Healthcare Purchasing News asked nine value analysis professionals to recount some of the success stories they either experienced first-hand or second-hand.

My favorite project involved Huber needles. Our Value Analysis projects are triggered by cost savings opportunities, quality improvement opportunities, or both. We are not just concerned with decreasing costs or increasing revenue. We are also concerned with improving clinician/patient safety and quality outcomes. Our supervisor is fond of saying, ‘If all I needed was people to cut costs, I’d have hired accountants.’ Being clinicians by trade, we can wear both clinical and business hats. 

With Huber needles, we completely converted to a new product that required months of intense inservicing for many of our 2,000 nurses. This was not an easy sell. Again, even positive change can be difficult. TWWADI (The Way We’ve Always Done It) rears its ugly head frequently as a rationale for resisting change. Our hypothesis was that by converting to a different type of Huber needle with a different safety mechanism, we’d reduce the needlesticks experienced by our nursing staff and therefore decrease their exposure to blood-borne pathogens. Prior to the project, our clinicians were experiencing about six needle sticks annually (from more than 22,000 opportunities) via Huber needles.

After conversion to the new (and slightly more expensive) product, only three needle sticks have occurred in 14 months…and each of those was from one of the old needles that nurses had hidden away because they were resistant to change! We’ve actually eliminated needlesticks from this device. Our hypothesis was not only proven but eclipsed. Calculating the savings from Worker’s Compensation claims, prophylactic pharmacotherapy, and the intense anxiety surrounding a needle stick injury far outpaces the minor cost increase for the product. The project was successful because the clinicians were process every step of the way and the administration was supportive of the philosophy: Spending a little more on this product will make our staff safer. All they required was an appropriate follow-up to determine the project’s return on investment.

– James Russell, R.N.-BC, MBA, Value Analysis Facilitator, VCU Health System, Richmond, VA

[We switched] from disposable laceration instrument trays to reusable trays in the emergency department. The physicians were requesting higher quality instruments to work with and had provided multiple examples of failed instruments impacting the quality of their care delivery in the ED. Vendors had offered multiple options to increase the quality of the instruments in their disposable trays, and/or options for custom trays that would cause a significant increase in the cost of this high volume item.

In order to increase the quality of the instruments while not increasing cost we came up with the idea of assembling reusable kits that could be sent down to SPD for reprocessing and returned to the ED. SPD was more than on board and even volunteered to do an assessment of the reusable instruments available to us from our contracted vendors in order to get the highest quality at the lowest cost. Value Analysis looped in the department director, educators and physicians and technicians to garner their support and ideas for implementation. The technicians were the key here in that they were the ones pulling the trays for the procedures as well as picking up the rooms after. They made it their own project to educate and manage the process which worked extremely well.

As a result of these efforts the physicians got the quality they needed to seamlessly provide care to our patients, and the ED department was able to lower their costs on these trays over $25,000 annually, and SPD was able to document their participation in an improvement project made possible by their willingness to support the additional items to process. The savings covered the cost of the instrument purchases in the first three months.”

– Karla Barber, R.N., Director, Clinical Value Analysis, Mountain North Denver Operating Group

Our client sought to reduce costs through improved procurement, particularly through a process where physicians and clinicians were heavily involved in the decision-making. The [value analysis] team at Nexera Inc. worked closely with hospital stakeholders to help implement a physician-led VA team structure, and then worked with the client’s supply chain professionals to assess the organization-wide spend by clinical service line. Once the service-line spend was established, the VA team was given responsibility for clinical decisions and service-line spend. Nexera worked with the physician-led VA team to create sustainable procedures that ensured contract standardization, utilization, and compliance throughout the organization. Within 19 months, the VA program was able to deliver $22 million in savings for this hospital.”

– Kristin Boehm, M.D., Senior Advisor, Nexera Inc., New York  

Recently an IDN approached a clinical preference item (surgical mesh) through evidence. What did the research body show on the appropriate use, length of stay, outcomes, infection rates of specific mesh? Once the body of credible research (not studies by the vendors nor white paper statements) was revealed the surgeons made very quick and evidence-based decisions on which mesh to use and when. Once the surgeons had indicated the mesh the evidence indicated they standardized their procedures and supply chain was able to negotiate a tremendous savings. A ‘win-win,’ highest quality through standardized process and products with surgeon support!

Efficiency savings can be obtained by taking a ‘divide-and-conquer’ approach to your value analysis process. Gathering and organizing stakeholder feedback and product information is a tedious task regardless of the size of your organization. A customer of ours shared a pro forma that revealed over $100,000 per year in efficiency savings. 

Greater efficiency can be realized in our system by automatically segmenting questions to the appropriate audiences. For example, the sponsor/champion will answer a specific set of questions (i.e., anticipated volumes, do you have financial interest, etc), vendors will supply some objective answers regarding the product (manufacturer, model number, pricing, 510(k), etc), and internal hospital stakeholders answer questions based on their role (i.e., financial, clinical, contracts, safety, etc).

A value analysis best practices success story at an organization involved the savings of $995,000 through the reduction in the variation and utilization of ‘Infuse.’ Upon the review of the spine fusion procedure data, it was apparent that there was wide variation in practice among surgeons with the use of ‘Infuse.’ It was identified that the largest size of ‘Infuse’ was being used in the cases of several surgeons, leading to waste in the majority of cases as well as variation among surgeons in the use of ‘Infuse.’

The key reasons for the success of the project include:

1.      It incorporated both clinical and financial data for optimal savings.

2.      A project plan was developed to identify the executive sponsor, key stakeholders (physicians), charter, goals, objectives and timelines.

3.      Clinical and financial data were analyzed and presented to the team along with literature, clinical case studies and outcome data.

4.      Physician engagement and support was critical in the implementation of recommendations for reducing the variation in practice.”

Data, collaboration and education were the keys for one of our members reducing their annual spend on bed rentals by $233,000. In our role of supporting their value analysis committee and through our work on utilization benchmarking we identified an opportunity, then used the data analysis and best practice considerations to foster discussion across the value analysis team. The data helped identify the opportunity. The collaboration of the value analysis team allowed them to realize that they were over relying on bed rentals. Through education around cost and process the clinical team was able to understand the cost impact of calling for a rental bed, better understand when they were really required, while ensuring patient quality was not sacrificed.”

Over a two- year period of time the University of Virginia Medical Center has reduced its pressure ulcer rate in half. Through the collaboration of nursing practice, WOCN, nursing value analysis team and supply chain a phased approach was developed that included product evaluations, streamlining of continence care products, the creation of unit-based skin champions and updated bed making practices. Methods were established for gathering baseline and ongoing [pressure ulcer prevention] rates through audits as well as using product evaluations and value analysis processes to calculate future costs. Using national cost averages, UVA has prevented the equivalent of 577 pressure ulcers with related savings of $5 million. This equates to $10 in overall cost reduction for every $1 spent.”

– Barbara Strain, MA, Director, Supply Chain Analytics, University of Virginia Health System, Charlottesville, VA, and Past President, Association of Healthcare Value Analysis Professionals (AHVAP)

In an effort to reduce the cost of linen, an analysis was performed that determined the cost per pound rate was well within competitive rates. However, the hospital's utilization of linen exceeded 30 percent of benchmark levels. Supply Chain staff, clinicians, and Linen Services staff met to discuss these findings and developed a strategy to pursue changes on how linen would be used in an effort to achieve benchmark levels.

Supply Chain worked with Linen Services to quantify departmental usage patterns; clinicians worked with Linen Services to obtain information related to linen utilization best practices; and Supply Chain worked with the clinicians to evaluate the impact of proposed practice changes. In the end, new linen usage protocols were established, department level utilization tracking was compared to baseline trends, then monitored and reported. Those departments that showed the most improvement without impacting customer service ratings were rewarded quarterly.

Working collaboratively with key stakeholders towards a common goal is illustrated here. Incorporating the knowledge and skill sets from those who are invested in the decision process is essential for end users to take ownership of the results generated from any value analysis effort.

Instead of signing off on a new wound care group purchasing contract being offered that would have saved them a few thousand dollars, one of our clients decided to pursue with their value analysis team an investigation of their wound care program with the goal of reducing their pressure ulcer rate. During this initiative their value analysis team reviewed its use of patient transfer devices, skin care and incontinent care products, ultra-absorbent pads, and its bed-making process.

In doing so, this organization uncovered inefficiencies (in the use of patient transfer devices, the efficacy of the skin care products, value mismatches with absorbent pads, and lack of consistent process in bed making). Once these inefficiencies were corrected, our client reduced its ulcer rate by 10 percent while reducing its total wound care supply spend by $262,000 annually.

The lesson to be learned here is never stop at your first best savings idea (e.g., GPO contract savings of a few thousand dollars), but instead move on to investigate the family of products and services that surround the product or service under investigation. This way, you won’t leave hundreds of thousands or maybe even millions of dollars on the table – untouched!”

HCA developed an initiative on reprocessing single-use devices with a third-party vendor at each of our acute care facilities. We quickly realized that this initiative would impact many stakeholders within our facilities and we asked that this initiative be included through their Supply Management Action Teams (SMAT) meetings. Not only was this a key to drive supply expense savings it is also the right thing to do for our environment and supported our ‘green’ efforts.

In order to ensure success with this program it required buy-in at the highest level of the organization and appointing an administrative leader champion. Working with our third-party reprocessing vendor we provided detailed information about the program, which included explaining how the program works, quantifiable information about savings, environmental impact and social responsibility (sustainability) should be delivered realistically and clearly.

The next step was to provide physician communication first by identifying a surgeon champion.  This included presentations at medical staff meetings, providing written communications and e-newsletters to deliver the message.  

The next step was to provide staff communication, which requires education for the staff to understand the whys, the hows and the details behind this program. We utilized our third-party reprocessing vendor representatives to assist with a launch campaign throughout the facility.  Again we identified staff champions to help deliver the message as well. 

Once the program was launched we monitored individual hospital results. It is important to ensure that the reprocessed devices or products are being used. On a regular basis we shared product savings, waste savings, as well as opportunities that might exist. It is extremely important to share this information with your physicians and staff. They will need to hear that their efforts are paying off.”

– Steve Tarkington, Vice President,
Parallon Supply Chain Solutions, Brentwood, TN