DO THE MATH Surgeons need to know how much their top-volume procedures cost your facility.

You can literally save your facility tens of thousands of dollars by switching out expensive surgical supplies for more economic options that will achieve the same clinical results. To do so, however, you must calculate your case costs for your highest-volume and highest-cost procedures, and then find affordable alternatives for high-priced items.

Case costing is hard work, but the results can be dramatic. We've lowered our case costs on laparoscopic appendectomies between last year and this year from $791 to $731. For laparoscopic cholecystectomies, we've dropped our case costs from $523 to $444. Here's how we saved:

• $296 per case. Only using the harmonic scalpel for complex cases.
• $165 per case. Substituting a reusable clip applier for disposable clips.
• $136 per case. Switching stapling devices.
• $121 per case. Reducing the use of closure kits.

Case costing requires dedication, hard work and constant communication with surgeons. Here's practical advice for getting there.

1. Drill down
You and your surgeons — especially your surgeons — need actual data to make the case for case costing. Surgeons are scientists who base their decisions on facts, not hearsay. Presenting black-and-white arguments to docs for reducing supply expenses is difficult. It's not that most managers and directors don't want to track supply expenses; they just might not have the tools to do it efficiently and effectively. You're in luck if you work with a robust finance system that can pull case costs for specific specialties and surgeons. If you don't, find a tool and a process that will let you drill down to the needed information.

Attack the 5 highest-volume procedures, regardless of which specialty they fall under, in order to compare costs between surgeons and procedures. Huddle with surgical services senior leadership to comb through the cost-per-case data and decide which numbers to present to surgeons during monthly meetings.

Then meet with surgeons as a group to show them how their individual case costs compare across the top 5 procedures. Break the data out to show high-cost surgeons the products that inflate their per-case expenses.

2. Make the case
Don't dictate that surgeons reduce their case costs — give them the data so they can change their behaviors. We've found that holding an ultimatum over their heads is counterproductive. Instead, present the numbers and put the onus on them to determine the range they want their case costs to fall into. Surgeons who decide what case costs are acceptable are more likely to make change happen. Tell them they're competing for cases, and as healthcare reform settles into reality, patients will seek out surgeons who achieve the best outcomes with the lowest costs.

You'll find that most surgeons who are presented with the cold hard facts will self-correct costly habits by clearing their preference cards of the toys that make surgery easier, but not necessarily better.

That's not to say there won't be outliers. One of our surgeons promised to consolidate several expensive supplies into one, but still hasn't. When we meet with his group of surgeons again, he won't be told to change, but he and his colleagues will be shown the disappointing numbers.

Many surgeons are unaware they use costly supplies, which is another benefit of presenting them with specific case-cost data. For example, one of our surgeons used a $27,606 mesh during 2 hernia repairs. He thought it was the best option at the time, but in fact there were less costly alternatives that would have achieved the same clinical results. He was way off the charts in his average costs-per-case because of using that mesh, and immediately decided to find another type to use.

3. Stay current
Constantly monitor case-cost data. We used to review the numbers only occasionally — if a surgeon inquired about how much he was spending on a particular surgery, it took months to pull the numbers — which isn't enough to recognize costly trends and act on them before they turn budgets red.

Create monthly spreadsheets to note in separate columns the high-cost supplies, procedures in which they're used, average costs per case, action steps to replace the expensive items, next steps required to fulfill the action steps and the ultimate cost-saving results.

My business director prepares case-cost data on a monthly basis, which our surgical nurse managers check periodically for opportunities to save. They also review preference cards on their own and bring cost-saving ideas to the meeting of the surgical services leaders, so we can let the surgeons know which items they should consider replacing.

Focus on shaving 5% of a case's cost, then 10%. When you achieve those goals, drill deeper to see what else you can trim, until you can't trim anymore. Don't ignore a case once you've reduced its costs. Closely monitor the situation to ensure expenses don't start to creep slowly back up to negate all the hard work you put in on the front end.

Aim to reduce case costs while maintaining excellent surgical care. It's exciting to work with surgeons who are sincerely willing to make economical choices, but keep in mind that they can't fix what they don't know. Case costing will spark momentum: The more data you give surgeons, the more they'll want.

ACTION PLAN
How to Measure Cost Per Case

LESS COSTLY ALTERNATIVES? Pick your high-volume, high-cost procedures, and examine the cost of each supply for each surgeon.

• Identify the 5 highest-volume and the 5 highest-cost procedures for each service line.
• Identify the surgeons and their direct supply costs per case within each of the high-volume and high-cost procedures.
• Identify the higher-cost supplies within each of the procedures and compare surgeon usage.
• Examine choice and use of items on preference cards for surgeons with higher direct supply costs per case within each of the procedures.
• Compare vendor use for supplies among surgeons to look for opportunities to standardize.

— Susan Comp, RN, BSN, MHA