Are your anesthesia providers pressuring you to purchase a portable ultrasound machine so they can better perform regional blocks? Many providers say ultrasound-guided regional anesthesia is becoming a standard of care. Newly trained practitioners are often accustomed to using the equipment to locate nerves because that's how they learned the technique. But at about $20,000 to $30,000 per machine, this equipment isn't cheap. What's more, your facility can't bill any extra for the use of ultrasound in administering anesthesia, making it difficult to cost-justify, especially at a time when facilities aren't exactly flush with cash for capital equipment purchases. Before you loosen your purse strings, ask these 5 questions to determine whether it's worth the expense.

1. Can you get your anesthesia providers to chip in? Surgical facilities can't bill extra for the use of ultrasound for regional blocks; the global anesthesia fee for the case will remain the same regardless of whether you use the technology. However, anesthesia providers can bill for ultrasound guidance. So why shouldn't they chip in for the up-front cost of the machine? After doing the math and showing our anesthesia providers how much of the cost they'd be able to recoup via billing and reimbursement, they agreed to cover half the price of the ultrasound machine. Depend-ing on your relationship with your anesthesia providers, you may be able to work out a similar deal to share the cost burden.

2. How often will the device be used? Start by looking at your case mix: How often do your anesthesia providers perform regional blocks? If you use regional for most of your orthopedic cases, and you're doing a fairly high volume of these cases each month, then chances are the ultrasound machine will get a lot of mileage. That is, if all or most of the anesthesia providers who perform blocks at your facility prefer to use ultrasound guidance. Make sure it's not just a lone voice in the crowd asking for the equipment. At our facility, the anesthesiologists only recently began using regional blocks for the 300 to 350 orthopedic cases we do each month. The anesthesia group we contract with was enthusiastic as a whole about using ultrasound, arguing that it's become a standard of care in the industry. That was a major factor in our decision to purchase a portable ultrasound machine for this purpose.

3. Are there other applications of this technology? Consider what other uses you may have for the ultrasound machine in your facility. For example, at my multi-specialty facility we reasoned that the device could potentially be useful in some of the 150 to 200 pain management cases we do each month, as a backup imaging device to complement fluoroscopy. Physicians can also use portable ultrasound systems for diagnostic purposes, so if you share a building with doctors' offices, you may be able to share the device (and its cost) with your neighbors.

4. Will ultrasound actually improve block performance? Despite claims that it's becoming a standard of care, many anesthesia providers will tell you they don't need or want to use ultrasound to locate nerves for blockage. Experienced anesthesiologists who've been doing blocks for years before ultrasound technology came into play may see little need for it. But newer practitioners, or those new to the block technique, are more likely to have been trained with ultrasound guidance.

One of the biggest rationales for doing regional anesthesia in the ambulatory setting is to ease post-op pain and speed recovery times. Since we started using regional blocks for orthopedic cases, our patients have been recovering more quickly with less medication, nausea and vomiting. This potentially lets us discharge patients sooner, saving us time and money. But regional blocks are only as good as the anesthesiologist performing them, and asking providers to perform blocks without the aid of technology that can help them do so more quickly and efficiently would only negate the time- and money-saving benefits of this technique. So if your providers say they need or prefer to use ultrasound guidance to get a good, efficient block, it may well be worth the investment.

5. Are there deals to be had? You may have a tough time finding companies offering a significantly good discount on the price of a portable ultrasound machine, but in an effort to make sales in this economy, some manufacturers are willing to sweeten the deal with extras like an extended service contract (5 years instead of 1, for example), free shipping or discounted components, such as a demo or refurbished printer. Be sure to trial more than 1 machine and get competitive bids from the manufacturers you're considering; this will help bring down the price. Also make sure the technology of the machine you're purchasing is upgradable in the event of future advancements. Ultimately, your decision should be guided first by your anesthesia providers' comfort level with a particular device, then by the deal you can secure from the manufacturer.