Getting doctors involved is a crucial component of a value analysis team
While a physician’s first priority is optimal patient care, infrastructure behind the scenes is critical to ensuring that can occur. Medical supplies and devices have an associated cost, and some provide better value than others. That’s where a value analysis team (VAT) provides support. A highly functioning VAT involves clinicians and facility leadership to follow a formal process for evaluating products, new technology and services that will provide safe, effective and compassionate patient care.
The most effective VATs will include physicians as a part of the process. Physicians provide a unique viewpoint, as they use the materials and instruments to treat and heal patients. A number of times over the last few years, articles in The Source have covered the benefits of value analysis teams and the process—typically from a supply chain or a clinician’s perspective. Resources interviewed from both disciplines have stressed the importance of physicians’ input into decision-making. However, with busy practices and many additional duties, getting physician participation can be difficult. We decided to turn the tables this time by asking three of HealthTrust’s Physician Advisors for suggestions on how best to engage their peers in value analysis.
What physicians can contribute to value analysis discussions
Physicians can provide real-time anecdotal feedback on value and quality that the rest of the value analysis and procurement team may not have insight into. They also bring a unique perspective on alternative approaches to choosing the best product for a specific need, says Ashley Mays, M.D., FACS, Head and Neck Microsurgeon at the Cleveland Clinic Florida and the Quality Director for the hospital system’s surgical subspecialties.
That unique perspective includes their own clinical experiences, “as well as the latest evidence found at conferences or in the literature to inform discussions around real and measurable outcomes,” explains Aron Wahrman, M.D., MBA MHCDS, FACS, Plastic Surgery Section Chief at Philadelphia Veterans Administration Medical Center and Clinical Associate Professor of Surgery at the University of Pennsylvania School of Medicine. This information can also be used to determine the cost effectiveness of potential supplies.
The value proposition is important because physicians are frequently the primary users of high-cost supplies and pharmaceuticals, adds Valerie Norton, M.D., FACEP, Chief Operations Executive Physician at Scripps Health, a Specialist in Emergency Medicine and President of Pacific Emergency Providers. “This means if you want to improve the financial stewardship of high-cost items, you’d better involve them.” Sometimes a lower-cost item works fine, she says, but the higher-cost alternative may provide better results and patient outcomes. “Only the people using it can describe the nuances of what makes it better.” She uses trocars as an example. “Generally, if proceduralists are given alternatives that perform equally well, they’ll support moving to a lower-cost item,” she explains, “but they need to be given the chance to try things out and voice their opinion and concerns.”
Using the literature to support adopting or declining a new technology is valuable, adds Dr. Norton. “Being able to ground the discussion with research is a very powerful tool for executives or committees with decision-making power over purchases.” A drug like sugammadex (Bridion), is a game-changer in anesthesia, and hospitals must come to terms with its cost. On the other hand, liposomal bupivacaine (Exparel) “continues to accrue negative studies that cannot find a difference compared to standard anesthetics,” Dr. Norton adds. Some hospitals are taking it off the formulary based on the accumulation of evidence. “Having physicians leading decision-making bodies is key to navigating these difficult conversations.”
Through value analysis, physicians can better advocate for products that help them increase job performance and improve outcomes. Dr. Wahrman uses biologics for wound care and hernia reconstruction. “I recently was able to get approval for a non-mammalian sourced product,” he says, but to do so, he had to stress its uniqueness. Dr. Wahrman routinely asks the hospital for new products that have been vetted by experts in his field. “Requests for these things are presented to a committee that wants to know what differentiates this product from other items. Price only becomes an issue if you can’t prove a measurable, better patient outcome.”
How physician involvement in value analysis has changed
Physicians are increasingly involved with value analysis, as the industry moves from fee-for-service to value-based healthcare. While fiscal issues have always been important to healthcare institutions, they are even more vital now. Of course, lower costs are not the only motivation. Value includes choosing the best products for the best patient outcome, at the right time and for the best price.
“There is no question that value analysis has rocketed skyward in importance in the past 10 years or so,” says Dr. Norton. “That has coincided with more and more physician involvement, because the value analysis teams need physician champions and thought leaders to convince their colleagues to embrace better financial stewardship.”
Over time, some clinicians have taken the perspective that evidence-based medicine leads to evidence-based purchasing, using the information gleaned from research and best practices to choose the right products. When we refer to the term ‘evidence-based,’ adds Dr. Wahrman, “we need to remember you can only test innovation through use, so one has to acquire the evidence.”
The best ways to engage physicians
Not every physician wants to be engaged the same way. The key is understanding what works for each individual. “I prefer it when senior leadership specifically asks for engagement,” says Dr. Mays. She has seen requests come from general surveys and other group electronic communications, but that seems impersonal.
Dr. Norton acknowledges that she enjoys a spirited committee meeting, debating the available evidence for a product. “But many physicians hate committee meetings and would much rather have a one-on-one discussion detailing differences with a trusted colleague, such as the operating room director or someone from the value analysis team,” she says. “Most physicians are team players and appreciate receiving a concise email laying out the case for making a change.”
VAT involvement leads to greater understanding
Dr. Norton’s first exposure to value analysis was as a neophyte service line leader, when she asked to see a list of the top 20 most expensive pieces of equipment they were using. “I discovered that our emergency departments were throwing away HoverMatts after a single use,” she recalls. By developing a clean-and-reuse strategy, they saved several hundred thousand dollars the first year, plus they made a positive environmental impact. “My eyes were opened to the seemingly endless possibilities for further savings and better environmental stewardship, which was a steppingstone to a deeper understanding of the intricate balancing act that constitutes a hospital budget.”
Without the combined overview of supply cost, product availability and supply chain issues, it’s hard for a physician or surgeon to understand how their product preferences can be affected. “If a surgeon requires a certain type of suture to close a patient’s wounds during surgery, and there is a supply chain shortage or increased cost of using that suture, it’s helpful for the surgeon to understand that a different type of suture may not be as efficient,” Dr. Mays explains.
Time commitments with value analysis
There are many ways to get involved in value analysis.
Dr. Mays has been active in value analysis at each of the three institutions she’s worked at, including during her multiyear fellowship. “I have been a quality officer with various job titles and responsibilities, including assessing product value,” she says. She has dedicated administrative time for quality-related matters. “Understanding cost and operations is a mere fraction of that time,” she adds.
Though Dr. Mays has a quality role in her institution, she does not feel a physician needs to have designated titles in the quality realm to be engaged in the value analysis process. Institutions often provide data to each physician regarding their own outcomes. Each doctor can use self-analysis to improve their own product utilization, and how that affects the bottom line.
Dr. Norton shares that her health system has woven value analysis into the standard work for governance at multiple levels, including departmental supervisory committees, systemwide service line meetings, systemwide pharmacy and therapeutics (P&T), and an executive-level committee which evaluates service line requests for high-cost items. “I’ve been involved at every level,” Dr. Norton explains.
“The background research completed by the value analysis and pharmacy teams is critical to the success of this work.”
A section chief at two hospitals, Dr. Wahrman is responsible for vetting colleagues’ requests within his specialty and trying to avoid duplication. The time involved varies. He usually spends about two to four hours per month engaged in various value analysis discussions, including pharmaceuticals, equipment and supplies. “Sometimes there’s an up-front investment needed to have conversations with outliers about their usage or to set up a gatekeeper for certain items. Once that process gets going, the time required to review compliance goes way down,” Dr. Wahrman shares.
For physician executives, value analysis is imperative
Physician executives should expect value analysis as part of their portfolio. Dr. Norton participates in a small, systemwide committee that serves as the final adjudicator for controversial decisions on high-cost items. “We review the available evidence on medical effectiveness as well as a cost-benefit analysis for each item. We also consider appeals when new information becomes available,” she says. She is also chair of her system’s P&T committee, which performs the same work for high-cost pharmaceuticals.
Dr. Norton enjoys facilitating discussions regarding the available evidence leading to a product consensus that everyone can live with. “It’s also important to involve medical directors to be the gatekeepers for high-cost items in their area. This allows us to have accountability for adhering to our guidelines for when these items may be used,” says Dr. Norton.Share Email