There’s a great deal at stake in hospital sourcing and the management of medical supplies. A focus on lowering costs by standardized purchasing of drugs or devices can’t come at the expense of compromising high-quality care.
In fact, savings can be lost if lower-priced solutions are less effective than options that physicians prefer.
But, Rob Schreiner, MD, managing director at Huron Consulting Group’s Healthcare practice, points out that if physicians don’t participate in efforts to change rising cost trajectories at their hospitals, patients may suffer as health plan providers shift more financial responsibilities onto their backs. Patients may even forego treatments that would be too expensive under their coverage plans, or face personal bankruptcy, defaulting on healthcare debt.
“If two courses of treatment are clinically equivalent in patient outcomes, and one is less expensive, then it is morally sound to choose the less-expensive one,” said Schreiner, former executive medical director for Kaiser Permanente Georgia.
[See also: Automating the supply chain .]
The solution is for physicians, clinicians, supply chain and materials managers and executive leadership to forge alliances that will lead to lower supply costs without impacting patient care. All their respective disciplines intertwine to deliver a true picture of the total cost of care per case, essentially providing a clinically integrated supply chain, says Zee Robertson, senior director of performance services for VHA Inc.
“The goal is to link high quality care with low cost results,” she said. So, organizations can’t just choose a product that costs $50 because it is the lowest-cost device. Information gleaned from patient care units or from quality and safety or workflow and productivity data, for example, is just as important. “Things go beyond just the price of the product,” she said.
The goal is to link high quality care with low cost results
Physicians want to be part of this communication and collaboration, Robertson said, including receiving evidence whereby they can have reproducible results for their patients regardless of the supplies they currently use or may change to. “They need evidence-based medicine, they need to understand how [product] quality and [patient] outcomes were and are being measured, and they expect to be part of a peer-to-peer network” that supports this, Robertson said.
They want this information to be transparent and quickly and easily accessible, perhaps leveraging data from electronic medical records, comparative utilization and benchmarking so they can care for patients as economically, and at the highest level of quality, as possible.
Starting the process Clinical-quality value analysis processes are an important step in determining whether a particular product is right to use in specific cases. A good foundation is to use committees that enlist physicians in care specialties where drug and device supplies are being reconsidered. Such committees can leverage analytic tools that pull together various types of information from multiple sources, gathering all the information in one place to ultimately make a sound supply decision, Robertson said.
More hospitals recognize the importance of this and are moving in this direction: “We see very few facilities that haven’t started some sort of value of care environment with the information they have available,” Robertson said.
[See also: An Amazon-like coup for the supply chain.]
Schreiner says that when external research and information is lacking, it’s good practice to be able to draw upon a culture of continuous improvement. “The idea that you have to wait for a randomized, placebo-controlled, double-blind study of 10,000 patients to improve healthcare for Mrs. Brown is just not true,” he said. All but the smallest hospitals “can create an infrastructure and information system, and produce a culture, to make daily, weekly and yearly continuous improvement in the care of all patients.”
He also recommends that hospitals revise their information distribution systems so doctors can have recommendations about which supplies the institution has deemed most appropriate to use at their fingertips, in the exam room or at the patient bedside. “One barrier is that all too often doctors don’t know in the moment of decision the cost of one course of treatment vs. another,” Schreiner said. “So the information infrastructure of U.S. healthcare has to be more accurate and provide more ‘just-in-time’ information.”