Stroke centers incur significant supply spend due to expensive stroke device investments and by providing 24/7 neurosurgical coverage. Effective management of supply spend enables stroke centers to drive innovation, provide quality care, and increase profits. To achieve effective management, hospitals can facilitate collaboration between stroke leadership, supply chain teams, and physicians to choose the best products and devices for patients. Besides, to achieve better outcomes stroke centers should analyze internal data to create benchmarks for spend per device per category.
IU Health Methodist Hospital is a 600-bed academic medical center in Indianapolis. It was certified as a primary stroke center in 2007 and as a comprehensive stroke center in 2014. HBI recently spoke with Dan Kidwell, executive director of neuroscience services, and Cassie Lund, imaging manager, interventional radiology, about best practices for managing supply chain spend of comprehensive stroke centers.
- Explore Different Purchasing Options With Vendors
Buying stroke equipment in bulk can be a financial burden, so it is advisable to evaluate products individually. When assessing new products, ask suppliers for a free trial. Also, conduct discussions with department leadership and neurointerventional staff to decide which products to trial based on available information and physicians’ past experiences to create a comprehensive product portfolio. It is worth examining different types of purchasing agreements, such as consignment, which Lund notes can prevent upfront costs, prompt suppliers to confine their inventory and allow an organization to only pay for products it uses.
Stroke centers can manage supply spend challenges by partnering with vendors to get bundled pricing on products and create a consistent product portfolio. Bundling can be done in two ways: bundling common stroke products such as a thrombectomy device, a catheter, and wire, or bundling based on the overall cost of each procedure that includes all products and devices required.
It is also important for hospitals to establish a strong partnership between the stroke team’s members and the supply chain to meet budgetary demands. Since the supply chain is the liaison between the stroke department and vendors for product price negotiations, it is positioned to select vendors that can provide different rebates, such as tiered pricing based on purchase volume.
- Establish Metrics to Track Spend and Operational Performance
When selecting devices, hospitals should attempt to build a consensus among physicians, clinicians, and supply chain team members to track supply spend. IU Health Methodist Hospital tracks its bundled pricing and monitors how frequently physicians utilize the bundled packages. If the utilization rate drops, resulting in increased spend, Lund and supply chain leaders meet with physicians to discuss alternative devices available in the market that should be evaluated.
“Hospitals should focus on creating workflows collaboratively to maximize patient outcomes and minimize time,” Kidwell said. “It is important for organizations to ensure caregivers are part of process implementation, as it can help in achieving consensus.”
Quarterly, IU Health Methodist Hospital conducts meetings with its primary vendors to review spend and performance. Included in the review is “cost per physician per procedure,” which looks at a device or product an individual physician is using and measures it against internally established benchmarks that compare IU Health Methodist Hospital physicians to each other. In the case of a physician with a high-cost discrepancy compared to peers, Lund and supply chain leaders independently discuss with both the physician who is the outlier and a physician who has lower costs to bridge the performance gap and ask if additional training from vendors to use the product or device is necessary.
Stroke centers should specifically monitor devices on an ongoing basis to maintain a balance between innovation and cost performance. Kidwell suggests having regular conversations on product selection with caregivers to maintain effective communication during product conversions. For device-related procedures such as stroke treatment, it is critical that staff can safely and effectively use the devices.
- Use Diagnostic Testing to Open Devices for Patients
As stroke devices are expensive, caregivers should know when to open devices for stroke patients to avoid product wastage and confusion among staff members. Diagnostic testing of stroke patients can help hospitals reduce product waste. Physicians and clinicians should know the location of the clot when preparing to open the supplies for stroke patients, rather than opening the supplies before diagnostic testing on the patient have been done. Hospitals should also have adequate information about diagnostic imaging that a physician needs before proceeding with the case.
“At IU Health Methodist, we open basic supplies, larger sheets, and guide catheters,” Lund said. “The one thing we don’t open right away is the specific mechanical thrombectomy device. But, to save time, we pre-prep all the other catheters with daily fluid.”
In 2018, the American Heart Association and the American Stroke Association provided new guidelines that allow for an extended window of treating patients for mechanical embolectomy. IU Health Methodist Hospital adopted the guideline and invested in software in addition to CT scans that help physicians determine if a patient requires advanced treatments or not. Following these guidelines prevents stroke supplies from being opened unnecessarily and wasted.