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And two medical staff leaders, chief of staff Larry Shuer and cardiovascular surgery chair Bruce A. Reitz, agree that a new, more methodical approach to evaluating medical purchases offers the promise of solving a dilemma that goes something like this:
Physician X has always used a particular brand of stent in the 15 years she has performed cardiovascular surgery. The stent is the most expensive on the market but physician X says she knows she gets better results and refuses to switch to a less costly brand even though all her colleagues have shifted."A few years ago, it was really hit or miss what could be done," said Gaich. Perhaps, we could talk with her department chair or a colleague in hope that he or she could help the doctor sort this out. We could suggest alternatives, but it really wasn't our decision," said Gaich.
Today, it still isn't Gaich's decision, but there is a process designed to determine whether physician X can continue to achieve the same quality of care if she gives up her stent and saves the hospital some money.
A materials council, comprised of purchasing administrators, caregivers and business managers from all SHC clinical departments, reviews all potential purchases. If the item, such as floor wax, is seen to have no clinical impact, the council uses written specifications of all available products on the market to evaluate quality and cost to make a selection. If the product has relatively simple clinical implications - a bandage, for example - experts from medicine and nursing are brought in to consult about cost/benefit issues involving particular brands and vendors of comparable brands.
On complex items, such as sutures or stents, the council, with the help of clinical experts in relevant departments, collects available efficacy and cost studies. Product data is presented at applicable clinical department meetings. Interdisciplinary questions - such as whether a particular anesthetic meets the need of both anesthesiologist and surgeon - are resolved by inviting interested parties to the materials council.
If questions remain, they can be sent to the Cost Containment Steering Committee, which is comprised of five clinical department chairs, two clinically active faculty, the chief of staff and six administrators, including chief operating officer Malinda Mitchell. The group is led by Peter B. Gregory, chief medical officer at SHC. The group was formed in 1999 and has been charged with cutting $9 million from the SHC 1999-2000 fiscal year budget.
The group has just begun to review specific purchases, noted Gregory, but has already reviewed issues, such as replacing albumin as a circulatory volume extender for most patients (see Dec. 1999 Medical Staff Update).
"This process brings critical decisions to a forum of informed physician leaders and key administrators," said Reitz, a member of the committee who had participated in cost-containment groups for CV surgery that served as a prototype for the institutional steering committee. "We found in our own specialty that a hard, scientific look at our practices can either validate or invalidate our instincts. And relying on instincts alone is clearly not a viable option," added Reitz."
"Patient outcome is still the most important criteria on any purchasing decision," said Shuer. "But if two products are clinically equal and one is cheaper, the less expensive product is clinically more efficacious, because it allows us to save money that in the long run can be returned to patient care. For example, when we consolidated sutures in the operating room to one vendor, we lowered prices sufficiently to pay for additional nursing support," said Shuer.
Gregory said the steering committee, has not had to resolve many difficult issues so far. He sees that fact as a testament to the seriousness with which all parties are addressing the need to cut costs.
He also noted that just having the committee in place serves two major functions. "First, it underscores to every practitioner and hospital employee that cost-effective practice is an issue of such paramount importance that leaders from both the practice and the hospital are willing to invest several hours each month to serve on this committee. Second, it demonstrates that we will be using objective criteria, subject to wide discussion and input, to determine what we need to deliver the best possible care to our patients in this hospital," said Gregory.
