Operations Management and Inventory Control Techniques That Positively Impact the Bottom Line

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1 Operations Management and Inventory Control Techniques That Positively Impact the Bottom Line Robin J. Ward, VP Strategic Operations Coram Specialty Infusion Services, Denver, CO CE Credit in Four Easy Steps! Scan your badge as you enter each session. Carry your Evaluation Packet to every session so you can add session evaluation forms to it. Track your hours on the Statement of Session Attendance Form as you go. At your last session, total the hours and sign both pages of your Statement of Session Attendance Form. Keep the PINK copy for your records. Put the YELLOW and WHITE copies in your CE Envelope. Make sure an Evaluation Form is in your CE Envelope for each session you attended. Miss one? Extras are in a file near Registration. Fill out the information on the outside of the CE Packet envelope, seal it, and drop it in the box near Registration. Applying for Pharmacy CPE? If you have not yet registered for an NABP e Profile ID, please visit to do so before submitting your packet. You must enter your NABP e Profile ID in order to receive CE credit this year! 3/27/ Speaker Disclosures The speaker has no conflicts of interest to disclose. No off label or investigational use of drugs or products will be discussed during the presentation. 3/27/

2 Formulary Development Know What to Buy Core therapy Seek multiple sources Identify alternatives Specialized needs Patient specific Account specific Consolidated SKUs Generic equivalents for supplies 3/27/ Formulary Development Know Who to Buy From Distributors Manufacturers Alternate vendors Know When to Buy Cash planning Days of inventory on hand Cost of carrying inventory 3/27/ SKU Rationalization What Is Stocked Cost equivalent Product equivalent Proprietary requirement Sourcing impact Account requirements Custom patient needs Personnel preferences considered in formulary decision 3/27/

3 SKU Rationalization How to Rationalize Select tier 1, 2, custom Designate primary and secondary sourcing Establish standard orders for non account specific requirement Isolate account/patient specific SKUs from standard SKUs Manage personnel preference by committee 3/27/ Conversion Case Study Brand A had been incumbent gauze product in company for 10 years Brand B manufacturer offered cost reductions that provided $15K in annual savings Nursing staff initially refused to convert due to perception that Brand A was a far superior product 3/27/ Conversion Case Study Set up a blind taste test to allow the nursing staff to evaluate the new product without bias Unanimously, the nursing staff selected Brand B based on quality, integrity, texture Cost savings were realized with a companywide conversion to Brand B 3/27/

4 Group Purchasing Organization (GPO) Assists in promoting quality healthcare relief and assists diverse providers in effectively managing expenses Aggregates purchasing volume of its members for various goods and services Develops contracts with suppliers through which members may buy at group price and terms if they choose Provides contracted discounts on medical supplies, nutrition, pharmacy and laboratory 3/27/ GPO Provides expanded contract portfolios to offer discounts on office supplies and non medical related services Provides value added benefits like: Clinical support Benchmarking data Supply chain support Comprehensive portfolios of products and services to address specific needs Enables administrative fees to be set as a percentage of the purchase or set as an annual flat rate, paid by the manufacturer, the member, or a combination 3/27/ Direct Vendor Relationships Based on volume and scope Direct sourcing or through a distributor Compare to GPO options Supply chain resource and triage Periodic business reviews to address opportunity and compliance Recall and product improvement 3/27/

5 Supply Chain Best Practices Segregation of Duties (SOD) Requisition How does staff let purchasing know what to buy Purchase Order System or manual Path to Payment Accounts payable Billing/collections 3/27/ Supply Chain Best Practices Just In Time Know when to buy Know what to buy Lead Time Patient order Vendor 3/27/ Supply Chain Best Practices Enterprise Resource Planning (ERP) Systems Does PO/inventory system communicate with the order entry system? Ordering Methods EDI / Fax / Phone / Online Templates for fax 3/27/

6 Supply Chain Best Practices Receiving Policy Packing list to product Packing list to PO Discrepancies Audit trail Processing Documentation to accounts payable Retention filing 3/27/ Supply Chain Best Practices Accounts Payable/Accounting Discounts/rebates Costing Methodology Standard, FIFO, LIFO, Average Purchase Price Variance Difference between PO cost and invoice cost Vendor Relationships Statement reconciliations, credit holds Monthly/quarterly review of key accounts 3/27/ Inventory Management Warehouse Management Work Flow Inbound Outbound Order processing picking, checking, packing Spaghetti Diagram Track steps taken for work flow management Rearrange to minimize steps or redundancies 3/27/

7 Inventory Management Inventory Placement Fast pick/frequency Shoulder to knee Labeling Shelving Layout Shelving Equipment Bins/Totes 3/27/ Inventory Management Perpetual vs. Non Perpetual Calculation of cost of goods sold Adjustments due to use or waste Vendor credits for returns 3/27/ Inventory Management Financial Accountability Wall to wall inventory Frequency determined by accounting team Cycle count Frequency, if required, determined by accounting team Waste/damage Document any waste to account for appropriate adjustments Department use Internal consump on nursing/compounding area/pumps 3/27/

8 Routine and tenure created an environment wherein staff knew where everything was stocked Orders were picked from rote memory versus confirmation that products were correct Patient satisfaction surveys indicated that supplies were either inaccurate or too many/too few 3/27/ Identified issues where similar looking items were stocked next to each other on the shelf; for instance, all Huber needles by the same manufacturer shelved next to each other Packaging and colors were very similar, causing picking errors or restocking errors 3/27/ Used listing of all items sold for a three month period Identified frequency an item appeared on an order Identified quantity picked Sorted report in descending frequency order. Segregated drugs from supplies 3/27/

9 Organized product by commodity/therapy grouping Placed pump tubing, 9V batteries, syringes together Placed dressing kits with tape, alcohol Put different sizes of like products on separate shelves, or separated them with another unlike item Positioned frequently picked items directly across from the pick/pack tables 3/27/ Labeled shelving to match inventory codes on order Retrained warehouse staff for new order Stocked drugs in alphabetical order by generic name Segregated different strengths in separate bins Labeled bins Used sounds like/looks like labeling 3/27/ RESULTS: Increased speed of order picking by 25% with higher accuracy extended the time needed to hire additional warehouse staff Patient satisfaction results improved by 20+% for supply accuracy 3/27/

10 Impact of Supply Chain on Purchase to Payment (P2P) Drug/Supply Data Integrity NDC accountability Average Wholesale Price (AWP): The average value at which wholesalers sell drugs to physicians, pharmacies, and other customers AWP is the generally accepted standard measure for calculating the cost of a particular medication 3/27/ Impact of Supply Chain on P2P Wholesale Acquisition Cost (WAC): The list price paid by a wholesaler, distributor and other direct accounts for drugs purchased from the wholesaler's supplier The WAC is developed by manufacturers using algorithms to account for expected demand for the product, future competition for the product, and project marketing costs Maximum Allowable Cost (MAC): This represents the upper limit price that an insurer or health plan will reimburse for generically available or multiple source medications Cost/List: Some payers pay based on an acquisition cost (+) or list price ( ) fee structure 3/27/ Impact of Supply Chain on P2P Payer Audits Invoice documentation Some state payers require invoice copies to validate cost + payment structure Order documentation Proof of deliveries required by some payers for reimbursement Validation of product received versus product purchased Audit Trail 3/27/

11 Questions? 3/27/

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