Clinical Supply Documentation in the OR

Transcription

1 Clinical Supply Documentation in the OR What s the Problem? Presented by: Karen Conway Executive Director, Industry Relations 1

2 An Area of Opportunity Food Service $23B Med-Surg Consumbables Highly Automated Automation has significantly increased visibility, accuracy and efficiency 2 Drugs $44B Ophth $3B Lab $5B Med Equip $13B NA Healthcare Product Expenditures = $185B Med Instrum. $16B $40B Cardiac & Ortho Implantables $40B ~ 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 Value opportunity even greater due to types of products and personnel involved

3 Many Players, Many Documents 3

4 PPI Market Pain PPI supply chain is $5B+ annual problem industry must create new model in order to manage cost pressures of Healthcare Reform. $3,000 $2,500 $2,625 M $2,725 M Low-Value Sales Tasks $2,000 $1,500 Revenue Leakage Loss & Expiration $1,000 $500 $- Loss & Expiration Low Inventory Turns Back-Office Labor Provider Low Inventory Turns Back-Office Labor Manufacturer Sources: PNC Healthcare; GHX Quantitative Research Study (Aug 2010; n=136 & n=25) 4

5 PPI Market Pain PPI supply chain is $5B+ annual problem industry must create new model in order to manage cost pressures of Healthcare Reform. $3,000 $2,500 $2,000 $1,500 $1,000 $500 $- $2,625 M Revenue Leakage Loss & Expiration Low Inventory Turns Back-Office Labor Provider Automation, data and process standardization and interoperability are necessary to realize benefits. $2,725 M Low-Value Sales Tasks Loss & Expiration Low Inventory Turns Back-Office Labor Manufacturer Sources: PNC Healthcare; GHX Quantitative Research Study (Aug 2010; n=136 & n=25) 5

6 Industry Pain Points Provider Pain Points Provider Pain Points Manufacturer 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) Redundant, inconsistent and highly customized processes cost both sides 6

7 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 7

8 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 BOTTOM LINE: Complex, manual processes lead to higher costs, uncontrolled spend, revenue leakage, waste, difficulty sourcing and tracking products

9 Complexity: An Industry-wide Problem 7 handoffs 6+ IT systems 3 Item masters 4X manual audits AP Billing Complexity/Variation is the enemy of quality and drives up costs ERP Order Log EMR ORIS MMIS/POU Removing complexity requires engaging the full supply chain community Bottom Line: Key is removing costs and inefficiencies across the supply chain, not shifting them 9

10 Complexity around PPI a Critical Challenge 62% All Challenges 53% 50% Most Significant 42% 40% 40% 38% 37% 20% 20% 13% 12% 7% 13% 5% 8% 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 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

11 The Cost Quality Equation 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 WHICH DEVICES contribute to WHAT OUTCOMES at WHAT COST without accurate and comprehensive DATA CAPTURE AT THE POINT OF CARE. Hospitals and providers will be reimbursed on value, not volume. 11

12 The CFO s View 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. - Interviews conducted at 2011 HFMA ANI BOTTOM LINE: Accurate data capture on supplies used at the point of care is critical to accurate charge capture.

13 Supply Documentation in the OR Still Highly Manual 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 Manually- paper Manually- keyboard Barcode RFID scanned into app RFID scannedcabinet 13 Survey conducted with OR nurses attending the 2011 AORN Conference N = 326

14 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 Survey conducted with OR nurses attending the 2011 AORN Conference N = 326

15 Who enters the Implant Info in the Implant Log? Nurse legally responsible for implant log Other 39 Entry Clerk 21 Clinical Staff 224 OR Ordering Mgr 28 Materials Mgmt staff Survey conducted with OR nurses attending the 2011 AORN Conference N =

16 Who Records Usage for Payment & Restocking Purposes? Other Supply Rep Clinical Staff OR Ordering Mgr & Suply Rep OR Ordering Mgr & Clinical OR Ordering Mgr Mat Mgmt & Other Mat Mgmt & Supply Rep Mat Mgmt, Clinical Staff, & Mat Mgmt & Clinical Staff Mat Mgmt, OR Ordering Mgr, Mat Mgmt staff & OR Mat Mgmt staff Survey conducted with OR nurses attending the 2011 AORN Conference N =

17 Who Records Usage for Patient Billing? Other 72 Entry Clerk 10 Clinical Staff 79 OR Ordering Mgr 55 Materials Mgmt staff

18 Healthcare: An Expensive Customer to Serve SG&A costs much higher in healthcare than other industries 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 Gartner Cross-Industry Supply Chain Top 25 (CP, High Tech,, A&D, Auto, Life Sciences, Industrial) Segment Mean 17.51% 18

19 Desire for Hub-based Solutions What is the likelihood that your organization would adopt the use of a manufacturerspecific solution for point-of-use capture? For inventory tracking? 60% 50% 40% 30% 20% 10% 0% Highly Likely Likely Don't Know Unlikely Highly Unlkely POU Solution Inventory Tracking Strong support for industry-wide model vs. one-to-one 19

20 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 sandtobacco/cdrh/cdrhreports/ucm pdf

21 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 ** National Quality Forum looking at use of UDI in quality measures, e.g., for infusion therapy (to be used by CMS, Joint Commission, etc.)

22 Leveraging UDI for Post Market Research Part of the Epidemiology Research Program (ERP) at the FDA s Center for Devices and Radiological Health CDRH) Collaborative program to understand the safety and effectiveness of medical devices after they are marketed 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

23 Making it all work together Facilitate/negotiate GTIN, UDI, and attribute adoption HTG Mercy, Mayo, Kaiser Intermountain, Geisinger Provide GTIN, UDI & attribute data and labeling Device Manufacturers Item Master ACC, SCA&I Define additional clinically relevant attributes ERP Business and Clinical Processes/Systems EHR Cath Lab Data submitted to CathPCI registry ACC NCDR 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 Real-time Messaging Hub Post-market Device Surveillance Enterprise Data Warehouse Data Marts Comparative Effectiveness Research 23

24 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 Recall Management Reduced time determining if a recalled product is in-house and locating patients with recalled implantable devices

25 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? How will you capture, share, store the required data? What process changes are necessary?

26 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 Interoperability and Leveraging Existing Resources Critical

27 A Coordinated Effort We re all in this together Communicate what you are doing, how and why