The average ASC spends $549,000 per operating room on drugs and medical supplies, accounting for nearly one-fourth of facility net revenue each year, according to VMG Health's 2018 Multi-Specialty ASC Benchmarking Study.
Despite the substantial amount of money devoted to inventory, ASC and surgical hospital staff rarely receive supply management training, according to Cardinal Health Senior Consultant Marvella Thomas, RN.
Due to their limited resources, ambulatory practices face a myriad of logistical challenges, such as inefficient delivery schedules, stocking locations and manual processes. During a Feb. 12 webinar sponsored by Cardinal Health and hosted by Becker's ASC Review, Ms. Thomas discussed and proposed solutions to three additional inventory hurdles:
1. Lease restrictions and rental costs. Smaller ambulatory facilities may not have a dock or receiving area, leaving deliveries to be made in a parking lot where supplies could be exposed to bad weather conditions, Ms. Thomas said. Additionally, receiving doors may not be wide enough to accept a pallet, or facilities may receive supplies in a public hallway.
Ms. Thomas said she frequently sees practices using OR suites as equipment storage rooms, which creates a major problem when the space is needed for procedures.
Practices may be tempted to rent additional space or expand an existing facility, but lease restrictions and expansion-related costs pose barriers to doing so. Before making space modifications, Ms. Thomas said, surgery centers should try to maximize what they have. Creating extra space can drive costs up while driving profits down, especially if it's devoted to non-revenue producing tasks such as storage, she noted.
ASCs struggling with physical constraints should consider adding outside storage space such as freestanding storage buildings, which can store bulk supplies and infrequently used equipment.
Practices can also consider investing in a secure external locker where items can be placed even when a facility is closed. Offered in various sizes, these lockers can be a convenient solution for facilities with crowded parking lots that could benefit from after-hours deliveries. These lockers ensure the supplies providers need are there when they arrive in the morning, according to Ms. Thomas. "No more wondering when your truck's going to arrive," she said.
For ASCs with a small or nonexistent receiving area, Ms. Thomas suggested adding a canopy over part of the parking lot or receiving door to protect shipments from poor weather. However, it's important for facilities to contact their leasing agent or building owner before making these changes.
2. Obsolescence of equipment and supplies. When ASCs do decide to pay for additional storage space, it's critical to evaluate what items are being kept there. Ms. Thomas recalled visiting a facility's two off-site rental storage units and finding obsolete equipment such as broken furniture and half-empty cans of paint.
Microscopes, lasers, broken machines and trays of unneeded instruments may be taking up space on-site as well. Ms. Thomas advised ASCs to look for items left behind by physicians who no longer practice at the facility, or equipment used for specialty services the facility no longer provides.
To tackle equipment obsolescence, practices can sell unexpired, obsolete or broken equipment to companies that will refurbish and resell the items, Ms. Thomas said. Other solutions include loaning the equipment — which works well for facilities that are members of a group — or donating it, provided there aren't legal barriers pertaining to the supplies.
However, the majority of items should be thrown away, according to Ms. Thomas. "If it needs to go, let it go. The important thing is to stop storing it — you're wasting both space and the money to rent that space," she said. "We all know how valuable and critical space is in our ambulatory world."
3. Unit-of-measure and case quantity restrictions. Distributors may require facilities to order a specific unit of measure, which creates higher inventory-carrying costs and wastes storage space. Supplies may also be shipped in multiple, inefficiently packed cases, leaving facilities to store corrugated waste until it can be properly discarded.
Practices can address these issues by asking their distributor about different purchasing options, reconfiguring kits to maximize space inside cases and sending back any shipments made in error.
"The goal is to make sure you're purchasing as closely as possible to what you're actually using," Ms. Thomas said.
Maximizing space, eliminating excess inventory and negotiating with vendors can improve efficiency, patient safety and performance, Ms. Thomas said. Although ASCs have limited resources, they can overcome logistical challenges one step at a time.
"It's that old [saying about] eating an elephant one small bite at a time. Start with one small area with whatever time you have — maybe between cases," Ms. Thomas said. "It's just a matter of maximizing the resources you have and the time you have available."