When Larry Teuber, MD, talks about vendor representatives entering ambulatory surgery centers, his voice rises like a father talking about the undesirable boyfriend of his teenage daughter. He says that's a fitting analogy, because in his view, vendor reps only mean trouble for ASCs in the form of higher prices for devices, particularly orthopedic implants.
While you can't bar your surgeon from seeing the rep, you can restrict his visits and hope the surgeon learns to choose better, says Dr. Teuber, a neurosurgeon, president of Medical Facilities Corp. and physician executive of Black Hills Surgery Center, an 11-OR facility in Rapid City, N.D., with 14 orthopedic and 5-6 spine surgeons. He provides eight ways to limit vendor reps' influence in surgery centers.
1. Sign-in required. Reps who visit the surgery center should sign in, providing the time, date and a legitimate purpose for the visit. They should then be given a prominent nametag indicating their vendor status so that everyone knows their purpose wherever they go.
2. No parking near the ASC. Do not allow reps to park in the patient, physician or staff lots. "I've had vendors' cars towed out of the doctors' parking lot," Dr. Teuber says. "Their car is put in a flatbed truck and towed past the OR for all to see."
3. No access to the supply room. Representatives have been known to go into the supply room on their visits and put more implants on the shelf as "consignment" items, which are owned by the vendor until they are opened and used. In a facility that intentionally keeps inventory low, reps know that extra implants on the shelf is an incentive to use them.
4. No entry to physician areas. Reps should not be allowed into the physicians' lounge or locker rooms. They must use the staff lockers to change into scrubs. "The more time you put a rep in front of a surgeon, the more opportunities he has," Dr. Teuber says. Representatives that have more time with surgeons can "upsell" their wares.
5. Surgeons must sign a disclosure form. Surgeons who do not disclose a relationship with the rep it could lead to the suspension of their privileges.
6. Talk to the surgeon. Showing the relative costs of implants can sometimes sway them. The rep's implant might cost $12,000, compared with the $3,500 implant the ASC can get in a single-vendor contract. It also helps to show the rep's income. A rep can get 12-15 percent commission on implants, which can translate into more income per hour than the surgeon makes on a Medicare total joint.
7. Be patient. Being realistic may not have any effect at first, because the surgeon and the rep can have a very deep bond. When confronted, "the doctor says he won't abandon the rep because he's a good friend," Dr. Teuber says. "He doesn't understand it's a conditional relationship. If the surgeon doesn't give him any business, he will not be his friend."
8. Understand the profit motive. "I've never heard of a not-for-profit implant company," Dr. Teuber says. "The goal is to sell metal. The sales guys are driven by the regional sales managers. They want better and better sales performance. The rep learns how to suck up to the surgeon: 'That was a real fast case you did!' or 'I've never seen a patient lose so little blood!' " He adds: "It’s our job as physicians to strike a balance between clinical indications and the product."
Learn more about Medical Facilities Corp.
Learn more about Black Hills Surgery Center.
Read more insight from Dr. Teuber:
- 4 Common Surgery Center Supply Chain Mistakes
- 3 Ways to Improve Physician Start Times