Few imaging sectors can say with certainty that this past year has been a strong one. But across the board, mobile imaging providers report new contracts for interim projects, contract renewals and an emphasis in moving customers from part-time to full-time systems.

“Right now, everything we own and control is out on a lease. It’s a good problem to have,” says Richard Dishman, vice president of the mobile provider MPX Sales and Services, LLC. “This was not the case the past few years.”

Hospitals rely on interim trailers when they need to upgrade from an older imaging system to a newer system. The new installation usually requires reconstruction, rewiring, or new heating and cooling systems and can leave a hospital without a functioning system for up to two years. In some states, it’s actually required that hospitals provide imaging services 24/7, so going without the service is out of the question for many.

For the past few years, the recession and the general economic climate have not been favorable for OEM sales. Dishman says that in his conversations with hospital administrators and radiology department heads, this has caused them to extend their usual upgrading cycle from five years to seven years.

“Now we are hitting that seven year benchmark and some hospitals are saying we waited and things are slowly getting better and we want a new scanner,” says Dishman.

Hospitals can only put off upgrading for so long, and there’s a strong need to be as current as possible with technology — not only to stay competitive, but also to give patients the best care possible.

Dishman says knowing that health care reform will now move forward with Obama’s re-election also plays a part in influencing capital purchases hospitals will make.

“Once they know the rules, then they can run the store,” he says.


He speculates that health care reform will have a positive effect on mobile business too. More people entering the health care system mean more people who need procedures. And more equipment will be bought and sold to accommodate the growing demand.

Popular mobile modalities
Wisconsin-based Shared Medical Services, Inc. provides mobile MRI, CT, PET/CT and digital mammography solutions for hospitals. Paul Zahn, director of sales and marketing, says that this year MRI has been particularly in demand.

“I’ve had to rent equipment from other competitors to fulfill orders,” he says.

According to a recent report from the research firm, IMV, the last spike in MRI purchases from hospitals happened from 2002 to 2004, making the average age of scanners in hospitals today a bit older: from 8 years in 2007 to 10.9 years in 2011. The report also says that hospitals and other users plan on replacing aging MRI units in the next three years.

Medical Coaches, Inc. specializes in manufacturing custom mobile CT, MRI, mammography and PET trailers. When Oshkosh Corp. exited the civilian medical trailer side of its business earlier this year [see DM18457] Medical Coaches became the main player in the U.S. certified to custom build trailers with the machines of top OEMs. Chad Smith, marketing director at Medical Coaches, admits that MRI as a technology is typically seen as an older piece of equipment these days. Nonetheless, he says they are getting more MRI orders compared with PET/CT.

Jim Varcarolis, general manager and vice president of Insight Health, which providers mobile and fixed-site MRI and PET/CT imaging systems solutions to facilities around the country, says they are seeing robust business on the MRI side as well.

“Many hospitals have MRI in house and we’re seeing that because of the increase in the use of MRI, they either need additional time to go buy a second unit, or they have a system that may be a few years older and they are looking for higher-end equipment,” he says.

Still, despite MRI’s strength, Varcarolis says PET/CT is a growth modality.

“When we look at our assets and how much equipment we own and operate and when we look to the future, we probably have a need to grow on the PET/CT side, with growth still happening on the MR side but the growth is shifting and part of it has to do with changes in technology. So as technology continues to advance, so does the need for the advanced technology,” he says.

David Johnston, vice president of sales and marketing at Shared Imaging LLC says that PET/CT is their strongest growth modality, especially as the technology gains increased acceptance.

Mobile as a business solution
Mobile imaging is a flexible tool that can provide service on an interim basis, but also introduce service to a provider, says Tobias Gilk, president and MRI safety director at Mednovus, Inc. and senior vice president of RADPlanning. In other words, it’s a way for hospitals to test out patient volumes for an imaging modality.

“Mobile imaging is great for essentially doing market research, to find out what the demand is without committing the long-term capital and providing your own staff,” says Gilk.

Candidates might be facilities that want to determine how many patients they will have in a typical week for the particular imaging modality they are introducing.

Varcarolis says mobile imaging can help customers build their business because it helps create a referral base until it makes sense for a facility to spend the money to add a first or second permanent unit.

Most mobile providers will also help customers transition from mobile into fixed. Gilk says the tipping point for facilities to consider this usually happens around two full days of imaging a week.

“If you’re providing two calendar days of imaging onsite every week you’re probably at the tipping point at which it becomes less expensive over say a five year period to go ahead and buy your own MRI [for example] and do the construction, and the build-out for the suite to have it installed,” he says.

Rural demands
Rural hospitals have traditionally sent patients to outside facilities for imaging procedures. But that is changing.

Mobile imaging is important in rural areas according to Brock Slaback, senior vice president for member services at the National Rural Health Association, based in Kansas City, Mo. He says doctors will prescribe an imaging scan at an outside location but many patients in rural communities don’t have the transportation means or the money to get to the central hospital for the scan.

“Anytime you can short-circuit that need to go the distance, it really improves the ability to do complete health care that’s responsive to the patient’s needs. That’s why many facilities look at these mobile options,” says Slaback.

Although many small rural critical access hospitals — typically less than 30 beds — probably don’t have the volume of patients to financially support a scanner, what they can do is pair up with other clinics in the area to bring a mobile trailer to a site, or they can even pay to have it parked at their facility a few times a month to provide the imaging service on a reoccurring basis for patients.

“To invest in a 2 million dollar piece of equipment is not possible for some of these rural hospitals, so if they can partner up with other hospitals in the area and share in the costs of that particular piece of equipment, it makes sense,” says Smith of Medical Coaches.

Slaback says it’s important for rural hospitals considering this option to make sure they have the patient volume to sustain the cost of the trailer. In fact, some mobile providers will not provide the service if there is no guarantee of the service being financial sustainable. At the same time, mobile providers are good at providing a break-even analysis and a payback breakdown. “They are really good about setting that up to give management a nice proforma to let them know what they need to prepare for as far as volume,” says Slaback.

Appropriate modalities for the rural setting
Slaback says complex imaging modalities like PET/CT, aren’t needed as much in rural environments. Collaborations among rural facilities to bring in a mobile CT unit used to be popular until the price point came down on equipment enough to convince facilities that transitioning into a fixed unit made sense. These days, Slaback says MR is a popular choice for mobile units in rural communities, but with less facilities moving into a fixed unit the way they did with CT.

Mammography is another popular imaging modality in the rural setting.

“It’s such a basic preventive service that’s so critical to have access to,” says Slaback.

However, many rural facilities have fixed mammography units in their hospitals and clinics, and many are digital as the price has come down and the convenience of PACS has made it more convenient for rural clinics to work with radiologists remotely.

The mobile mammography units that do frequent rural and underserved areas are normally screening exams because regulations for mobile diagnostic mammography exams are much more stringent.

“Diagnostic imaging means you have to have a radiologist on board or immediately available to look at the film,” says Theresa Weaver, manager of the mobile mammography program at St. Joseph’s Medical Center in Northern California. St. Joseph’s operates one digital mammography mobile unit and provides services to women through partnerships with clinics and consortiums of clinics that do not offer the service.

Weaver says they require a provider referral for the exam. “We find that 20 percent of the time, women will need further imaging services and we need a provider to manage the post-screening mammography care.”

Although Weaver says they encounter a significant number of no-show patients, the program has grown from screening 946 patients in 2007 to 2899 in 2012.

Across the board, mobile health care for rural and underserved areas has witnessed increased support from Congress and health care stakeholders in the past few years.

“Mobile health care can fit in with many health care initiatives and there is more funding from various agencies for mobile,” says Darien DeLorenzo, CEO & executive director of the Mobile Health Clinics Association.

Important considerations
All mobile providers interviewed for this story told DOTmed News that they offer their customers planning guidance on what to consider technically and logistically in regard to a mobile imaging trailer.

“The main piece is patient safety,” says Varcarolis.

It’s not enough to simply have a trailer and an extension cord running from the hospital. Mobile providers say trailers need a dedicated power connection, as well as a power supply for a phone system and a PACS workstation.

In addition to ensuring proper calibration, providers need to make sure there’s a safe passageway—typically a covered walkway—from the facility to the trailer in addition to the pad being built correctly to support the weight of the unit, and that cars and people can get around the trailer safely.

Gilk says with heavy equipment like an MRI machine, which can weigh up to 25 thousand pounds, it’s important to check if the parking lot can hold the weight since most asphalt covered lots cannot support heavy equipment.

In addition, mobile MR scanners are held to the same types of safety protocols as those machines situated in a fixed room site.

In fact, many mobile units, like the ones Medical Coaches installs, are regulated and certified for fixed site standards. Not only does that include a rigorous testing and approval process by the machine’s manufacturer, but it also includes an extensive planning guide for the facility.

“We pay attention to safety. It’s the most important thing with hospitals,” Smith says.

DOTmed Registered DMBN December 2012 - Mobile Service Providers (MR, CT, PET) Companies

Names in boldface are Premium Listings.
Domestic
Michael Hardesty, Advanced Mobility Specialty Vehicles, IL
DOTmed Certified
Todd King, KING Equipment Services, Inc, IL
DOTmed Certified
DOTmed 100
Larry Brewer, Oshkosh Specialty Vehicles, IL
Greg Kramer, C&G Technologies, Inc, IN
DOTmed Certified
DOTmed 100
Jeff Rogers, Medical Imaging Resources Inc., MI
DOTmed 100
Paul Zahn, Shared Medical Services, Inc., WI
DOTmed Certified
DOTmed 100