Whether you use automated supply software or rely on pencil-and-paper recordkeeping, here are three rules to follow to get the most out of your preference cards.

1. Prune your cards by following the 80/20 rule
When was the last time you blew the dust off the preference card file to see which supplies should actually be on each surgeon's card? Has it been more than a few months? That's too long. Inaccurate preference cards could be costing your center thousands in lost charges. You may even be using outdated preference cards to case cost. Nothing's worse than planning for budget surpluses when in reality that plan is putting you in a whole before a single incision is made.

Perhaps you've adopted the time-honored tradition of requiring physicians to perform annual reviews of their preference cards. Do you realize how much billing you could lose in the 11 months until the next review? Plus, with all the reports your surgeons must see and sign, how much time do you think they spend ensuring the accuracy of their preference cards? I would bet that fewer surgeons actually know what's on their preference cards than those who do.

It's your job to know. Determine the top 10 procedures performed at your center, review those cases' preference cards and apply the 80/20 rule. If an item is used less than 20 percent of the time, it should be removed from the card. Why? Time is money, and the minutes wasted in pulling and returning unused items to stock has to be considered a cost — not to mention the small risk of compromising the sterility of items that are handled unnecessarily. On the flip side, you also need to monitor and add items to preference cards that are requested more than 20 percent of the time the procedure is performed.

Make copies or print out each surgeon's preference card, give them to your circulators or surgical techs and have them note all unused items as well as supplies added to a procedure that aren't on the card. Look over these reports from your frontline staff quarterly instead of relying on your physicians to report their own supply usage. You'll be able to spot trends that will dictate changes in the supplies you should include — and those you shouldn't — on preference cards for future cases.

2. Standardize your preference cards
Variety can be costly. I recently visited a surgery center where one surgeon had preference cards that read like novels — long novels. If he actually used each listed supply, his case costs would average $200 more than his colleagues' for identical procedures. The surgeon readily admitted that he simply wanted to guarantee that everything he could possibly need was available in the OR. I know of another surgeon who demanded that four expensive suture packs be on his field, even though he never used them all. To make matters worse, his center didn't reprocess open and unused suture. This suture snafu was costing them close to an additional $100 per case. And I cringe when I hear about a surgery center that contacts the town's main hospital when preparing to host a new surgeon's orthopedic cases. The center's staff wants to get him everything he needs — that much I understand. But I can't fathom that the surgery center would receive the doc's preference card from the hospital and immediately order the same supplies.

Trust me, it happens. And it's not the best plan. It's possible that the center has just committed to ordering new suture, new and expensive surgical gloves, a specialized wound dressing and a new type of patient positioning device that the staff has never even heard of. The time spent researching these products, finding the space for storing them and sorting through three types of the same supply is not the best use of anyone's time. All that fuss also costs the facility money.

When you start a new procedure or add a new doctor, feel free to call the hospital for his preference card. But instead of a knee-jerk ordering of supplies driven by a desire to please the new surgeon, study the card and match his requests with similar items that you already stock.

Let's say a surgeon's preference card calls for size 8.5 gloves from a specific manufacturer, but you already stock that glove size in a different brand. I'd create the preference card using your gloves. Some other common products that can be easily swapped include surgical dressings, syringes and suture. And remember, standardizing your stock may help your facility qualify for a volume discount with a single distributor. You can obtain these discounts when your usage of specific items meets a pre-determined volume level set by the manufacturer. Periodically review information provided by your GPO to see how and if each item you order qualifies.

One way to standardize your preference cards is to consolidate cards for similar procedures. I know that some of you scoff at the notion of achieving across-the-board agreement between physicians. Why not try to instigate a friendly competition to spark a consensus? Take the preference card for one surgeon's knee arthroscopy, price it out and come up with a total cost for his requested supplies. Do the same for the knee supplies of another doc. Then sit down with them both and share the findings, emphasizing the per-case costs of the more frugal surgeon. You'll be pleasantly surprised at how well this doc-versus-doc practice works in getting them to agree on the most cost-effective supply purchases.

Remember, surgeons will almost certainly argue with your recommendations if given the chance. Take the initiative and create surgeons' preference cards by substituting similar but less expensive items for their brands. Once you've completed the card, present the list in an offhanded way, saying something like, "I've finalized your preference card, can you look it over and initial right here?" Ask for forgiveness instead of permission. More often than not, the doc will agree with your choice.

3. Sell your surgeons on what's already in your supply room
It's easy to tell when a surgeon has attended a conference. The phone starts to ring and unexpected sales reps begin to show. They tell you just how badly your surgeon needs the company's latest and greatest. It's possible that your surgeon might be truly interested. It's more likely that he simply stopped by the company's booth while wandering the conference's expo hall. Still, the rep does a great job of selling you on your surgeon's needs, right?

You too can create that sales rep buzz for the items you already stock. Many surgeons can be easily sold on your in-house supplies if you take the time to develop a strong presentation. Ask for your staff's feedback on items you want to showcase; the nurses and techs that use the supplies on a daily basis will inform you of the features you need to highlight. Record their thoughts, add them to a quick-reference sheet and use it to remember why the product is a must-have. You can also troll company Web sites for product brochures or fact sheets — both are sure to provide essential selling points.

After researching and preparing your pitch, perform a brief product demonstration for your new surgeons or for established surgeons starting new procedures at your center. Take one of those drapes out of its shiny package and describe it as a proud sales rep would. Commit to the role. Point out the cost savings when comparing the item to what the surgeon currently uses and extrapolate that number to reflect the annual savings that your center might realize.

While every surgeon is different, I find that my sales pitch is most effective at the end of the day. Perhaps I'm most successful then because the surgeons are tired, ready to go home and therefore more agreeable, but I'd like to think my technique is a key factor. Regardless of the hows and whys, I'll take every soft sell I can get.

Does this scenario sound familiar?
Shelly has been scrubbing cases since W.'s dad held office. She can pull supplies with her eyes closed and recite your physicians' preferences on command. Her experience may seem like a great asset — and it is in most ways — but her ability to go without preference cards hampers your billing department, which needs to reference up-to-date cards to accurately capture and code case charges. Your bottom line: There's yet another reason to tend to your preference cards.