Business Advisor: Bridging the Supply Chain Gap

Use clinical evidence to achieve consensus about which products to buy.

A thorough and well-meaning ASC administrator purchases a new product for their OR only after they read a study about it that notes stellar outcomes. While the administrator can feel as though they did their due diligence, things can go south in a hurry if they weren’t careful. For example, if they later found out that the data was from a poorly-constructed, retrospective study that included just a few patients, all of whom were treated at inpatient surgical facilities, it won’t be surprising if the new product doesn’t perform up to expectations.

That’s where ECRI can assist. We help our members bridge the gap that can exist within facilities between physicians and the supply chain folks as important new purchasing decisions are made. Facility leaders want to make sure that people selling them products aren’t moving the target in terms of how a product is being marketed versus what the data about it actually says.

Marketing vs. reality

Vetting those potential gaps is part of the evidence assessment process, which at its core focuses on patient outcomes. The critical question and focus of assessment is whether the new item will provide better outcomes for patients compared with the alternative options. We also have price benchmarking tools and can look at a product’s market share and the recent prices that were paid for it. Fortunately, the process often allows us to help facilities make the best clinical choices and enjoy cost savings as well.

A classic example is the overuse of antibiotic bone cement, which is much more expensive than regular bone cement, for patients undergoing joint replacement surgery. Antibiotic cement is appropriate for high-risk patients and revision surgeries, but many facilities waste money by broadly using it in scenarios where it will not deliver lower infection rates than standard bone cement. When we use evidence to support purchasing decisions, we look at patient outcomes and how they compare to those of similar treatments for a particular condition. In the case of bone cement, we can determine that the regular type is safe and effective for most knee or hip arthroplasties and that antibiotic-infused cement provides no additional benefits to average-risk patients undergoing joint replacement. But for those undergoing a revision, the evidence indicates that the antibiotic cement improves patient outcomes. Knowing what the evidence shows allows you to strategically plan to achieve good outcomes at a lower cost.

Systematic vetting help

We use our training and bandwidth, which doesn’t exist in the supply chain environment for ASCs, to systematically vet the key factors a surgery center should consider. After an ASC has an internal consensus discussion about an item, we pull from all our databases to research it. We pull prices paid by region to make sure they don’t overpay. Our device evaluation team will have information on its usability if we’ve tested it in our lab. Then our evidence team will look at all the clinical trial data from peer-reviewed published studies. On top of that, we provide unbiased consultative services about the ultimate purchase that include reporting whether there have been alerts, hazards or recalls about the item, the conditions of its approval or clearance by FDA, and whether the intent is to use the item for its approved indication or an off-label application.

Making evidence-based purchasing decisions has come a long way.

Sometimes we’re contacted after a facility has conducted a value analysis or discussed the potential purchase in its technology assessment committee. Other times a physician wants a particular item and they want to know everything about it before they decide to buy it in a week or a month. We assist in either instance, be it if the facility has a proactive and robust process or when they’re reacting to an enthusiastic surgeon returning from a vendor’s new product expo. In each case, our ability to pull all the relevant data in a few days is immensely better than relying solely on a vendor-issued white paper or a haphazard PubMed search.

The information we can provide is particularly important in the climate of supply chain disruptions that have taken place over the last three years. Independently researching something new is the last thing on the supply chain team’s mind, as they’re focused on finding immediate substitutes for items that are on backorder. Our input provides an extra unbiased layer of analysis that can prevent a facility from making important purchasing decisions based solely on information from vendors or physician preference. Considering the evidence results in cost savings and improved outcomes that those approaches often do not.

Using evidence to support purchasing decisions has come a long way. ECRI has performed evidence assessment for over 30 years, and our original clients were third-party payers who needed to understand clinical evidence in order to author better coverage policies. Today, health systems and facilities also join us because safe, quality, cost-effective care are standard components of every decision they make. Today, that support is more important than ever. In fact, supply chain disruptions made our list of top patient concerns in 2021 and 2022. Adopting evidence-based assessments of medical devices and supplies can help you prevent or reduce waste that can be even more damaging when your ability to get the supplies you need is already subject to significant delays. OSM