How supply chain and clinical alignment plays an important role in outcomes.
By Graham Garrison and Daniel Beaird
Photography credit: Cleveland Clinic
Newsweek’s World’s Best Specialized Hospitals 2023 ranked Cleveland Clinic No. 1 in the world for cardiac surgery and cardiology and among the top hospitals in the world for specialized care. It’s the second consecutive year Cleveland Clinic was ranked No. 1 for cardiac surgery. Newsweek’s rankings, according to the weekly news magazine, help those in need of care “to know which hospitals or state-of-the-art facilities have the most accomplished physicians and diagnosticians, and offer the highest level of care.”
Brian Jones is the senior director of the clinical sourcing team and physician preference items (PPI) for Cleveland Clinic. His team is tasked to be the subject matter experts within those specialized areas and to lead all initiatives and manage contracts for them. After witnessing some of the challenges surrounding PPE during the pandemic, Cleveland Clinic segmented its teams into the PPI side and the commodity side. Jones leads a director of capital and a director of ORs, and he’s also the director of the heart, vascular anesthesia and respiratory teams on the PPI side.
Physician requests
“When a request comes in from a physician, supply chain takes that work and that new product, and does all of the comparisons,” Jones said. “We identify what’s currently being utilized and if it’s a brand-new procedure, we identify if there’s reimbursement and get all of those details. We package that for our clinical leadership review and that goes to the service line leaders, administrators and budget owners so we can look at all of those inputs.”
The physician is brought in for a presentation to walk through the strategy for the device’s utilization. At that time, it’s either approved for a three- to six-month trial to measure outcomes or it’s approved for permanent use with guardrails and guidelines associated with the type of patient for use and the data used for value measures. Or the device could be denied or approved for permanent use.
“In each of our service lines, we have established committees,” Jones said. “So, in GI, endoscopy and endovascular, for example, we have committees that those requests flow through. So, it gets to the appropriates users who truly understand the devices and they’re the ones making the decisions.”
Jones’ team sits on about 15 committees to help facilitate these discussions. He says the support from the top – at the institute chair level – is the key to success at Cleveland Clinic with specialized care areas. That support gives them the confidence to see projects through and to speak up at staff meetings.
“Good, clear dialogue and everyone respecting each other’s opinions and relying on the facts and the data in front of them has been successful for cost savings and engagement,” he said.
The Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute
Jones is excited about the work being done within Cleveland Clinic’s Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute because it’s new and different.
“It’s not just the project work of which supplier are we going to award what, but it’s within a portfolio of how we reduce cost within a type of procedure, without compromising the quality of patient care” he said. “It’s identifying cost per case by surgeon on similar procedures and what are the outliers. That’s helping drive some of the initiatives around waste management, utilization and appropriate use criteria.”
A clinical leader will identify two or more individuals within their clinical institute to collaborate with supply chain to help build out teams and opportunities to vet products. The group meets regularly to review standardization opportunities, appropriate use criteria, guidelines, waste reduction and cost reduction, while prioritizing patient safety and quality care.
The heart, vascular and thoracic team has identified key champions this year and Jones notes the level of engagement and excitement among the staff is appealing to work with. “I put out the monthly numbers for them and they’re enjoying it,” he said. “It’s a bit different. They still have their day jobs but they like the collaboration and working through some of these opportunities.”
Patients travel from all 50 states and 136 countries to the Heart, Vascular & Thoracic Institute for expert care and exceptional outcomes. It’s home to many of the world’s best physicians practicing cardiovascular medicine and surgery. In 2021, Cleveland Clinic cared for 786,871 patients at its main campus in Cleveland, Ohio. It has received the highest overall composite score star rating – 3 of 3 stars, a rating that reflects better than expected outcomes in each category – in all Society of Thoracic Surgeons (STS) cardiac and thoracic star rated categories:
- Isolated coronary artery bypass (CAB)
- Isolated aortic valve replacement (AVR)
- Aortic valve replacement with coronary artery bypass (AVR+CAB)
- Mitral valve repair and replacement (MVRR+CAB)
- Transcatheter aortic valve replacement (TAVR)
- Lobectomy for lung cancer
- Pulmonary for lung cancer
- Esophagectomy for esophageal cancer
Surgical outcomes are grouped by disease umbrella. This brings together the teams that focus on specific disease processes led by an umbrella director. The structure supports the investigation of these disease processes and the tracking of outcomes of innovations in care delivery.
“We have five supply chain medical directors, and they carve out a portion of their time to assist in supply chain challenges,” Jones said. “If we have a disruption or need to identify an alternative, the first person we go to is our supply chain medical director to start vetting it and understanding if it’s accurate and appropriate.”
Jones says they vet many of their presentations around standardization or cost opportunity through the supply chain medical directors before large committee meetings. “They play a very important role in bridging the supply chain side to the clinical side,” he said.
A savings tracker: average utilization, appropriate use criteria and more
Each month, Jones’ team puts together a savings tracker. It covers the average utilization of a device and the appropriate use criteria that is built in.
“That’s level setting for every meeting we have with our physicians,” he said. “No decisions made by the group are to ever impact the quality of care of our patients. That gives them the breathing room to say, this isn’t just about reducing costs, but it’s maintaining the highest level of quality and finding areas of opportunity where we didn’t have the awareness of price variations. But now we do, and we can make informed decisions of what to utilize.”
Jones says the physicians want to be good stewards and it’s his team’s job to educate them on the differences in price, for example, if a supplier has three generations of devices.
“They don’t know that, so it’s our job to educate and create awareness in these committees and groups in order to identify when it’s appropriate to use the most expensive widget,” he said. “That’s what we’re working on and tracking savings that way.”
Ready to go
Clinical leaders at Cleveland Clinic educate the supply chain side too. “It’s incredible to hear them go around the table discussing different devices. A lot of people would like to hear that. They are amazing surgeons and educators who are always willing to work with us and teach us as well,” Jones said.
The clinical side is very busy in their practices and the biggest challenge for the supply chain side is just finding time to work with them. It’s about being available at 6:30 a.m. before their OR times or when they’re done at 5 p.m. or 6 p.m. Jones’ team stresses being ready when the clinical side is available.
“It’s ensuring that we’re ready to go, we have all of the information and that it’s good, clean, accurate, understandable and actionable, and we can share it in a short amount of time,” he said. “If we fail there, it’s going to be much more difficult to get that access again. So, let’s be prepared.”