Common Ground

Engaging Physicians in the Supply Chain Process Pays Dividends

Physicians, hospital administrators and supply chain professionals all desire to provide patients with high-value care based on quality outcomes and cost efficiency. Each group, however, has a different perspective on how to achieve that mission. This can sometimes lead to misunderstandings and disagreements.

Overcoming miscommunication and engaging physicians and surgeons in the supply chain decision-making process will take time, says John Young, M.D., MBA, chief medical officer for HealthTrust. “You have to build relationships, establish trust and demonstrate a willingness to be transparent with the information you have

and timelines you’re dealing with,” he says. “Decisions are often made on incomplete information, and the more transparent you can be with this process, the more likely the physicians will stay engaged.”

Building stronger, more transparent relationships always comes back to finding and articulating each side’s shared goals. “Everyone in healthcare is facing the same external forces around cost and quality,” Young adds. “That’s common ground for both physicians and supply chain professionals.”

The Advantages of Physician Involvement

Hospitals are turning their focus to cutting costs as healthcare continues its shift toward a value-based reimbursement model, in which claims are tied to quality of service. The supply chain process is one of the first areas hospital administrators examine. When the healthcare supply chain operates more efficiently, hospitals can create cost-saving opportunities throughout the entire organization. However, when the  supply chain decision-making process doesn’t include the physicians who have personal preferences about the products, tools and technologies they use, cost-saving efforts can be jeopardized.

“Every hospital system is unique, and there’s no single recipe to gain physicians’ cooperation,” explains Gregory Mishkel, M.D., MBA, FRCPC, FACC, executive medical director of the cardiovascular product line at Prairie Heart Institute of Illinois. “Perhaps it starts with the realization that physicians are more business-minded

than many hospital administrators give them credit for.”

At Prairie Heart, supply chain committees are made up of inventory management specialists and physicians from all areas of the cardiac service line (cath lab, electrophysiology, non-invasive and CV operating room), as well as a physician executive leader. When physicians or surgeons want to use a new product or device, they make a request to the committee. The committee then examines whether it’s a duplicate item, something novel or unique, or simply a more cost-efficient product.

“Using our product line committee with shared governance between physicians and hospital administrators, we have recovered about $1 million in the cost of implantable devices and reduced the cost of a percutaneous coronary intervention by more than $1,000 per procedure over the past two years,” says Mishkel, who serves as a HealthTrust Physician Advisor.

By keeping up with industry connections, reading the latest scientific literature and attending expositions at medical conferences, physicians typically have access to new technologies, devices or treatments while they’re in development, Mishkel explains. And, due to the less-regulated climate in Europe, much of what is new on the market is already in practice there, which provides a platform for determining its utility in the United States.

Leveraging physician awareness of promising treatments can be in the best interest of a hospital—if the decision-making structure is sufficiently strong. “Physician leaders could help identify truly promising technologies and collaboratively create roadmaps about the clinical proof points they need and the data that matters to hospital operators,” according to an article in Becker’s Hospital Review, co-written by Atiq Rehman, M.D., director of Robotic and Minimally Invasive Cardiac Surgery at Our Lady of Lourdes Medical Center; Michael Schlosser, M.D., FAANS, MBA, HCA National Group’s chief medical officer, and vice president of clinical excellence and surgical services; and Eugene Schneller, Ph.D., professor of supply chain management at W.P. Carey School of Business. “Although hospital employment of physicians has been associated with better supply chain performance, the fact remains that administrators still have to demonstrate the value of their initiatives and set up the right committee structure to drive standardization of care and products as well as manage the necessary utilization changes.”

Regularly scheduled committee meetings targeted to different specialties can help provide a clinical context and better understanding of the profitability of certain procedures, explains Genevieve Everett-Sigwalt, M.D., FHRS, director of cardiac electrophysiology at Johnstown, Pennsylvania-based Conemaugh Health System.

“When we have new technologies or products, we bring those to our scheduled meetings for discussion. These meetings are a good opportunity to interact with supply chain leaders. They are the ones negotiating with suppliers and making decisions about product purchases,” says Everett-Sigwalt, a HealthTrust Physician Advisor. “We have conversations about the device and its safety, efficacy and importance in clinical settings before we ever discuss the financial aspect.”

A technique used to treat atrial fibrillation is a prime example of the importance of looking at the total cost of a procedure—and including physicians in on the decision. As Everett-Sigwalt explains, there are two types of ablation procedures—cryoablation, which uses extreme cold to restore the normal heart rhythm, and radiofrequency ablation, which uses radioactive energy. Because the equipment and tools needed for a cryoablation are more expensive, it would seem to make sense not to purchase that technology at first glance.

“But, if something is truly a better technology or technique, it’s going to be a win-win for both physicians and supply chain,” she says. “With an atrial fibrillation cryoablation, the procedure time is much shorter, safety is improved, and patients don’t have as many repeat procedures or hospitalizations. In short, patients achieve excellent outcomes and require fewer future interventions. Better outcomes typically result in more savings.”

Mind the Gap

Although many physicians are cognizant of the pressures and challenges of rising healthcare costs, many often don’t believe their input is needed to make purchasing decisions. However, physician input can help supply chain executives better understand how products and tools are used in the clinical context, Mishkel says.

In what other ways can supply chain and hospital administration bridge the gap? Young, Mishkel and Everett-Sigwalt recommend the following:

1. Make it worth their time. Physicians are among the busiest people in the hospital, interacting and treating patients, performing surgeries or procedures, documenting notes on electronic health records, and conferring with staff members. If scheduling a physician meeting, make sure it’s about a specific topic. Trying to carve out time for a 30-minute or hour-long meeting can sometimes be a challenge, especially for physicians and surgeons who are doing the procedures and using the tools that need to be discussed. Keep in mind also that physicians are likely to stay engaged only if they participate in something that leads to significant change.

2. Focus on the data. Physicians respect data-driven exchanges. When presenting new products or technologies to physicians, present them with evidence-based studies and clinical data to gain their support.

3. Find common ground. Each institution needs to find creative ways of fostering alignment, cooperation and understanding. Find mechanisms that help align physician and supply chain interests, whether that’s a shared savings model or some other method.

4. Close the loop. While physicians are regularly asked to give their opinion about certain products or technologies, more often than not, they never learn of the final decision. It’s important for supply chain to close that communication loop. Explain to physicians why a decision was made one way or the other and the reasons behind that decision.

How HealthTrust Can Help

HealthTrust created its Physician Advisors Program to help bring together supply chain executives and physicians for mutually agreed upon goals. The program seeks physicians’ insights on clinical evidence reviews in categories that significantly impact patient care. HealthTrust’s more than 140 physician advisors help lead technology reviews, study and analyze drug and device utilization trends, and identify ways to better drive value for partners and members.

“Being a HealthTrust Physician Advisor has given me credibility within my own healthcare institution and introduced me to other physicians who share their own experiences, which I can learn from,” Mishkel says. “Through HealthTrust, I gain an objective overview of new technologies not available through industry sources.”

“HealthTrust continues to educate its physician advisors on the contracting process, the information and decisions our supply chain colleagues are faced with, and how collaboration improves not only the cost of care, but quality as well,” Young adds.

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