This article appears in the July/August issue of Surgical Products.

A product’s performance doesn’t mean much if it doesn’t justify the cost to acquire and utilize it. When it comes to surgical imaging equipment, value is often best understood when considered within the context of purchase price and financing terms.

A new piece of imaging equipment may impress doctors or prove useful for a certain type of surgery, but recent purchasing trends suggest the dollars and cents must be right for it to find its way into many hospitals.

“Technology is still a driver, but it’s not the primary driver,” says J. Michael Brown, Executive Chairman for Olive Medical Corp., a provider of high-definition minimally-invasive surgery imaging equipment. “I don’t think anybody starts right now in today’s marketplace because of technology in an evaluation.”

According to Brown, performance and preference are not the purchasing drivers they were just a few short years ago. While they remain key considerations, deciding whether or not to invest in new imaging equipment often comes down to two more quantifiable factors. 

Cost Of Performance
“The first thing that’s critical is being able to satisfy your doctors, because they will not go backward in terms of imaging,” says Brown. “You can’t take them back to standard definition. But as long as images are comparable, you don’t have to prove yourself having a better image. You just have to be as good, and then it comes down to price and terms.”

Hospitals demand high-definition imaging. That’s the standard right now, and it is expected to remain so for the immediate future. Brown estimates about 70 percent of hospitals in the United States have converted to HD imaging in their operating rooms. It is a number that should continue to rise, especially since he feels there isn’t an alternative that offers a better combination of price and performance.

3D imaging is being used by some hospitals, and it does draw the interest of certain customers, says Brown. However, because the price is so much higher than HD, purchasers aren’t willing to pay a significant premium for a jump in performance.

“It certainly isn’t taking the market by storm any more than it has in the consumer market,” he adds.

Making A Move
According to Brown, often what pushes hospitals to look at purchasing new pieces of imaging equipment is when doctors express they are less than satisfied with the level of degradation they are seeing on the screen. For a minimally-invasive video, this means degradation could be coming from any portion of the video chain – the display, the camera head, the light source, the light cable, or the endoscope. But that’s not the only reason to make a purchase.

“The other reason they start to move is a lot of these guys have five-year leases, and that’s kind of been the norm,” says Brown.

“If you could get three-year leases, you did because it allowed you to move quicker,” he continues. “It used to turn at least every five years, but it started to get stretched out to seven or eight years, but I think we’re starting to move back toward that five-year cycle.”

That way facilities can ensure their equipment is still performing at a high level, he adds.

The Rise Of The Hybrid OR
While new imaging technology isn’t the purchasing driver cost is right now, it seems the increased prevalence and popularity of hybrid operating rooms are affecting imaging purchasing trends and video management in hospitals across the country. The introduction of 56-inch and 60-inch, 8-megapixel displays, as well as video management gives surgeons the ability to better access images.

“The display layout can be formatted for physician preference and procedural preference,” says Ken Crocker, Global Accounts and Customization Team Leader, Eizo Medical Monitor Solutions. “And it can be changed with an intuitive touch interface during the procedure. This allows the surgeon to better concentrate on the procedure and spend less time visually searching for desired images.”

Since the cost of these displays is quite substantial, some hospitals have been able to justify the expense thanks to more effective room utilization.

“Outcomes can also be improved because of the more advanced imaging capabilities of the hybrid operating room, and the more immediate feedback to confirm successful surgery can be quite helpful,” notes Crocker.

However, the desire to invest can sometimes depend on the types of surgical procedures being performed at a particular facility. Crocker says procedures that are more advanced, such as newer cardiac or neuro-type procedures, have shown to justify the investment in cutting-edge imaging technology.

“Everybody seems to want the higher resolution of the 8-megapixel display,” he notes. "They really appreciate the image quality and clarity from the higher pixel density, and they also appreciate the ability to display practically any type of image at any zoom magnification needed during the procedure.”

Healthcare Reform
Much has been made about the ramifications of upcoming healthcare reform legislation, which is set to go into full effect on January 1, 2014. The main goal of the reform is to expand health insurance, which means insurers can no longer refuse medical coverage to those who need it. Just how much this will affect quality of care, cost of care to patients, and cost to the healthcare provider is not yet known. While the effects of this legislation is a concern to those who decide how capital is allocated at a hospital or medical facility, it seems those concerns have not had a significant bearing on recent purchasing decisions related to imaging equipment. Simply stated, many hospitals aren’t able or willing to wait and see what will transpire with healthcare reform

“We are not seeing an impact, either positive or negative,” says Crocker. “Capital budgets for these types of projects are not being affected. This is still very much a growth area for surgery.”