Buying refurbished is a great way to outfit your facility with reliable, working equipment without breaking the budget. The only problem? You can get stuck with a lemon if you don't do your homework. "I wish there was a Carfax for used equipment," says Stuart Katz, FACHE, CASC, executive director of the Tucson (Ariz.) Orthopaedic Surgery Center, referring to the vehicle history reports that tell shoppers the ownership, accident and repair history of used cars. No such service exists for surgical devices, but you can perform your own assessment of a piece of refurbished equipment by focusing on 3 areas: the equipment's history, its present condition and its future reliability.

History:
Where has this equipment been?
Start your investigation by asking how old the equipment is — meaning, when was it originally manufactured? If significant changes in the technology or design of the product and its parts have come along since it was first manufactured, it may be difficult finding replacement parts or getting the device serviced, says Gayle Evans, RN, MBA, CNOR, CASC, of Continuum Healthcare Consultants in Kennesaw, Ga. Or, there may be newer technological advances that have changed the way clinicians use the equipment, so if you buy an older model, you'll be forcing your staff to take a step backward in the way they practice.

This is one reason why Ms. Evans recommends you stick to the "workhorses" of the OR, things like tables, lights, electrocautery units and sterilizers, when thinking about which types of equipment to purchase used. "These things aren't going to change much. There's no need in spending the money on new equipment when you can buy it remanufactured at a much [lower price]," she says. However, specialty items like certain types of microscopes or must-have technological advances like HD video equipment may be better purchased new for the value they bring in attracting surgeons to your facility.

Also, ask the vendor how the equipment ended up on the market. "I want to know why the piece of equipment is available," says Mr. Katz. What kind of facility was it in before? Did they go out of business? Did they trade it in for an upgrade? Or was the equipment's uptime less than acceptable (say, less than 80%)?

Present:
What's the equipment's current condition?
Many people use the terms "refurbished" and "remanufactured" interchangeably when talking about used equipment, but that's a mistake, says Ms. Evans. "You've really got to understand if someone is selling you remanufactured equipment and what that means vs. refurbished equipment and what that means. That's the first and most important thing."

"Remanufactured" is a very specific term that means the vendor has brought the equipment back to the quality and standards it was at when it was sold as new, she explains. "Refurbished," however, is not as specific — it simply means the used equipment has been spruced up, a process that could entail putting a new coat of paint on it or performing extensive repairs and maintenance to make it as new. Ms. Evans recalls facilities that bought equipment refurbished and found rust on the tables. "Refurbished could mean taking it out of one facility and putting it in your facility," she says. You want to make sure the equipment has been rehabbed since it left its previous owner's hands, so try to get as much detail as possible about what the remanufacturer is going to do with the equipment before it's sold to you.

Of course, any vendor could tell you a piece of equipment has been remanufactured, but you don't really know unless you see for yourself. Ms. Evans recommends asking the vendor to bring the equipment in to your facility for a test drive.

The best way to ensure the equipment is in good shape is to find a reputable vendor you can trust. There are both large, national companies and smaller, local companies that refurbish used medical equipment. "Ask for references and ask your colleagues" if they've dealt with the vendors you're considering, what they bought and how it worked out, says Mr. Katz. Also consider how long the company has been selling used equipment, and what its track record is in the industry. "Look for someone who's been in the business for a long time, so you can trust the product you'll be getting from them, and they'll stand by that product," says Ms. Evans.

Future:
What if it breaks down?
As with any piece of equipment — used or new — securing a good warranty can be difficult but well worth the effort. Ideally, the sturdy types of equipment that you're likely to purchase used, such as OR tables, should last you as long as 7 to 10 years. But that doesn't mean they won't need servicing down the road. Without a good warranty, "you might have paid half the cost of a new one and wind up with twice the headaches unless you're careful," warns Mr. Katz.

Ms. Evans notes that warranties on remanufactured equipment are often short, lasting only about a year, but the longer you can extend it, the better. "I wouldn't take anything less than a year, with parts and labor, for remanufactured equipment," she says. "You could get something and it could break within a month. If you don't have a specific warranty, then you're liable for it." Again, purchasing from a reliable, dependable vendor whom you can trust to follow through on the service contract will help ensure you don't have to cancel cases because your refurbished equipment is down. Ask how quickly the vendor would be able to respond to service requests and get the equipment back to you in good working condition.

You'll also want to consider the possibility of future upgrades to the technology you're purchasing. When it comes to items like OR tables, chances are slim the technology will change dramatically in the next few years and you'll regret having that older table. But with something like an anesthesia machine, you may find that there are no parts available for the older model if it needs repairs, or your anesthesia providers' techniques may be evolving to the point where the older machine will be obsolete in a few short years.

Tread carefully
Buying refurbished can be a great way to save as much as tens of thousands of dollars on equipment that you use everyday. Ms. Evans has been purchasing remanufactured major capital equipment items for more than a decade and swears by the quality of the equipment and the vendor she works with. But if you're new to the used equipment market, tread carefully and take the time to do the necessary research and planning to ensure you're not just getting a good deal financially, but also a good deal on the quality and reliability of the equipment and the customer service that the vendor offers.