Mobile imaging trailers provide many benefits to healthcare facilities. They can boost patient workflow and provide quality healthcare services to patients in rural or underserved areas.
ICE Magazine recently asked several healthcare imaging leaders insightful questions to gather helpful information that other healthcare facilities can use to improve their operations and patient care. Participating in this Director’s Circle panel discussion are:
• Beth Allen, director of clinical operations, Banner Imaging
• Elizabeth Chapman, director imaging administration, UT Southwestern Medical Center
• Rick Pizzala, R.T. (R) (CT), manager, imaging, Corewell Health West
• Krissie D. Stich, MBA, CRA, R.T. (R), radiology director, east market and mobile fleet, University Hospitals of Cleveland
Q: Why should an imaging department consider using a mobile imaging trailer?
Allen: Imaging departments should consider using a mobile trailer if they have a significant backlog or if they are attempting to retain volume during an equipment replacement, significant repair or upgrade. Depending on the needs of the community, it can be an important service to provide to avoid gaps in service.
Chapman: Our primary reason for using a mobile trailer is that we had a large backlog of patients that needed to be scheduled and trying to install a net new PET/CT wasn’t an option due to the time that it takes to plan, construct and install would add further to the backlog of patients and add another 12-18 months of more patients. Using a trailer provides a quick and easy way to bring your backlog of patients down significantly without compromising long wait times with construction, greater flexibility and accessibility within your organization. In addition, the trailer provides continuous operations for any downtime of another unit or use while installing a new unit/replacement. Having a mobile trailer is an efficient way to help decrease long scheduling turnaround times and retain physician referrals and those relationships, besides the obvious increase in revenue.
Pizzala: Imaging departments should consider using a mobile trailer when patient volumes for a given area are not sufficient to support running 12 hours a day 5 days a week. Mobile imaging trailers also offer greater flexibility to utilize differing types of mobile imaging trailers in the same space. An example would be offering a few days of MR followed by a couple days of PET/CT each week.
Stich: An imaging department should consider a mobile trailer for multiple reasons:
• Patient at the forefront of any business decision
• Enables the ability to leverage costly resources.
• Allows for relocation and access to patients and communities.
• Supports standardization and systemness.
• Level of access
• Benefit to expanding your footprint.
Q: What are the costs associated with operating a mobile imaging trailer?
Allen: The costs associated with operating a mobile trailer can be varied. Of course, there is the obvious rental fee along with potentially an increase in staffing required, IT resources, power and emergency equipment. There may be a need for an awning or other structure to keep patients protected from the elements. There can also be a cost to not utilizing a mobile trailer in lost reimbursement during fixed equipment downtime.
Chapman: Rental cost of trailer, adequate power, and water, if the mobile trailer is a PET/CT, to have a hot toilet close by. Adequate staffing and awning for inclement weather.
Pizzala: The cost associated with operating a mobile imaging trailer can vary based on the state with which it is operated. The simplest breakdown is that you have costs associated with operating a tractor trailer and costs associated with the imaging equipment. You will need a truck which if not purchased could be rented or contracted with a trucking company. The truck and trailer require DOT inspections, brakes, tires, oil changes, insurance, registration, fuel and an operator with the appropriate license/certifications. In my experience, the cost associated with repairs and maintenance on the truck is in line with what you might expect for your car. For MR units, there is an onboard gas-powered generator that requires routine maintenance. This generator keeps the magnet cool while in transit or when site power is offline. Mobile MR units contain a smaller amount of compressed helium then a fixed unit. The helium (which keeps the magnet cool) can boil off should the generator not operate. In my experience, recharge of the helium is $15,000+ and can take several days or weeks.
Stich: The costs associated with operating a mobile imaging trailer are very complex and can differ depending on what your organization has to offer. We own multiple mobile imaging trailers, but also lease quite a few for short-term or long-term solutions. This allows us to evaluate our market share and overall need in the communities until we can purchase and provide our own individual assets. The costs also vary for the trucking company to transport and move trailers around our nine-county service area. Staffing can also be a challenge, and you must consider whether we can staff each mobile or if we need the leasing company to provide staffing with each of the leased units. Additional costs to consider are the repairs to each of the trailers and supplies to stock them for patient care. I will not go into many details regarding this, but you also need to decide how to split salaries and revenue if you are part of a multi-hospital system, or you utilize a mobile fleet costing center.
Q: How do you manage scheduling and logistics for a mobile imaging trailer?
Allen: To manage logistics of a mobile trailer, an additional resource may need to be added to the RIS system schedule template. The mobile unit may be further from the waiting room and require more staff to move patients to where they need to be. There may be a ramp to be navigated and training for staff.
Chapman: We currently rent this machine monthly, it is parked at a designated stationary area. This increases the ease for our scheduling partners to direct patients to the same area for their exams. The rental term maintains the trailer. We have contracts for maintaining the toilets, etc.
Pizzala: Scheduling and logistics of the mobile imaging trailer are handled a variety of ways and can depend on the size of the fleet. I’m aware that there are mobile companies which sole purpose and leadership structure is to schedule the units between multiple sites and entities. I operate three mobile trailers for one entity across four locations and the scheduling, movement and logistics are primarily handled by myself and my driver with support from a specialist who ensures we are compliant regarding our CON (Certificate of Need).
Stich: Scheduling is based on the need in each of the communities and expanding the level of access for modalities that are available on the mobile imaging trailer. As far as logistics, our organization has access to real-time data that drives our decision making. It shows us utilization of each mobile and number of days until next appointment for our patients. We can utilize the mobile fleet to increase access at locations that do not have these modalities available, or we use the mobile in addition to their stationary units to allow for increased access for our patients. Our mobile fleet also has been a huge benefit when it comes to planned or unplanned downtime for stationary units that support medical centers with EDs and inpatients.
Q: How do you assess the effectiveness and ROI of a mobile imaging trailer program?
Allen: To assess the effectiveness and ROI of a mobile trailer, all costs need to be analyzed and compared to potential reimbursement. Patient volume needs to be considered as well as hours of operation. The needs of the community should be considered based on the risk of not providing a service through the utilization of a mobile trailer versus the total cost of the mobile unit.
Chapman: Typical ROI process, operational utilization, and scheduling metrics with first and third next available, no-show rate, and same-day cancellation rate. Feedback from our referring partners.
Pizzala: I would assess the effectiveness of the ROI by looking at the patient volume that will be imaged utilizing the trailer. If the volume will create revenue generation that is greater than the cost of the depreciation of the trailer value and associated greater than the cost of operation like labor costs, supply costs, routine maintenance, and repair, then the trailer would be good option for the scenarios mentioned earlier. There is also the added benefit that you could also lease the trailer out to another facility if there are any days or times the trailer is not being utilized.
Stich: Assessing the effectiveness and ROI of an imaging trailer program is evaluated by the real-time data as well as monthly volumes and financials for each unit. Access is everything for our patients. The minute the patient has a delay of getting an appointment, they have a choice to go elsewhere in our communities for their care. Providing a service that is close to their home makes all the difference in our overall patient care and experience.
Q: What else would you like to share with ICE Magazine readers regarding mobile imaging trailers?
Allen: One thing that is very important to consider when utilizing a mobile imaging trailer, is to make sure you partner with a reputable vendor that has uptime guarantees and a solid service agreement. Our system has established relationships over time that ensures we are confident in the unit that will show up. It is also important to plan out all the potential pain points for the workflow. Physicist testing or a state survey may be required depending on the modality.
Chapman: When considering a trailer, think of location, ease of patient access, environment/climate conditions, and close to checking patients in and out.
Pizzala: Mobile imaging trailers are an effective tool for addressing underserved needs or at locations where space is limited. It is important to get or utilize a trailer specific to your climate as it will need to effectively handle hot or cold temperatures. Doing this will minimize complaints related to temp from your team and patients. If you are in a state where you must work within a CON be deliberate in setting up the routes to avoid confusion as you will have to keep track of which trailer has moved, to what site and remember which sites trailers “are” or “are not” allowed to go. Roadside breakdowns do occur due to equipment failures or inclement weather so be prepared. It is important to build a relationship with the companies who service your equipment as they will be there to get you back up and running. I’ve found that paying invoices timely is one of the biggest contributors to building a positive relationship along with respecting that you are likely not their only customer.
Stich: I have responsibility to oversee our system mobile fleet that consists of four MRI; two PET; one mammography; and one CT. We also have two MRI stationary units that are located at one of our medical centers and one at our ambulatory locations. We have a dedicated mobile leadership team. It consists of a manager as well as a supervisor and modality team leads. This structure has allowed us to be very flexible with our fleet and expanding our footprint on a weekly, bi-weekly or monthly basis.
