How to Buy Refurbished Instruments with Confidence

Most surgical facilities could easily buy as much as 30 percent to 40 percent of the capital equipment they need through resellers, saving tens or even hundreds of thousands of dollars without sacrificing quality. Regrettably, though, many do not, for fear that they will end up with instruments and equipment that is either obsolete, unreliable or both. In this article, I will try to pass along some advice on how to buy and save with confidence.

1. Decide what you are looking for
The first step toward buying with confidence is knowing what to buy used and what not to buy used.

I recommend steering away from buying instruments that are subject to abuse or significant "wear and tear" in normal use, including flexible and rigid scopes and instrument sets used for specialties such as general surgery, OB/GYN, and ENT. I would also generally recommend buying new in areas where the technology is moving quickly. For instance, I generally suggest that facilities buy video equipment like cameras and monitors new rather than refurbished.

However, there are many items that do not sustain a lot of wear and tear and that do not become obsolete quickly. You can almost always safely purchase the following items in the refurbished market and save thousands by doing so:
- Stretchers
- General stainless steel equipment (e.g. carts, mayo stand, IV poles, instrument tables, kick buckets)
- OR tables
- OR lights
- Anesthesia machines
- Electrocautery units
- Warming cabinets
- IV pumps; and
- patient care monitors.

2. Choose a vendor
There are literally hundreds of surgical equipment and instrument refurbishers. I recommend narrowing the list down in two ways:
- Ask colleagues at other surgery facilities which companies they've used and what their experience has been. Remember that several original equipment manufacturers are now getting into offering their own refurbished equipment;
- All other things being equal, give preference to vendors with installations that are near your facility-preferably within 100 to 200 miles. I'll explain why in a minute.

During your search, keep the following item in mind. Refurbished equipment, unlike new equipment, is not a commodity item. Therefore, you do not necessarily want to find the cheapest vendor, but rather the most reliable one.

Once you have narrowed your list to four or five refurbishers, call them up. At least 90 percent of the phone calls these individuals receive center on price. I recommend not asking about price at all during this first conversation. Instead, ask the following questions:
- What are the precise credentials of the persons that are involved in the refurbishing process? Press for details. You want individuals who have served as biomedical engineers in hospitals or have other medical equipment experience.
- What is involved in the refurbishment process? Ideally, the reseller should completely disassemble the item, inspect it closely for worn or defective parts, and replace them with parts from the original equipment manufacturer. Ask for a written description of the refurbishing process.
- Can the reseller provide a list of references? Any reseller that offers good products and promotes lasting customer satisfaction will be happy to do so. Contact these references and ask about their experiences with the vendor, including post-sale experience.
- Does the reseller have a policy of allowing potential customers to use equipment on a demonstration basis? Reluctance may be a red flag that the company is selling substandard equipment.
- What is the standard warranty policy offered by the reseller? Good resellers offer at least a six month warranty on refurbished equipment; some warrantee their products for as long as two years. Some warrantees cover all parts, but exclude the necessary labor; the ideal warrantee covers both. Finally, ask about a replacement policy in case of equipment failure. The best dealers will fix or replace the item within 24 hours. Ask the refurbisher to fax you a copy of the standard warranty.

Once you've found the vendor with the people, policies and customers you like best, visit the vendor if at all possible, meeting the employees, watching the refurbishment process and handling the merchandise. Although this requires a significant time investment, there is simply no better way to confirm your confidence in the vendor.

3. Make a deal
When you've found at least one and preferably more than one refurbishers in which you have confidence, it's time to buy something.

I would recommend starting slowly, if possible. Make one or two small purchases first so that you can evaluate the vendor prior to making additional purchases. At first, ask to examine any equipment prior to signing the check. As time goes on and you develop trust in the vendor, the need to do this will decrease.

When negotiating price, try to estimate how long the item will last before becoming unreliable or obsolete. A stretcher that has been completely remanufactured may be worth up to 60 to 70 percent of its original value; a patient monitor (which generally lasts seven to ten years) that has been in use for five years and has not been remanufactured is worth significantly less than its original price.

Be sure to contact the original equipment manufacturer and price its refurbished or demonstration equipment prior to making the deal. OEMs generally are not as price competitive as non-OEM resellers, but if nothing else, their pricing provides an excellent baseline. You should also price shop some other resellers before making a decision, particularly if it involves a large capital expenditure. Even though the reliability of your vendor is much more important than the price differential, it never hurts to have the information when trying to determine the fair market value of a piece of equipment.

A few other tips:
- Verify certification of both anesthesia machines and sterilizers for use prior to utilizing them in your facility. Also, confirm that stretchers are equipped with new pads and casters, stainless equipment is sanded and polished as needed and provided with new casters, OR tables have been given new pads and controls, and OR lights have been serviced with new optical accessories, as required.
- Realize that some resellers will pressure you to buy equipment as it arrives and becomes available prior to the actual refurbishing process. Don't let them!
- Involve the surgeons who will use the equipment early on. Many physicians are suspicious of the term "remanufactured". Involving them in the process will help alleviate their fears, and will provide you with a good source for additional insights and/or questions that might not immediately occur to you.