item, the leverage to control spiraling costs has basically vanished,” he says. “Add to this what some claim to be opportunistic ‘price gouging’ and our industry is vulnerable. Over the past few years, for example, an intravenous analgesic came to market as a single- source item for approximately $10 per dose. After witnessing volume traction and surge, today we see prices hover- ing around $30 per dose.”

Ezerskis adds, “Medication is now

usually my biggest line item for a case if there is no implant associated with the procedure.”

Manage Your Drug Supply

Effective ways to keep on top of shortages and costs BY ROBERT KURTZ


anaging her ASC’s medication inventory is not just an occa-

sional part of the job for Cheryl Ezer- skis, CASC, executive director at West Parkway Ambulatory Surgery Cen- ter in Pompton Plains, New Jersey. “I spend more time managing our inven- tory than I care to admit,” she says. “I have to monitor medications every day. Getting the medications we need to do our procedures is a never-ending game I have to play.”

ASCs throughout the country are

facing growing challenges with acquir- ing medications, says Christopher Dembny, president of Dembny Phar- macy Consultants in Richardson, Texas. “If you cannot get the drugs your patients need, you may have to cancel cases, and cases are the entire source of your revenue,” he says. “And since


ASCs typically get paid by the case, if the cost of medications goes up, that usually comes directly out of the profit on the case.”

Across-the-Board Price Increases The rising cost of drugs is putting sig- nificant pressure on her ASC’s bottom line, Ezerskis says. “Not one medica- tion has gone down in price. Every- thing has gone up at least double since we started using it.” Medication

prices shift in the

marketplace for the same reasons as for most commodities, says Shel- don Sones, president of Sheldon S. Sones and Associates, a pharmacy and accreditation consulting firm based in Newington, Connecticut. “Whether it is supply and demand or the evolution of a single-source

Shortages Hit Hard A visit to the US Food and Drug Administration’s (FDA) web page on drug shortages (www.accessdata. cfm) and ASCA’s drug shortage page ( reveals a significant number of drugs that have experienced a shortage, and the dozens still in short supply. Sones notes there are many causes for drug shortages, such as interruption of the supply chain of raw materials, unanticipated demand and manufacturers abandoning low-profit products. “The health care industry, and ASCs in particular, are highly vulnerable to this uncontrollable challenge,” he says. An “increase in regulatory enforce-

ment” by the FDA is another contribu- tor to the shortage, Sones points out. “That has been a double-edged sword. Increased enforcement can delay drugs from entering the supply chain, but it helps provide protection against com- promised products or products devel- oped through a compromised—or one thought to be—manufacturing practice from reaching facilities and patients.” When the quantity of available medications goes down, ASCs can expect to see prices head in the oppo- site direction, Dembny says. “If you have to buy the drug from a third-party or smaller wholesaler, it is probably

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