Supply Chain leaves stamp on quality, physician business

Running parallel to Piedmont Healthcare’s multifaceted STARS teams that identify and implement cost management initiatives throughout the integrated delivery network, Supply Chain also participates in the IDN’s Quality, Safety and Service (QSS) committee and advises physicians on prudent practices.

QSS comprises a team of improvement consultants, infection preventionists and improvement managers who, along with Supply Chain, work on reducing healthcare-acquired infections and other inpatient-hospital quality measures through products and services.

QSS also includes CEOs, CNOs, and CMOs from each facility, as well as executives from Finance. “When they vet a solution and it is ratified at the larger QSS meeting, Supply Chain supports the initiative with our new product request, conversion, and cost analysis processes,” said Greg Milton, Director, Project Management.

The selection of the appropriate product takes place within the QSS construct with support from Supply Chain, according to Milton. “We sometimes choose the more expensive product depending on the outcome of trials and the indicators of white papers, best practice, and other case studies brought to bear by the QSS team,” he added.

QSS highlighted a project to reduce central line-associated bloodstream infections (CLABSIs). The QSS team, which included Vice President of Supply Chain Joe Colonna, vetted a number of products, opting for Curos caps, after conducting extensive product and process research.

“While cheaper alternative existed, a case was made for Curos as the product standard and, in an effort to achieve improved quality outcomes, cost was not a major factor in the selection,” Milton noted. “Initial projections showed a $270,000 supply cost increase to the system after netting out the positive reductions in cost for fewer CLABSI events.”

Actual expenses have fallen below expectations, however.

“We are spending less than we projected due to the fact that not all staff have complied with the procedure involving their use,” Milton noted. “Six of our facilities have been standardized to the new protocol. Three of the six facilities have seen CLABSI almost entirely eradicated. Three of our other hospitals (Piedmont Athens, Piedmont Atlanta, and Piedmont Henry) actually saw a slight uptick in CLABSI rates. However, as our quality teams have begun to aggressively audit at these facilities for compliance to policy, Atlanta has gone four months without a CLABSI and we are seeing improvements at our other two facilities. Our newly acquired facilities will go on these protocols as soon as Epic is implemented.”

Supply Chain also works with Piedmont physicians, advising them on how to manage their business and clinical practices more efficiently.

Among the projects is an orthopedic Bundled Payment for Care Improvement/Gainshare program.

“With the introduction of a structured, legal gainsharing [program] came a different conversation around cost with incentive alignment,” said Amy Chieppa, Executive Director of Integration, Performance and Systems. “This created a different way to incentivize physicians to engage on the cost reductions. It was actually the physicians that approached administration about implementing a BPCI. We trialed it one facility on two cost factors –with success – and now have expanded it to three additional facilities and looking at seven factors.”

The initial BPCI involved two factors at one facility – implants and drugs, according to Chieppa. The expansion areas focused more on total supply utilization, including bone cement, single use instruments, resection guide kits, fixation pins, osteotomes, flex rods and trial items/new products, rather than a list of individual supplies, she added.

Supply Chain interfaced the clinical systems with the electronic medical records, matching invoice costs to implants to patients and their doctors. Then they were able to show average cost by DRG per facility, vendor and physician, along with the patient’s length of stay. They identified consistencies and variations of instruments and products used to help physicians make optimal choices on their practice patterns and product choices.

Supply Chain also works with physicians on managing expenses using centralized service offerings through Piedmont, such as courier services, document storage, freight management and rebates.

• www.hpnonline.com/piedmont-basks-in-biomed-glory-glow/