On any given day in the communities in and around Ocala, Fla., Marion County Fire Rescue (MCFR) personnel respond to an average of 170 emergencies for a department that serves more than 300,000 citizens. Since 2006, Shari Hall, who began with the government-owned fire rescue department in 1995 as a firefighter/paramedic, has served as EMS Division Chief, overseeing EMS-related operations of MCFR’s 31 fire stations and 57 advanced life support units.
During the past several years, Hall found that keeping medical supply costs low while ensuring high-quality pre-hospital and emergency medical services for the county’s citizens was becoming more challenging. In search of a cost management solution, she discovered AdvantageTrust, the HealthTrust division that shares the power of the GPO’s volume with smaller, non-acute care sites. Choosing AdvantageTrust in 2012 meant MCFR found a one-stop purchasing solution for all of its medical supplies—bringing in much more significant savings than she first imagined.
A New Challenge Every Quarter
MCFR carries more than 375 different types of supplies on its rescue vehicles, from bandages to cardiac drugs to stretchers and everything in between, Hall says. Because the county has a large elderly population, MCFR’s supply list also includes several specialty items. Charged by the government with finding the best prices for each of these supplies, the staff had to engage in quarterly public bids. The bid process was driven by a Florida law that requires government entities to be transparent about how they spend taxpayer dollars.
“Because Marion County is required to provide taxpayers with this spending visibility, it has an obligation to go with the lowest price item,” explains Jenifer McGuire, account director with AdvantageTrust. “The bid process meant they were often ordering different supplies and switching suppliers every quarter.”
The process was not only time-consuming and cumbersome, but it also didn’t result in significant savings—or the best quality products.
“Whatever bid came in the lowest, that’s the company we used, but some of the supplies that we were receiving weren’t equal to that of a previous supplier,” Hall says.
If MCFR used Supplier A for its IV prep kit one quarter, the next quarter it might have to use Supplier B—meaning it would have to research the ins and outs of that new prep kit. “That kind of research takes a lot of staff time,” Hall says.
The AdvantageTrust partnership means Marion County Fire Rescue spends less time on purchasing and more time on other mission-critical initiatives and community outreach projects.
MCFR’s inventory process also was manual and labor-intensive. Because suppliers were changing so often, no loyalty was being built that could aid when certain items were in short supply.
“It was tough to try to maintain inventory under those guidelines,” McGuire says. “The system was archaic, and there was never any sense of the process running itself.”
“We were constantly having these challenges, so we realized there had to be a better way,” Hall says.
Eliminating a Burdensome Process
Fortunately, the Marion County Commissioners allowed MCFR leaders the leeway to search for innovative solutions to the challenges. However, a GPO system wasn’t on Hall’s radar until a local hospital CEO who was a member of MCFR’s fire advisory board mentioned its benefits.
“He told us that there were other ways that we could buy supplies and save money,” she says. “All I had to hear was, ‘You can save money.’ That was the driving force for exploring AdvantageTrust and making such a big change.”
AdvantageTrust offered a tailored approach to streamlining MCFR’s purchasing operations, including fixed mark-ups, low units of measure, timely committed schedules for delivery and supply chain efficiencies. “AdvantageTrust walked through our warehouse, assessed it and knew right away that they could save us money,” Hall says.
And because HealthTrust’s process is guided by member advisory boards that make the final contract decisions, AdvantageTrust allowed MCFR access to industry-best pricing while meeting the requirements of Florida’s transparency law. Since HealthTrust’s competitive bid process meant that visibility would still be in place for taxpayers, the county commissioners were fully supportive of the partnership, Hall says.
“The lowest price isn’t always the driver of HealthTrust contracts—quality is the ultimate driver of the awards—but the GPO model itself ends up commanding the best pricing in the industry,” McGuire says.
Eliminating the quarterly bid process and frequent changeover of suppliers has been advantageous to MCFR in multiple ways. Not only do they have much better visibility on their spend, but the partnership also means MCFR spends less time on purchasing and more time on other mission-critical initiatives and community outreach projects.
Easing Inventory Headaches
Compared to other cost management solutions that MCFR investigated, AdvantageTrust was the standout because it offered hands-on, customized support. The team set up MCFR with a custom-made purchasing portal, a streamlined order guide, barcode hardware and software for purchasing supplies, and an inventory management system.
“We get great pricing on supplies and all the ordering happens on a website that’s easy to use, translating contract terms into everyday language,” Hall says.
The automated, Web-based process was a welcome change for Hall’s team, which used to order supplies over the phone. It also eliminated many of the errors that were rampant with the manual inventory system. For example, in the past, Supplier A might win a quarterly contract for one-half of MCFR’s supply list, and Supplier B for the other half, which meant the logistics staff had to constantly ensure they bought from the right supplier. There were sometimes long delays in getting certain items, with little communication about when those items would arrive.
“It used to be routine that we would order 10 of one item and would receive only seven,” Hall says. “Not only is the logistics staff relieved of a daily count, but that kind of error is taken off the table. Now we know exactly what’s coming off the truck and what’s going in the system.”
“We understand that every item won’t always be the cheapest item out there, but it will be the best quality for the money. The bottom line is what’s important. We anticipated an initial result of 10 percent [savings] and went way over that. And we’re just getting started.” — EMS Division Chief Shari Hall
The barcoding inventory system has reduced personnel costs. “It has saved so much staff time that we didn’t rehire when an employee retired,” Hall says. “People have been reassigned to other tasks. The increased accessibility in ordering has made everyone much more efficient.”
Hall says the online ordering system also is helpful because the suppliers learn what and when MCFR buys, which helps ensure that short-stocking or overstocking doesn’t occur. MCFR has even been able to reduce its inventory of supplies from three months to one.
An AdvantageTrust-authorized distributor meets regularly with MCFR to ensure it’s receiving orders on time and that any issues are resolved. The distributor notifies MCFR if important items, such as IV fluids, are on national back-order. “When these back-orders happen, our distributor works with us to use a different process that still maintains top-quality patient care,” Hall says.
Allowing for Staff Feedback
Hall admits that the change was difficult for some of her crew at first, especially long-time medics who were comfortable with certain products. “We were changing everything out, not just one or two items, like a brand of gauze or gloves,” she says. “That’s why it was important that the suppliers we selected would provide supplies that were better than or equal to what we already had.”
Hall explains that one of her best practices as a manager was to bring her employees into the process, explain the new program’s goals, listen to their concerns and let them help her make some decisions. To that end, she asked her crews to test-trial a bunch of different products and provide input.
“When there was negative feedback, the supplier found something equivalent to what our guys preferred, or HealthTrust staff called other suppliers to locate hard-to-find supplies,” she says. “Now our guys are accepting the changes and reporting that they like these products better.”
For example, she was particularly concerned about how new advanced airway devices were going to be accepted by her crews. “One paramedic told me he wasn’t going to like it, but he agreed to try it,” she says. “He ended up giving it a glowing report and telling other paramedics that the device was top-notch.”
Expanding the Portfolio
Because emergency medical services (EMS) was an emerging non-acute market for AdvantageTrust, the team convened weekly meetings so MCFR staff could better familiarize the distributor about the EMS field and the kinds of items they would need to purchase.
The AdvantageTrust contract portfolio also was adjusted to accommodate MCFR (and future EMS members) with the addition of the kinds of new, competitively priced and clinically approved items that it required.
“The AdvantageTrust team worked with us to broaden its contract portfolio to include the types of items, such as oxygen cylinders and ALS [advanced life support] kits, that are vital to our day-to-day rescue operations,” Hall says.
“If HealthTrust doesn’t have a contract for an item that a member wants or needs, it will look at current existing manufacturers and try to get that product added to the contract,” McGuire says. “Likewise, if a member has a supplier that it really likes working with, HealthTrust examines whether we can negotiate a contract with them, too.”
Racking Up Savings
Within its first year of AdvantageTrust membership, MCFR was saving more than 20 percent on its medical supply purchases. Here are just a few examples of how those savings have racked up:
- MCFR pays less than half of what it used to pay for gloves, a huge savings in one of its most utilized daily supplies.
- Compared to what it used to spend on a glucometer, a common test to determine a patient’s blood sugar, MCFR saves more than $4 each.
- Another of MCFR’s biggest volume items are IV prep kits—pre-packaged plastic kits with items to start an IV, including tape, tourniquet, povidone-iodine preps and tegaderm wound dressings. MCFR uses an average of 125 prep kits a day and saves $3 on each.
Efficiencies like these add up to between $7,000 and $10,000 a month, or more than $100,000 a year, Hall reports. Even if some items cost a few cents more, she and her staff understand that the focus is on overall value.
“We understand that every item won’t always be the cheapest item out there, but it will be the best quality for the money. The bottom line is what’s important.
“We anticipated an initial result of 10 percent [savings] and went way over that,” Hall continues. “And we’re just getting started.”
MCFR also is looking to AdvantageTrust to help it examine its capital purchases—items that cost more than $5,000.
“We’re going to look at everything from $11,000 hydraulic-powered stretchers to $24,000 defibrillators,” Hall says. “Even on simple things like linens, when you’re using more than 50,000 sheets a year, those costs add up.”
The Marion County Procurement Department is now looking at participating in AdvantageTrust on a more global level for some of its non-medical needs, including office supplies, express shipping and even cell phones. Vehicle licenses, such as for ambulance and fire trucks, could even be on the horizon. Nearby county fire departments also want to hear more about how they can share in MCFR’s success.
“The more we work with AdvantageTrust and build that close relationship, the more synergy we create,” Hall says.
As a member of the governor-appointed Florida Sterling Council, Hall, who is the only female division chief in Marion County, examines and ranks companies on their communications and customer service practices. “That’s why I’m very confident that I can speak of HealthTrust’s stellar performance,” she says. “The customer service we receive from the AdvantageTrust team has been so professional, and their follow-up is amazing. They fly here for quarterly reviews to see how everything is going. The transition was hard work, but it was well worth it.”
For more information on the benefits of AdvantageTrust, call (866) 841-2992 or visit www.advantagetrustpg.com.