Sustainability Strategies at Piedmont Hospital: 10 Years of Reprocessing Success in the EP Lab

The EP lab at Piedmont Hospital in Atlanta has been running a successful reprocessing program for nearly 10 years, an achievement too few EP labs share. In 2010, Piedmont saved more than $303,000, and is on track to increase its savings for 2011. Learn more about their strategies here.

A commitment to technological advancement is part of the reason Piedmont initially pursued reprocessing — the FDA-regulated practice of reprocessing and remanufacturing specific single-use medical devices — before it became the common practice it is today.

EP labs, though often a major profit center within hospitals, face expensive equipment upgrades and contend with labor-intensive procedures within strict budget confines. After examining the bottom line, we turned to reprocessing as a natural cost-savings strategy that maintains a high standard of care, while allowing for continuous improvements to optimize performance in the EP lab.

Ten years later, Piedmont has grown its EP reprocessing program every year, and successfully maximized cost savings in ways that wouldn’t have seemed possible on Day 1.

“At this point, we’re reprocessing every catheter we can,” said Dolores Martin-Montero, former clinical manager for Piedmont’s EP lab. “It’s critical to stay one step ahead of the curve to take advantage of savings opportunities. It sounds simple, but the key to success is open communication between three parties — the EP staff, the manager, and the reprocessing rep. This way, we know when new catheters are cleared for reprocessing, and we’re equipped to reap the cost benefits.”

Steady growth is a critical factor. According to Stryker Sustainability Solutions, a new EP lab that begins a reprocessing program today can expect to save between $25,000 and $50,000 in its first year. After three years, potential annual savings can reach $150,000 or more in annual savings. In a healthcare landscape that is more precarious today than it was even two, three and four years ago, maximizing the potential of a reprocessing program has become compulsory among hospital systems that are committed to realizing impactful cost-savings solutions without compromising the quality of care.

Here we share the 10 strategies that have contributed to Piedmont’s success, and offer a roadmap for maximizing reprocessing programs through staff training, open communication and smart process efficiencies. Part of reprocessing success should also be attributed to open-minded program administrators with a willingness to understand how reprocessing savings can have a big impact on multiple areas of the hospital, even beyond the EP lab.

1. Do research, stay educated. Learn to separate fact from misinformation or personal impressions when it comes to reprocessing. Work with your reprocessing rep to arrange a tour of a reprocessing facility, and open dialogue with others who have taken advantage of savings opportunities through reprocessing programs. Though third-party medical device reprocessing is subject to strict FDA regulatory guidelines, it is not uncommon to encounter the belief that reprocessing refers to in-house sterilization or cleaning. Get the facts to help set the record straight — the savings potential is too great to be offset by inaccuracies.
2. Staff education. In 2001, Piedmont restructured its education program so that oncoming staff members receive specific EP training, in addition to basic orientation, to ensure awareness of how reprocessing fits into the operations of the lab. By working closely with Piedmont’s reprocessing vendor, Stryker Sustainability Solutions (then Ascent), EP lab staff learn which devices can be reprocessed, including the ins and outs of collections logistics, and undergo comprehensive in-service training. 
3. Open communication with reprocessing vendor. It’s imperative to work closely with your reprocessing vendor to constantly refine and improve processes. Piedmont works in partnership with our reprocessing rep to ensure each potential savings opportunity is maximized as well as to review any obstacles or challenges with the program. An open line of communication is critical to every successful reprocessing program.
4. Open communication with staff. It is equally critical to maintain open communication about the benefits of reprocessing with staff. When the staff is aware of the overall fiscal picture and what goals you are trying to reach, they will understand how reprocessing enables essential savings that are redirected to patient care initiatives, such as the purchase of new equipment. 
5. Pull reprocessed catheters first. Successful reprocessing programs depend on a seamless process and convenient operations. Piedmont and its reprocessing vendor worked together to integrate reprocessed and remanufactured single-use devices into the facility’s inventory management system. To make the integration complete and effective, staff are trained to pull reprocessed catheters first and to keep an open line of communication with physicians about what they are doing and why. Pulling reprocessed catheters first is a simple yet critical factor to maximizing the savings potential of a reprocessing program. Reprocessed diagnostic catheters are becoming increasingly common — in 2010, a medical technology market intelligence group forecasted 15 percent growth in this category through 2014. 
6. Ongoing staff training. As Piedmont’s EP lab advances its practice to include more involved procedures such as complex ablations and new treatments for arrhythmia disorders, it invests in IBHRE-accredited (International Board of Heart Rhythm Examiners) staff with a firm grasp on current field training in cardiac rhythm device therapy and cardiac electrophysiology. Advanced, ongoing training increases familiarity with the benefits of reprocessing, which encourages trust and confidence among the Piedmont EP physicians. 
7. Increase collections to pave the way for growth. Piedmont works with its reprocessing vendor to collect all used catheters, regardless of reprocessing clearance, to minimize Piedmont’s waste and handling costs. Diverting used catheters from the waste stream has the added benefit of helping reprocessors pursue additional 510(k) clearances on devices, a tactic that pays dividends in the future. For example, when Stryker (then Ascent) began reprocessing the Carto 3 catheter, Piedmont had already been sending Carto 3 devices through the collections process, so it was in a good position to buy them back at a fraction of the price of the original device after the Carto 3 had received 510(k) clearance. 
8. Beware of anti-reprocessing tactics. Original equipment manufacturers may try to interrupt your reprocessing program. Some OEMs have embraced reprocessing as an effective sustainability offering, though others are continually threatened by how reprocessing negatively impacts their bottom lines. When you are negotiating contracts and pricing, protect the savings you’ve realized through reprocessing by questioning OEM technology upgrades or contractual stipulations that could interfere with your ability to buy back reprocessed and remanufactured devices. You have the leverage to challenge vendor contract language about “one-time-use-only.” 
9. Constantly evaluate performance. Regularly review your EP lab’s financial picture in conjunction with your reprocessing program to identify new opportunities for savings and growth. Work with your reprocessing vendor to establish fiscal and environmental metrics for success, and then meet quarterly to review the data against your program’s performance. Though reprocessing is an essential solution for fiscal and environmental sustainability, it requires strict accountability measures to ensure maximum success. 
10. Think beyond the EP lab. The whole hospital system can benefit from reprocessing. At Piedmont, the EP lab is the primary generator of bottom-line savings from reprocessing programs. The same sorts of savings possibilities exist in other parts of the hospital, including general surgery. Don’t leave it to one part of the system to be the main generator of savings from reprocessing programs — share your results with the hospital’s executive team. Make the case. The numbers are self-evident, and the need to maximize effective cost-savings strategies in a time of resource scarcity and uncertainty cannot be overstated.

Reference

1. PR Newswire (Nov. 19, 2010). “Reprocessed Catheters: A Growing Force In the US Electrophysiology Diagnostic Catheter Market, According to Millennium Research Group. Press release. https://www.prnewswire.com/news-releases/reprocessed-catheters--a-growing-force-in-the-us-electrophysiology-diagnostic-catheter-market-according-to-millennium-research-group-70455337.html Retrieved 2011-8-22

About Piedmont Hospital

Named Best in Atlanta for Overall Cardiac Care, Cardiac Surgery and Coronary Intervention (2011) by HealthGrades^® (a leading healthcare ratings company), Piedmont Hospital has consistently ranked in the top five among metro Atlanta hospitals in patient satisfaction scores according to the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey and is recognized as one of the nation’s Most Wired hospitals for seven consecutive years in the 100 Most Wired Survey and Benchmarking Study. A private, not-for-profit organization with over 4,000 employees and a medical staff of over 1,100 physicians, Piedmont Hospital is a 481-bed acute tertiary care facility in the north Atlanta community of Buckhead. Piedmont is a member of Piedmont Healthcare (PHC), a not-for- profit organization that also includes Piedmont Fayette Hospital, a 157-bed, acute-care community hospital in Fayetteville and one of the 100 Top Hospitals^® in the nation for 2009; Piedmont Mountainside Hospital, a 42-bed community hospital in Jasper; and Piedmont Newnan Hospital, a 143-bed, acute-care community hospital in Newnan. Piedmont Healthcare also is the parent company of the Piedmont Heart Institute (PHI), comprised of more than 100 affiliated cardiovascular specialists in Piedmont Heart Institute Physicians with over 35 locations across north Georgia and North Carolina; the Piedmont Physicians Group, with over 100 primary care physicians and specialists in more than 35 offices throughout metro Atlanta; the Piedmont Clinic, a 700-member physician network; and Piedmont Healthcare Foundation, the philanthropic entity for private fundraising initiatives. For more information about Piedmont Hospital, visit piedmonthospital.org.