Beverly Bryant, MSN-RN, CASC, administrator and director of Yuma (Ariz.) Endoscopy Center, discusses the biggest challenges and opportunities in the center's supply chain management.
Question: Where have been the biggest pain points in your center's ASC supply chain management? What specialties are the most difficult?
Beverly Bryant: The main issues I see are increased prices or back-ordered items. So, once we have a great price for an item, and we know where to get it consistently, there is always an unexpected back-order with no head's up from the supplier. It makes it difficult to sustain efficiency by only keeping a minimum of necessary products in-house when all of a sudden the item becomes unavailable.
I have noticed a trend as well that if an item is back-ordered, it seems to be back-ordered from most suppliers. Those that may have the item in stock also know that it's back-ordered and then they raise the price because it is now a high-ticket item. So, what once cost $1.25 for a bag of saline is now $5 per bag. It's difficult to budget for a 400 percent increase on an item that every patient has to have; literally an increase of thousands of dollars!
In regard to specialties most difficult, I would have to say that medication is the biggest pain [point]. There are numerous medications every facility has to keep on-site. The majority of them will expire because they are only emergency medications. Some suppliers also have medications that expire. I've ordered medication because it will expire soon and received the replacement item that will expire in three months. Medications are nonreturnable and so that puts me in a tough spot.
There is a mysterious paradigm that occurs with normal saline, propofol, fentanyl and now 1 percent lidocaine. Every couple of years, there seems to be an unexplained shortage. Prices increase and sacrifices have to be made in order to continue doing procedures. Then it seems as soon as you make a seemingly back-door drug deal with a medication representative, the shortage is over. Whether anyone admits it or not, the trend most certainly exists!
Our specialty is GI, so there typically is never a back-ordered snare, biopsy forceps or endo clip; these items are completely necessary, and they are also very expensive.
Q: How do you handle device representatives in the operating rooms at your center?
BB: My physicians are tried and true and have decades of experience. They know what they want, and I explain to all representatives that if you want my doctors to want your product, you will have to appeal to their preference. My physicians feel that certain items are worth the increased cost because it improves ease of their job and in turn maintains patient safety.
Device representatives would only be allowed in the OR if there is a new item. For what our facility does —endoscopy — there is rarely a representative needed in the procedure room. I believe that whatever the representative wants to present should be introduced before there is a patient in the room. I expect them to show the doctor/staff how it works and allow them an opportunity to use it prior to utilizing it in a procedure.
Q: What has been the most effective tool you've implemented to make your supply chain more efficient and cost-effective?
BB: This is still a challenge, however, I involve my entire staff in this issue. I am very transparent about the fickle availability of supplies and the cost of items. Almost every staff meeting includes me talking about what shortages we have and how we can save on supply costs. It also gets everyone brainstorming more efficient ways to do things. If they see an item is low, it is imperative that they communicate it.
We have a dry erase supply board that anyone (even our cleaning crew) can write what supplies are running low or [are] out. This triggers the supply technician to track a previous order or order the item immediately. She also indicates on the board when the item is due to arrive or if it's back-ordered. This helps with catching things in enough time to order them without having to pay for overnight charges.
I also am constantly reviewing the supply invoices to monitor price increases. Our main supplier seems to change order numbers for common products often. It will show up on the website as 'unavailable' or 'discontinued.' At first, I spent hours researching other suppliers for an identical item when in fact the item is still available, but the supplier now manufactures their own brand of the identical item. So, I've learned to call the supplier on those items and get verbal clarification on discontinued supplies.
Q: What disruptive forces in healthcare do you see making supply chain management easier or harder to manage in the future?
BB: Healthcare costs are constantly rising; I guess that happens with everything. However, reimbursements seem to be decreasing year after year, especially for GI. The biggest challenge I see is being able to run an efficient and profitable ASC while the cost to do the procedures increases and reimbursements decrease, all the while maintaining patient safety. This is not something that only our facility or specialty will experience, but all ASCs.
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