At AAMI 2012, held this past weekend in Charlotte, N.C., attendees had a handful of major points of interest. Perhaps the biggest topic on attendees' minds dealt with the preventive maintenance requirements being enforced by Centers for Medicare & Medicaid Services.

Those preventive maintenance requirements mean facilities must follow manufacturer recommendations when it comes to service schedules. And although it has hit a high level of enforcement since late last year, in actuality, the recommendations have been part of the CMS guidelines for more than a decade -- just loosely followed.

That's why there has been a bit of an uproar among medical professionals confused about how systems exhibiting a proven record of success for more than two decades can now be under fire. To help alleviate the confusion among attendees, members of the standards interpretation group shared the information they gathered during discussions with CMS.

First, as the Joint Commission's George Mills explained, the whole process was kick-started because CMS agents in some states were holding hospitals to manufacturer recommendations regardless of a hospital's documented outcomes. So, as Mills explained, "the agents in Indiana, Ohio and California were enforcing the recommendations that weren't being followed elsewhere." The main system of CMS was frustrated because of these mixed protocols and it was determined that there should be a system-wide way to manage everywhere.

In theory, according to Mills, it made sense. But in practice, facilities have put effective processes into place that have been followed for years -- if not decades -- that would take significant time, money and redirection of limited resources to alter. Yet, The Joint Commission had been allowing hospitals to base maintenance on risk assessment and hospital experience with CMS' blessing. That allowance came to an end when CMS sent notice in January 2010 to stick strictly with manufacturer recommendations.

A wrench is a wrench is a wrench
One of the first sticking points was the requirement that facilities only maintain equipment with tools recommended by manufacturers. This meant, if a manufacturer identified a crescent wrench, for example, as an x191, a facility would have to purchase an x191 -- which typically meant the tool would be significantly more expensive and facilities would be purchasing tools they already, for all intents and purposes, owned.

Ultimately, the group meeting with CMS managed to get everyone to agree that a wrench by any other name still does the job. It's estimated that this concession alone saved facilities from needlessly spending between $1 and $3 billion dollars to replace existing tools with "official" tools.

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