Take the next step on managing surgical supplies
By John Whittlesey
For some years, the surgical supplies cost category has remained a most frequently cited Top 10 excess function, and with the largest excesses. It’s a complex and problematic area to manage well. Just think of all the stock keeping units (SKUs) and contracts that materials management staff and the surgical team must track. Supply chain management (SCM) concepts have done great things to help streamline and consolidate inventory handling operations, and they can help provide insights into lowering costs for surgical supplies. But what happens when you’ve driven as far as you can down those SCM avenues?
A materials manager frequently thinks that once the contract is negotiated, their job is done. They will typically review the purchase orders and inventory to make sure that the orders are adhering to the contract, and that the payments are correct. But what about utilization? A contract doesn’t even try to address that issue. Even if a contract has tiered pricing for various levels of implants (joints, spines, or even pacemakers), as long as the SKU matches the price list, you’re compliant. But SCM needs to evolve to a second generation of improvement: effective utilization. Contract compliance doesn’t assist in utilization.
I often get blank stares when I ask surgical managers how or if they track which joint implant was used and why. The surgeons know what clinical conditions the patients have, what their activities of daily living (ADL) needs will be after discharge, their comorbidities, etc. These factors influence their decision about if they should use a low- , medium- , or high-demand knee system. You know for sure that the vendors understand that decision tree better than you do, and will try to influence those decisions to upsell whenever they can, or even go off-contract to get full price.
What’s wrong with everyone else knowing that? I encourage the joint teams to sit down with the surgeons, include materials management staff, AND even the vendors. The group should establish the clinical criteria about what particular joints would be best used in which type of patient. Cost is a secondary byproduct here. Develop a decision grid, listing all the clinical criteria on the left side, and at the top, include the grade knee or hip system. Then track usage for a month, aiming for 80 percent compliance to the clinical criteria that the surgeons established.
At the monthly joint team meeting, talk about the results and why certain patients or physicians didn’t meet the criteria. If the criteria need adjustment, fine – if behavior needs adjustment, even better. The costs will drop and you’ll be in good stead for the next contract cycle.
John Whittlesey is a principal at HMC.
