Where do you turn when your scopes need service and repair — the scope's maker or a third-party vendor? More than three-fourths of the 33 GI facilities we surveyed rely on the original equipment manufacturer.

Lori Knepp, BSN, RN, CGRN, the administrator of St. Petersburg Endoscopy Center in St. Petersburg, Fla., has sampled both options. Her assessment: The scope manufacturer's higher repair bills save her in the long run. "The scope manufacturer fixed everything, while the third party tried to keep costs down and fixed only the primary issue. This caused the scope to go out more often," she says.

A service company that goes the extra mile — and comes to your door — is a nice draw, says Doretha Smith, RN, nurse manager at Quad City Endoscopy in Moline, Ill. Her repair service performs on-site evaluations of scopes and reprocessing equipment, quarterly or on-demand, she says.

For many, the choice to stick with the manufacturer for service is an automatic one, since they signed favorable service contracts with their purchase contracts or lease agreements. Others report a brand loyalty to the company — especially to the reps that sold them their scopes — and wanting peace of mind. "Scopes are maintained at the manufacturer's specifications, so the physicians have the same quality scope every time," says Christina Haven, RN, CGRN, director of the GI Endoscopy Center in Middletown, Ohio.

For Suzanne La Du, RN, the ASC assistant coordinator at the Oregon Clinic in Portland, Ore., a continued service association with the manufacturer meant better pricing on other endoscopy supplies through her service contract. However, some respondents admitted to concerns that sending scopes to the manufacturer for service means they overspend on repairs and wondered if they would be able to negotiate a better deal from an outside service company. "Our cost goes up every year with the increasing number of scopes, and aging scopes," says an administrator from a Georgia facility whose 14 scopes ring up about $50,000 in service and repairs a year.

Outside assistance
About one-fifth (21.2%) of respondents say they send scopes to companies other than their manufacturers for maintenance, but they have convincing reasons. Nearly every third-party service customer named price as a deciding factor, but the combination of good price and quality service may take some shopping around, our respondents say.

Under a maintenance contract with a Florida dealer, which costs the center $1,000 per year per scope for its 10 scopes, "repair costs are less than half of prior repair organizations, and service is better," says Stephen Lloyd, MD, medical director of the South Carolina Medical Endoscopy Center in Columbia, S.C.

In either case, whether respondents contracted with the manufacturer or a third party for their scope service, the availability of replacement equipment for temporary loan was frequently cited as an invaluable benefit. Even though a large number of respondents said scopes sent for service were typically returned in 3 to 5 days, running an endoscopy service short-scoped for 3 to 5 days can tax your reprocessing staff and your schedule.

Conditions of coverage
Respondents to the survey say they annually spend anywhere between $4,000 (for a 1-room center with 4 scopes that does 2,400 procedures a year) and $52,000 (for a 3-room center with 25 scopes and 6,000 procedures a year) on scope upkeep.

This maintenance is conducted, and service expenses are paid out, in one of 2 arrangements with manufacturers or third-party repair dealers: through a service contract or on a fee-for-service basis.

One of the chief advantages of the service contract, which all but a small handful of respondents have in place to cover their scopes, is that it brings predictability to your repair costs and consequently your budget, they say. It covers the cost of service and repairs for a fixed price during a specified time for a certain number of scopes — whether that's $4,000 for a year for 4 scopes or $152,000 over 60 months for 14 — allotting a controlled amount toward maintenance.

Depending on the contract's terms, once that fixed price ceiling is reached, any additional service requested during the contract's time span is either charged on a fee-for-service basis (a point you may not reach if your contract is generous enough, say respondents, though a potentially expensive situation if you do) or is not charged at all (which can actually reduce your annual repair costs if you know that they normally exceed the limits of the contract, respondents say).

A generous service contract may also lead to better patient care, as it lets a facility service its scopes more often, says Marion Auld, BSN, MBA, clinical director of the Endoscopy Center of Santa Rosa in Santa Rosa, Calif. "We send the scopes in for minor repairs," she says. "Having a service plan encourages better maintenance of the scopes, which will decrease major repairs."

The disadvantage of a service contract, however, is when it doesn't get used. They can be a pricey option for new scopes in the first year and a half when few or no repairs are needed, says Ms. Auld. Plus, your facility may be fortunate enough to employ a highly skilled reprocessing staff. "We have a well-trained scope washer, which also decreases our scope repairs," she says.

The large advance cost of a service contract is the main argument put forth by the survey's fee-for-service respondents, especially among new startup facilities looking to control their capital outlays. "It works very well for us," says a Missouri GI center administrator whose facility spends $20,000 a year for service through a third-party provider. "We make the interest off of our money, instead of the manufacturer."

Perhaps the cost-conscious GI administrator would find it beneficial to cover her scopes with different service plans at different points during their life spans, as Ms. Haven does. "The older scopes are on a service contract, the newer scopes are fee for service," she says. And, for additional budgetary control over the fee-for-service scopes, "I do not agree for them to repair without calling me first to review what is required."

Care and handling
Scope maintenance is an unavoidable expense, but it's nowhere near the temporarily avoidable expense of buying a replacement scope, a cost that the respondents who point out that their facilities just opened within the past 3 years and who are still using their startup equipment would presumably prefer to postpone as long as possible.

Our survey found that most scopes last for 5 to 7 years. In order to reach or exceed that lifespan, training new employees how to handle scopes is essential. "It helps to tell them the scope generally costs as much as their car," says an administrator from a Pennsylvania hospital.

Respondents agree that the best resources for training your nurses, techs and reprocessors are annual (or more frequent) visits by representatives from your manufacturer or service company for in-services on scope handling, cleaning, quarterly inspection and knowing when repair is necessary, since immediate service prevents worse damage. The Society of Gastroenterology Nurses and Associates (www.sgna.org) even offers courses on how to train your facility's trainers.

Some respondents argued that, with sufficient numbers of staff, only limited and specially trained personnel should handle and clean a facility's scopes. "The more hands that are on the scopes, the less consistent the reprocessing can be," says a nurse and GI tech from a North Carolina endo center. With sufficient numbers of scopes, a Connecticut nurse administrator says, equipment should be dedicated to specific rooms and block scheduled to specific surgeons. "Too many users increase the potential for breakage," she says.

In the final analysis, proper scope care depends on precision every time. "The most important step to ensure the life of the scope is correctly performing the leak test before cleaning," says the North Carolina nurse. "Detecting any leaks and sending [scopes] out for repair quickly helps [prevent] prolonged fluid invasion."