EDs recoup over $480,000 improving supply charging
At Deaconness Hospital in Evansville, IN, the ED was losing about $60,000 per month on lost charges for supplies. Does this sound familiar?
Here are the strategies they used to recoup more than $480,000 a year:
• Switch to a computerized charging system.
At Deaconess’ ED, supplies were removed from patient rooms and stored in a central supply room. When the patient’s name is pulled up on an electronic system (Par Replenish, manufactured by Cincinnati-based Par Excellence Systems), specific items are selected and then charged automatically. "We now charge about $1.5 million a month from that room," reports Donna Goebel, RN, BSN, an ED nurse at Deaconness.
Previously, nurses often took items from the patient rooms and forgot to charge for them, such as angiocaths, Foley catheters, oxygen nasal cannulas, and intravenous fluids. These items were typically charged as "floor stock" to the ED’s budget, instead of billing to individual patients, she reports.
Now, Goebel gets a printout of everything charged as floor stock and can go to specific nurses for more information if needed. "Previously, nurses would charge a tetanus shot to floor stock, or Valium for a patient having a seizure, because the patient wasn’t registered and we had no name to charge to," says Goebel. "We would eat those costs, and it was taken out of our budget."
Now, nurses document patient identifiers such as time and room, so that Goebel can figure out which patient should be charged later. The system has increased revenues about $480,000 annually, she reports.
• Give medications in unit doses.
Previously, multidose vials or containers were used for many common medications such as antacids, acetaminophen and ibuprofen elixirs, antiseptics, normal saline flush vials, antibiotic ointment, lidocaine and other local anesthetics, says Goebel. The problem is that these couldn’t be individually charged to patients, she says.
"These medications are now stored in unit dose containers so they can be charged to individual patients. This has increased our revenues about $500 a month," says Goebel.
• Let nurses know how much money is being lost.
To improve compliance at Deaconness, a monthly memo is sent out listing the most frequently missed items and how much they cost. The ED also held a contest for nurses to correctly match supplies with their costs, with dinner certificates given as prizes, says Goebel.
• Share savings with nurses.
Nurses at Deaconess’ ED benefit financially from increased revenues with the ED’s "Quality Share" program, which pays nurses twice yearly. "If we meet our satisfaction and compliance goals, and spend less than the amount we budgeted for, that money goes into a pool and is divided equally among the staff," says Goebel. "Full-time staff were recently paid $400 each."
• Standardize supplies for savings.
The ED has worked with central supply to choose less costly items and buy them in larger quantities, such as selecting cheaper wound adhesives, says Kathy Hendershot, RN, director of clinical operations for the ED at Clarian Health Partners in Indianapolis. "This way, we do not have duplicate product and can get good deals from vendors," she explains. If the products are equal in quality, then they look for the best deal. "Usually if you can get everyone in the hospital to buy the same product, you end up getting a better price per unit," Hendershot says.
She has worked closely with physicians to establish types of sutures and par levels for the ED. "We have saved thousands by doing this and then just monitoring the stock," she says. "We make sure sutures are available from central supply if needed, but only the high-demand suture is kept in the department as part of our inventory."
ED physicians were asked what sutures they used 80% of the time and asked what sutures they thought should be stocked in addition to those, says Hendershot. "We then compared the costs and worked to get a very manageable number of sutures," she says. Suture inventory was reduced by 30%, she reports. Hendershot also recommends evaluating casting material, orthopedics products, disposable trays, and duplicate cervical collars. "It can be a challenge to get the physicians to agree on something as simple as a triple lumen catheter — but it can be done with effort and support," she says.
• Don’t let supplies disappear.
Nurses were shocked to discover that the ED’s sutures were stocking the rest of the hospital, says Hendershot. "We would find someone in the supply room grabbing a entire box of sutures or orthopedic supplies," she says. "We are always available in a pinch, but we worked with some of the other units by showing them how to order their own supplies instead of taking them from the ED."
Sources
For more information about increasing supply revenues, contact:
- Donna Goebel, RN, BSN, Emergency Department, Deaconess Hospital, 600 Mary St., Evansville, IN 47747. Telephone: (812) 450-2679. Fax: (812) 450-3996. E-mail: donna_ [email protected].
- Kathy Hendershot, RN, MSN, CS, Director of Clinical Operations, Emergency Medicine and Trauma Center, Methodist Hospital, I-65 at 21st Street, P.O. Box 1367, Indianapolis, IN 46206-1367. Telephone: (317) 962-8939. Fax: (317) 962-2306. E-mail: [email protected].
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