No matter how many times you crunch the numbers, that new piece of equipment your surgeons want is beyond your budget's reach. Well, maybe not. You could buy a manufacturer's demo and save big. We asked three facility managers who recently bought gently used equipment for the keys to making a wise next-to-new purchase.

Dick Farr, OPA-C, CASC, director of the Outpatient Orthopedic Surgery Center in Statesboro, Ga., furnished his two-year-old ASC's ORs with a mini C-arm, arthroscopy tower components and vital signs monitors that had been test driven in other ORs and trade show exhibit halls. While demo discounts vary - his purchases included 17 percent to 25 percent price cuts - "even if it's just 10 percent, that's still 10 percent off new," he says.

Discounted demo equipment is clearly a boon to facilities just setting up shop, as Donna Dolan, BSN, director of operations for the Western Pennsylvania Surgery Center in Wexford, Pa., describes. "When we were just opening our surgery center in 2000, we didn't want to spend all our money on anesthesia," she says. Ms. Dolan's center purchased four demo anesthesia machines for its ORs before opening its doors and a fifth later.

But the benefits of pre-trialed equipment extend to established centers, too, especially if you've got to upgrade a fleet of items. At the Eye Surgery Center of Augusta in Augusta, Ga., the surgical staff had begun to notice that the stretchers in use since the facility was built seven years ago no longer accommodated an increasingly obese patient population or the nurses who had to maneuver them. Re-equipping with a combination of new and demo electric stretchers not only didn't break the bank, says nurse manager Charlotte Austin, BSN, "but when they're lined up, no one can pick out the used from the new."

Of warranties and trials
Rule No. 1 of buying demo equipment: Get the full warranty. "You have to be careful with that," says Ms. Austin, who notes it's one potential downside to the purchase. "They might offer a little less than what you'd get if you bought new equipment."

It may not be a lifetime warranty, says Mr. Farr, but you'll want to make sure you get the original manufacturer's warranty with your purchase. If they say they'll service your equipment as new, it's as good as new to you. "If you're selling it to me as your demo, I want the new warranty. Just a 90-day warranty, I probably would not buy it," says Mr. Farr. "Remember, everything's negotiable."

When it's your turn to take demo equipment for a test run, you'll want to see it work with your own eyes. First and foremost, says Mr. Farr, be sure that the equipment that the vendor's rep has brought over are the same items you'll be buying.

Next, let your experts take the wheel. Budgeting and writing the checks may be the domain of the administrators who open and run a facility, says Ms. Dolan, "but it's always best to check with the end provider and see what they'll want to know about the equipment." Let your anesthesia providers weigh in on the anesthesia machines, let your nurses try out the monitors and so on, even if you're a hands-on manager with a clinical background.

Look into the item's past. Ms. Austin recommends asking for service records to ascertain the equipment's age and perhaps its usage schedule, what service it's undergone and whether it's suffered any recurring problems. Regardless of whether the service records offer any insight into the equipment you're considering, you'll probably also want a history of the product line. Network with others who've bought and used the same model new to get their sense of its reliability. If you're looking at an item that's nearing one year old, for example, "ask them how it has handled through the second, the third year," says Ms. Austin. "Maybe they'll say, after about the second year we experienced this and that. Then you'll know there's a possibility that you have one more year before those things arrive."

The service reputation of the manufacturer or reseller providing the equipment to you is another valuable opinion to seek out. Ask your counterparts in other departments or other facilities - "the Web helps out with this," says Ms. Austin - about their experiences with the company.

Market timing
The availability of demo models for purchase is ensured by two factors, say our panelists. First, manufacturers and their representatives occasionally rotate out their trial stock to keep it looking new. Second, manufacturers and reps are more than willing to work with equipment buyers to make a sale.

How do you get your hands on a demo deal? There's no magic to it, says Ms. Austin. You just ask, whether you're planning a list of things you need to open a new facility, visiting an annual meeting's exhibit hall or fielding a regular visit from your rep.

"If they know you're looking for a piece of equipment, they'll call you up with offers," she says. "You can say, 'That's a little more money than I care to spend. Do you have any demos?'"

If the purchase isn't an immediate need but one you're planning for the future, watch your calendar for the AORN, AAOS or other specialty conferences, says Mr. Farr. "Oftentimes, a few months after the big meetings, they'll be retiring some demos, so you might want to ask around then."

Or you might ask if the equipment's already on-site. When a manufacturer lent Mr. Farr's facility a mini C-arm for trialing, the doctors found it worked to their satisfaction. "As I was on the phone discussing the shipping and freight costs for a brand-new model, I just said, there's one already here, can we just buy this one?" he recalls. "They checked with their managers and came back with an answer. That's how we bought our mini C-arm."

Power of the purse
Just because the equipment is being sold as a demo model doesn't mean there's no room for negotiation. The amount of the discount, the terms of the warranty and other factors should always be open for discussion, our panelists agree.

"Sometimes small centers don't have much influence in negotiating," says Ms. Austin. "But if you set up your reputation and experience, it can get you a little more buying power."

With only two ORs, her ophthalmology center is seen as a small buyer, she explains. "But we do 4,000 cases a year in our area. To a distributor, that's a lot of cases. So we're a small center, but we're large in our area."

In the case of Mr. Farr's demo arthroscopy equipment, the accessories provided the incentive for reliable future maintenance. "They're dependent on us buying the disposables, so they're willing to switch out equipment for service," he says.

Ms. Dolan says there's nothing stopping you from courting more than one vendor. "The best way to negotiate is always to leverage [a manufacturer] against another manufacturer's offer," she says. "Not just with demo equipment, but with anything you're buying."

Your purchasing history or the amount of money you've spent with a manufacturer may give you more standing in making a deal. But even if that's not the case, negotiation is particularly worthwhile if you're making a large capital purchase or buying more than one of an item. "Let them know your intentions, and ask, 'What can you get for me?'" says Ms. Austin. "If they can sell you five new stretchers and three used ones, you can bet they'll do it."

"The only downside of buying a demo is that they'll obsolete faster than a brand-new model," says Ms. Dolan. "But, depending on the financial position you're in, you may be better off."

If you're just opening a facility, buying demos lessens your capital expenses, potentially letting you turn a profit sooner, she explains. With any luck, by the time you're in the black and you need to replace your equipment, you'll have the means to buy top-of-the-line new models.