Brent Petty: Willing to walk a mile in a physician’s shoes

He is recognized for his work with the medical staff on technology, utilization and cost control

Brent Petty learned many things while managing shoe stores for the now-defunct Kinney Shoe Corp. “The hours were miserable – not for a family man,” says Petty, corporate supply chain director at Wellmont Health System, Kingsport, Tenn. “But I learned people skills and how to manage the customer.” Indeed, the shoe company’s founder, George Kinney, had built his company on superb customer service, good value and a dedication to entrepreneurship.

The lessons have served Petty well. “When I’m talking to a physician, sales rep, or one of our clinical departments, I keep in mind that they are our customers, and that’s the way we treat them.” In fact, it is Petty’s work with Wellmont’s medical staff on technology assessment, utilization and cost control that factored largely into his selection as Contracting Professional of the Year by the Journal of Healthcare Contracting.

Fortuitous NASCAR event
Born and raised in Abingdon, Va., Petty worked for Kinney for seven years. When the company shut down its regional stores, young Petty decided to take a summer off to regroup. As chance would have it, he met a hospital CFO through a friend at a NASCAR racing event, and the two got to talking about management skills and the supply chain, such as inventory management. “He told me he had a materials manager who was sick, and he asked if I could come over and help manage the inventory department at his small, 78-bed hospital,” recalls Petty, who cancelled his plans to take the summer off.

It was the start of a productive seven-year career with Brentwood, Tenn.-based Community Health System. And it was a baptism by fire. “There wasn’t a computer in the department,” he recalls. “So we got it automated and processes set up.”

Community Health offered Petty the nurturing, educational environment he needed in order to learn healthcare supply chain management. He stayed with the company until 2001, when he accepted a position as director of materials at Holston Valley Medical Center in Kingsport, Tenn., Wellmont’s largest facility.

Today, Wellmont is an IDN spanning northeastern Tennessee and southwestern Virginia, comprising eight full-service hospitals (one of them operated as a joint venture with Adventist Health System), three surgery centers, two outpatient imaging centers, three oncology centers, 22 physicians’ practices and more.

But in 2001, it was smaller and, at least from a materials perspective, not very integrated. Each facility did its own purchasing and materials management.
In 2006, when Wellmont’s leadership decided to consolidate and centralize the supply chain, they asked Petty to take on the job. He was appointed corporate director of supply chain.

Big job
Pulling all the facilities together was a big job, “more than you could take on internally,” says Petty. The IDN asked Atlanta, Ga.-based MedAssets for help.

“I’ve been with many GPOs, and MedAssets has made a huge difference to us,” he says. “If I had to summarize what they do, I would say they help us manage our business.”

MedAssets committed to keeping a regional director onsite at Wellmont. With that assistance, the IDN set about centralizing its supply chain, starting with implementation of an automated materials system. The IDN entered into a relationship with Pyxis® for management of both pharmacy and medical/surgical supplies. “Then we pulled all our people together,” says Petty. (Today, each acute-care facility has an operations manager and a stock room, but the central materials staff is physically located in a corporate office in Kingsport.)

Although Petty’s department handles contracting for the 22 physicians’ clinics, Wellmont has contracted with McKesson Medical-Surgical to distribute their supplies to them.

In 2009, Petty contracted with Cardinal Health to be its primary med/surg supplier. “Cardinal has taken the same position [as MedAssets] in helping us manage our business,” he says. “Anybody can show up and deliver a box. But can you walk around my building and tell me how I can do things differently?” Cardinal proved it could, and hence won the business.

Working with the medical staff
An ongoing initiative for Petty is his department’s work with Wellmont’s medical staff in the introduction and utilization of technology, both equipment and implantables. “Gaining the collaboration of our physicians is absolutely key to our success in the future,” he says. “One of the biggest challenges we face is new technology,” specifically balancing its cost with clinical outcomes and reimbursement.

“We take pride in our adoption of cutting edge technology,” he continues. While Wellmont might not be into “bleeding edge” technology, “we’re on the left side of the bell curve in terms of equipment and patient care technology, such as pacemakers and orthopedic hips,” he says.

“When I used to do my presentations, I would draw a triangle, with the physician, manufacturer and hospital being at each point. Now I draw a square – with the physician, manufacturer, hospital and payer at each corner. How much we get paid for procedures is at the forefront today.”

Wellmont has instituted an efficient new-technology process, says Petty. A New Technology Review Committee, co-chaired by Petty and a physician, oversee the process (though Petty himself doesn’t get a vote). “Every piece of new technology must have a physician sponsor, regardless of how the physician learned of it – at a trade show, through a sales rep, in a magazine.” The physician is asked to document why he or she wants or needs the technology. The manufacturer of the equipment (or implantable) is asked to fill out a form with more details about it. Petty’s department weighs in as well, researching the cost of the technology, potential reimbursement, and a study of what the technology would replace at Wellmont.

“All the voting members are physicians,” one from each subspecialty, says Petty. “It’s interesting to watch them talk amongst each other. To see a cardiologist question a neurosurgeon about a brain stent, or to see one orthopedic surgeon ask another if this new knee is really different. It’s peer review. Clinical efficacy is always determined first,” but supply chain ramifications are also a factor.

Today, Petty meets with the key medical specialties on a regular basis. “A lot of the thunder of what I’m doing with my physicians is what I was trained to do by MedAssets,” he says. For a period of time after he came on as corporate director, MedAssets was with him virtually every day as he navigated his way through the physician-preference thickets. “But I’m confident now when I stand up and speak to a group of physicians.”

Self-taught
In addition to all the training and support Petty has received from MedAssets, he has picked up a few valuable lessons on his own. And some of them from the most unlikely places.

For example, he recalls watching a television show one evening. In the show, an infant is brought to the ER with a respiratory problem; he’s turning blue. The mother is panicking, but the doctor tells her to be calm, because the baby is getting enough air to breathe. The doctor orders a blood gas test. Respiratory therapy draws blood, takes it upstairs for testing, then comes back to the ER with the bad news that the sample had been contaminated, and that more blood would have to be drawn. Still the doctor is reluctant to take action. “Aren’t you going to do anything about my baby?” the mother asks her. After blood is drawn a second time, the doctor follows the respiratory therapist to the lab and waits for the results. As they are printed out on the tape, the doctor says to the respiratory therapist, “Don’t give me the printout, just read me the results.”

“Then it clicked with me,” says Petty. “The doctor does nothing until she gets the data. You have a baby turning blue, but doctors react to data.”

That’s when Petty began what he calls his “data push,” that is, providing physicians with volumes of data about new technology, about their own utilization of it, reimbursement, etc.

But soon it was time for Lesson No. 2. “I was publishing 1-inch-thick binders for our physicians every month, but I kept finding them unopened,” Petty recalls. “I was at a nurses’ station one day, and I watched the different doctors working. They would pick up the patient’s chart – this is before we went electronic – and read the lab results. Those results are one page, with results on one side, values on the other. Then they see the patient.

“And it dawned on me: My data has to be simple, measurable and repeatable. And I learned that by watching the doctors look at patients’ charts.” So now, Petty’s reports for Wellmont physicians are all of one page. Surgeons receive reports listing the implants they use, their cost, reimbursement, length-of-stay, payer, etc. At the meetings, Petty displays information on a screen for all the doctors to see, so they can compare their performance with their peers.
The physicians have come to rely on the reports, says Petty. Recently, due to a family illness, he was unable to distribute the monthly reports. “I got a call from one of the surgeons asking me, ‘Where’s my data? Did I improve last month?’”

Future of technology
“Technology is moving quickly, but reimbursement is going down,” says Petty. “Balancing our margins against clinical outcomes is one of the toughest challenges we face.” Obtaining the best price is a good start, but it’s only a start, he says.

“With new technology, we have to ask, ‘Is there truly a clinical difference?’ I have looked at my physicians and asked, ‘Is this technology truly different? If so, how much is it worth?’ For the first couple of years, they would say, ‘That’s an unfair question; I can’t put a dollar value to the benefit.’” Today, they’re at least trying. “And that gives me huge leverage with vendors,” says Petty.