Debugging supply chain-clinician partnerships requires transparency, tact and some finesse.
By R. Dana Barlow
Novmeber 2024 – The Journal of Healthcare Contracting
If you believe the stereotypes whispered throughout the underground crosspatch, you likely buy into the perceived love-hate relationship between physicians, surgeons and supply chain.
Physicians and surgeons love to hate supply chain because they argue that supply chain’s focus on cost savings can impede the level of patient care they seek to deliver.
Supply chain hates to love physicians and surgeons when clinicians collaborate and cooperate because it happens so infrequently as they try to balance financial operations with high-quality patient care.
The reality resides somewhere in the gray gulf in the middle where the needle vacillates between the black and red fringes of the balance sheet.
Some observations to bank on:
1. There are plenty of collaborative and cooperative physicians and surgeons who partner with supply chain.
2. There are plenty of supply chain professionals who have cultivated successful relationships with these physicians and surgeons who understand how to deliver business and clinical excellence.
3. If only there were a validated list of these professionals to poach and recruit for your organization.
How can you arrive at that point of clinical business nirvana (short of having access to “the list,” of course)?
Some supply chain leaders point to the well-worn mantra of “show them the data,” as others stress involving physicians and surgeons – where appropriate – in the decision-making process without entangling them in the weeds. In short, the successful strive for facilitation over “fascism,” so to speak, on either side even as many know that the mystery surrounding the balance between clinical and business decisions remains less a democracy, monarchy or republic and more a strategic alliance of “frenemies” to operate within a “payorocracy.”
Yet, these recommendations serve more as workplace meds applied to symptoms. In fact, inoculation to prevent these attitudes from developing may be necessary.
What if training could start in medical school to prepare physicians and surgeons for the business and market dynamics of practicing medicine, which includes supply chain?
“Medical students and residents get little – if any – education about supplies, cost or value as part of their traditional training,” indicated Stacy Brethauer, MD, MBA, Professor of Surgery, Vice Chair of Quality and Patient Safety, Department of Surgery, Medical Director, Supply Chain Management, The Ohio State University Wexner Medical Center. “Graduate medical education, medical schools and health systems can do a much better job preparing their faculty for this kind of work, so they are prepared to participate in the business of medicine. Offering courses, seminars or lectures to those audiences is a start but ultimately, it should become a core part of these curricula.”
Anand Joshi, MD, MBA, Senior Vice President, Procurement and Strategic Sourcing, New York-Presbyterian Hospital, acknowledges a larger void.
“Overall, there is a general gap or deficit in what I would describe as systems and operations training in medical school for what happens after medical school,” he noted. “Supply chain would just be the tip of the iceberg in terms of the things that medical students are not educated on during the course of their medical school career that are critically important for actually being a practicing physician in a hospital setting. I think there actually is a gap.
“In some ways it’s unclear that that gap necessarily needs to be filled in medical school,” Joshi continued. “It could certainly be filled increasingly in residency programs. I believe in the curriculum of the ACGME, the certification and accreditation council for residency and fellowship programs, is placing a greater emphasis on systems learning – not necessarily specific to supply chain, but more broadly. What does quality look like within a large healthcare organization? What do supply chain and finance look like? This type of training is probably better suited in the residency years than in medical school. In medical school, you’re still many years from being your own independent physician who’s asking for new stuff.“
Maybe it’s time to update medical school curricula, according to Jimmy Chung, MD, MBA, FACS, FABQAURP, CMRP, Chief Medical Officer, Advantus Health Partners and Bon Secours Mercy Health.
“Ideally, we would begin by redefining what medical practice is all about,” he said. “We need to teach that healthcare is a team sport and that we have to be mindful of resources and affordability. Maybe things are different now, but when I was in medical school, talking about finance was frowned upon because that was for the administrators to worry about, and our job was to deliver the best care possible. Medicine is not an art; we can’t leave care delivery to be creatively determined by the individual physician. It has always been a paradox to me that doctors are scientists by (self-selected) nature, but then we allow them to practice according to individual desires instead of scientific methods.”
Capitulation or some type of coerced collaboration might be options. Yet, how much sense does it make to give the physician or surgeon what he or she wants because they’ve trained on a particular product and are comfortable with that product, which likely translates into patient safety because the surgeon doesn’t have to learn about a new product?
Ohio State Wexner Medical Center’s Brethauer urges caution and careful consideration.
“That is always a consideration, particularly in specialties like orthopedics and spine surgery,” he noted. “Our contracts never require 100% compliance with the vendors that are chosen, so if we are 80% committed to specific vendors, we sometimes allow a new physician to use what they were trained on as part of the remaining 20% spend. If their spend starts to impact our current commitments, though, we work with them to start using on-contract devices as much as possible for certain cases.
“If adding a device for a new physician isn’t an option, we leverage our current faculty and vendors to get them trained and comfortable with the devices on contract and invite them to participate in our sourcing process when that contract is over,” Brethauer continued. “All of the devices are FDA-approved, used by thousands of surgeons, are safe and provide good outcomes. It’s usually just some nuance in using the products that requires a short learning curve, and we support them through that transition if needed.”
If selected products are deemed to have clinical equivalency in terms of basic operation, then how much sense does it make to tell the surgeon that the organization is only willing to pay a certain amount for the “non-contract” product (based on the “contract” price negotiated) so if the surgeon wants that product the surgeon will have to pay the difference personally?
“We can’t hold the surgeon personally responsible for adding cost to the system,” Brethauer countered. “In private practice, that may be different, but it’s not possible in a large academic medical center with salaried or contracted surgeons. We do work with surgeon groups to capitate prices if we can’t agree on a single or dual vendor contract. If the group feels we need to have four vendors for a specific service line, we set prices that the vendors must meet in order to get their product on the shelf, and this strategy has been effective, particularly when the surgeon gets involved in the negotiations and is willing to stop using their product if they don’t come in at our price point.”
Ultimately, this shouldn’t be about nursing frenemies but articulating teamwork united by a common cause.
R. Dana Barlow serves as a senior writer and columnist for The Journal of Healthcare Contracting. Barlow has nearly four decades of journalistic experience and has covered healthcare supply chain issues for more than 30 years. He can be reached at rickdanabarlow@wingfootmedia.biz.