Simply picking equipment that fits your budget when renovating or building a surgical facility is not sufficient equipment planning. Good medical equipment planning actually comprises considering the future of the equipment, your goals for the future and how your facility can incorporate those future visions.

That's why it's integral that you pick your equipment while drawing blueprints; not only will it prepare you for technology down the road, it will help control costs. Here are the equipment-facility issues the pros say you should address to help ensure your center's overall viability five, 10, even 20 years from now.

Start with sterilization capacity
Nothing will stop a surgical center's growth or achievement faster than a dearth of sterilization capacity. The additional capital expenditure required to acquire larger-capacity sterilization equipment will almost certainly pay off in future savings as the center expands, either physically or in case volume.

If buying additional equipment isn't feasible initially, consider your goals:

• It might be cost-effective to add to the infrastructure now to support larger sterilization capacity, including additional feed lines, venting and electrical needs, say equipment planning experts.
• Look at developing sterilization technologies and techniques, and make sure your plans include the necessary infrastructure to support these, even if you won't use them initially.

Buy equipment that lasts
You want equipment that embodies two qualities: reliable short-term, and adaptable to advancing technologies long-term.

"There are ways to find equipment that will be with you in the future and not gathering dust in a corner," says Debbie Heitzman, president of Strategic Hospital Resources, Inc., a Smyrna, Ga.-based hospital equipment planning consulting firm. "Look at previous versions of the equipment to see what changes the manufacturer made, and ask the vendor what changes are planned."

By taking this approach, you can gauge the vendor's level of support for the equipment and see where that equipment is headed. You might also discover that recent changes to a piece of equipment were only cosmetic or were changes you don't need. In that case, you might be able to acquire an earlier version of the device that fits your needs, but at a substantial savings. Ms. Heitzman cautions buyers to go beyond the sales and marketing material, and instead talk to manufacturers' design and development personnel to get a more detailed and accurate picture of future enhancements to a device.

"Looking for open-architecture technologies is one way to ensure that the equipment you buy can keep pace with changing technologies," says Alex Seifert, director of surgery center systems for Arthrex, Inc. "The initial cost may be higher, but in the long run, the equipment is more likely to remain useful for a longer time."

Negotiate warranties and service contracts
Regardless of which version of a device you buy, take steps to protect your investment. "Be sure to include an upgrade clause in the purchase contract, especially one that offers no- or low-cost upgrades within a specific time frame," advises Ms. Heitzman. "You also need to determine how long the vendor plans to support a device, especially when buying an earlier version of the equipment."

Another overlooked aspect of long-term equipment planning is the equipment service contracts and warranties you can negotiate with vendors. This can save you significant money over time. The long-term cost of service and repair not only impacts the bottom line; in cases where equipment requires prohibitively expensive service or repairs, you might be forced to abandon an expensive piece of equipment.

"Find out about the reliability record of a device so you can make a smart decision about the level of service you need to maintain that equipment," advises Mr. Seifert.

The best time to negotiate a service contract? At the same time you purchase the system. "This will lock in a better rate and guarantee uninterrupted service for the system," says Marion Meusel, service product manager for Siemens Medical Solutions in Cary, N.C.

Plus, this is the time when you have the most leverage for both equipment and related service coverage. "Salespeople can often greatly reduce contract cost or even provide complimentary maintenance or service in order to secure a sale," says Melissa Reece, RN, CASC, the director of the Cedar Laser & Surgery Center in Cedar City, Utah.

Include service costs as part of the overall equipment price comparison and cost analysis when making purchasing decisions during the competitive bid process, says Don Fox, the director of purchasing and materials management at Nueterra Healthcare.

Essential equipment must be functioning for you to perform surgery. Examples include electrocautery machines, ventilators, and life safety, infection control and imaging equipment. They need service contracts. Non-essential equipment is necessary, but business could continue without it, such as computer terminals or backup machines. "Dedicate more resources to your essential equipment than non-essential," says Ms. Reece. "For example, I don't have a service contract for our two-year-old back-up phaco since it is rarely used and significantly cheaper to service as needed."

Another question to ask yourself: How much revenue will you lose if this piece of equipment is down for an extended period of time? "With capital items, backup equipment is not always readily available," says Sarah Martin, RN, BS, of Memphis, Tenn. "A good service contract, with a reputable customer service department, will make you a priority when repairs are needed."

With non-electric OR beds or surgical lights, for example, it will probably be safe to have a preventative maintenance contract only. Another option is to cover the equipment for one year, then leave it uncovered for one year. This is usually a good solution for newer equipment that doesn't have a history of frequent repairs.

Weigh initial cost, long-term savings
A piece of equipment that sits in the corner or that costs a lot to use will only waste money.

"Since hospitals last for at least 50 years, you must plan for that length of service," explains Carolyn Korbel, president of Korbel and Associates, a medical equipment consulting firm based in Minnesota.

Over the years, the per-procedure cost of using a particular device actually might exceed its purchase price. Therefore you should factor the per-procedure price when calculating equipment's true cost of ownership.

"Factoring in the cost of expendables and routine maintenance is essential when planning for the long term," says Mr. Seifert. "While the ongoing utility of a device is critical, the cost of using it cannot be ignored."

In addition to the per-procedure cost, consider the labor costs associated with a device. Some devices might offer significant savings in labor costs if they let you reduce your staff. "Labor costs can be 55 percent of your operating costs, so the additional investment in a device that really saves on labor may be, in the long run, well worth the money," says Ms. Korbel.

Plan communications infrastructure
Increasingly, medical equipment is being designed for integration into communications systems, either for remote control or with streaming video and electronic medical records interfaced with the Internet. Such systems let you automatically gather data and share it across vast distances in real time.

While the vast majority of surgical centers aren't using the full range of currently available electronic systems, it's clear that electronic communications in the surgical suite will become increasingly commonplace. "Even if a surgical center has no plans for extensive use of communications now, you would be wise to plan for it in the future," says Mr. Seifert. "The way to do that is to buy equipment that supports open-architecture technology and to design facilities with the necessary infrastructure to support electronic communications."

Design for growth
A good time to plan for growth is during the blueprints phase. While over-building - in terms of larger rooms, more storage and more robust booms - isn't necessarily a good idea, you should be realistic about any impending growth in your facility's caseload.

"Accurately determine how many procedures of a certain type you expect to perform at some future date," says Larry Zelner, a partner at HLA Systems, a medical equipment consulting firm in Englewood, N.J. "Modeling everything that happens in your surgical center - including equipment used, types of procedures, and traffic patterns - is an effective way to ensure that your plans are going to work in the long run."

Then you can extrapolate details, such as the size of the room you may need, additional heating or cooling requirements, drainage and feed lines, all of which are easier and cheaper to install during construction than later, according to Mr. Zelner.

Understand your project
While there's no doubt trying to plan your medical equipment for the long term is a time-consuming challenge, there's also no doubt that, when done properly, it helps ensure the equipment you buy is useful for a longer time. In addition, planning that focuses on the long-haul can save a significant amount of money by lowering daily operating costs, reducing the need to replace equipment, and decreasing the cost of expansion.