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Clinical Supply
Documentation in the OR
What’s the Problem?
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1
An Area of Opportunity
Med Instrum. $16B Med Equip $13B Lab $5B Ophth $3B Drugs $44B Food Service $23BCardiac & Ortho Implantables Med-Surg Consumbables NA Healthcare Product Expenditures = $185B $40B $40B 2
• Automation has significantly increased visibility, accuracy and efficiency
•
~ 40% of total hospital supply spend
•
50-80% of total costs for some procedures
Sources: Datamonitor, hfm benchmarking tools for reducing costs of care April 2000
Highly Manual,
Duplicative and Disjointed
Highly Automated
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Many Players, Many Documents
PPI Market Pain
PPI supply chain is $5B+ annual problem – industry must create new model in order to manage cost pressures of Healthcare Reform.
$- $500 $1,000 $1,500 $2,000 $2,500 $3,000 Provider Manufacturer $2,625 M $2,725 M
Sources: PNC Healthcare; GHX Quantitative Research Study (Aug 2010; n=136 & n=25)
Low-Value Sales Tasks
Loss & Expiration
Low Inventory Turns
Back-Office Labor Back-Office Labor
Low Inventory Turns
Revenue Leakage
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PPI Market Pain
5
PPI supply chain is $5B+ annual problem – industry must create new model in order to manage cost pressures of Healthcare Reform.
$- $500 $1,000 $1,500 $2,000 $2,500 $3,000 Provider Manufacturer $2,625 M $2,725 M
Sources: PNC Healthcare; GHX Quantitative Research Study (Aug 2010; n=136 & n=25)
Low-Value Sales Tasks
Loss & Expiration
Low Inventory Turns
Back-Office Labor Back-Office Labor
Low Inventory Turns
Revenue Leakage
Loss & Expiration
Automation , data and
process standardization
and interoperability are
Provider Pain Points
• Lack of data re: role products play in lowering costs, increasing value • Revenue leakage and difficulty
tracking recalls due to inability to accurately document usage
• Nursing time spent on non-clinical activities
• Duplicative processes and
inconsistent data due to lack of system integration/interoperatbility • Difficulty ensuring contract pricing
• Reimbursement cuts driving price pressure
• Need better data in order to focus on value/total cost of ownership • Extremely low inventory turns • Lack of demand signals
• Just in case inventory
• High cost consignment model • High cost to serve (SG&A)
Industry Pain Points
Redundant, inconsistent and highly customized processes cost both sides
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What do we need to fix the problem?
Technology
• Clean, accurate, standardized data and systems that can use the data
• System interoperability (EMR, ERP/MMIS, Clinical Systems)
People
• Greater understanding of what data is needed, for what and by whom
• Reduced duplication of effort
• Collaboration /mutual understanding of what it takes to reduce total costs of ownership and care delivery
Process
• Standardized and Coordinated Processes
Why Focus on Implantables
“60% of my O/R spend is on
consignment products and I have zero
visibility into what I’m spending”
- VP, Supply Chain
“We closely track our $500,000 in
hospital supplies, but I have a closet
with over $3M in consignment
inventory that I am not tracking at all”
- Director, Materials Mgmt
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Complexity: An Industry-wide Problem
9
Bottom Line: Key is removing costs and inefficiencies across
the supply chain, not shifting them
ORIS Billing EMR AP ERP Order Log • 7 handoffs • 6+ IT systems • 3 Item masters • 4X manual audits MMIS/POU
Complexity/Variation
is the enemy of quality
and drives up costs
Complexity around PPI a Critical Challenge
Q. What are the challenges to your existing healthcare supply chain model? Please select all that apply.
Q. LIST CHOICES MENTIONED IN Q13: Of the challenges you just selected, which one is the most significant? Please select one.
Source: Gartner AMR Supply Chain, Healthcare Providers
62% 53% 50% 42% 40% 40% 38% 37% 20% 20% 8% 13% 12% 7% 13% 5% Rising Cost of Supplies Complexity of product and information flow Ability to drive rationalization of physician product preferences Lack of leadership vision, maturity and control in the
SC Lack of Consistent Service in Supply Limited Best Practice Sharing Lack of SC partnership and visibility with specialty areas (OR, Cath, IR, EP,
Radiology)
Contract Process with Suppliers
All Challenges
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The Cost Quality Equation
11
Hospitals and providers
will be reimbursed on
value, not volume.
Under healthcare reform, healthcare providers
will need to report on value delivered
COST + QUALITY = VALUE
What role do products play in lowering total
cost, while improving quality?
Can a more expensive product reduce
hospital acquired infections or readmissions?
BOTTOM LINE: We cannot know
The CFO’s View
BOTTOM LINE: Accurate data capture on supplies used at
the point of care is critical to accurate charge capture.
What HFMA members have to say:
“In our fully electronic system, when there is a problem with charge capture, the clinician did not pick or document something correctly.” “When the charge is not driven by a clinical documentation event, there are charges not being captured.”
“We are not fully electronic, so there are errors in picking the wrong item off the charge master and thus the wrong patient charges are
captured.”
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Supply Documentation in the OR Still Highly Manual
13 224 166 37 2 2 5 Manually- paper Manually- keyboard Barcode
RFID scanned into app
RFID scanned- cabinet
Even with electronic implant recording capability, most nurses use paper and stickers for recording usage during procedure
Only 10% of entry is based on barcodes or RFID
Paper Still Predominantly Used for Implant Logs
One-third of OR nurses still rely on paper implant log as primary source; Less than two-thirds use combination of electronic and paper implant log
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Who enters the Implant Info in the Implant Log?
15 52 28 224 21 39 0 50 100 150 200 250 Materials Mgmt staff OR Ordering Mgr Clinical Staff Entry Clerk Other
Nurse legally responsible for implant log
Who Records Usage for
Payment & Restocking Purposes?
109 1 1 4 1 1 2 10 1 1 8 3 9 0 50 100 150 Mat Mgmt staff Mat Mgmt staff & OR … Mat Mgmt, OR Ordering Mgr, … Mat Mgmt & Clinical Staff Mat Mgmt, Clinical Staff, & … Mat Mgmt & Supply Rep
Mat Mgmt & Other OR Ordering Mgr OR Ordering Mgr & Clinical … OR Ordering Mgr & Suply Rep Clinical Staff
Supply Rep Other
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Who Records Usage for Patient Billing ?
Healthcare: An Expensive Customer to Serve
18
Pharma
Biotech
Generic
Medical
Device
Segment Mean
33%
Segment Mean
29.8%
Segment
Mean
23.9%
Segment
Mean
32.7%
Three-Year Weighted SG&A Expense As a % of Revenue
SG&A costs much higher in healthcare than other industries
Gartner Cross-Industry Supply Chain Top 25
(CP, High Tech,, A&D, Auto, Life Sciences, Industrial)
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Desire for Hub-based Solutions
19 0% 10% 20% 30% 40% 50% 60%
Highly Likely Likely Don't Know Unlikely Highly Unlkely
POU Solution Inventory Tracking
Strong support for
industry-wide model
vs. one-to-one
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Value of UDI and the GUDID
UDI provides global visibility and supports:
• Medical device recalls
• Adverse event reporting
• Tracking and tracing
• Supply chain security
• Anti-counterfeiting/diversion
• Disaster/terror preparation
• Shortages/substitutions
• Reduction of medical errors (e.g., bedside scanning)
• An easily accessible source of device information for
patients and clinicians
UDI Central to the FDA’s preliminary report “Strengthening our National System for Medical Device Postmarket Surveillance”
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Leveraging UDI for Better Value
• Documenting device use in patient’s EHR/PHR*
• Patient Safety/Quality Care Implications
• Revision surgery, e.g., which hip implanted
• Emergency cases, e.g., when patient en route
• Notification of patient allergies
• Quality measures and reimbursement**
• Recall Management
• Did you buy it, did you use it and on whom
• Comparative effectiveness and safety research
• Ability to link with larger data sets,
e.g., national and international registries
• Supply chain efficiency
* FDA and ONC discussing requiring UDIs as part of Stage 3 of meaningful use
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Leveraging UDI for Post Market Research
Unique Device Identifier Demonstration Project
• Develop an end-to-end (purchase to point of consumption) UDI tracking system • Utilize electronic health records and clinical registries to assess the safety and
effectiveness of medical devices after they have reached the marketplace • Stents first, then ICDs
International Consortium of Orthopedic Registries • Classification and harmonization with UDI
• Identify and capture clinical attributes that impact performance
• Demonstration projects: bearing surface, femoral head size, fixed vs. mobile knees, pediatric joints
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Mercy, Mayo, Kaiser Intermountain, Geisinger
Device Manufacturers
Provide GTIN, UDI & attribute data and labeling Facilitate/negotiate GTIN,
UDI, and attribute adoption
Item Master ACC, SCA&I Define additional clinically relevant attributes
ERP EHR Cath Lab
Data submitted to CathPCI registry ACC NCDR Enterprise Data Warehouse Data Marts Real-time Messaging Hub Comparative Effectiveness Research Post-market Device Surveillance
Business and Clinical Processes/Systems
23
Integrate UDIs into EHR Link EHR with ERP and
clinical software
Create data sets for analysis and sharing with FDA and partnering health systems Link to national registries
Link with other health systems
Measuring Value
Master Data Management Easier to develop and maintain cross walks
between data held in multiple systems; source of truth for product data
Contracting, Ordering, Invoicing,
Spend Analysis Simpler means of identifying devices, reduced reconciliation time, especially for UOM; attributes enable “like” product identification Receiving Scanning made possible, guaranteed unique;
no relabeling required
Inventory Management UOM conversions; aggregation of GTINs
available in FDA UDID; product expiration can be better managed; Better understanding of demand
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Maximizing Value
To Achieve Return from Required Investment,
Manufacturers need to view as a strategy, not a project
•
Consider Objectives, Benefits, Impacts: Why are you doing this?
•
Regulatory compliance
•
Customer demand/service
•
Supply Chain Efficiency
•
Other
•
Who needs to be involved?
•
Who, what is impacted?
Providers need to leverage UDI for multiple purposes
•
What applications will be required (EMRs, claims, quality measures)?
•
What other non mandatory applications deliver value?
•
Who needs to be involved?
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Key Takeaways
Impacts and risks to both clinical AND financial
performance, patient safety and regulatory compliance
Shared industry issue –
Requires industry collaboration
Hospitals
• Supply chain, clinicians, finance
Suppliers
• Supply chain ops and vendor reps
Technology providers
• ERP, EMR,ORIS, PACS, POU
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