CONSTANT WATCH Never stop searching for cheaper supplies that don't compromise quality patient care.

I'm convinced most facility managers don't take the time to consider the not-so-obvious ways they could save money and eliminate wasteful spending. Sure, you might be thinking, I'll start looking for loose change in my spare time, right after the accreditation surveyor leaves, the surgeons stop griping and next month's staffing schedule is set. I'm an anesthesiologist and the medical director of a small surgery center, so I get that the amount of hats you wear outnumber the hours in a day, and the last person you want to hear from is someone who's threatening to make your to-do list even longer. But what if I told you that the following 7 creative solutions help save my facility between $50,000 and $100,000 a year. Do I have your attention now?

INSIDE INFORMATION Eugene Zamora, a surgical tech and materials manager at Bay Surgery Center in Oakland, keeps close watch on supply use in the OR.

Put a scrub tech in charge of supplies
If you don't have the time or patience to monitor supply usage in the OR, then you have no idea which items are actually being used during cases. You assume everyone has the supplies they need, but what you might not see is that the surgical team throws out half of the items contained in your procedure packs. Why are you paying for those items? And why isn't that kit customized? To save on supplies, you need input from someone who's in the OR on a daily basis. Why not make a trusted scrub tech your materials manager? No one is better positioned to know exactly which items are used during cases and which get routinely thrown away. That's the case at my facility, where surgical tech Eugene Zamora is also the materials manager in charge of tracking supplies, managing par levels and ordering. He assesses the contents of our custom packs on a monthly basis. Vendors make up the packs 2 to 3 months in advance, so it takes time for requested changes to reach the front line, but the constant reviews ensure changes are made as soon as possible and the packs only include essential supplies.

Post prices in the OR
Everyone on the surgical team should be aware of what supplies cost. If they know what your facility is spending on individual items, they might think twice about opening something if it's not needed or a less expensive option is available. Hang sheets in your ORs that list the costs of certain pricey supplies. The next time a surgeon wants to open a little-used supply — sutures, burrs or cautery tips, for example — a quick point by the surgical tech will remind him to check how much it will add to the case's expense. The surgeon might realize it's best to leave the item unopened on the case cart until it's truly needed.

Limit immediate-use steam sterilization
Medicare regulations state you can perform immediate-use steam sterilization only if an essential instrument is dropped on the floor during a procedure and is needed immediately in the same case. But do you realize that by decreasing the number of immediate-use cycles you run, you'll save on the cost of paper, water and electricity?

Several years ago, before the Medicare regulations went into effect, we had only 3 trays of instruments for hand cases. Following the first 3 procedures of the day, we'd rely on immediate-use sterilization to get the trays ready for subsequent cases. After building additional hand sets with loose instruments that had accumulated over the years, tracking which instruments were being flashed on a frequent basis and purchasing additional units of those items, and putting individual and rarely used instruments into seal packs until they're needed, our flashing rate went from 14% in 2013 to 0.8% at the end of 2015, which saved the facility $40,000 in staff time, supplies and resources.

We also invested in a relatively new sealed sterilization tray that is FDA-approved to run a full sterilization cycle in 10 to 15 minutes. Instead of waiting 45 minutes for a sterilization cycle to end, we have needed instrumentation back and ready for use in a fraction of the time. The tray's single-use paper and filters are a little more expensive than standard supplies, but turning around instruments quickly and effectively helps us avoid spending $15,000 to $20,000 on a new instrument set that we'd rarely need.

ALWAYS AWARE Review custom packs regularly to determine if the supplies they contain need to be updated.

Shop online
Have you ever reviewed how much your main supply vendor is charging for items that your surgical team rarely needs? Have you shopped around for alternate sources? At my facility, we don't use a lot of suture — maybe 1 or 2 per case — and saved thousands of dollars per year simply by shopping for it online, where you might find small companies that sell you identical supplies for 40% to 80% less than what the industry's big players are charging.

When shopping online, pull up the websites of at least 3 companies to compare pricing. The cost of one option might be more expensive at first glance, but take a few minutes to drill down further, because 2-for-1 discounts or limited-time offers could drop it below the prices of the others. The smaller companies are usually willing to ship items overnight and sell one-offs, which are extremely helpful when you're looking to save money on supplies that a low-volume surgeon requests.

See Dr. Durick Live at OR Excellence
Do you like what Dr. Durick has to say about thinking outside the box to trim expenses? Come to OR Excellence in Bonita Springs, Fla., from Oct. 12 to 14, where he'll lead an interactive workshop dedicated to discussing creative and practical cost-saving solutions. Register now at orexcellence.com.

Know your shipping costs
Instituting just-in-time par levels can keep inventory supply costs down, but you'll pay tens of thousands of dollars a year in shipping costs if you're constantly ordering supplies overnight to keep up with just-in-time inventory management. By always planning ahead and ordering supplies a week before they're needed, you'll spend $8 for standard ground shipping instead of $180 for overnight delivery.

Negotiating shipping costs is a potential source of big-time savings, even if you're not ordering supplies on an as-needed basis. Will your main supply vendor waive shipping fees in exchange for all the business you provide? If the vendor insists on charging, use the account your facility has with a delivery service such as FedEx if frequent use qualifies you for a volume discount.

Some vendors require certain items to be shipped overnight, because they have to be temperature-controlled in order to maintain sterility. If that's the case, perhaps you can negotiate a deal that covers those shipping costs. Our main vendor of orthopedic implants waives the price of overnight shipping if we pay by credit card at the time of ordering. That minor detail saves us around $800 on a shipment of $20,000 in hardware. We also have the option when ordering online to split up orders placed with the vendor, so we pay ground shipping for basic supplies that don't need to be sent overnight.

ON-THE-SPOT REMINDER Instrument tech Hubert Martinez checks the sheet that lists the costs of select surgical supplies used at Bay Surgery Center.

Get in the habit
Set aside a few minutes on specific days to review your facility's recent spending and identify cost-saving opportunities. For example, I order medications and irrigation fluids on Monday mornings, when warehouses are full and I'm more likely to secure the order at a reasonable price.

Know which supplies have to be sent overnight, which you'll get free shipping for if you pay by credit card and which you'll get at a discount if you pay within a certain time of placing the order. I've programmed my online calendar to send recurring reminders that alert me to pay invoices from our primary orthopedic vendor within 15 days to receive 3% off the invoice price. If there's a $30,000 purchase order sitting on my desk, that pop-up alert on my computer saves me $900.

Review your supply contracts to ensure the deals you worked so hard to negotiate don't expire. Our go-to contrast medication for pain management cases went off contract within our group purchasing organization, sending the price of 10 vials from $41 to $570. We use up to 100 bottles a month, so the facility could have paid an extra $5,000 per month if no one was monitoring that contact.

Play hardball with vendors
Stop negotiating with vendors. That's right, tell them exactly what you expect and give them one opportunity to name their best price. Vendors who drop their initial "best price" by 5% only after I tell them I've secured a better deal elsewhere have zero credibility in my eyes and will not get my business. I've taken my entire account away from a vendor who pulled that trick. Vendors know that I'm a person of my word, that I'll do business with them as long as they treat me fairly by providing great customer service and bottom-line pricing. That's the reputation you want to have, too. Work to establish an open and honest relationship with the vendors. If you tell an ortho rep that every anchor, plate and screw that's placed in your patients will come from his company, he's going to want to play ball by giving you the best possible deals.

Work with reps you trust, but don't ignore the fact that their ultimate goal is to get their products into your ORs. My hard-and-fast rule: Never pay for products that you didn't first approve for use. Five years ago, one of my podiatrists used an external fixation device a rep had brought in without my knowledge. You can imagine my surprise (and anger) when I received a $7,000 bill for the device, which was used in a case that paid $6,000. So now before doing business in my center, all vendors must sign an agreement that stipulates there are only 2 people who can sign a valid purchase order — the materials manager and me — whether it's for a single suture or an implant that costs thousands of dollars. If someone else's signature appears on a purchase order, I thank the rep for donating the product. OSM