Despite what facility administrators used to say about him, Mark Redner is not insane. "Many years ago, I approached administrators with the idea of buying a used scope, and they would look at me like I was completely nuts," says the president of Prescott's Inc., a refurbishing company based in Monument, Colo.

The explosion of the refurbished scope market validates Mr. Redner's sanity and the viability of such scopes in profit-minded facilities. They're a low-cost option for administrators who have tight equipment budgets, caseloads consisting of basic procedures, the need to add another scope to handle an increased caseload and surgeons who can live without the latest technology. But how does money saved up front balance against features and servicing issues? Here's what facility managers and industry experts say you should consider.

Significant savings
Mr. Redner says a facility can expect 50 percent to 60 percent savings when buying refurbished scopes. Here's a look at savings by specialty:

• Refurbished ENT scopes cost between $5,000 and $15,000 compared to $15,000 to $45,000 new.
• Refurbished ophthalmology and hand/plastic scopes cost around $20,000 compared to $50,000 to $75,000 new.
• Refurbished spine/neurology scopes cost between $60,000 and $100,000 compared to $150,000 to $225,000 new.

Some experts say that refurbished scopes are ideal for centers that are just starting out. "They can serve as a bridge to grow case volume and revenue, which will lead to the ability to buy a new piece of equipment," says Robert C. Amort, sales manager for Zeiss Certified, a division of Carl Zeiss Surgical that sells remade scopes.

There are exceptions, but large hospital systems generally have budgets for new scopes; small ASCs that need to stay lean and mean drive the refurbished scope market.

Consider case mix
If price is the No. 1 reason to consider refurbished scopes, case mix is a close second. Let's say, for example, you need to purchase a scope for a fledgling specialty that, at least at first, won't produce the volume to warrant a large capital expenditure. Patti Moore, RN, BS, CNOR, CASC, faced such a scenario.

Ms. Moore, the director of River View Surgery Center in Lancaster, Ohio, bought a refurbished scope for the ENT portion of her facility's practice. The program made up less than five percent of her caseload, about one-third required a scope and a refurbished model easily met the needs of the program's lone surgeon. "The procedures were less extensive so there was no need to go with the Cadillac model," she says.

She found a refurbished scope for about one-third the price of new and used the cost-effective model until the volume of complex ENT cases justified the purchase of an advanced scope. Over a seven-year span, River View Surgery Center's ENT program has expanded from one to four docs, and from 12,000 cases to 50,000 cases a year. "We were able to use the refurbished model to substantiate our case volume," says Ms. Moore, "and used it as a staging process to establish and invest in our ENT program."

What about shelf life?
Experts say shelf life is less about how long a scope can function, and more about technological advances. You'll need to upgrade a scope's technology before it breaks down.

"Sales cycles of new scopes last approximately seven years," says Mr. Amort. "Tremendous improvements occur over that span and it really varies from facility to facility with respect to how important those advancements are."

More of an issue to a scope's longevity, says Mr. Amort, is the availability of replacement parts; the company stops making parts when the model they're intended for begins to age. "My advice is to build funds into your budget for the newest possible system," says Mr. Amort. "The more time a scope has spent on the market, the closer it is to becoming obsolete."

A call to a company's technical support department and pointed questions to sales reps will also protect you from getting stuck with a machine that the company can't support. "Put them on the spot," says Mr. Amort. "Ask, 'is this scope slated for obsolescence?'"

The repair myth
You would think repair costs are higher in refurbished scopes. Not so, says Mr. Redner. "That's a scare tactic. As is the case with new scopes, warranties and a regular maintenance program will drive repair costs way down," he says.

You should negotiate a warranty as part of the sales agreement. The industry standard for a warranty on a new scope is one year, although you can negotiate for more; the lengthiest you can expect to find on remade scopes is two years.

There isn't a major difference between the cost of maintaining new versus refurbished. A regular cleaning and lens adjustment will run you in the neighborhood of $200 a year; pricier policies (one administrator said her policy costs $2,000 a year) will cover parts and labor in the event of a major malfunction.

The technology advantage
One advantage new scopes have over refurbished models is the technology capabilities they offer. Here are some of the latest developments.

' Illumination. Zeiss improved light transmission by up to 50 percent with its new series of OPMI Visu scopes, according to the company. More light transmission means ophthalmologists can work with lower light settings. The result? Patients are subjected to less harmful light, and your surgeons will be able to view the optical area in better resolution and contrast.

Leica says its latest neuro scopes are equipped with not only a primary 300-watt xenon bulb, but also an identical backup - most scopes are outfitted with halogen backups. Instead of searching around for a replacement xenon bulb if the primary blows, the surgeon can immediately switch to another xenon bulb without missing a beat, says the company.

' Efficiency. Zeiss says its latest ENT scopes have a built-in universal lens; gone are the days of physically changing lenses when switching between throat and ear cases. The same design principle applies to the company's ophthalmology scopes; they can be switched to accommodate left and right eyes, eliminating the need to stack surgical schedules.

Additionally, you can reset a surgeon's starting X/Y settings on Zeiss's new ophthalmic scopes after a case with the simple push of a button.

' Hands free. Surgeons can move Zeiss's OPMI Movena scope with subtle nudges of the head, letting their hands remain in the surgical field at all times. Topcon has also developed a new combination of lenses that illuminates the retina without the need for hand-held fiber optics, the company says.

The right match
Talk to other administrators to see what experiences they've had with the scopes they bought and the company they bought from. Go on site visits to see the equipment in action and check with hospital biomed departments to determine how a particular scope performs under heavy usage. Ultimately, it's up to you to match the proper scope with the needs of your facility and surgeon.