Cost containment

[Neogenesis]

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Hey everyone, I have a favor to ask. I have been tasked by our department to help look at ways to reduces spending. Now I will be the first to admit that I know jack squat about the business end of things. Can any of you out there that are either involved in PP groups that look at this or that are involved in the budget committee in your respective hospitals give me any recommendations on areas to start, things you've found to be helpful. Honestly, anything anyone says will be a great start for me. Thanks.

 

[Man o War]

Would need a lot more information about the model you run, what you pay out to any employees, benefits, shift differentials/call pay, etc.

 

[Noyac]

Need more details. What areas are they wanting you to look at?
1) medication use
2) equipment
3) pt recovery
4) staff and shifts
5) collections
6) billing
7) management

These are just some areas to look into.

 

[Consigliere]

Hey everyone, I have a favor to ask. I have been tasked by our department to help look at ways to reduces spending. Now I will be the first to admit that I know jack squat about the business end of things. Can any of you out there that are either involved in PP groups that look at this or that are involved in the budget committee in your respective hospitals give me any recommendations on areas to start, things you've found to be helpful. Honestly, anything anyone says will be a great start for me. Thanks.

Almost certainly one of the ways to "reduce spending" will be cutting YOUR salary.

 

[Planktonmd]

Almost certainly one of the ways to "reduce spending" will be cutting YOUR salary.

🤣

 

[deleted126335]

Almost certainly one of the ways to "reduce spending" will be cutting YOUR salary.

Not until they pick his brain to find out where he can save money in other areas first.

 

[Ezekiel2517]

First thing is understanding the difference between cost and cost effectiveness. Just because something costs less does not mean it's cost effective. Many times opting for the less expensive option will end up costing you much more. Example: you decide to get rid of precedex because it's expensive. But if it's more effective than haldol at treating delirium and results in fewer days in the icu and shorter hospital stays, it's far more cost effective. I could go more into this but you get the point

 

[Noyac]

I find it odd that the OP was asked to do this knowing that he/she has no experience in this area. Seems suspicious to me.

 

[Planktonmd]

I find it odd that the OP was asked to do this knowing that he/she has no experience in this area. Seems suspicious to me.

My thoughts too!

 

[Consigliere]

I find it odd that the OP was asked to do this knowing that he/she has no experience in this area. Seems suspicious to me.

Not me. I know this gambit well. They'll thank this poor slob for his efforts and say "well, it's a good start but unfortunately in these difficult times sacrifices need to be made." Then they'll take away the 401k match or plan altogether, reduce his salary, and maintain theirs.

 

[Noyac]

Not me. I know this gambit well. They'll thank this poor slob for his efforts and say "well, it's a good start but unfortunately in these difficult times sacrifices need to be made." Then they'll take away the 401k match or plan altogether, reduce his salary, and maintain theirs.

I guess you were not understanding my gist.

 

[Planktonmd]

I guess you were not understanding my gist.

😉

 

[Consigliere]

I guess you were not understanding my gist.

Guess not. And I still don't......apparently Planktonmd does, though. Maybe one of you can clear things up for me.

 

[Planktonmd]

Guess not. And I still don't......apparently Planktonmd does, though. Maybe one of you can clear things up for me.

I guess we are all concerned that the OPs group is preparing him for some bad news related to his employment!

 

[Consigliere]

I guess we are all concerned that the OPs group is preparing him for some bad news related to his employment!

Thanks. I thought that's what Noy was alluding to but wanted to make sure.

 

[psychbender]

Well, considering Neongenesis still owes a few more years to the Army, I doubt they're getting ready to can him, and his local command cannot change his pay (which is already lower than what most of you guys pay CRNAs). Things like this come up every once in a while, with commands trying to figure out how to save a few bucks without worsening outcomes.

 

[Mad Jack]

I find it odd that the OP was asked to do this knowing that he/she has no experience in this area. Seems suspicious to me.

That's SOP for most managers I've ever worked with. They just look at budget sheets and start cutting without rhyme or reason.

 

[Noyac]

I was unaware that the OP was military.
Plank summed up my post.
So now that we know he isn't about to get canned, we can focus on helping him cut costs effectively.

 

[Neogenesis]

Well, considering Neongenesis still owes a few more years to the Army, I doubt they're getting ready to can him, and his local command cannot change his pay (which is already lower than what most of you guys pay CRNAs). Things like this come up every once in a while, with commands trying to figure out how to save a few bucks without worsening outcomes.

Yeah, what he said.

For anyone who has been in the military, the term "collateral duty" should be familiar.

Mostly what I'm looking for at this point is suggestions regarding evaluating and finding ways to reduce material costs. Staffing is beyond the scope of this, I believe.

And psychbender is right, I make less than most CRNAs, FPs, some PAs/RNs, a few fast food chain managers and a couple you tubers.

 

[pgg]

Drug costs are the low hanging fruit. For example, look up the price of nitroprusside or vasopressin these days and ask yourself if anyone should be routinely using either.

Optional proprietary consumables like Bis monitor strips are another thing to look at. Employ peer pressure and shame to discourage their use when there isn't a good reason to.

The main costs in military ORs are essentially fixed and unchangeable (personnel). Resist the inevitable ***** who thinks that flogging people to cut OR turnover times by 4 minutes will somehow improve efficiency. It can't be done at a MTF. Any effort that relies on the efforts of shift workers (you know who I'm talking about) to be voluntarily efficient will fail.

I'd focus on drug costs. Nice hard numbers, a couple of easy recommendations, neat PowerPoint slides, and they'll consider their project a success and get off your back. BZ, well done!

 

[Noyac]

Look into the drug waste bin. Which vials are thrown away with drug left in them. For example, neostigmine is expensive these days. We get it in 5cc vials. I never use 5cc. See if your pharmacy can split it up in syringes and add the necessary glyco for ready to use dosing? You just cut that cost in half.

We just added disposable blades and handles in order to complete a TJC visit. They are expensive when used only once. But we found out that the handles can be sterilized and are good for 5yrs. So now we use reusable blades with disposable handles and sterilize larger numbers less often ( once or twice a day).

 

[Planktonmd]

Yeah, what he said.

For anyone who has been in the military, the term "collateral duty" should be familiar.

Mostly what I'm looking for at this point is suggestions regarding evaluating and finding ways to reduce material costs. Staffing is beyond the scope of this, I believe.

And psychbender is right, I make less than most CRNAs, FPs, some PAs/RNs, a few fast

Drug costs are the low hanging fruit. For example, look up the price of nitroprusside or vasopressin these days and ask yourself if anyone should be routinely using either.

Optional proprietary consumables like Bis monitor strips are another thing to look at. Employ peer pressure and shame to discourage their use when there isn't a good reason to.

The main costs in military ORs are essentially fixed and unchangeable (personnel). Resist the inevitable ***** who thinks that flogging people to cut OR turnover times by 4 minutes will somehow improve efficiency. It can't be done at a MTF. Any effort that relies on the efforts of shift workers (you know who I'm talking about) to be voluntarily efficient will fail.

I'd focus on drug costs. Nice hard numbers, a couple of easy recommendations, neat PowerPoint slides, and they'll consider their project a success and get off your back. BZ, well done!

Exactly! What matters is the shiny PowerPoint, and to form a committee that meets regularly for a few months, and then comes up with recommendations that are designed to solve a problem, not necessarily the problem you are trying to solve, just a problem that you think you can solve, like the outrageously high prices of fried chicken in the canteen, or the lack of a cost cutting permanent officer position!

 

[Neogenesis]

Thanks all

 

[urge]

But if [precedex] it's more effective than haldol at treating delirium and results in fewer days in the icu and shorter hospital stays, it's far more cost effective.

Is it more effective?

 

[Noyac]

Is it more effective?

Nope. It just costs more which makes it sexy.

 

[DrCommonSense]

Exactly! What matters is the shiny PowerPoint, and to form a committee that meets regularly for a few months, and then comes up with recommendations that are designed to solve a problem, not necessarily the problem you are trying to solve, just a problem that you think you can solve, like the outrageously high prices of fried chicken in the canteen, or the lack of a cost cutting permanent officer position!

Actually, those Powerpoint presentations pay very well in consultant fees. There is no need to "solve" anything since that isn't the purpose of the issue. Its to make money for the consultant class that is often paid quite well.

 

[sigrhoillusion]

Drug costs are the low hanging fruit. For example, look up the price of nitroprusside or vasopressin these days and ask yourself if anyone should be routinely using either.

Optional proprietary consumables like Bis monitor strips are another thing to look at. Employ peer pressure and shame to discourage their use when there isn't a good reason to.

The main costs in military ORs are essentially fixed and unchangeable (personnel). Resist the inevitable ***** who thinks that flogging people to cut OR turnover times by 4 minutes will somehow improve efficiency. It can't be done at a MTF. Any effort that relies on the efforts of shift workers (you know who I'm talking about) to be voluntarily efficient will fail.

I'd focus on drug costs. Nice hard numbers, a couple of easy recommendations, neat PowerPoint slides, and they'll consider their project a success and get off your back. BZ, well done!

Ahhh the BIS monitor... the foundation of CRNA training it seems. I swear it seems like 90% of CRNAs I work with use them. Then I'll come back into the room and the BIS is reading in the 20s-30s and the gas is set to about 1.3 MAC adjusted to age and that's not even factoring in the supplemental narcotics used.

I BIS shame the residents... But then I hear that some of the attendings encourage its use. I'll attempt to tell people not to use it, but half the time you come in the room and it's already opened or sometimes on the patients head (but at least they're using it apporpriately...)

 

[deleted171991]

That brand name has an extra I in it.

 

[criticalelement]

Send the person who asked you how to save money a mirror. Undoubtedly it is a Bureaucrat who asked you this question.

At the top of the mirror, write in big bold red letters.


I would save money by getting rid of this man/or woman.


and they would be looking at themselves....

 

[Consigliere]

Send the person who asked you how to save money a mirror. Undoubtedly it is a Bureaucrat who asked you this question.

At the top of the mirror, write in big bold red letters.


I would save money by getting rid of this man/or woman.


and they would be looking at themselves....

Thank you for explaining the complexities of a mirror.

 

[criticalelement]

Are you a lebowski achiever?

 

[Gastrapathy]

Biggest way to save money at a MTF: do less work. Move the costs to the network. Then moonlight more. Everyone except the taxpayer wins.