health care insurance coverage for sold under the names “NatureTronics,” “AstroPulse,” “Bio- Americans through their employer. According to Rep. Robert Solutions,” “Energy Wellness,” and “Global Wellness.” The Andrew’s (D-NJ) opening remarks, this hearing will be part of press release says that testimony at trial indicated devices were a series on health care reform. The House Committee’s web manufactured by the defendant and others in the San Diego site says that while nearly 47 million Americans currently area, which was not registered with the Food and Drug Ad- have no health insurance at all, more than 27 million of those ministration (FDA) as a device manufacturing establishment. uninsured have jobs. The testimony also indicated the defendant marketed his device “for investigational purposes,” which deceived consum- ers into the false belief that he possessed a valid investigational device exemption from the FDA. The press release says evidence showed the device had settings for specific conditions including AIDS, diabetes, stroke and more. The press release states that Assistant U.S. Attorney Melanie K. Pierson, who prosecuted the case, said the devices were adulterated - marketed without a valid investigational device exemption, without pre-market approval, and marketed without valid clearance from the FDA, did not bear the name and address of the manufacturer on the labeling, and were produced in an unregistered manufacturing establishment.

National: Senators Introduce Physician Payment Sunshine Act A bill has been introduced by Senators Chuck Grassley (R-IA) and Herb Kohl (D-WI), which amends title XI of the Social Se- curity Act to provide for transparency in the relationship between physicians and manufacturers of drugs, devices, biologicals, or medical supplies for which payment is made under Medicare, Medicaid, or SCHIP. The Physician Payments Sunshine Act of The witnesses included Mark Derbyshire, a Small Busi- 2009 would require the makers to report payments to doctors ness Owner of Aberdeen, MD, who testified that small busi- to the Department of Health and Human Services, and in addi- nesses such as his that did provide health insurance bears the tion, those payments would be posted online for public review. brunt of the costs for the uninsured workers of other compa- Penalties for knowingly failing to report the information could nies. John Sheridan, CEO Cooper University Hospital, testified be as high as $1 million. According to Sen. Grassley’s web site, about the decline in health care coverage and increase in the the bill incorporates many recommendations of the Medicare uninsured and underinsured in New Jersey. Mr. Sheridan also Payment Advisory Commission, an independent congressional spoke of the costs of uninsured patients shifting to the pay- agency advising Congress on issues affecting the Medicare pro- ing patients (employer-based health coverage) and said that gram. The bill is now in the Committee on Finance. increasing health care insurance coverage will help to stabilize “Shedding light on industry payments to physicians would the inflation of health care expenses yet still would be insuf- be good for the system,” Grassley said in a press release on his ficient to reduce health care costs, unless greater resources are website. “Transparency fosters accountability, and the public allocated to primary care and the proper clinical management has a right to know about financial relationships. Patients rely of chronic diseases. Jim Winkler, Health Management Prac- on their doctors’ advice. Taxpayers spend billions every year tice Leader Hewitt Associates, stated that many of the large on prescription drugs and medical devices through Medicare employers Hewitt surveyed were concerned that rising health and Medicaid. They also fund tens of billions of dollars of care costs would result in small- and medium-sized businesses medical research each year, and the doctors conducting that dropping health coverage to keep their business competitive, research have a big influence on the practice of medicine.” and leading to the large employers assuming an even larger Sen. Kohl was also quoted in the release: “Since we first economic burden including increased costs picked up indi- introduced the bill, there has been a groundswell of support rectly through cost shifting. from every corner. Patients want to know that they can fully trust the relationship they have with their doctor. I am confi- Online: dotmed.com/dm8555 dent this legislation will pass during the 111th Congress.” •

DOTmedbusiness news I a p r i l 2009 59 old into gold DOTmed Premium Auction Success Stories

Bringing Customers A New Radiologist in center was able to save up to $200k by Together Pennsylvania Means purchasing a system just a year old. DOTmed Auction Specialist Mike New Equipment for the Galella contacted White Plains Hospi- Repeat Business Hospital … and Zambia In January a DOTmed user successfully tal Center in Westchester County New A hospital in Pennsylvania hired a auctioned a Toshiba Aquilion. The ex- York to inventory some equipment for new radiologist with the condition that perience went so well that they recently auction. the radiologist would work with only returned to list a Dornier Epos Ultra. The center had some endoscopy Hologic digital mammographers. The The auction started a little slow with re- equipment as well as a three year old problem was – the hospital had pur- jected bids of $10k and $15.5k before “never used” Air Shields TI 500 Trans- chased a GE Senographe 2000 D just hitting the magic amount of $20k from port Incubator. the year before. This machine now a dealer in California. The endoscopy equipment sold needed to find a new home. Auction Manager Cole Johnson as- quickly but the plans to start a transport The machine was purchased by a sisted with arranging the shipping from kitch with another hospital failed to ma- dealer in Florida who then relisted for Wisconsin to California and another terialize. sale on DOTmed with a starting price successful Auction concluded. Fortunately, Vassar Brothers Hospi- of $100k and a Purchase Now price of tal in Poughkeepsie New York - another $175k. The system sold for the Pur- DOTmed user - found the Transport Third Time’s the Charm – chase Now price to a company in Lu- So Were the Second and Incubator on our site about four weeks saka, Zambia that is currently building into the auction. a state-of-the-art medical center. the First Twice last year EECP units were auc- They took part in the auction and Due to the delicate nature of the tioned by a cardio clinic in Missouri. were the high bidder at $12,500, both equipment and the high price involved, Both auctions went so well that they de- parties were very pleased with the out- DOTmed arranged for an independent cided to give it one more try with a final come of this auction. engineer to inspect the staged system and unit they had left. Just like the others, this The seller was happy about the sale to remove the digital plate for shipping unit successfully sold. The final price price and the buyer was happy about purposes. DOTmed Auction Managers saw the unit out the door for $7500. finding a great piece of equipment at a worked with the buyer and seller to ar- decent price that fulfilled their need to range crating and shipping. The medical replace an older unit. • Online: dotmed.com/dm8566 You Can Auction Online! Learn how easy it is to turn your idle assets and used equipment into cash.

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Lithotripter Mobile: 633271 - OLYMPUS CX 21 w/ PLAN obj. Want to sell? Microscope $1,075 You can post a free classified 635094 - SIEMENS LITHOSTAR Litho- Olympus CX 21 Binocular Microscope with ad on DOTmed.com. tripter Mobile $15,000 PLAN objectives. Terence Michael, S E O Just visit our website and register. Siemens LithoStar Lithotripsy System: PART Enterprises, Inc. , 863-644-3555 ONLY - Ceiling Mounted X-Ray Tubes (... Mark Swaffer, American Diagnostics Inc 635565 - BRISTOLINE BristoScope Micro- 635396 - ACUSON 128XP - 10 OB / GYN - scope $300 Vascular Ultrasound $3,500 MRI Coldhead: This microscope is great for any doctor Acuson 128XP - 10 Imaging Modes 2-D or student. JOE HALLORAN, DR’S TOY 113105 - APD F2000 MRI Coldhead M-Mode Color Flow CW Doppler PW Dop- STORE pler Har... Anthony Garcia, Imagine Imaging APD F2000 cold head rebuild kit available. International Inc. Marc Fessler, Independence Cryogenic O/R Camera: Engineering, 609-294-0012 635195 - SIEMENS ELEGRA OB / GYN - 635584 - LINVATEC LIS8170 w/light&more Vascular Ultrasound $10,000 MRI Compressor: O/R Camera $1,400 siemes elegra(mfg 2000), excellent Listing includes: 1x camera box LIS8170, 1x 113099 - SUMITOMO CSW71D MRI condition,like new, wiht 3 probe to choose(. camera head 8171 non-autoclavable, ... Andy Compressor Raul cruz, Integrated Diagnostic Services Senske, Excess Materials Management Remanufactured Sumitomo compressor OB / GYN Ultrasound: available. Marc Fessler, Independence 635547 - STRYKER 1088 HD, X700, 40L Cryogenic Engineering, 609-294-0012 O/R Camera $9,900 629473 - GE Voluson 730 Pro OB / GYN Stryker Laparoscopy/Arthroscopy Tower. Ultrasound MRI Mobile: Scott Haas, H+H Surgical Technologies, LLC AB2-7, RAB4-8, RIC5-9, SP6-12 Transduc- 635197 - SIEMENS Seimens Impact 1.0 ers available, Color & B&W Printer. Maureen 633807 - LINVATEC C3134E O/R Camera MRI Mobile $75,000 Dutton, Pinnacle Diagnostic Solutions, $1,200 Siemens Magnetom Expert Plus 1. manny 901-312-1010 Linvatec C3134E 3CCD Digital Camera Box go, pacific coast mri With C3136 Camera Head. Sam Kanaan, 632968 - GE Voluson 730 Expert OB / GYN Mammo Unit: Laproman Ultrasound Voluson 730 Expert BT05, RealTime 4D, 633719 - GE DMR Plus Mammo Unit $10,000 O/R Instruments: DICOM, SRI, TUI, STIC, VOCAL II, VCI, 2000 Dmr Plus was desinstalled working in 635281 - AUTOMATED MEDICAL PROD- B-FLOW, Extended view, B&W Printer, Color very good condition. Ramon Diaz, Electro- UCTS ARH 22 O/R Instruments $1,500 Printer, Intergrated DVD. Maureen Dutton, medicine Services,Inc. Pinnacle Diagnostic Solutions 22” in length single arm, with 3/D Swinger Microbiology: (U. Shirley B. Pia, Champia Medical Consul- Orthopedic - General: tants, Inc. 635855 - BACTEC BAC-T-ALERT Microbi- 635533 - STRYKER Cast Saw Orthopedic ology $12,500 O/R Instruments Power: - General $1,200 This is as Model BTA 100-120 microprocess- 633737 - XOMED Micro-Craft Power Drill Stryker Cast Saw with vaccuum. Ray Carter, er controlled 240 vial cabable unit r. Thomas System 2000 O/R Instruments Power Hospital Equipment 4U Marr, Arrowhead Biomedical $1,700 Orthopedic Table: Xomed Micro-Craft Power Drill System 2000 Comes with Foot Pedal & 2 Xomed MPS 633447 - CHICK CLT Orthopedic Table For more information on any of these 2000 Instruments Please feel free to contact $600 listings, visit www.dotmed.com and us ig you have any questions. Danny Tipei, This Orthopedic table is complete with all enter the Listing # in any search box. Inex Surgical, Inc. attacments. Art Stanfield, A. L. Stanfield & You can post a free classified ad on Associates, Inc. DOTmed.com. OB / GYN - Vascular Ultrasound: Phototherapy Lamp: Just visit our website and register. 625675 - ACUSON Aspen OB / GYN - Vascular Ultrasound $13,500 627742 - REVITALIGHT ST-747 Photother- [?] 456102 Search Equipment Save 75% off OEM Pricing! The Acuson apy Lamp $4,000 Aspen ultrasound system resulted from a u. This is an excellent unit in perfect working To run a classified in Kristi Edwards, Echoserve, 303-384-3246 condition. Bruce Hoffman, Rejuvange DOTmed Business News call 212-742-1200 Ext “Ads” (237)

DOTmedbusiness news I a p r i l 2009 65 EQUIPMENT FOR SALE EMPLOYMENT OPPORTUNITIES

635580 - TOSHIBA PVF 375MT Ultrasound For more information on any of these Transducer Ultrasound $2,000 Join the industry’s fastest listings, visit www.dotmed.com and 3. LAKSHMI NARAYANA, MAN MACHINE growing Independent MRI enter the Listing # in any search box. ELECTRONICS You can post a free classified ad on and CT Service and Sales DOTmed.com. Ureteroscope: Just visit our website and register. organization. 635237 - STORZ 27410SL Ureteroscope [?] 456102 Search Equipment $4,500 Karl Strorz Endoscope semi rigid Uret- Due to increased growth, eroscope 7. Miguel Rosello, Biomedical To run a classified in Technician Genesis Medical Imaging is seeking DOTmed Business News experienced MRI and CT Field Urological Procedure Table: call 212-742-1200 Service Engineers — we have 633597 - BIODEX Model 058-800 Urologi- Ext “Ads” (237) cal Procedure Table $34,900 openings nationwide. Fully Accessorized for Urologic Procedures - The Urology C-Arm Table features m... Rich Full bene ts Package includes: Portable X-Ray: Schubert, Biodex Medical Systems, Inc. t$PNQSFIFOTJWF4BMBSZ #POVT 635151 - GE AMX4 w/Canon DR Portable Ventilator: X-Ray $100,000 & Commission Package 375170 - SIEMENS Servo 300A with 390 Refurbished GE AMX4 Portable with New t)FBMUI%FOUBM-JGF*OTVSBODF Graphic Monitor Ventilator Canon 50G DR Panel. Jason Olenio, Associ- ated X-Ray Imaging Corp. Siemens Servo 300A Ventilator with t, Automode and 390 Graphic Monitor Basic t"VUPNPCJMF1BDLBHF Pump IV Infusion: Description Manufacturer: MAQUET GmbH & Co. Bill Murdock, VIP Medical, Inc., 888 635605 - BAXTER AS50 Pump IV Infusion 931 9996 Forward resume with $1,400 Units come patient ready with 90 day war- Video Endoscopy: salary history to: ranty, pole calmps, chargers. Jason ragazzo, KPCPQFO!BPMDPN 634863 - OLYMPUS vecas 140 Video En- Biomedix Medical doscopy $7,500 SPECT Camera: complete 140 system with gastro scope 140 cv 140 clv u20d monitor. Fusako Hashimoto, 633631 - ELSCINT SPX-6 SPECT Camera Fair Medical $10,000 Or Best Offer 1995 Elscint SPX – 6 The Viewbox Motorized: system is available for immediate delivery. 635418 - DDP MAMMOVIEWER 810 View- Reno Itzhaki, Eltec Eng 0óDF box Motorized $3,500 Sterilizer: Medical Office Upgraded. Debbie Medina, 'BY BUYTHETRUCKLOAD www.genesismedicalimaging.com 634990 - RITTER sybron Sterilizer $1,095 Ritter SYBRON STEAM Sterilizer Model: 635300 - DDP Vidiviewer 4000 Viewbox Motorized $3,499 1100v 11” tray Condition: Used In fully . Todd Want to buy? Fentress, Bio Equipment Sales and Services Features Portable membrane switch control panel Moveable rheostat-controlled br... For more information on any of these Sutures: Rosina Kanerva, EFW Radiology listings, visit www.dotmed.com and enter the Listing # in any search box. 635747 - US SURGICAL Auto Suture Wheelchair: [?] 456102 Search Equipment TA30V3S Sutures $79 US Surgical Tyco Healthcare Auto Suture 634828 - UNKNOWN Permobil Chair-man Want to sell? Wheelchair $2,000 TA30-V3 (TA30V3S) DST Series 2. Abbott You can post a free classified Jackson, Alpha Equipment LLC This wheelchair was known as the “Cadilac” ad on DOTmed.com. of wheelchairs. Judy Joiner, Candlelight Just visit our website and register. Ultrasound Table Ultrasound: Christian 635000 - BIODEX 056-605 Ultrasound Table Ultrasound $1,200 U/S Chair No arm rails. Jim Connolly, ICON Post Jobs for Free on DOTmed.com MEDICAL INC Just register for Free on DOTmed, then post Ultrasound Transducer Ultrasound: up to 30 jobs at a time – for Free. 635222 - PHILIPS 21369A Ultrasound Transducer Ultrasound $7,500 Try it today! Phillips 5. Rita Napal, Arc Diagnostics

66 DOTmedbusiness news I a p r i l 2009 www.dotmed.com EMPLOYMENT OPPORTUNITIES

EXECUTIVE MANAGEMENT NURSING

631596 - Management Position, 632708 – Nursing Position, Phoenix, AZ, USA West Coast hospitals Client looking to hire a full time Cath Lab National Hospital System searching for Manager., Jim Angel, SpringBoard Health- an Area Director of Case Management - 5 care Staffing, 866-465-6286 facilities. Tamarahan Gaudet, Hyman Medical Group, 603983 - Management Position, 281-213-4684 Kalamazoo, MI MagnaServ is a nationwide ISO Opportunity in Health Information Depart- 572716 - Nursing Position, ment for a RHIA or RHIT to manage and Baton Rouge, LA specializing in MRI and CT modalities. coordinate. Director of Post Surgical Services to develop and recommend policies and procedures. MagnaServ is currently seeking Field Service PHYSICIAN Professionals with 5 or more years of experience Tom Gradowski, Paramount Healthcare for employment opportunities in various markets. Placement Service, 610-636-2252 623953 - Family Practice, Alabama, USA MagnaServ offers a competitive salary and Physician needed to join a well-estab- 621098 - Nursing Technician, benefits package that includes: car allowance, medical, dental, vision, life, and 401K. lished private practice, wanting to add Las Cruces, NM due to increase in volume & retirement. Telemetry Nurse in 168-bed facility with fully Please email or fax your resume in confidence, Kelly Bownes, MedPlan Recruiting, Inc., staffed 24-hour emergency care and more. or fill out our application online. 205-870-7068 TECHNOLOGIST/TECHNICIAN 2862 S.E. Monroe Street, Stuart, FL 34997 604012 - Neurology Position, Parts: 772-219-2229 ● Fax: 772-283-2450 South Carolina, USA 630429 - Laboratory Technologist, Office: 772-283-4288 [email protected] BE/BC Neurosurgeon with excellent clinical Montana, USA www.magnaserv.com skills and experience in practice to join a part-time 16 hours/week who can function Private Practice Neuroscience group. Steve as a generalist, incl. working in blood bank Cannon, Franklin Joseph & Associates, (does not include micro). Karyn Trainor, St. 888-575-4511 x3607 Patrick Hospital and HSC, 406-329-5716

599505 - Physician Position(s), 627057 - CT Service Engineer, Chicago, IL throughout Texas, USA Field Service Technician 2 - responsible for THE TECHNICAL RESUMEBANK Physicians (MD/DO) for Physician House CT/MR general service, planned mainte- NATIONWIDE OPPORTUNITIES Call Practice needed throughout Texas. No nance, updates and installation. BIOMEDICAL & RADIOLOGY nights/No weekends/No call 629355 - MRI Position, Locations in USA International OEM seeks experienced field service profs. to install in top hospital/medical center environment.

Index of Advertisers Advertiser Page Advertiser Page Amber Diagnostics 20 MED iMAGE 50 ANDA Medical 5 Med1Online Inside Bk. Cvr. Atlantis Worldwide, Ltd. 49 Medical Imaging Resources, Inc. 18 Atlas Medical Technologies 21 MEDRAD MVS 9 Bay Shore Medical, LLC. 22 Metropolis International 47 Beacon Surgical 8 Nationwide Imaging Services, Inc. 3 Block Imaging International, Inc. 52 Owen Kane Holdings, Inc. 61 C & G Technologies 25 Oxford Instruments 13 Colossus Medical 32 RedMedPar 11 DUNLEE Inside Ft. Cvr. Sage Point Transport, LLC 19 Endoscopy Development Company 39 Sunrise Medical Technology, Inc. 36 Endoscopy Replacement Parts, Inc. 40 TYRX, Inc. 51 Imaging Services 23 Unfors Instrument, Inc. 4 Integrity Medical Systems, Inc. 48 Varian Medical Systems Back Cvr. MagnaServ, Inc. 7 Viable Med Services 15 Marston Technical Service, Inc. 33

DOTmedbusiness news I a p r i l 2009 67 blue book price guide Recent equipment and parts auctions on DOTmed with actual for-sale prices.

SURGICAL 739L: M/N: 2103319-2 S/N: 656179YM9 Intelligence™ Processing Image Intelli- FREQ: 6.7/D5.0MHz. Auction 6246 – sold gence Image Display and Processing – CR MEDTRONIC Defibrillators Lifepak 500 This for a broker in New York, $6,000. Console A multi-function console that allows is a LOT of Four (4) Medtronics Lifepak 500 quality assurance activities, image process- Automated External Defibrillators. Each MEDRAD Injector MRI Spectris This is a ing, as well as all the complex procedures Medtronics AED 500 Bi-Phasic Defibrillator Medrad Spectris Injector: This unit was used of digital X-ray imaging – patient ID, image includes a pad and impact-resistant suitcase with a Picker Polaris that was just removed preview, processing and printing, DICOM with removable foam inserts. LIFEPAK 500 from service. Removed in working condition. interface, etc. – from a single workstation. Automated External Defibrillator : Sleek, Auction 6399 – sold for a broker in Texas, A multi-function console that allows quality lightweight design for grab-and-go portabil- $4,000. assurance activities, image processing, ity. Each unit weighs approximately seven as well as all the complex procedures of pounds. Clear screen messages, voice digital X-ray imaging – patient ID, image prompts, readiness display and lighted but- FUJI CR FUJIFILM FCR CAPSULA XL CR- preview, processing and printing, DICOM tons guide responders. Intuitive design ideal IR 356 Specifications Standard Compo- interface, etc. – from a single workstation. for infrequent or inexperienced users. Pre- nents: • FCR CAPSULA XL Image Reader Auction 6415 – sold for an imaging center in connected QUIK-COMBO electrodes with (Model: CR-IR 356) • AC power cord Other Canada, $25,000. REDI-PAK preconnect system save valuable System Components: • IP cassette type time on-scene. Electrode pad diagrams il- CC, LC • CR Console • Image Recorder : PHILIPS Rad Room Bucky Diagnost TH lustrate optimum placement. The field-tough DRYPIX 1000/3000/4000/7000 Supplies: This is a Philips Bucky Diagnost TH General design is proven in real-world emergency CR Plates Included: 3 X = 14 x 17 inches Radiographic System with a Optimus 3 conditions. Automatic self-testing helps 3 X = 24 x 30 cm 2 X = 18 x 24 cm Read- PH 50 KW generator. Manufactured 2002 assure you that your device is ready to go. ing Gray Scale: 12 bits Network: 10 Base “LIKE NEW CONDITION” Includes: Optimus Auction 6038 – sold for broker in Pennsylva- T/100 Base TX Dimensions (W x D x H): 590 3PH 50 KW Generator APR, SRO25/50 nia, $3,500. x 380 x 810 mm (23” x 15” x 32”) Weight: SRO25/50 X-ray Tube/Manufactured 2001 99 kg (218 lbs.) Power Supply Conditions: Ceiling Mounted Tube Crane Motorized 4 HOMECARE/REHAB Single phase 50-60Hz 120-240V ±10% 5A Way Float Top Elevating X-Ray Table 90 (max) Environmental Conditions: • Operating Degree Tilt Wall Bucky with attached Col- Conditions: Temperature: 15-30°C Humidity: limator Control and Light System has Servo INOGEN Oxygen Concentrator One 10-100 15-80%RH (No dew condensation) • Non- and Auto Collimation UPGRADEABLE TO This is a InogenOne 10-100 oxygen con- operating Conditions: Temperature: 0-45°C DR The Bucky Diagnost is the workhorse centrator. Less than a year old, used briefly. Humidity: 10-90%RH (No dew condensa- RAD system, desinged to perform the entire Perfect running condition. Includes: Mobile tion) Easy-Operations Viewed On Small range of general RAD applications. From power charger BA-106 AC Power supply Monitor Capable of automatically launching its superb reliability, to its well thought out BA-101 Satellite Conserver SC-100 5 batter- the image reading process when the IP cas- design and efficiency, the Bucky Diagnost ies BA=100 external battery charger BA-103 sette is inserted, the system is designed with is the perfect system for the busiest room in Inogenone Carte and carry bag CA-100 Ex- simple operations to read, erase or set other the X-ray department. Auction 6411 – sold cellent cosmetic condition. All accessories in settings with buttons while viewing the moni- for a manufacturer in Canada. $12,500. original boxes and have patient manual and tor. The screen also displays the status and instructions for use. Unit is unblemished and the time remaining to complete the read- in perfect working order. Auction 6095 – sold ing process to enhance user-convenience. BEDS for an individual in Canada, $2,500. Compact Frame to Effectively Utilize Work Space FCR CAPSULA XL is designed with IMAGING MIDMARK Beds Electric Midmark 204 You an IP cassette inserted in an angle to ensure are bidding on: 8 Midmark 204 tables ($540/ effective utilization and layout of the equip- ea) 1 Midmark 204 with a bad cover ($400) DORNIER ESWT Epos Ultra This is a ment in the working area that tends to be 1 Brewer Access manual Table ($540). Auc- Dornier Epos Ultra Extracorporeal Shock packed with many high-tech medical equip- tion 6832 – sold for a broker in New York, Wave Therapy System. B-K Medical 1101 ment. As a result, the new model requires $5,260. Merlin Ultrasound Scanner B-K Medical less installation space to setup the main unit 8560 8 MHz MFI Transducer. Auction 6228 compared to previous horizontal insertion – sold for a leasing company in Wisconsin, models, and therefore, can flexibly be setup $20,000. in smaller work areas. Supporting Various Diagnostic Imaging Sizes The equipment GE Shared Service LOGIQ 500 MD GE can be set with 2 IP cassette types (Type DOTmed Auctions LOGIQ PRO 500 MD MR3 ULTRASOUND CC, LC) for various image sizes according to SYSTEM VERSION: 4.10 M/N: 2212962 the image of the body part, since it provides Want to auction equipment S/N: 514558YM6 DOM: DECEMBER IP cassettes for chest, lumber, extremities, on dotmed.com? 1998 VOLTS: 120 Vac 1 PHASE POWER: as well as pantomography (15 x 30 cm). 1350VA FREQUENCY: 60Hz INCLUDES: Compact with High Efficiency FCR CAP- Contact an auction specialist. -SONY VIDEO CASSETTE RECORDER SULA XL enables extremely high throughput M/N: SVO-9500MD2 S/N: 31062 AC120V ~ of up to *94 IPs/hr. and time to display on 212.742.1200, ext. 296 0.6A ~ 50/60Hz -SONY UP-897MD VIDEO the CR Console is just 26 seconds or less or [email protected]. GRAPHIC PRINTER -PRESETS -PROBES: regardless of its small size. Featuring Image

68 DOTmedbusiness news I a p r i l 2009 www.dotmed.com

Replacing your GE Mammography Tube? Replace your Senographe 500T, 600T, 700T, 800T, DMR, or DMR+ with a Varian!

You have used the Varian M-151 for years for your 500T and 600T; Varian now offers a replacement tube for your GE Senographe 700T, 800T, DMR, and DMR+. Varian replacements meet MQSA requirements!

M-151: a direct replacement for the GE D4122M

M-152: replaces the GE D4142M & D4172M. sRhodium/Moly track. sDesigned to calibrate on DMR and DMR+ systems.

M-153: is a direct replacement for the D4162M. sUpgraded bearing. sDesigned speciﬁcally to calibrate on the 700T and 800T systems.

Contact Varian Interay or your favorite dealer for all your GE mammography replacement tube needs today!

USA Contact Information Europe Contact Information Varian Interay Varian X-ray Products Germany 1-800-INTERAY TEL 49-2154-924-980 TEL 843.767.3005 FAX 49-2154-924-994 FAX 843.760.0079 [email protected] E-mail [email protected] www.varian.com

“All trademarked terms are property of the respective manufacturer.”

GE Mamo Family Dot Med BKCover.indd 1 2/20/09 3:53:59 PM