Implementing Defensible Alternative Equipment Maintenance (AEM) Programs
By Al Gresch
The Centers for Medicare & Medicaid Services (CMS) has authorized healthcare providers to deviate from the maintenance recommendations provided by the manufacturers of certain types of medical and facilities equipment when the provider has data to substantiate that such deviations will not affect equipment safety and effectiveness. By adopting such Alternate Equipment Management (AEM) programs, providers can save significant resources without sacrificing patient safety and care throughput.
While it is possible to use data collected within a single provider to make such decisions, due to the small number of equipment of the same brand and model typically installed in each institution, it would take many years to accumulate enough data to start an AEM program. Since CMS accepts the use of data collected elsewhere, an Asset and Maintenance Management provider with a large installed base and a proven methodology to collect and analyze a large amount of service data can help its customers deploy AEM quickly and easily.
With approximately 55% of the United States hospitals as customers, Accruent can take advantage of extensive data as well as data scientists devoted to analyzing this data. To ensure cleanliness and normalization, Accruent captures as much data as possible to draw data conclusions. As a result, clinical engineering or Healthcare Technology Management (HTM) and Facilities (HFM) departments can draw upon Accruent’s data to justify manufacturer deviations.
Justifying Manufacturer Deviations
For an organization trying to implement AEM programs, there can be several challenges involved in the process. If the organization’s rationale for implementation is specifically to save time and increase technician productivity, those reasons are not acceptable to regulatory agencies. Whatever an organization does when implementing external solutions, it cannot negatively impact patient safety. For any potential AEM decision that is to be made, an extensive amount of data is needed to support it. Not only must you have a good rationale for making deviations for procedures or intervals, you also must be able to perform continuous monitoring of failure rates to ensure these deviations have not negatively impacted safety. This process is not difficult, but incredibly important.
There are outliers, of course, in terms of what equipment can and cannot be included in an AEM implementation. Organizations cannot deviate from these categories of equipment:
- Any imaging device, (x-rays, etc).
- Anything regulated by state or federal regulations.
- Devices that are new to the industry, as organizations need relative history in order to deviate.
Using Evidence-Based Maintenance
Extensive studies conducted in the last several years by consultants and researchers have indicated that Evidence-Based Maintenance (EBM) is one of the best and most straightforward methodologies for selecting equipment for AEM, as well as confirming AEM’s safety and effectiveness as required by CMS. An EBM is, in essence, a continual improvement process that analyzes the effectiveness of maintenance resources and processes deployed in comparison to outcomes achieved previously, or elsewhere, and makes necessary adjustments to maintenance planning and implementation. Evidence-Based Maintenance is based on the same principles as Evidence-Based Medicine, also known as the scientific method, in order to raise accuracy and dependability. By using EBM methodology to implement an AEM program, an organization can be confident that they are on the path to doing more with less.
Every healthcare organization is faced with the task of doing more with less and looking for ways to increase general efficiency.
Consider this real-life example. An Accruent client studied a group of medical devices that exceeded the established failure rate threshold and looked for ways to increase frequencies or add steps to the PM procedure to lower the threshold and failure rates. By investing in an additional 135 planned maintenance hours, the client garnered over 1,500 annual hours in reduced corrective maintenance. After extensive customer interviews and consultations, Accruent has found that most healthcare organizations are at about 1,000 annual device hours per technician. Through using an AEM solution, the customer garnered over 3,000 annual hours in reduced planned maintenance, the equivalent of two full time employees worth of annual device hours.
If organizations are not analyzing data to this degree, then they may miss opportunities to save time and increase efficiency. Data shows that while Health Delivery Organizations are acquiring more equipment, these organizations are not hiring more healthcare professionals, even as many experienced professionals are retiring. Therefore, it is increasingly imperative to work smarter instead of harder. AEM and EBM outcome studies have shown that it is possible to do the right maintenance correctly and at the lowest possible cost.
About the Author
Prior to joining Accruent, Alan was Vice President of Capital Technology Management at Alpha Source and held similar roles at TriMedx Healthcare Technology Management and Alexian Brothers Health System, where he led both Healthcare Technology Management and Capital Supply Chain functions. Much of Alan’s experience and reputation in the industry came from building and leading one of the nation’s premier Healthcare Technology Management programs at Aurora Health Care, a 15-hospital system headquartered in Milwaukee, Wisconsin. Using his experience and success from past roles, Alan helps Accruent clients adopt industry best practices and streamline processes that have resulted in significant increases in productivity and cost savings. A recent Accruent customer engagement identified $5M in annual net dollar savings and over 4,000 in saved manhours that could be applied toward other opportunities. Alan has authored and contributed to numerous articles on Leadership and Clinical Engineering management, including Creating a Cradle-to-Grave Asset Management Program, the 2011 winner of BI&T Best Article of the Year. Alan has presented several keynote addresses at Healthcare Technology Management events, including 2017’s NCBA conference. Alan was Chair of AAMI’s Healthcare Technology Leadership Committee from 2010 to 2017 and still serves on the committee. He is an active member of BI&T’s Editorial Review Board, and is currently authoring a Healthcare Technology Management Manual for AAMI.