Here are five ways ambulatory surgery center administrators can approach cost reductions on physician preference items.
1. Gather data on preference items and supply costs. Before approaching any physician about product costs or supply chain issues, analyze your internal data to determine that particular physician's product/supply utilization and cost per procedure — in other words, what he or she is actually costing the organization in terms of utilization, says Randy Peters, senior director of surgical services for Provista. Experience demonstrates that physicians respond to data about their individual performance. Presenting the data in a blinded fashion preserves privacy while informing and educating physicians.
This process often spurs conversation between specialists regarding procedural differences, the reasons behind variation and the impact of these cost differences on the organization. Tying this conversation to the use of savings to acquire new equipment or improve the OR links physician behavior to the organization's overall ability to provide the necessary resources for patient care.
2. Appoint a physician champion to begin the discussion. The physician champion should be someone who is in a senior position at the surgery center and interested in promoting future cost savings through standardization. To appoint this person, bring all high volume surgeons from each specialty in one room to discuss supply chain management, liability and their commitment to success at the surgery center. During this meeting, a leader should come forward to really advocate for reducing costs by streamlining implants.
"Typically, physicians will listen better to their fellow surgeons than to someone from the outside," says Lori Pilla, vice president of Amerinet Clinical Advantage and Supply Chain Optimization. "Keep the physician champion in the loop about steps you are taking to standardize implants and communicate with them on a consistent basis. Additionally, if you come across someone who isn't willing to change, ask the physician champion to help stand with you from a united perspective to discuss the issue."
The physician champion will play the key role of influencing other surgeon partners to participate in the process and provide insight into the best method for standardization. Remind them that standardization of products in the market today does not necessarily mean "one" as it did historically. It could be just reducing the multiple suppliers to a much smaller number.
3. Appeal to the surgeons' competitive nature. Mr. Peters says giving physicians insight into the financial impact of their supplies can push them to get involved. "Even if they don't have a financial stake in the organization, most physicians like to be considered in important decisions, and savings from the supply chain can lead to enhancements that surgeons value," he says.
When looking at physician involvement, there is no substitute for a conversation.
"Administrators should plan to meet with active surgeons in the center at least quarterly to review overall performance, to ensure that the surgeon's needs are being met, to identify and resolve any concerns about scheduling or staffing and to discuss issues such as supply utilization that might not come up in routine work conversations," says Mr. Peters. "In addition, periodic review of preference cards, case costing and waste should be a natural time to discuss supply utilization."
Analyzing cost per procedure for each surgeon is one way to start the conversation about cost. If one surgeon's costs are higher than his or her peers, that can be the starting point for a conversation and eventual change.
"Physicians are highly competitive by nature, and very responsive to data," says Mr. Peters. "For example, if you have a surgeon whose case costs are out of line relative to peers or to reimbursement for a certain procedure, providing them blinded data comparing their costs to their peers or data on reimbursement relative to costs can be a strong motivator to change their behavior."
4. Ask physicians to fill out a "clinical justification form" for new products. If physicians are hesitant to accept standardization — or they come back from every specialty conference with a request for a new piece of equipment — you might ask them to fill out a "clinical justification form" for every new product. Josh Billstein, practice manager of the ambulatory surgery center at The Polyclinic in Seattle, says if a physician wants to bring a new product to the surgery center, he or she must fill out a form that details any relationships the surgeon has with the product vendor, why they want to use the product and how it compares to other products on the market.
He says mandating this process for every physician helps each surgeon feel comfortable about what his or her colleagues are receiving from the surgery center. If every physician has to go through the same justification process, the surgeons can assume that purchasing decisions are not taken lightly. They also may hesitate to come to the administrator with a request for expensive equipment if they know they don't really need it.
5. If you must have physician preferences, keep preference cards updated and eliminate waste. If your surgeons have custom packs, make sure they are using everything in the packs. If something goes unused, the surgical team should not open the package. "If there is something we don't use on the physician preference cards, we don't open it. That saves on costs for items like shaver blades," indicates Erika Horstmann, Director of Operations for Pinnacle III. "We include surgeons on the decisions about what should and should not be opened. When surgeons want everything opened just in case, we tell them how much it costs just to open an item as well as the cost burden on our surgery center when it's wasted."
You can also go a step further by eliminating the unused item from the custom packs.
"We look at custom packs annually to ensure we are using everything in the pack and not wasting any of it," states Ms. Horstmann. "We also obtain bids from different vendors to ensure we are receiving the most competitive pricing. Last time we did this, we saved $100 per pack, which is significant savings."
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