Cardinal Health procedure packs

Getting started
By all accounts, implementing a custom procedure pack program is not an easy task and certainly not one to be taken lightly. A reputable vendor will include a detailed evaluation of the facility’s supply chain process which may include clinical, financial and logistics analyses."Bundling products is the mechanism to achieve standardization, but we’re really looking at a much broader and deeper supply chain solution," said Turner. "We have a comprehensive implementation team and process. It’s critical to the success of a program. You can do all the analysis, and it can all look good on paper, but if you don’t implement it properly it can be very time consuming and expensive."

The first step in Medline’s analysis prior to implementing its Complete Delivery System (CDS) includes a comprehensive clinical review to identify the customer’s current supply protocols. "These supply protocols become the cornerstone data for the remaining logistical and financial analysis," said Turner. "The clinical supply consumption is what creates the day to day demand for supplies and in essence ‘pulls through’ all the supplies through the hospital supply chain."

He also described the comprehensive nature of Medline’s logistic analysis for CDS. "Our logistical people look at several buckets of things including product flow from the receiving dock all the way to the point of therapy. They look at the waste stream where it’s appropriate. They also look at storage and space utilization, as well as do a complete case cart analysis.

"At the end of the day, they’ve got to get the supplies on some kind of cart to get them into the operating room. And whether they have a comprehensive case cart program or whether they just have an ad hoc program up in surgery, that part of the analysis is very important. The last thing which our logistics expert looks at, which ties this whole thing together, is the packaging of the modules throughout the whole process. There are several different packaging options which affect storage, handling, space utilization, case cart design, etc," said Turner.

In addition to its clinical and logistical analyses, Medline performs a detailed financial analysis in order to determine whether a customer would benefit most from a full CDS program, a hybrid or partial program, or even if they would be better off sticking with their current program, said Turner.

Before Medline’s CDS is implemented, Medline representatives perform a dry run to be sure all necessary components are in place, added Turner.

For the implementation of its ReadyCase program, SRI brings in a team of experts in nursing, CS management, surgical instrumentation, logistics and finance to analyze the hospital’s current operating environment and establish a cost baseline. A proposal is then developed from that assessment and presented to the client. Once the client agrees to proceed with the ReadyCase solution, SRI engages additional resources to help ensure a seamless implementation.

Cardinal Health describes its implementation process as essential to creating a "roadmap to standardization", said Kelly. "What we bring to the table, is the data and the clinical and logistical resources that we can work with customers to analyze.

"It’s not a cookie cutter approach," added Kelly. "The assessment looks at: What are your procedural requirements? What’s your current supply chain? How do you get products from the time they’re received to the time they’re used on a patient? And then what are your financial requirements? Those are all inputs into that assessment process that ultimately addresses: What’s the best way that we can redesign your internal supply chain to optimize this for you?"

Kelly noted that Cardinal Health has a team of more than 25 clinical project managers who work onsite to design the modules and work with the hospital clinicians to look at utilization and the opportunity to standardize on products. He added that communication with all of the clinicians in the operating room is key to the program’s success. "You need to broadly communicate and inservice everyone involved on what changes they’re going to see, how the program’s been developed, and what benefits it will bring."

Medline Complete Delivery System

Specialty packs
Alcon Surgical Disposables is an ophthalmic company that makes procedure packs designed specifically for use in eye surgery. Alcon’s Custom Pak offering is custom-designed to meet individual customer specifications and can be as small as one or two items or as large as needed to cover the entire ophthalmic procedure. These packs can also include many non-Alcon components, such as gowns, needles, gloves, etc. Alcon inventories over 4,000 different items specifically for ophthalmic procedures, according to Vonderhaar.

Alcon’s PikPak includes only Alcon sterile finished goods that can be ordered as a standalone or with the Custom Pak. "These are generally used in facilities that desire a common basic pack while allowing the various surgeons the flexibility of having a small number of customized products for their individual techniques," said Vonderhaar.

Vonderhaar noted some recent trends that are addressed by Alcon’s Custom Pak: More surgeons per facility; varying surgeon preference; changing surgical techniques; surgeon mobility (between facilities and to ASCs); standardization – reduction of inventory; cost containment due to flat or declining reimbursement trends; procedural efficiency required to handle more volume in less or the same OR time; accountability of procedural costs to insure proper reimbursements; waste minimization concerns because of rapidly increasing costs; managed care; and a focus on increasing revenue in the OR.

Over the last year, SRI signed several large hospitals and an IDN to its ReadyCase for Laparoscopy program, said Kirtser. One of these hospitals, Abington Memorial, PA, has published realized savings of $340,000 in year one from reduced disposable instrument use and reduced instrument repair. According to the facility’s nursing director, Abington was spending over a quarter million dollars a year on repair expenses alone prior to the SRI program. The entire Abington surgical team has been pleased with the results including the surgeons who note that quality instruments are always on time and ready when they need them. The end result has been improved quality of care and a more efficient operating room.

Managing packs
Once a custom pack program is implemented, managing those packs becomes an ongoing necessity to keep costs at bay and preference cards in line. Several vendors have launched internet-based programs that give customers a detailed look at what’s inside their packs.

SRI recently launched its ReadyView web-based portal that ReadyCase customers can use to analyze procedural costs, drive product standardization and maintain preference card accuracy, said Kirtser. In addition, SRI’s nurse consultants and territory managers actively work with the client to evaluate product utilization in the packs throughout the relationship with the client.

Cardinal Health recently added new tools to its online Pack Manager program. "There’s a ScoreCard feature now within Pack Manager," said Kelly. "We typically work with customers to populate that score card so we track on an ongoing basis what we’ve delivered for them in terms of savings via programs like standardization. He noted that there are also opportunities for customers to look at savings opportunities within Pack Manager, to look at reports that can give them information around standardization, as well as features that show the customer’s inventory status, and show them video images of their kits and how they’re assembled.

In addition to the Pack Manager program, Cardinal works with customers on an ongoing basis to ensure the success of their PBDS program. "How do we measure our resolve together?" asked Kelly. "Installing one of these custom procedure pack programs is a big step and a lot of work, but then how do you make sure the program is continually optimized for that individual hospital? That’s by having frequent steering committee meetings, by constantly bringing back our team of clinicians to really assess the program again and adapt it on an ongoing basis to meet the customer’s requirements and address any changes that may occur. For example, there may be new doctors coming in, or growth in certain procedures. So, it’s not only assessing and designing the program on the front end, but how you manage the program going forward?"

Medline’s MedPack internet-based tool provides customers with real-time data on the status of their custom packs. Turner said that the most frequently used tool of the MedPack program is its Inventory Control feature in which customers can see how many kits have been manufactured; if there’s a new version coming they can see how many days of the current version they have and get the release date for the new version. In addition, a "Bill of Material" feature allows clinical staff to view individual components of their module or pack and evaluate options for kit configurations.

To help provide their customers with some flexibility in the development of custom packs, Medline offers a component return program. "We know that from time to time, there are going to be contract changes and clinical practice changes that affect products within custom kits. We don’t want our customers to be financially penalized by any of those changes and we also don’t want them to run out of kits. We’ll give them credit for any unused components during the transition time period between kits," said Turner.

A look at reusables
Though disposables remain the mainstay of hospital textile usage today, more and more facilities are reconsidering reusable linens and textiles in order to save costs per procedure. With the advent of new materials, reusable surgical gowns, for example, are becoming more and more protective while becoming more and more comfortable for the wearer.

SRI’s mix of reusable linens and disposable supplies provides hospitals with an option that they say provides the best of both worlds.

SRI’s team performs a complete cost analysis of reusable products to disposable products. According to Kirtser, "We can reduce up to 70% of all the medical waste generated by an operating room. We do that by converting all the disposable surgical gowns, towels, basins and some of the drapes to our reusable platform. The client immediately can realize cost savings by converting away from expensive single-use products and reducing cost of single-use product disposal."

SRI recently launched its Premium Protection Liquid Resistant Gown that incorporates Gore material in the critical zone area, which allows moisture to escape to keep the wearer cool, yet will not allow liquid to penetrate, keeping the wearer safe. The company provides surgical gowns that perform to the requirements set by Levels 2, 3 and 4 of the AAMI protection standard.

Standardization trends
In the push to drive down per procedure costs, standardization has become the buzz word, not only standardizing on components within kits across an organization, but also in standardizing the custom kit into a more standard procedure kit for customers to choose from.

Both Kelly and Turner said that customers are asking for more of a standard offering to choose from.

"People are saying, why don’t you manufacture a broader scope of standardized kits and we’ll tell our people that’s what they have to use," said Turner. He noted that Medline already has an extensive line of standard procedure packs and prides itself on extensive research that goes into the packs and the components they contain.

Kelly noted that Cardinal is also working to develop more additions to its range of standard kit offerings. "The availability to line up more standards that closely align with procedural needs is important. While many of the items contained within packs are "fairly commoditized and should be standardized, sometimes within kits, they’re not," said Kelly.

Turner echoed that sentiment. "We’re talking about products that are very much commodity items that are used very routinely and in high volumes. These items have less to do with physician preference than they do with the customer’s supply chain."

Kelly also noted that sometimes a move that’s too aggressive may defeat the purpose of standardizing on kits in the first place. He gives an example of an IDN that may be using five different custom packs for a particular procedure across the IDN, with an average of 30 components within the packs. "If everyone is only able to agree on 10 items within the pack and you’re going to pull those 20 items that are outside of the pack, and they’re all still different, then how much have you gained? Have you really standardized, or just moved the items out of the pack? Do we really understand the financial implications of some of those decisions? Do we go back and say, ‘now what’s the total cost?’ Sure the pack costs less, but do we understand the cost of now pulling all those items separately?"