Empower Your Business with Sales Contract Management in UAE

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name is Dean skeleton I'm currently and I am the Imaging manager at St Luke's health system in Boise Idaho uh I've been in clinical engineering for 37 years started in the Air Force and I've been at varied places uh longest tenure job was at Phillips Healthcare to where I ran a contract with L.A county department of health services for eight years it was Imaging in biomed and I basically did everything at that account and he was my service cell solution person so uh we're here to talk about contracts and and trying to do insourcing with yes benzene medical equipment Imaging service can we have a typo an amazing a new Benzene would try and find something yeah so yes we'll correct that thank you appreciate it we've been over these slide picks we stared at them for so long 25 30 times we just never picked that up spell check didn't get that uh but currently part of my job at St Luke's is to move our services in-house we are front loaded with service agreements full service agreements amongst all of our Imaging equipment so they brought me in to do two things one was to be strategic in thinking and and how to leverage our relationships with our vendors to reduce our contract structure and the other was to do technology management on Imaging equipment so you know the agenda for today you know we're going to be understanding contracts analyzing the data building contract structures managing and assessing agreements negotiating agreements establishing kpis and this is going to be something that's uh important to me managing oems and vendors how to hold them accountable talk about a little bit about point of sale contracts is it an option uh managing Fleet technology and then how make rights help construct contracts okay real real quick for Gohan is there anything does this kind of match what everyone's expectation was when they decided out they get up in the morning and come sit down here yes no it's anything we're missing if there is I mean if we don't touch on it we'll make sure there's room for questions at the end but please interrupt us at any time this is really a back and forth okay St Luke's is in a hospital system in Southern Idaho and Southwestern Idaho we cover Boise Twin Falls we have five rural hospitals and then three major medical centers and then we have 300 clinics so we have over 40 000 medical devices on our inventory is that right Ryan we're over 40 now and I work with Mr Walker and Miss chuma sitting there by menzing um so go ahead and move the slide yeah we are oh okay so let's talk about understanding contracts and data is knowledge so when Brian and I constructed this slide we really want people to understand when you're looking at your contracts you need to have data from your performance of your equipment to be able to look at what you have in the contract and compare it against performance right so you know we're looking at you know do you understand the complexity and the details of your contracts because the contracts got stuff buried in there folks that you may not be aware of okay uh there are specific things like you know uh uh and service training for users uh you know are they doing remote Services uh 24-hour monitoring of your systems so you need to understand what's in the contract so you can understand what the value of that contract is so when you go to assess it uh you know what is the most appropriate data uh needed to initiate this process I can't tell you what the most important data is that's going to be up to you because it's your contract so you need to identify what that data set is going to be establish some measures with it and and some what we'll talk about later kpis so that you can make sure that you're analyzing your contracts were Effectiveness you know uh you know how's this the service under price their agreement Brian I'm going to leave that one up to you you know it's it's a combination uh depending on the oems or if it's an independent service organization it's going to be based on their labor it's going to be based on their ability to gain to get parts it's going to be based on the market need it's going to be on the cost of the equipment it can vary dramatically also it'll vary by your particular Geographic Market where are you and how is your vendors staffed so you have to these questions are really meant to meant to kind of get us kicked off and started thinking and we're going to answer them as we go through but you have to think about and then it's also the competitive nature of it from a from a sales perspective if I'm selling or positioning a service contract to someone I'm also curious about who am I competing with if I'm an oem and I'm competing against independent service organizations okay it's going to be it's going to be more of a price war or it might be more of a quality issue if I'm competing against an in-house organization I'm going to answer some of these further questions you know what kind of training training what kind of influence do you is the customer going to have or the language of my agreement do they have a Contracting Department you know I'm thinking about that steps and steps ahead so to me the last one is very very key and how and when to hold performance review meetings we hold them quarterly with our vendors and it's a business meeting and this is not just a review of our service agreement and the performance of it it's a total overview of our relationship with the vendor and how we can work with them closely to monitor situations that affect our contracts and hold them accountable for that but it's also about holding them responsible for their portion of our relationship and the relationship isn't just come in let the vendor throw up a bunch of data and ask a few questions it's bring your own as Dean said very early on presentation already bring your own needs and desires and what's going on also go back to if this is a original equipment manufacturer a reseller of equipment what quote-unquote deals do they have going on within the organization what capital are they selling what equipment or services are they providing in other places keep that in mind while they're there so that you can leverage that and we'll go into that at least garnering that information especially that from the capital side many of you I know Steve and Isabella and benzing understand this is that when when you identify the future business then you're able to identify the future opportunities for your in-house departments because I can guarantee you the oems are looking at you as an organization as a whole they're looking at what equipment what uh what services what um and by Services I could mean disposables what kind of ongoing contracts you might have if you look at large organizations like GE and Siemens for instance there in many departments and they're in they're providing a lot of different Services across your ecosystem they look at you that way so you should look at them that way you know next is analyzing the debate data to support your decisions financially and clinically so one of the things that our organization it was into was doing uh replacement of equipment as it fails fixed brake fixed mentality of replacement okay something we're trying to move off of so we can have planned Capital replacement Cycles but it took me pulling mounds of data for a year to get them to understand that they were spending money that they didn't need to spend okay and so you need to be able to pull your your performance information out of your databases and analyze it mean time between failure of devices even down to major components mean time between failures on tubes detectors other specialized components uh so that you can make appropriate decisions and discuss the data with the vendor as you're analyzing the performance of your contract because I found one contract that we have that we have tubes and detectors on okay I got 13 cath Labs with this vendor the last 10 years they have full coverage on detectors and full coverage on tubes two detectors one two in 10 years so it goes back to Fleet what is your Fleet what is your usage what's your utilization so you have to work with your clinical teams to say are those all those 13 rooms in Dean's example being used 24 7 often times they are and it's critical but oftentimes they're not so is there redundancy in your system based on the technology and and the locations of where those where those uh in this example where those labs are to see is there some flexibility in the service contract coverage and therefore the pricing but you can balance your risk so how many of you are in management in this room how many of you ask your vendors to supply you an annual report on your service agreement going back for five years on the equipment history yeah oh you ask and and when you and what do you get when you ask yeah and you need to have drug trust it you have to have it structured the way you want the data pulled okay I I beat heads with with my vendors over this send them a spreadsheet to do it they did it their way I sent it back to him said do it mine I'm your customer this is the way I want it done and what came back was the stuff that I found on tubes and detectors you have to look at the utilization of major components and the uptime of the equipment compare it against what your services are because in the end going back to the other side it's all about how you're going to reflect your clinical operations and your Revenue outcomes not the fixing of the equipment that's just the daily things we do so strategically when we're looking at things we want to see what our impact is to the clinical application side and the uptime with the equipment and how much revenue they're either deferring or losing when the equipment's down I'm sorry was there a question on the other side I wasn't sure if I saw Hound okay I got it sure absolutely I spent the year that I talked about spending and digging that data led to an intense business plan for medical imaging to where we identified a potential reduction in service agreement costs of 12.5 million dollars over the next five years that is correct in scaling our services down from Full Service using the vendor getting trained okay and then finally taking it in-house fully as much as possible in five years because beyond that then it exponentially grows on the back end okay and there's a that and and there's a slide that comes up a little bit more but great question great question yes doctor in 2010. that's a great question okay uh it's going to depend on your organization mine on our high-end equipment the one thing that that they have done on our Mrs and our CTS which are with Siemens uh they bought evolve coverage so our Mrs and CTS are being maintained and upgraded every five years which is something that I think is appropriate for some organizations not necessarily all of them you have to make that decision yourself okay uh but our agreement with them also says that as long as we have contract coverage with them at a minimal basis okay as a shared service agreement expert type agreement I know they're changing it now we still can get the Evolve coverage so it's about partnering with your vendor also and it's it's a dynamic situation right equipment ages new equipment comes in are you sun setting the old equipment appropriately it's that Fleet Management that you have to maintain on a regular basis to see has that service model changed it has has the technology creeped away from your staff and how do you can you get them back up to speed or is it better to go more full service at that particular time and actually they charge we we try since the the Evolve type services or continuity with GE or whatever you want to call them okay uh we pay for those out of clinical engineering even though it's a capital thing that they separate out of the contract we pay for it and then we track what those are so that we can help schedule those upgrades at the right time that we want them done and we do it through project management at that time is there another question on this side yeah yeah uh you know oh on the clinical side accidents and abuses that's a it's a great question benzing uh it's one we are working on at our organization uh at first the organization has what is called the term vendor-friendly policies they don't like to push the vendor very much okay uh however they've learned in the last year and a half that they have to especially with a lot of the supply side issues that we're having and deliveries as Service uh you know the vendors are there as an opportunity to help us as much as possible clinically our people are starting to understand and try to get get their hands around what the effects are of equipment utilization we're not quite where I want us to be I don't expect us to be there for another 18 months let's see but it is something that we need to do we need to understand our utilization especially when systems are down so that we can identify what those Revenue deferment opportunities are and what those Revenue loss opportunities are and if something is taking more than 48 to 72 hours who's stepping on the on the gas pedal with the vendor to get second level support in to charge or even the factory to come in and start taking a look at the problem we had some issues with a vendor earlier this year uh to where they delayed and and cost us severely and we took them to task over it we escalated all the way to their Senior Management before we finally got results and sometimes folks you have to leverage those opportunities with your vendors if they are not performing don't let them just sit there and non-perform it'll cost you money and it cost us money they ended up making some make rights to us which we'll talk about later yeah um the bottom the bottom portion of this slide is it was kind of the world I lived in for seven and a half ten ten years somewhere around there um again everything on that contract is negotiable it just depends on how hard you as a customer wish to push so if you have a Contracting Department if you have a legal department get them involved ask them to look at this and and marry up your kpis as a department and as a healthcare organization as and as the utilization side the clinical side marry that up for something that doesn't make sense necessarily in the contract terms at the very minimum your if you can't get it changed for whatever reason um because the vendors depending on your Market again might be an extremely competitive situation they might be able to bend but at the same time if you don't well now they know that you're looking under every every rug every corner you're doing your due diligence and they're going to be a little more heightened with you so when it comes back to the data coming um and and it's not about necessary a lot of times they'll say they can't that's not necessarily the case they don't want to okay you got to ask the question you have a question right here yes okay guys no no it's my job or it was my job sorry I'll do something else now but it was my job when I was with Phillips for 11 and a half years working with him was we didn't want to go to the Clinton engineering department we wanted to go to contracts and grants in L.A County I'll tell you we want to as a as a salesperson put that hat on we want to go to the least path of resistance and we want to know who our influences are influencers are who are our decision makers and we want not just because I mean it's not an adversarial situation I mean I know it feels that way um but we're looking for the quickest path to the deal okay but we also know that if someone like Dean is there who is extremely diligent or yourself I'm sorry what's your name Rodney you know you sound like you're very diligent you know it's taking seven years because you gotta move the needle slowly it takes time um we know you are involved in the process and try to go around you will eventually hurt us so I'm sorry but you I don't think we got to the Crux of your question yet well we own the contracts okay I never heard that you know and then nobody was really bad well since we took over managing their contracts you know both of them used to be just trying to grab we have got tons of people with under control [Laughter] the short answer to that then I'll go backwards and Dean probably has an opinion too is if they weren't doing anything go get your money back yep okay that's number one and that and that's reasonable that's the key word here in in service right reasonable and it's a legal term too but who owns the contract um you could say it's clinical you could say it's the financial you could say it might be a Consortium of of a group like as you're discussing here so um but I think you have to I always go to the money who's paying for it and who's responsible for the margin I'm sorry well the way we're set up is supply chain owns the relationship with the vendor period everybody in the organization understands that we still get the behind the scenes stuff that happens with the Physicians and trying to buy equipment and stuff okay we're not perfect but what the way we have it set up is we have a contract Management Group in our supply chain uh division that works closely with our capital and then they work closely with us in clinical engineering so we're The Gatekeepers of the contract we have a person who manages those contracts works with supply chain on renewing anything new that comes in comes in for Imaging equipment comes across my desk if it's for biomedical women goes across Ryan's desk okay so that there's an influencer in the decision in making technical decisions with the users so we go to the table with our our clinical staff I go to the table and talk about contracts with my mng managers all the time and they are becoming very supportive we've turned things to corner and they're becoming very supportive of tracking us to move Services in-house as much as possible where it makes sense don't go grabbing linear accelerators and taking them off the contract folks or mammography you're going to run into problems with those folks you got to establish the relationship manage the relationship and then move it forward and get their support um we I jumped ahead the next slide but I think we've already covered most of these yeah you're the users but they're not the ones from an administrative that's going to be managing it they're not negotiating they're not the client changes supply chain we happen to have some experiments sure is Tony still there running supply chain um you have a great advocate in Tony which is wonderful but you know sometimes it's like you know where do you cross the line who does what right because sometimes so to answer your question yeah our workflow is it's in transition right now to be honest with you I would say we're probably about 75 80 where we want to be there's still the excuse me onesie Tuesday things that happened that we end up dealing with on the back end but mainly our our major vendors especially for Imaging have been notified you have a contract proposal it goes to our Contracting department and Supply Chain management supply chain brings it to me for review okay I work with our users saying I got this contract here's where I think we can go with this they prove it we have what is called an image community of practice so I bring some of this to the Imaging Community Practice if it affects the whole system or if it's individualized I go to each of the individual facilities we make a decision we go back to Contracting and say this is what we want and then they go back to the vendor and say no we don't want a point of sale service agreement or we don't want full service here's what we want then they bring it back to us that is our current process there's some things that need to improve with it yes sir what was it depends um it uh the vendors will be happy to well I shouldn't say the vendors the oems um they're trying to be Innovative they're always trying to come out with something new you know it's going to be faster it's going to have better Edge quality it's going to give you it's going to give if we're looking at Diagnostic Imaging it's going to give uh the Radiologists more confidence you know Etc because they're all everyone's being measured to death these days right um you have to take the mark you have to yeah there's just there's no easy way to do this but you have to take the marketing material and then go back to the clinical teams and say what are you measuring and see where they align because everyone says it'll be better faster and it's going to cost this much and it'll pay for itself you've got to break that down from a business perspective if they say that throughput on a particular piece of equipment whether Imaging or what have you you're going to get the same information or better faster we'll have them prove it was there a white paper was there a study done um put a spread okay put a spreadsheet together for me have the vendor do that for you say this is this is our case work this is our volume this is what studies we do and then line it up with the clinical team and see if those things come together but it's it's a it's some spreadsheet work and then you know again what's your budget you know as Dean said earlier with the CT example um sometimes that makes great sense in my current role I work for an AI company that does neurodegenerative analysis with MRI we take something that was manual we make it automated we have proven case studies that show that you used to do X number of patients you should now be able to do why and there better be an improvement there and you better have confidence in it and it's harder if the customer hasn't been upgrading their MRI the scans take longer so again depending on the technology and the clinical space you're in so I don't I know I'm doing this with your answer I'm kind of going oh that's a tough question to answer because I'm going to be honest with you vendor can't even answer that question they'll be the first to tell you that we believe we're going to do X number of updates so it's one of those past performance is not indicative of future but you have that's all you've got to go on so what is this Fender or OEM done for you done for this system or this type of piece of equipment what have you done to date they've had one update over three years but you want me to wrap it into the service contract I'm not seeing it I'll just pay capex for it I'll pay Capital out of my capital budget when it comes time I mean it's it I mean but if they're if they're constantly pushing updates if they're helping managing your network on the back end with your I.T people they're they're providing some other value ads okay probably a good idea and and it depends on the type of upgrades that they're also providing whether they're going to be billable to you or inclusive in your contract so you need to have them spell that out for you yeah because a lot of times they won't the late exactly well and it goes back to the clinical teams I mean I have a really cool tool what I sell today but not everyone buys into it you know they they don't do that they don't they don't fully segment a brain they don't have a need so you have to but doctors again I'm generalizing love cool stuff they do you know it's kind of like get them to justify you know why or you go back to the data that says okay you're not even doing this today so what where you'll get your marketing department involved well are you going to have more referrals if you get this goes back to the revenue side of it yeah it's it's it's a great question but there's no easy no easy answer so at the bottom of this sorry and real quickly the bottom of the slide is how do you monitor vendor performance and you know you're going to need to design your own methods and processes and systems but who within your organization helps evaluate the vendor's effectiveness because you can't do it by yourself you got to have the cut your custom internal customers the users as part of that team you're also going to have to have your Supply Chain management people because if there are performance issues they're going to be the ones that are going to hold the vendor to the table oh we got all this Capital Equipment we're going to buy from you and you can't fix this really okay oh we've got we've got to thin the slides down yeah I know uh it's it's about teamwork and I think you guys can see you know we've talked about the tubes and detector stuff and transducers image intensifiers how many of you have moved services on your systems from being starting at eight o'clock to maybe starting at noon and going until nine or ten pm at night and Steve how effective has that been I'm looking at it but we had we had Ministries that wanted to move it just for the sake that based on when FedEx arrives right and when parts are right they're just I mean logistically there's no way available it's a great point so more often than not our teams have adjusted to the just adding later hours early as you can the next day um is best to minimize operation so you guys used to look take a look at your data and the fact of the shipping deliveries and everything to maybe reorganize the structure of your contract and that I think that's a great great Testament that's a great idea I mean that's you're looking at especially if you're in a remote area where like you said the planes don't even land with the parts until we run into that in Boise all the time I love it there we could discuss remotely meaning what in Seattle but we have we have delivery issues with and it's not the vendors that create the delivery issues most of the times it's the shipping vendors and we have issues trying to get parts in by 11 o'clock and so I've started looking at that Stephen going with if you're not available because you can't do the repair what do I need you for from eight o'clock until 11 o'clock if it if 15 or 60 percent of my service is done after that time what can we do to restructure absolutely and it's there's the that's where I was going to go the local Depot um every organization calls it something else they either share a place with FedEx UPS DHL they have their own um the local service manager should have some say in what parts are there doesn't mean that they get listened to by their organization Oh you mean your so you you worked it in trying that's where I was doing the word Depot with the vendor it scares the living blazes out of it well what I was going to get through storage yeah oh exactly that have them Define what local part storage is and don't be afraid to go see it yep and check the level of dust we we've offered a couple of our vendors storage on site yeah at our locations and Meridian we do that we have a storage locations where our major vendors to put stuff we have you know uh condensers uh for chillers uh you know we have we're even getting a couple of tubes the detectors that we're going to be storing High failure type parts that are major components we've got us what we call a forwards I would call a forward stock English occasion Steve we also have some Montana Medford Oregon and yeah theaters where they're just the geographical limitations climate yes so bring those pieces into it as well because it's unlikely the vendors would typically de-stockers each step in those locations so working with them to front load some critical things that we can have available to us and to their teams if needed if they have other local customers they could use those same parts for those local customers right I mean but yeah it it starts having the discussion yeah yeah and and being very upfront with it and forward about it and um sometimes there's there's uh um that's what I'm looking for there's storage requirements of particular Parts they have to be kept by at a certain temperature or immediate you know it's kind of like wine you can't have temperature swings that go too much but if you can accommodate those for your vendor there's an option um there was a hand over here oh yeah right most of our service they were doing like seven in the morning during the day after three year period our MRI now so over time they get calls from service they'll come in at night to do it or at the ends at night and then they'd build the hospital we have higher billables than contract costs so I got what we and I said I want my contract from Seven at night seven in the morning well we can't do that I don't have to stop I said who the hell does it that night any Catholic church if we ended up rewriting that contract instead of the night until seven in the morning over the next three years contract we had two heartbounds hmm yeah it costs us a little bit and that goes to the yin and the yang right you you you have the Monday through Friday to five or whatever coverage that you're gonna catch eighty percent of your problems but is it sometimes better to pay outside out of pocket for the one-offs that happen and again you got to go back to your history you gotta you got to see what kind of delivery they have from a vendor perspective yeah foreign they're gonna they're gonna use it until it yes so unfortunately one of the key components here is at the bottom is you know refined to build a master service agreement if it's appropriate how many of you have mastered termed agreements with one termination date for all equipment from from a vendor or for a particular modality yeah or yeah so I'm talking about leveraging volume yeah okay and then cycling it all will save your organization and its own internal labor a lot more okay real quick to go next slide yin and yang right you do that you better be ahead of when that contract's coming due because usually when you do that you're at a three plus year term everyone forgets about it and then it's 90 days out and you're scrambling and the vendor knows they're all tied up with you yep so it's it's now become a symbiotic relationship so you have to start the renewal process I would suggest six months out we've actually done it to pushed it to where it's almost a year out yeah and we get our first notification to grab our data yeah and and that's I mean that saves your supply chain and you're purchasing people a lot of time just managing one document but it also um again tie it into that last bullet leveraging your position is their equipment purchases happening at the same time I will guarantee you every equipment manufacturer I won't use names would rather sell they make they make most of their money on service honestly but sale equipment sales drives the business so if you can if you know that the department is about ready to buy 10x of something and you've got a nice big service contract coming due trust me they will do whatever they can to make sure that Capital sale goes through including dropping the price on the service if they have to they don't want to work together but they have to there's some questions yes and it can also be clinical staff so if you have a high level of turnover for your your clinical Tech or application team sometimes the vendors will charge you okay when you first buy it you get a certain number of hours certain number of classes or on-site visits then they want to charge you so it's both you know moving for an in-house organization you want to have flexibility as Dean is doing but you also want to make sure your clinical team is taken care of can it so they have questions one off they have new staff how can you address it so how can you do that with a master service agreement because if you have the singular contracts every single piece of equipment has its own uh in service education tied to the contract so when you talk to the vendor about these issues you need to talk to about bundling of the training applications training application support you know remote support because you're paying for that individually individual contracts and if you do Master agreements how much can that drive the price of the service agreement down if it's all funded okay uh well one last question correct varying contract Varian contract linear accelerators that's a totally different animal to tackle can we get can we put that's a sidebar discussion we can have can we do it at the end okay but it's a long discussion we can talk about it after this we won't leave but we'll no that is a that is an animal that I come with a tank with okay that's pretty much it this is your slide Dean yeah uh establishing kpis uh you know and I'm not talking about kpis for for joint commission or Regulatory Compliance folks I'm talking about your vendor performance kpis that you need to determine and they they need to be built into your contract as part of your service deliverables and expectations okay so you know what is the routine mean time between failure rate of of all your MRIS and part of those MRIs is what were the big component failures that you had did you have in our RF amplifiers or gradient amplifiers going out you know uh was it cold head issues was it Chiller issues what time did the service call get placed versus them showing up compared to the agencies of the contract the response time on-site response time from the time the calls open you know different vendors write different performance standards you know it was one hour response by phone yeah how do you measure that you know uh but making sure that they're to a level okay there are occasions where they're going to call and say do we need to be there within four hours that's your call but at least they need to be asking that question and the user is the one that makes that call not clinical engineering okay real quick the uh all vendors Manpower or our vendors Manpower quantities and levels guaranteed um Kristen brought this up I mean she's involved in this world Manpower for your vendors is tough just like it's tough for you to find good people so that's as the as the market has changed and shipped over my career that is where I might cut my vendors from slack depending on how hard they're looking do you if they say they're looking to hire people there's one way to prove that they are aren't go to their website and see if there's a job posting how many existing decreased response times since code would happen and and help them if you know someone who's interested but doesn't want to be an in-house person but likes the idea of being in the field you know probably helps you on that on the back side yes sir considering everything what's the average cost of MRI depends on the vendor yeah depends on the age of the technology the vendor your key I can't give it to you because the key he said when at The First beginning location it's going to be the location so where are you sir Loma Linda oh okay yeah so you're you're a big luminary site they they should be taking care of you and they should be getting multiple quotes yep um so and then again depending on how new your you know your equipment is uh newer equipment will tend to Service pricing we've been toying with this but I'll try to do it with my hands brand new system right just come off the line arson a big deal your docs want it you're going to buy it so there is no other uh source for service you've got to go to the OEM that might be the time for a point of sale service agreement because you don't really have a choice draw use the equipment sale to drive the Service pricing down as far as you can over its time the OEM if they if they built something that people like that pricing if we're going time this way in dollars this way it'll derive it competition will drive it Down Right Siemens will come in your example GE Cameo some cool g now Siemens did well now they've got to compete then the in uh independent service organizations they pick it up they have guys that'll take care of it all right now there's more competition uh oh now there's something new hitting the market the one you have is old uh now the OEM wants to end of life so they don't want to upgrade it anymore so now the iso has a has a window of opportunity to kind of Drive the price up a little bit and then it's end of life and it just goes to zero because no one wants to touch it so I can't give you a dollar amount but that's the evolution of a service contract pricing and one Vengeance Service pricing on an MR will be different from another vendors to be quite honest with you I'm sorry they used to the rule of thumb used to be eight percent of the cost of the equipment it's really more what's what will the market bear I hate I hate to be that all right but I don't really there's a finite measure yeah I use it as an eyeball type of perspective MD byline is sometimes a good reference for you I'm sorry thank you right but no one's litmus testing it you know a customer can and upload that and they can honestly say whatever they want it I mean because they can't give them the contract because that's quote unquote right I ask you this how many of you have group purchase organizations that you're using at your organization Steve gpos yeah most of you you need to work with your Supply Chain management people because those gpos most of them already have agreements with the vendor for pricing on the service agreements I caught a vendor selling us eight large modality systems and the service count the contract price discount they sold them a point of sale service agreement to lessen the capital of three percent and the service agreement discount was five when the agreed upon pricing with the GPO was 38 percent a lot they lost 33 percent and when I pointed it out to them all of a sudden the discussion about point of sale service agreements changed a little bit and they went back to the vendor and said don't do that again you got to watch that real quick Sir Mr gentleman's been waiting for a while I'll come back okay here sales Hat's on I learned over the years that whatever I'm going to reimburse you for is never going to cover the cost of all the Manpower that was wasted from a clinical standpoint or the reimbursement of that patient not even to mention the care that was maybe delayed and caused harm so it's more of a penalty back to the equipment or the service provider because they're going to have to write a check because that's not a simple process I mean these companies are put in place to make money not to give you money um so I would use it more as a penalty of you didn't meet your obligations that's one of three strikes that gets me a chance to cancel the contract if I want to you didn't or from from a financial perspective honestly it's more of a headache when I worked for an oem sold a contract didn't meet an obligation I got to go through 16 approvals but the actual dollar amount was a drop in the bucket to us so I would look at it more from a metric negotiation standpoint yeah because you're not going to be you will not get a vendor to reimburse you for lost Revenue yeah yeah I mean it's it's standard boilerplate stuff you can you can increase it a little bit but at the end of the day it's still not going to get you back whole if it's severe enough that's where you need to be working with your legal department on a by either canceling the service agreement or forcing renegotiation of your service agreement or to kind of make right as a part of the make right okay and we'll talk about make rights here in a second but establishing kpis is a big thing oh what kind of window is like myself it's that sale that's why it's called a point of sale that it's at the equipment sale sometimes they'll give you during the warranty period of the equipment but most of the oems have scaled that back they want it at the time of booking yeah if they extend warranty to two years that's a misnomer okay they're building you for the second year as part of the purchase agreement on the and they have to tell you of it yes they do it's in the agreement do for this for the cmris if they're down for more than 48 hours that vendor is obligated to bring in a mobile unit there you go that's one I never even thought about that's that that I've had to write those in then make sure call the vendor ask who are they bringing in is it their own system is it someone they're partnering with call that partner have them explain how quickly they can actually get one to you and because because the OEM is or or the service writer is not going to call you not going to call for that mobile until the 48 hour one minute Mark right and then is there another delay and there was one more question over here then we're gonna we're gonna jump between so good my crystal ball is hazy on that yeah that's another side discussion I think it needs to occur but probably not here because it's a supply side issue discussion not contract but it it's tough the main point is you know develop key performance indicators oh I'm sorry uh you know make sure that they're smart okay we all know about smart being specific measurable attainable realistic and time-bound you know and make sure that you're protecting your organization with the correct contract language about kpis and performance as much as possible you're not going to be perfect at it you monitor these things and if certain kpis work great or if they fix a problem and then the problem is fixed do you really need that kit to be continuously monitoring that kpi okay change them up on the Fly um point of sale I think I hit most of these yeah and this is again from a sales perspective to you my customer I have more pricing flexibility the longer the term right now does that work for you a lot of organizations say we don't do anything longer than three years the next thing if I was a salesperson okay I'll give you I'll give you this the second or the two the two years the last two years of the five-year agreement as an option year okay guarantee the price in there so then you have an option to easily renew it or extend it that helps supply chain departments too um I mentioned tying it to the Capital Equipment the data we talked about contracts Professor again the benefits I mean there's all kinds of things we can do on the service side because now it becomes an operational cost to your department or to you or your clinical team rather than a capex um yes or Contracting yeah I think we I think we touched on both yeah that's pretty much stick around work we're getting towards the end yes oh so fleet Fleet technology management this this we could we could spend a whole hour on ourselves um this is an ever-evolving process someone mentioned they bought it they've been servicing it no one's touched it or that hasn't been in the in the hospital for years again this is not this is not a personal issue nurses love to I Love X you bought all of these I'm going to put these in the closet and I'm going to use these all the time and they don't tell you um you still have to service it yourself to find it um so it's an Ever evolving process and it goes back to the gentleman that asked the question I think he he left about software and upgrades how long are you holding on to it and what is what is too long you know oh yeah and vendors are pretty good but it's so hard I mean we could buy throughout ourselves and some companies that's your windows set and then that yeah I'll give you an example so I'll give you two examples deal he'll take the second one and run as soon as I say it but the first one was uh when I was at Phillips we had a customer that had just a basic rad room but it was running on a sun Microsystems computer Sun Microsystems does not exist anymore um Phillips had not end of life the room but obviously Sun or the people who bought Sun I forget who that was end of life the server well Phillips had an end of life to this they had a service contract going out two more years hold them accountable for this don't let them say well that's end of life I don't know what to do I don't care it's your problem and I was actually on the customer side on that one I stood there Toe to Toe and we we found a vendor that actually rebuilt the whole server now it took a month so then but that goes back to what it is and then I'll say it the Phillips cath Labs with Microsoft operating systems that all of a sudden snuck up on Phillips and oh gotta upgrade them we can't service them you know everything went to went to heck that happens even at large multinational companies um work probably the theme we should we should consider here is you are not an island get your it team involved early get your supply chain people involved early you're purchasing you're Contracting your legal your administrative your clinic it's it's a it's a village and have everyone just no just check a box yeah yeah it's got Microsoft whatever I don't I don't know when it when that's expiring I don't know when I needs to be upgraded because the OEM they're going to tell you it's your fault or it's our fault but you're never going to know until you know the rubber hits the road that day so I'm sorry but it's it's a tough discussion uh we'll make sure these slides are available but this is kind of a good feeling is MD publishing is going to make the slide sets available after the conference is that correct and what I would I think we're this is a flashlight yeah so make rights everybody understand what a make right is okay make right is any solution that the vendor is going to provide for you for a wrong they have committed to your organization I don't care if it's comping of a service call that's billable unbillable labor that's a make right all the way up to uh equipment replacement equipment replacement and Brian and I went through a couple of those at Phillips when I was at LA County specifically with this PET CT everyone has them everyone makes mistakes trust me nobody from from a manufacturer service provider decides to wake up and screw their customer that's not their goal but things get around them people make mistakes and again leverage it it's working with the vendor and having you know my my thing is you have high level make rights those have to be with an account executive from the uh from the vendor because they're going to be your Advocate going to the upper uh levels of management in the organization in their organization to get approval to do big make rights okay understand what the make right is about what your ask is and work with the vendor to get the right solution uh you know we but accessing your account executive is going to be a key because they're going to help you walk through that question if you came into a situation isn't as responsible receptive who do you suggest that you here you can use this as this escalates I call teasingly a bat who's a vendor attitude adjustment tool um and that can be anything from we're going to cancel your service agreement we're not going to do business with you and we're going to debar you from doing business with our you're jumping ahead you're jumping ahead yeah before you go there um they're probably trying to solve it at their local level and they don't want to escalate it for some kind of visibility issue um there's nothing wrong with jumping ahead of their organization going straight to the website and if they're big enough they're going to have a customer support advocacy you fill out that form send it it might take a couple of days or a week it will trickle its way from on high to the local people and have your sea level executive person send it yeah and take the initial call and then have it sent to you you will get all it takes is after this we're not going to buy anything from X yeah yeah I mean nothing nothing tightens someone up than an executive of sales and revenue and that's the exact process I used with a certain vendor last year and then do what he said if you don't get what you want service I worked with the local service team to try and get service issues fixed it didn't happen they tripped over themselves and cost us in downtime for a week on a cath lab that's enough is enough I contacted my account executive and then my c-level guy from supply chain we held a meeting with the upper level of of their service organism service and sales organization we flat told them you have 30 days to fix this stuff I never saw a whole bunch of scrambling as I saw as this vendor all of a sudden trying to turn Corners that they couldn't said that they just couldn't turn and nine comes out of ten it's in the agreement already yep so leverage your contract language and make sure if you have make rights that you work with the company with your account Executives but make sure you are working with your organization first and have a battle plan to put the vendor in a position to do what you want them to do okay