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A patient’s heart monitor sends an alert to a physician that her arrhythmia is back.

A senior forgets to take their prescribed medication on time, and a devices helps remind them to take it and also documents what time they took it.

 A man’s implanted device monitors blood glucose symptoms and delivers a corrective insulin stimulus, alerting the physician simultaneously.

All of these examples are the epitome of the “Internet of Medical Things” (IoMT). The Internet of Medical Things refers to an ecosystem of medical devices and applications that collect data that is then provided to healthcare IT systems through online computer networks. Wi-Fi enabled devices are a catalyst for machines to communicate and link to cloud platforms for data storage. The “Internet of Things” (IoT) has influenced several industries, and the healthcare field is no exception. The medical industry across the board has gradually started to enter the integrated world of IoT.

IoMT covers a broad spectrum, such as wearabledevices, remote patient monitoring, sensor-enabled hospital beds and infusion pumps, medication-tracking systems, medical supply and equipment inventory tracking. Electronic Medical Records (EMR) are being implemented across the United States in healthcare facilities; patients have access to online portals to obtain their own records. Doctors can also now digitally prescribe medication and upload it directly to the patient’s pharmacy for pick-up. Additionally, portable diagnostic devices can make routine blood and urine tests easier on our aging population—where mobility is more challenging and who need to take these tests more often.

Benefits to Patients

IoMT can improve patient diagnoses. This is possible through connected devices — allowing data collection for analytics — and patients that benefit from the data down the road. Almost 60% of healthcare providers are utilizing IoMT devices – and they’re reporting improved patient care, according to a Frost & Sullivan study. Wearable healthcare devices and healthcare apps allow patients and their medical providers stay in touch.

IoMT devices can also make operations more efficient for healthcare workers, who are often simultaneously caring for a number of patients. Ironing out processes and improving efficiency decreases the burden for health workers while increasing the quality of care they can give.

One of the most obvious and popular applications of healthcare and the IoT is in remote health monitoring — sometimes known as “telehealth.” In some instances, patients don’t even have to visit an ER or be admitted to a hospital.

If a person has restricted mobility, or needs to utilize public transportation, remote monitoring can be priceless for patients. Not only does this reduce costs, but it spares them the inconvenience of being away from home.

The IoMT can help monitor and notify not only caregivers, but give healthcare providers real data to pinpoint issues prior to a desperate situation and allow for invention earlier.

There are even safeguards in place for remote healthcare tools. For example, a new IoT-driven solution from Philips, is called “e-Alert.” Instead of waiting for a device to fail, Philips’ system takes a proactive approach by virtually monitoring medical hardware and alerting hospital staff members if there’s a problem.

Patient Compliance & Reporting

One of the biggest concerns of IoMT is adherence to doctor’s directions. IoMT isn’t intended to substitute healthcare providers, but to provide them with the data gathered from devices for better diagnoses and treatment plans. Healthcare facilities also currently use the IoMT to help with streamlining workflow, overseeing inventory and medical device integration.

A connected IoMT device provides objective reporting of authentic occurrences. Without these findings, providers must rely on subjective patient reports based on their memory and feelings alone.

IoMT devices help monitor patient behavior and activity from a distance so the provider will have actual data to refer to regarding compliance to treatment recommendations and what ensues after a patient leaves the healthcare premises.

It’s Personal…and Here to Stay

Although today’s modern technology can sometimes get a bad rap (i.e. a nurse is too busy to have eye contact because they’re completing medical notes on an iPad), the reality is that IoMT can actually offer more personalized healthcare for each individual patient. From creating customized therapy plans, to determining care guidelines based on the unique situation of a patient.

There’s no doubt that IoMT is here to stay, and will continue to evolve as technology continues to advance.

Stay tuned for our next blog in the upcoming weeks— we will elaborate on the future of IoMT and what to expect.

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Elective outpatient hip and knee replacements increased by 47 percent from 2012 to 2015, according to a study by Sg2. This insight is an early indicator that total joint replacements (TJR) are becoming more common in the Ambulatory Surgery Center (ASC) setting as a higher number of surgeons become experts on minimally invasive technology and pain management techniques for outpatient procedures.

Total joint surgeries moving toward outpatient can also be attributed to:

• The transition to value-based care since ASCs are a high quality, low cost option
• Insurance companies are more willing to cover outpatient TJRs
• Studies show that patients who fit a particular criteria can achieve desired results in the outpatient setting

In this month’s newsletter, we’re peeling back the TJR outpatient trends, cost analysis, and how ASCs are taking a driver’s seat in the total joint arena.

TJR on the Rise

According to a report from the American Academy of Orthopaedic Surgeons, the number of total joint replacements is expected to dramatically jump between the years 2030 and 2060.

Primary total hip replacements are projected to grow 171 percent and primary total knee replacements are expected to grow 189 percent by 2030. Also, people are having TJR surgeries done earlier in their lives. The average age for primary total hip replacements dropped from 66.3 years old in 2000 to 64.9 years old in 2014. The average age for primary total knee replacement dropped from 68 years old to 65.9 years old.

A report by Vizient estimates that outpatient total joint replacements will grow 77 percent from 2016 to 2026, but inpatient total joint volume is expected to remain relatively flat.

Behind the Costs of Total Joint Replacement

According to a new report, there is a significant variance in the cost for a joint replacement surgery. It can cost $5,000, all the way to $30,000 depending on the medical center.

Total joint replacement surgery is one of the most common procedures performed in the United States. More than one million joint replacements are performed every year in the U.S., and by 2030 that number is expected to grow to more than 4 million.

The analysis published by Premier, found that the cost of joint procedures vary considerably between facilities due to the differences in practice patterns and the devices that are used on patients.

According to the findings from Premier’s database of 1,100 hospitals, the overall median cost of TJR surgery is $14,520. However, 50% of cases run between $12,000 and $17,900.

The average cost of primary knee implants was $4,464, among 350 hospitals polled. Yet, 50% of the hospitals paid between $4,066 and $5,609 on the devices. Additionally, the same group of hospitals paid an average of $5,252 for primary hip implants, but 50% of the hospitals paid between $4,759 and $6,463.

Because devices make up a significant portion of the procedure’s expense, there is significant gap in pricing among vendors.

Another cost associated with TJRs is OR staff. Some OR’s may use a dozen people in the room while others many only have a handful of staff in a case.

And bone cement, which is used to hold the implant against the bone, can be quite costly too. Research shows that bone cement infused with antibiotics doesn’t improve patient outcomes, and it costs 120% more per patient compared to bone cement without antibiotics.

On the flip side, costs associated with length of stay and recovery have decreased due to advancements in modern healthcare.

How Ambulatory Centers are Capitalizing on TJRs

Ambulatory Surgery Centers are leading the way with Total Joint Replacement. The number of ASCs offering outpatient total joint replacements has increased from about 25 in 2014 to 200+ in 2017, according to a report from Advisory Board.

One of the reasons for this increase is because of the value-based model of healthcare. The Affordable Care Act’s necessity to publicly report data and holding back payment when you don’t meet certain quality objectives plays a role.

Another reason the number of ASCs providing TJRs continues to increase is because some insurance companies are more inclined to reimburse for the procedure. Outpatient total joint replacements remain a relatively unconventional concept in many parts of the country, but it is certainly on the rise and becoming more and more common.

Surgeons will likely take TJRs to outpatient departments primarily because reimbursement has increased and the hospital’s proximity. However, as the demand for high-quality, low-cost care increases and surgeons become involved in independent surgery centers, they will take higher volume to ASCs.

How ASCs Can Cut Costs With TJRs

Joint Surgery requires larger sterilizers, larger OR tables, and a laundry list of other necessities that may not have been previously needed at an outpatient center. As ASCs take on TJRs, outfitting your facility with the appropriate equipment comes at a price. Purchasing refurbished medical equipment can certainly help shave costs.

Auxo Medical’s expertise is in refurbished, good-as-new medical equipment, which is thoroughly inspected to ensure it meets original manufacturer standards, Whether you may need sterilizers, washers, operating tables, or surgical beds to prepare for your influx of joint surgeries to come — we are happy to be a resource for your needs.

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Value-based healthcare is a delivery model in which providers are compensated based on patient health outcomes. Under value-based care agreements, providers (including hospitals and physicians) are recognized for helping patients improve their health, reduce the ramifications and incidence of chronic disease, and live a healthier lifestyle in an evidence-based process.

Value-based care is different from a traditional fee-for-service (FFS) approach. FFS providers are paid based on the amount of healthcare services they deliver. The “value” in value-based healthcare is derived from measuring health outcomes against the cost of delivering the outcomes.

 Benefits Of Value-Based Healthcare

1.) Quality and patient engagement measures increase when the focus is on value instead of volume. In addition, providers are not placed at the financial risk that comes with fee-for-service payment systems.

2.) Value-based care models focus on helping patients recover from illnesses and injuries quicker and avoid chronic disease in the first place. As a result, patients face fewer doctor’s visits, tests, and procedures, and they keep more money in their pockets on medication.

3.) Less money is spent helping people manage chronic diseases and experience expensive inpatient and medical emergencies. Value-based care has the promise to significantly reduce overall costs spent on healthcare.

ASCs are Positioned to Add Extra Value

Ambulatory Surgery Centers (ASCs) are designed to provide cost-effective, quality care. Now, with value-based care, they are already positioned to make good on the model’s mission.

For example, infection rates* after surgeries performed at outpatient surgical centers are quite low. This can be attributed to the fact that many ASCs have specialized areas and a focused approach with less variables, which leads to less complications. This ripple effect is the perfect equation for value-based care.

It’s important to make sure that consumers truly understand and appreciate the value-based care provided by an ASC. In addition to delivering quality care at a reduced cost, ASCs need to walk the walk and not just talk the talk. In other words, they need to prove it to consumers.

Helping Patients Find the Value in Value-Based Care 

Transparency + Sharing Success

Some healthcare providers go as far as sharing prices for procedures on their websites. Unfortunately, what is not shared with consumers due to HIPAA, are surgical results. Prospective patients do not necessarily know if a surgeon has had stellar surgical outcomes — from complications, to death. So it’s important for ASCs to provide transparency in any way possible. Calculate recovery rates by surgeon, for example, vs. average patient recovery time. Get creative in showcasing commitment to outcomes.

Customer Service + Clinical Excellence

Of course an ASC encourages surgeons and healthcare providers to follow best practices, but sharing this with the online community is incredibly important. In today’s Google-heavy, social media crazed world, customer service has never been more critical. Clinical and non-clinical employees are the frontlines of ensuring a “positive” experience in what is typically an uneasy medical circumstance. Viral and online channels will either serve your bottom-line through referrals or hurt it through scathing reviews — make sure staff is in alignment to make patient needs and comfort levels as high as possible.

Painless Billing

There is enough pain associated with medical procedures, the patient doesn’t need to worry about more discomfort once it comes time to process medical bills. A competent and trained ASC billing staff member will help standardize coding and billing accurately. Patients deserve to understand both charges and cost savings in relation to value-based care.

Patient-Centered Care: Look into the Future

As the healthcare terrain continues to advance and providers increase their implementation of value-based care models, moving from a fee-for-service to a fee-for-value system, they may see short-term financial hits before longer-term costs decline. However, the transition from fee-for-service to fee-for-value has been embraced as the best method for lowering healthcare costs while increasing quality care and helping people lead healthier lives. By implementing these strategies, an ASC can improve patient experience and outcomes, and decrease costs. Most importantly, they can influence consumers’ appreciation and understanding of the value in value-based care.

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All month long, we have been focused on the importance of medical equipment maintenance. For this #ASKAuxo blog post, we wanted to dig a little bit deeper. We asked an expert about the fundamentals of proactively keeping equipment fully functional and reliable.

1. What is your name & title?

Mark S. Fisher, Vice President of Contract Sales and Service Manager with Auxo Medical.

2. Generally speaking, how often should medical equipment be inspected?

Medical equipment should be tested for patient safety annually.

3. Of course medical equipment maintenance needs will vary depending on each individual product. How do you know which equipment needs maintenance and how often?

There is a tier system for inspection of different equipment and how often they should be tested.

4. What is the difference between ongoing maintenance/inspections (i.e. Such as getting a car’s oil and filters changed), and annual inspections (i.e. A car’s state inspection)?

Preventative Maintenance should be performed quarterly on sterilizer, boilers and washers. Annual calibrations are strongly recommended and annual descaling of boilers are strongly recommended. Monitors should be calibrated Annually and tested bi-annually. Stretchers and or tables and or lights should be checked and tested bi-annually.

5. Do You Recommend An Outside/3rd Party Professional Do Equipment Inspections, Or Can An Onsite Company Employee Conduct It?

It is required that a biomedical technician inspect the equipment.

6. In your opinion, why is it in a business’ best interest to make ongoing equipment maintenance a part of their standard routine?

It is best practice and in the best interest of the facility to have their equipment operable and fully functional for staff and patient safety. It is also most cost effective to repair and maintain equipment through the year verses a complete failure of equipment leading to costly facility down time.

7. Can Auxo Medical be outsourced for help with medical equipment inspections/maintenance?

Yes. Auxo Medical is a biomedical repair and Capital Hospital Equipment company specializing in sterilizers, washers and OR Equipment.

8. What do you enjoy most about your job/working at Auxo Medical?

I enjoy seeing my customers and helping them when they are in need. It is very rewarding when I have something back up and operational for them, and how grateful and appreciative they are when they are up and running again.

Do you have a topic that you would like to see covered on #ASKAuxo? We would love to hear from you!

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Maintenance. The word itself can often times come with a negative connotation due to the term “High Maintenance.” But when it comes to medical equipment maintenance, the key here is PREVENTative. In this issue’s Auxo Medical newsletter, we’ll peel back why the importance of preventative maintenance cannot be overemphasized.

1) Liability

In 2017, The Joint Commission (TJC) released its new requirements for maintenance. According to the Association for the Advancement of Medical Instrumentation, under the new elements of performance (EPs), all planned maintenance activities on medical equipment – regardless of risk – must be completed 100% and on time.

If your equipment is not under any type of accreditation system, then the FDA states that PM inspections on your equipment should follow the manufacturers recommendations for routine maintenance. If your company does not consistently having equipment go through PM, you are taking a chance of being out of compliance and subject to liability if it is used on a patient and issues occur.

2) Saving money

A factor which is critical to healthcare facilities is the cost of maintenance vs. the cost of downtime. Not performing preventative maintenance can lead to equipment failure — it’s that simple. The same can be said for your motor vehicle. If you do not abide by the manufacturer’s specific recommendations, you inevitably run the risk of expensive problems and repairs. The amount of money saved on the cost of a service technician repairing the issue, would easily cover the investment to procure parts needed.

3) Safety

Without question, medical equipment that is properly maintained is safer for patients and medical staff. For example, if a mechanical heart value sizer is compromised in the OR, and an autoclave is immediately needed, but the autoclave has an unforeseen failure occur — the patient is in jeopardy of not having the procedure performed on the table, and the medical facility is at risk for backlash. Although this may sound like an extreme circumstance, the last thing you would want to do is end up in this situation. If the autoclave had scheduled, timely, and tracked maintenance proactively, this outcome could have been avoided.

4) Efficiency

When a service technician visits your facility, are you taking advantage of utilizing the scope of services that your provider can offer during the same appointment? Having multiple items serviced at once reduces overall costs, and also lowers the cost of maintenance per item.

Another efficiency that is simple to apply but has a lasting impact is tracking maintenance, front and center. Instead of having the data stored on a computer where it may be out of sight, out of mind…or buried in an overcrowded filing cabinet, create a label and write down the procedures that are needed and the performed date directly on the equipment. Stick the label where it will be easily noticed.

PM Checklist Example

Auxo Medical is committed to ongoing support after medical equipment is acquired and set-up. Our objective is to help you avoid putting patient safety and wellness in danger due to preventable equipment failure. By taking these recommendations into consideration, and keeping your medical equipment on a routine PM cycle, you’ll protect you and your company.

Click here to set-up a phone call with our team and we’ll discuss how Auxo can support your specific preventative maintenance needs.

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What is easy to do is also easy not to do.  – Jim Rohn

As a “microwave society” — we enjoy seeing results immediately, and not necessarily waiting for the compound effect to kick in over a long period of time.

Taking a few minutes every single day to clean sterilizer chambers has both short term and long term benefits. Think about the concept of dental hygiene; it is preventative maintenance. Do you brush your teeth daily? Of course you do. But, do you floss daily? Maybe not. It’s easy to do, but it’s also…easy not to do. The benefits of doing this mundane and extra minute or two of work every single day has exponential benefits for your health in the long run.

The same can be said for sterilizers and the health of your patients. Over time, substances accumulate on chamber walls and can contaminate packs and impede performance. Consistent daily, weekly, and annual cleanings can lengthen the equipment’s lifetime, improve operational heating efficiency and steam quality, improve the esthetics visually, and most importantly — ensure safety and surgical efficacy for patients.

Additionally, having a professional clean the sterilizer chamber is highly recommended.

You can either pay for it now through investing a few minutes daily of your time, or you pay for it — literally — in the long run with purchasing new capital equipment and costly repairs.

For example, Boiler descalings cost approximately $1500. If bolts break, the rescaling turns into a descaling and repair. Chamber cleanings for small to large vessels can run upward of $1,300.

To summarize, cleaning your sterilizer regularly will: 

• Reduce chamber residue, contamination, and rejected packs
• Lower the potential for substance blockage and unnecessary issues such as downtime due to service calls
• Improve surgical and patient outcomes
• Having a professional annual chamber cleaning extends the machine’s life and overall performance

If you’d like to be proactive and schedule a chamber cleaning with Auxo Medical, give us a call and we’ll take care of your maintenance needs.

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