the equipment outright, you gradually
pay off the purchase by giving the
manufacturer a per-procedure fee over
an agreed-upon term. In our case, the
vendor bundled the cost of the endo-
scopes, video towers and monitors,
and divided the amount by our expect-
ed annual case volume to determine
that we had to pay $4 to $5 per proce-
dure — our monthly payments are
linked to our procedure volume, so our fee fluctuates slightly based
on our caseload — over 5 years before we own the equipment. We're
in year 3 of the agreement and on schedule to gain ownership after 2
more years of per-procedure payments.
We also applied the lease-to-own concept to the purchase of the
AERs. Instead of paying for the units upfront, we added 10¢ to the
cost of frequently used disposable supplies (such as endoscope chan-
nel cleaning brushes) and 50¢ to the cost of low-volume disposables
(such as esophageal balloons) that we purchase from the AER manu-
facturer. That loose change added up to significant dollars over time,
and we nickeled and dimed our way to paying off the sterilizers in less
than 3 years.
We also assessed the cost-benefit of purchasing refurbished scopes.
A new scope costs roughly $40,000, a refurbished one around $25,000.
When our physicians trialed both new and refurbished scopes and
found there wasn't that big of a difference in clinical performance
between the two, we purchased 7 brand-new HD scopes and 5 refur-
bished HD scopes. Financially, this seemed to be the best option. Both
came with a 1-year warranty, so we determined we could save $15,000
on the slightly older models without sacrificing quality. Another way
M A R C H 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 3 7
There are several
creative ways to
reduce capital
outlay when
investing in new
technologies.
