Becker's ASC Review

38 Supply Chain P remier Orthopaedic Surgery Center Administrator Natalie Soule and DISC Sports & Spine COO Karen Reiter discuss how they've taken control of materials management to lower supply costs at their centers. 1. Verify everything as the administrator. Every new item purchased at DISC Sports & Spine Center must have Ms. Reiter's approval. Ms. Soule in- sists on approving all new material purchases at Premier Orthopedic Surgery Center as well. As a result, device representatives won't introduce new, more expensive technology or materials for the surgeon without regard for cost. "We have a fairly strict process for ordering spine implants. Each request goes from the physician to the surgery scheduler and then to my desk, where I verify the purchase price and that it's an implant for which we have already made an arrangement," says Ms. Reiter. "Then my tech emails the vendor to make sure they have it here." When device representatives ask surgeons whether they want to use new materi- als, surgeons are instructed to send them to the administrator. Ms. Reiter says if she can negotiate the right price with the vendor, the purchase will be approved. "When surgeons follow this procedure, I have a lot more power than if I'm negotiating with a rep that says the doctor wants to use it and we're coming in on Friday," she says. 2. Write a policy on upselling. DISC Sports & Spine Center has a written policy to combat upselling in the operating room. Device reps are not able to upsell technology without approval from Ms. Reiter, and if they do, they're responsible for the cost. Reps must sign our vendor pol- icy when they first come to the facility plus the center's tech has a signa- ture on his page with a vendor written policy so there can be no mistake. "The policy says that if reps bring anything to the facility for which they do not have authorized pricing, the physician is welcome to use it, but it's con- sidered a no-charge trial," says Ms. Reiter. "That has stopped a lot of people from running into my office to say they want to use a new biologic." DISC also holds an orientation for device reps to explain their expected role at the center. "If you can work out a good process to have an in-service for the reps when they first arrive about what you expect from them, things go a lot smoother," says Ms. Reiter. 3. Inform physicians about implant costs. Only a few years ago, physicians could focus on their medical practice without thinking about the price of implants and materials. Now, nearly every provider focuses on costs in addition to quality out- comes. "It is not our place to tell a physician whether they can or cannot use a particular type of implant or supply; however, if a physician requests an implant or supply that is not on contract, we would com- municate to the physician the cost of the implant/ supply, and my contract alternative," says Ms. Soule. "We strive to educate our physicians to the cost of implants and reimbursements." Ms. Reiter keeps a spreadsheet for the cost of every implant and disposable used per case and periodi- cally shares it with surgeons. "A lot of my physicians are on staff with the hospital implant committee, so they are getting trained about implant pricing there as well," she says. "For the spine surgeons, we use a lot of new products here. I let them know how much a construct with the company would be, and if the company won't drop the price, the surgeon has to work with me to get the price down." 4. Enlist surgeons to help negotiate new technology. Administra- tors can leverage their surgeons to negotiate implant prices, especially if the surgeon has a strong relationship with the rep or performs a high volume of procedures using the company's devices. "Even if one of my surgeons doesn't perform a high volume of cases with the implant at my ASC, he is using that implant at the hospital and helped the rep get it in there," says Ms. Reiter. "I tell reps that the ASC is physician- owned, and I'll tell the surgeon if the rep won't work with us. Then the sur- geon makes his own choice about what to use at the hospital as well. That gives the rep something to take back to the company." Ms. Soule found her surgeons are eager to understand how cost can impact the center. "Oftentimes, the physician is misled by sales vendors on the 'latest and greatest' implant introduced to the market," she says. "It is part of my re- sponsibility as an administrator to inform them of the true cost to determine if an increase in cost is more beneficial compared to the quality of what the center is currently using." 5. negotiate the entire sale. Instead of negotiating just the implant price and accepting additional disposables costs, Ms. Reiter negotiates the entire construct at once. "Instead of paying one price for the screw and another for the implant, I dis- cuss it all together," she says. "There are no hidden disposables after the fact. Sometimes vendors say they'll drop the price of the implant significantly, but then there's $500 worth of disposables open. If you negotiate the entire construct, they have to disclose the price ahead of time. That has made a big difference for us." 6. Make reps responsible for their trays. There have been instances where device reps come for surgery and leave without clearing all their mate- rials. Then the rep charges for the materials missing from the tray, oftentimes for things the surgeon didn't use. 10 Steps to Take Control of Implant Prices By Laura Miller Karen reiter Natalie Soule Facility Development & Management, LLC YOU FOCUS ON YOUR PATIENTS WE FOCUS ON YOUR BUSINESS Development • Management • Consulting • Regulatory Compliance Experts Your Center In Our Hands Let our expertise guide you to success Contact us www.facdevmgt.com 845.770.1883

• Cover