Consultant:
Hold docs accountable for resource usage 
by
James M. Berklan
Plan: Set acceptable consumption levels and then compare
Michael Rudomin has watched hospitals' bottom lines generally go from
bad to worse over the last two years.
That's why he thinks it is finally time to put physicians' work habits
under the microscope. Rudomin is calling for "economic credentialing"
of doctors. The veteran material management consultant thinks doctors'
resource consumption levels should be monitored and compared against
other doctors' consumption and their outcomes records. "The run-of-the-mill
person might still consider this a little extreme and think I'm just
crazy," admitted Rudomin, vice president of Bolton, MA-based consulting
firm AdvanTech Inc. "Nonetheless, I think it's even more applicable
than two years ago when I first brought it out. Things are getting more
dire; finances are getting tighter and tighter."
Part
of bigger picture
Rudomin believes material managers first need to look beyond supply
costs as they exist in a hospital. He calls for a broader look at supply
management throughout an integrated delivery network. Rather than just
looking at supply costs at a given hospital, managers should examine
the use patterns of individual departments such as radiology, pharmacy
and the operating room.
A second thrust would be judging whether certain clinical outcomes merit
the amount of resources consumed. Identifying physicians who routinely
use a lot of resources with routinely weaker results is the goal, Rudomin
said.
"It's
reasonable to suggest that, after a review of enough data, we could
say a typical patient with diagnosis 'X,' of a certain age and risk,
should range from 'X' to 'Y' on the scale of cost and consumption of
supplies," Rudomin said. "So we hold physicians to that level in virtually
all cases. If they don't make it, at least we have enough information
to find where the offenders are and see what's going on. They don't
have to do it the cheapest. But cost effectiveness must be considered.
"There
is no way we can allow people responsible for the consumption of resources
not to be held accountable for consumption levels," he emphasized.
Influencing decisions
Material managers can only influence, not unilaterally force, change
in this area, Rudomin acknowledged. But few, if any, material departments
are even collecting consumption data, yet alone approaching physicians
with it, he complained.
There are several ways to gather the data, experts agree. Firms such
as HCIA-Sachs, Evanston, IL, analyze vast amounts of hospital data.
It can show whether one doctor's costs are much different from others'
to serve as a starting point for further analysis, said John Froelich,
a company vice president and analyst.
Another good source of data is automated vending machines from companies
such as Pyxis and Omnicell, experts agreed. Facilities can index resource
usage by procedure, patient or physician. Studying doctor habits, however,
has not been pushed as a selling point, one Pyxis manager noted.
"I
think it's a viable but sticky topic," said Rob Sobie, a senior market
manager with the San Diego-based company. "The percentage doing it today
is relatively small, but it will continue to grow. I see the economic
credentialing idea growing more in the OR. From a surgeon's standpoint,
they'll raise success rates, turnaround times and all those factors"
to counter calls for standardized comparisons.
High
hurdles
One industry veteran thinks consumption data often may be in the hands
of hospital executives without material managers even knowing about
it.
"Some
administrators would say 'share it with others,' and some would say
'it's executive information,' said Ray Holm, vice president of marketing
for HealthShare, a subsidiary of the Texas Hospital Association.
James F. Panto, a regional sales director for clinical care management
company CareScience, San Francisco, disagrees with Rudomin's plan.
"We
certainly do not espouse physician credentialing, but rather something
that will get physician buy-in," Panto said. "If you look at fixed,
variable and overhead expenses, frankly physicians have a difficult
time seeing how they can affect those things."
But
Rudomin, knowing he has an uphill battle, will nonetheless continue
to push his idea, hoping others will warm to it.
"We
have an environment where we have fixed resources," he said. "If we're
losing money and don't have good outcomes, somebody has to do something."
HPN
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