October 24, 2008

Supply purchasing streamlined

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Lori Lagmade of Medical Center Support Services shows some of the different types of defibrillators available at VMC. (photo by Joe Howell)

Supply purchasing streamlined

Greg Mencio, M.D.

Greg Mencio, M.D.

Bill Obremskey, M.D.

Bill Obremskey, M.D.

Totaling costs for everything from Band-Aids to artificial heart valves and mechanical knee implants, Vanderbilt Medical Center spends around $135 million per year on medical supplies and equipment.

Looking to promote safety, quality and cost-effectiveness, VMC is moving to expand faculty oversight of these purchasing decisions.

The new oversight process brings more consistent and thorough committee evaluation of product claims, medical evidence and market information. The change is intended to leave VMC more effectively protected against powerful sales pitches, potential conflicts of interest and informal influences.

The previous process for purchasing oversight at VMC was similar in its goals but is said to have lacked transparency and faculty participation.

“New transparency will be made possible by the process being physician-driven with peer review of all decisions,” said Associate Hospital Director George DeLong.

The new approach is called the Medical Economic Outcome Committee process, or MEOC. Oversight will be spread among four MEOCs.

“MEOC will introduce more useful information to aid clarity about medical evidence and cost comparisons, so that our purchasing decisions are on a more reliable, objective basis,” said Greg Mencio, M.D., professor of Orthopaedics and Rehabilitation and co-chair of the surgical/procedural MEOC.

“The goal of MEOC is to provide quality care to patients at Vanderbilt,” said Bill Obremskey, M.D., M.P.H., associate professor of Orthopaedics and Rehabilitation and co-chair of the MEOC for surgical/procedural areas. When it comes to so-called physician-preference items, “every user will have an opportunity to provide input for these purchasing decisions,” he said.

Three MEOCs recently began evaluating products for use in surgical/procedural areas, cardiovascular services areas and, more generally, across Vanderbilt University Hospital and The Vanderbilt Clinic.

A fourth MEOC, not yet formed, will evaluate hospital equipment purchases over $3,000, Vanderbilt's capital spending threshold.

VMC's well established Pharmacy and Therapeutics Committee, overseeing drug purchasing, will continue unchanged.

To aid product evaluations, MEOCs will pull information from companies that evaluate health care technology, and from a company that surveys hospitals nationally to gather current contract information that can help hospitals as they evaluate price offers from suppliers. The committees will not only evaluate new products that individual faculty members want to bring into the institution, they'll also evaluate some products currently in the VMC supply chain that are similar and that could be standardized.

Obremskey and Mencio say the new process will reduce the chances of letting in products that don't properly aid safety and clinical quality, while also heading off needless acquisitions and correcting any overspending.

The MEOC Web site, at www.mc.vanderbilt.edu/meoc (log-in required), lays out the new process in detail.

MEOC is patterned on a similar process at the University of California at San Francisco, where oversight committees comprised of faculty members have approved 80 percent of faculty requests for new medical products.

VMC faculty members who disagree with a MEOC decision can appeal to an executive committee led by C. Wright Pinson, M.D., M.B.A., associate vice chancellor for Clinical Affairs, and Martin Sandler, M.D., associate vice chancellor for Hospital Affairs.

“MEOC is proving to be a little bit of a hot-button issue,” Mencio said. “When faculty hear about it, the first thing they want to know is how it will affect them. We don't want this process to be restrictive to the point where docs can't use new stuff. You need balance. Within certain limits, we ought to be able to use products we're comfortable with.”

“MEOC is a more rational process that engages physicians in really constructive ways. We'll know it's a success when it's deemed to have brought value to physicians, and when we've been able to standardize some additional number of physician-preference items,” said Nancye Feistritzer, associate hospital director for Perioperative Services and a member of the MEOC executive committee.

For more information or new product request forms, go to the MEOC Web site, www.mc.vanderbilt.edu/meoc.