Since moving to Madras, Oregon last year, I’ve had essentially carte blanche to use any surgical instrumentation and clinical products I choose. My office management has, for example, approved the use of expensive wound healing biologics in the clinic, trusting my judgment that these costly products would benefit my patients. Similarly, my hospital OR manager has permitted the use of more costly fixation products, simply because I’ve asked. It’s a very satisfying situation.

But certain equipment is just too expensive right now. Small rural hospitals have to watch their expenses even more than the big hospital systems.

So, here’s my question to the podiatry community: what would you do? How can I improve my situation? All opinions are valid regardless of time in practice or residency. This is an important factor for podiatry in general and specifically for those in rural areas...

In the future, we’re likely to see issues like this with new technologies. What’s a podiatrist to do?

I was wondering what business plan you proposed to get the purchase approved? I would sat that there are 2 main concerns, patient liability and profit.

Would not having this make the place open to lawsuits? Legal bills can run more.

Then how much of a return on investment is there? How close is the nearest machine? How much is the expected payment from insurance for this device? Are there enough practices to send people there? And is the population sufficient to sustain it?

Doing the leg work, and having a solid plan will go far to get anything approved.

I agree with above, great point. If the purchasing dept still will not budge upon being presented with the viewpoints of Ray, would you consider potentially seeking an agreement with Vasa Med entailing use of their product in exchange for data collection and potential publication of such findings - basically doing research sponsored by the company? Do you have the pt volume and pathology to support such? Just a thought!

buy the unit and market it to docs in the area

Isidore Steiner

All good considerations.  From my research and discussions with different companies it would be cost profitable to acquire a unit in the office as long as you have enough patients.  At my point in practice in Oregon I don't have enough patients yet to warrant having a unit.  However, the above recommendations are ones I personally hadn't considered and may add numbers.  Thus far I have only been screening "obvious" patients: wounds, claudication-type complaints, etc.  Our vascular surgery colleagues are also advocating screening for other patients (ex advanced age) due to the greatly increased risk of MI in PAD patients.  l think there's a significant market for generalized screening, although I'm not sure if insurances will reimburse for that yet.

The cost profitable statement is a no brainer. Anything can be profitable with enough patients.

I would use their marketing people to get you first case studies and then actual pratices that may be a similar situation to yours and how they do it.  And will the company let you borrow a machine for a couple of weeks to try?

I dismissed the buy and rent idea before my previous post as it could get to be more trouble then it is worth. I also think that with your population numbers, there would not be enough doctors to partnership purchase even if you were all willing to eat some of the cost out of pocket for the patients benefit.

Another avenue is to see if there would be a patron who would be willing to donate the machine in exchange for the writeoff and publicity.