Estimating the cost of failure as a potential $4 billion to $12 billion drag on U.S. healthcare, the Joint Commission (JC) is asking the clinical engineering community to be its wingman as the JC seeks to persuade the Centers for Medicare & Medicaid Services (CMS) to relax its controversial December 2011 directive on medical equipment  maintenance.

The directive requires that hospitals strictly adhere to manufacturers’ recommendations for preventively inspecting most categories of medical equipment, including those that present a low risk of injury to patients and staff.

The JC made a case for clinical engineering to get behind the JC’s “evidence-based” approach, which prioritizes higher-risk and critical-care devices while judiciously foregoing routine “PMs,” or preventive maintenance checks, on many others, at a May 18 webinar featuring its director of engineering, George Mills. 

The webinar, co-organized by the Association for the Advancement of Medical Instrumentation (AAMI), followed a similar event hosted by ECRI Institute last February at which attendees voiced their consensus that the JC system—in use for years with little if any incident—improves efficiency, increases time for more pressing technology-management activities and saves hospitals money without compromising patient safety, quality of care or performance of equipment.

“There are estimates in the field about the cost of this” to clinical engineering, said Mills at the May session. “The estimates range between $2 billion and $4 billion, based on having to increase our FTEs (full-time equivalents) by 25 percent and based on having to increase our contracts with our service companies to truly meet the manufacturers’ recommendations. So we’re talking about a significant cost to the industry.”

Mills pointed out that the CMS directive originally called for the use of manufacturers’ tools, and only manufacturers’ tools, to calibrate and service their related pieces of equipment. He then told attendees about an April meeting at which the JC asked CMS to permit the use of after-market tools as long as they function in an equivalent way. “The best news, right off the top, is they agreed,” he said. “Channel locks are channel locks. A crescent wrench is a crescent wrench. So that’s off the table. That alone, we estimated, [saved us] between $1 billion and $3 billion in equipment.”

The most significant action item to emerge from the April CMS-JC meeting calls on the JC to “do some research” for CMS, said Mills. “CMS certainly wants to work with us,” he explained. “The bottom line here is that CMS wants to be assured—through research, through some survey process—that the Joint Commission process truly is safe, and that their allowing us to continue doing what we’ve been doing for the past 30 years is going to be safe as far as patient care, patient safety and patient outcomes.”

To that end, the JC is putting together a bibliography of its own writings on the subject plus related works published by AAMI, ECRI Institute and the American Society for Healthcare Engineering, among others, said Mills.

He then rolled out his call for active involvement from the clinical engineering community, issuing something of an urgent plea for attendees to participate in a seven-question online survey.

“I’m begging for your help. We need you to answer those seven questions by the middle of [the week of May 21],” said Mills. “I wish I could be there, looking at you face to face so you could understand how concerned I am for us as a [profession] doing the right things right. This questionnaire will equip us with the information CMS is looking for, so that AAMI and ASHE and I can hopefully meet with CMS in the very near future to share these survey results and continue explaining to CMS why our process is safe; it’s not hurting individuals or patients and it’s been reliable, based on the good work that you’re providing in the field.”

“By undertaking the Joint Commission process rather than manufacturer recommendations—if we had to do manufacturer recommendations, the estimates from the experts in the industry are between $4 billion and $12 billion with the increase in FTEs, with the increase in time, with the downtime of equipment and the equipment you’d have to buy to replace equipment that’s down for service, all the other factors—a $4 billion to $12 billion impact. Please, please fill out the survey.”

The JC is conducting a concurrent survey, with ASHE, for facilities managers.