OEC 9600 vs. Ziehm 7000 vs. Philips BV 300 Plus

[drpainfree]

looking for a starter c-arm to bring cases in-house. out of three systems above, which one would you consider? I know they are antiqued, but as long as I can get work done. Most importantly, reliable and easy/cheap to repair (parts/labor) if broken in 1-3 years.

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[willabeast]

i would go with the OEC and at least a one year warranty. preferably 5 year. would not get the phillips. ziehm no experience with.
BTW a warranty solves a lot of headaches - if only one has a warranty/service agreement, get that one (all things being equal).
it will break, and fixes are $$.

 

[drpainfree]

thanks for the input. willabeast, why not phillips bv 300?

three parameters I'm considering,

image quality:
not sure which one would be better. Any thoughts?

cost to repair:
yes, OEC 9600 seems to be everywhere and if it breaks down, parts and labor costs are probably the least expensive.

reliability:
also considering leasing a c-arm in 40-50k range, like a newer philips pulsera (2007+/-) , to avoid unreliability issue.

 

[pmrmd]

Spend the money and get a new machine. A new 9900 financed over 5 years is 2k a month, which is a few cases on one day of work. Pictures are great, its reliable, and you have an asset at the end of the term.

 

[drpainfree]

pmrmd, I hear you. So brand-new 9900 would cost over 100K? It is pretty steep, especially considering how many procedures have fluoro bundled these days. I don't know if it's worthwhile to invest this much in a c-arm. What do you anticipate the residual value of the machine after 5 years? Also I'm relying on my saving from the days when I was doing anesthesia to get me through the first 1 year of full-time pain management. It's a stretch. How do you compare leasing a 2007 pulsera at roughly $1k for 5 years vs. financing a brand new unit like 9900 at $2k for 5 years? If I go with a brand-new unit finance, are there other options out there that's more affordable now?

 

[willabeast]

thanks for the input. willabeast, why not phillips bv 300?

three parameters I'm considering,

image quality:
not sure which one would be better. Any thoughts?

cost to repair:
yes, OEC 9600 seems to be everywhere and if it breaks down, parts and labor costs are probably the least expensive.

reliability:
also considering leasing a c-arm in 40-50k range, like a newer philips pulsera (2007+/-) , to avoid unreliability issue.

old phillips machines had nice image but broke twice as much as old oec.

 

[drpainfree]

I see. So reliability is an issue. I also heard it tends to be more expensive to repair a philips.

 

[drpainfree]

BTW, anyone know much about GE GoldSeal Refurb C-arm program?

http://www3.gehealthcare.com/en/pro...lite#tabs/tab5CC5A3E6C5E8439A914EE210A79006AD

 

[hyperalgesia]

I wouldn't think twice about getting an OEC 9600 with no service contract from another doc or hospital (not "refurbished"). You need to test it out first of course, look at the image yourself. Trust the seller. Unless new paint is really important to you, I could care less if a salesman tells me it is "refurbished" or "remanufactured" or whatever. The less fingerprints on the sales record, the better value you get. If it works, it works. OECs are like tanks.

Regardless of what you get, it's always nice to have an ASC or hospital as back up.

Of course, if you have an established practice and are reliably busy, you'll enjoy the piece of mind of a new machine with the service contract, etc.

 

[BobBarker]

Can you get a SBA low interest loan and get a new 9900?

 

[drpainfree]

hyperalgesia, yes, I will continue do cases at local ASC and hospital.


bobbarker, I'm pretty sure I can get a SBA loan with my credit score (I don't know what's considered as "low interest"). I'm just not sure if it's worth it to invest so much in a c-arm in this kind medical economy.

 

[pmrmd]

pmrmd, I hear you. So brand-new 9900 would cost over 100K? It is pretty steep, especially considering how many procedures have fluoro bundled these days. I don't know if it's worthwhile to invest this much in a c-arm. What do you anticipate the residual value of the machine after 5 years? Also I'm relying on my saving from the days when I was doing anesthesia to get me through the first 1 year of full-time pain management. It's a stretch. How do you compare leasing a 2007 pulsera at roughly $1k for 5 years vs. financing a brand new unit like 9900 at $2k for 5 years? If I go with a brand-new unit finance, are there other options out there that's more affordable now?

So you want to lease an old machine for 1k month for 5 years, and then in 5 years lease another old machine for 1k month for 5 years, and then what? Does that 1k per month include a service warranty? For an additional 1k per month you OWN a NEW machine after 5 years. $1,000 a month to own a new machine is nothing. I am sure you will inject a knee or shoulder or hip under fluoro guidance every month. $1,000 a month averages $50 per day considering 20 working days per month. That is less than one fluoro guided peripheral joint code.

 

[drpainfree]

so one of the questions is if you will be getting a brand-new unit, is oec 9900 hands-down the top choice? If not, are there other options available at more affordable rate? How many years of warranty does the new 9900 have?

Yes, I would have to call to find out if 1k for pulsera include service warranty.

Yes, I understand your calculation perfectly. Unfortunately, I have already bought a brand-new (but affordable, around 15K) u/s a few months ago. I'm already doing joints/nerve blocks under u/s. The c-arm will be used exclusively for spinal procedures and stims. It kinda defeats the reason I bought an u/s for if I commit into another 120K investment.

If I don't get a cheap oec 9600, I see I have most likely 3 options:

2007 pulsera,
- buy: refurb, at around 40k, and sell it after 5 years for 15k, my net cost is 25k, then get a brand-new c-arm by then if I have to.
- lease: refurb, at under $1k/mo, 5 yrs, sell it after 5 yrs for 15k, my net cost is 45k

2016 OEC 9900
- finance, 2k/mo, 5yrs, cost is 120k but the actual price is probably 100k (I'm guessing). Let's say hypothetically speaking, I will sell it at 5 years mark, consider 40% depreciation, get 60K back, then my net cost is 60k. Of course, I'll be much more comfortable keeping a 2016 9900 for many more years at 5 years mark compared to a 2007 Pulsera, which will be 14 years old by 2021.

Please correct me if my assumption is unrealistic above. I haven't really look into these machines yet as I was mostly looking at low-end system. You guys made me really salivate for a better system, even a new one. I'm evaluating this option seriously now since knowing myself I don't like to settle with anything inferior.

But honestly though, if you just start out a practice and don't know how this healthcare reform will affect the landscape in next 5 years, will you really commit 120K of investment into a brand-new c-arm? Provided that it will be financed, but still it's a financial obligation.

 

[pmrmd]

US for tendons and nerves and it isn't a bundled code. Fluoro for joints and it isn't a bundled code. If you are using US for joints you are working at a discount.

 

[drpainfree]

I hear you. Probably easier to do joints with fluoro anyway.

 

[hyperalgesia]

so one of the questions is if you will be getting a brand-new unit, is oec 9900 hands-down the top choice? If not, are there other options available at more affordable rate? How many years of warranty does the new 9900 have?

Yes, I would have to call to find out if 1k for pulsera include service warranty.

Yes, I understand your calculation perfectly. Unfortunately, I have already bought a brand-new (but affordable, around 15K) u/s a few months ago. I'm already doing joints/nerve blocks under u/s. The c-arm will be used exclusively for spinal procedures and stims. It kinda defeats the reason I bought an u/s for if I commit into another 120K investment.

If I don't get a cheap oec 9600, I see I have most likely 3 options:

2007 pulsera,
- buy: refurb, at around 40k, and sell it after 5 years for 15k, my net cost is 25k, then get a brand-new c-arm by then if I have to.
- lease: refurb, at under $1k/mo, 5 yrs, sell it after 5 yrs for 15k, my net cost is 45k

2016 OEC 9900
- finance, 2k/mo, 5yrs, cost is 120k but the actual price is probably 100k (I'm guessing). Let's say hypothetically speaking, I will sell it at 5 years mark, consider 40% depreciation, get 60K back, then my net cost is 60k. Of course, I'll be much more comfortable keeping a 2016 9900 for many more years at 5 years mark compared to a 2007 Pulsera, which will be 14 years old by 2021.

Please correct me if my assumption is unrealistic above. I haven't really look into these machines yet as I was mostly looking at low-end system. You guys made me really salivate for a better system, even a new one. I'm evaluating this option seriously now since knowing myself I don't like to settle with anything inferior.

But honestly though, if you just start out a practice and don't know how this healthcare reform will affect the landscape in next 5 years, will you really commit 120K of investment into a brand-new c-arm? Provided that it will be financed, but still it's a financial obligation.

I believe when you lease the machine (with dollar buy out at the end), the payments are tax deductible. If you buy one outright, the expense should also be tax deductible, which will save you many thousands. Just don't forget the table, which is also not cheap.

 

[Doctodd]

I just added a second c-arm to my practice.....bought a used 9800. I passed on an 8800 which i regret. I leased/bought the 8800 new for close to $100k in 2005......they are offeing $5-10k as a trade in now, so the depreciation is painful. I will never buy new again. The 8800 makes no noise......the 9800 has a spinning tube so it makes alot of noise in a small procedure room. If i order another 9800 i will follow up with you.

 

[powermd]

We're happy with the two OEC 9800s we bought last year. One item worth considering is how you plan to store images. Look carefully at the networking and data ports the machine provides. Ours has only an image output for printing, and ethernet. We had to figure out a cheap DICOM server solution.

We set up this free, open source DICOM server with minimal trouble. http://www.orthanc-server.com
The staff just send the images to the server at the end of each case. Ever so often I back up the images. As the server directory fills, the search function becomes increasingly painful and slow to use. So if you're going to be storing A LOT of images, you may want a more powerful server. I haven't seen anything in the PC world that comes close to the Mac based Osirix for power, ease of use, and low price. So I'm still looking for a good solution for our PC based network at the office.

 

[drpainfree]

hyperalgesia: i'm aware of the tax benefit of a monthly lease program (as well as financing). easier with a monthly lease program, i believe. but still, if i can save allocate the budget to something else more productive (for example, build a surgery center down the road), i'd rather go that direction).

doctodd: so you wouldn't buy a brand-new c-arm anymore? your 8800 has depreciated 90% in last 10 years, or 10k a year, painful, but not unreasonable, right? think about it, if you had leased a refurb 10 years ago, you'd be paying as much on monthly lease payment as you'd have suffered on depreciation. On the other hand, you had a reliable machine to use for last 10 years. I think the reason for steep depreciation for 8800 is there's not that many 8800 ever produced. I think you're one of the few who's suggesting not to bother with a brand new unit. thanks for the input as well.

powermd: thanks for your suggstion on open source DICOM server. I would definitely look into it if I go with 9800 (or even other brand/models that don't have usb output option). I might ask for your pointers when I get to the point.

now since a few of you brought up 9800. I see the price on dotmed is close to 40k to 50k, very close to 2007 pulsera i mentioned. i gathered pulsera has better image quality than 9800 from past discussions. which one would you choose if they are both at the similar price range for the similar DOM? I'm looking for three things, reliability, cost/ease of repair and image quality, in this order.

 

[nvrsumr]

I like the pulsera usb port. Easy for staff.

I bought "floor model" for 100k plus a 20k 5 year warranty. Already new tube and battery. Got a 5% practice loan over 10 years.

Having good tools is always worth a little bit more.

I have been very pleased with machine and warranty work.

For my payors i get paid more for fluoro and joint than us and tendon. Bursas may be billed as joints.

 

[drpainfree]

completely agree with you, nvrsumr. i'm pretty OCD on quality. took me 3 trials (exchanges) to find the u/s machine I felt good about. so knowing my personality, i will likely be better off with a new or nearly new one.

it seems it's more or less an even-split between you guys when it comes to getting a new vs. used c-arm. for u/s, i remember almost everyone was suggesting getting something used or cheap because of the reimbursement for u/s has been going down. but isn't it the case with fluoro cases, too? and new fluoro is almost 4-5x of the cost of new u/s. I guess it's a reason why you'd get a new fluoro because it's such a large investment, so rather get something reliable for long term.

but it's just interesting how we think about investment while ROIs for both are both trending down.

 

[Doctodd]

You can still depreciate a new unit, just not as fast....at least that is what i understood from my CPA. I will also say i saved $3-4000 in sales tax by buying from someone other than GE.

 

[Doctodd]

No i dont think ill ever buy a new c-arm just for the "security" that the GE sales reps preach. The 9800 wont depreciate much, and parts will be available throughout our lifetime.

 

[hyperalgesia]

You can fully depreciate up to $500k in business tangible asset purchases instead of using the depreciation deduction over the years. In other words, you buy a $120k c-arm, and you claim the entire purchase price at the end of the year, and save about $50k in taxes.

The limits on this deduction have been raised at the end of the year for the past few years. Always on the chopping block but still good at least thru 2016. You can't buy real estate though

http://www.section179.org/2011_section_179_expense_deduction.html

 

[drpainfree]

hyperalgesia, this is the problem: I have more than enough deduction from other expense to offset my income.