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Standardize and Save Reduce costs and improve care BY ROBERT KURTZ
R
aquel Rios noticed a concerning trend after she became the admin-
istrator of the Crystal Run Ambulatory Surgery Center of Middletown in Mid- dletown, New York, in late 2012. “I saw a significant variance in case
costs, particularly for orthopedics,” she says. “I knew that in order to bet- ter manage this, I needed to get to the root cause.”
It did not take long for her to dis-
cover the problem. “I saw several sur- geons doing the same procedure, but they all had different costs attached to their cases,” Rios says. “We were not standardizing the implants and supplies used. We have different ven- dors for different surgeons. The time it takes for an orthopedic surgeon to do a case varied as well.” At the end of 2013, the ASC began a project to improve standardization in orthopedics. Here are six steps the ASC is taking. 1. Develop a project committee. The committee includes Rios, the ASC’s executive director, chief transformation office, chief qual- ity officer and physician represen- tation. “The way to get surgeons fully engaged was to have their colleagues involved,” Rios says.
2. Conduct initial, simple data col- lection. “We examined two differ- ent surgeries and selected three surgeons who performed these procedures,” she says. “We col- lected information on supplies used for the same procedure and how much time each surgeon spent in the operating room for the same procedure. This opened up our eyes to issues we had in the ASC. We lacked a current interface be- tween our inventory management system and our scheduling system. It created a discrepancy in prices. We did not have a true reflection of
26 ASC FOCUS MARCH 2015
Reducing variation will help bring down cost, minimize the risk of error and provide more accessibility for patients.”
—Raquel Rios, Crystal Run Ambulatory Surgery Center
what we were paying per case until we started doing this project.”
3. Educate surgeons. “We have to let the surgeons know about the differ- ence between one brand of a supply and another,” Rios says. “We are in the process of showing them their preference
cards and discussing
what we are paying for their cases. We are making them comfortable with looking at what we can change so we can bring cost down without sacrificing quality. Once we have a true picture of what it takes to manage these procedures, we can manage the scheduling process and have a true picture of how many cases we can safely take on.”
4. Challenge variation. If a surgeon wants to use a new supply or de- vice, “we ask why there is a need for the change,” Rios says. “If he feels it will improve quality, he can absolutely use it; but if there is not a great reason to make a change, we will discuss whether it is necessary. We want to reduce
variation as much as possible. The more variation you have, the higher the risk is for error as staff become less familiar with the sup- plies used from case to case.”
5. Limit vendor influence. “Ven- dors often come to me and say a surgeon is requesting a new de- vice,” Rios says. “But if the physi- cian wants something, we have a variation analysis team that needs to hear from him as to why he needs it. If a new supply or device is approved, we can ensure staff receive the necessary in-service training and practice.”
6. Surgical technique. Down the road, the ASC intends to analyze surgical technique and identify opportunities for improvement in standardization there, Rios says. “We will look into what barriers exist that prevent our surgeons from performing proce- dures the same way across the board and in a manner that provides the best outcome at the lower cost in the shortest time possible.”
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