Authors’ note: This article was collaboratively written by Duke University Medical Center and WakeMed to document their experiences with SUD reprocessing and share lessons learned with other EP labs.
Single-use device (SUD) reprocessing in the electrophysiology lab is a strategic initiative for many leading U.S. hospitals to help maximize limited healthcare resources. For good reason: hospitals that are highly engaged in a vascular reprocessing program can save $300,000 or more per year. However, achieving this magnitude of savings is not a slam-dunk. Two similar-sized health systems can achieve very different results.
Case in point: WakeMed in Raleigh, North Carolina, has seen its SUD reprocessing savings in the EP lab grow 326 percent since 2011, reaching $750,000 in 2014. Whereas Duke University Heart Center in Durham, North Carolina, saw its savings drop 43 percent — by over $355,000 — from 2013 to 2014. It’s difficult to comprehend how reprocessing results between these two health systems, which incidentally are located only 30 miles from one another, can be poles apart. Let’s take a look at the differences between these two programs, identifying potential pitfalls to savings growth and best practices for maximizing reprocessing program benefits.
SUD Reprocessing 101
For those who are unfamiliar with SUD reprocessing, it’s the process by which third-party reprocessors disassemble, clean, sterilize, and remanufacture SUDs under strict FDA oversight and sell them back to hospitals at a significantly reduced cost of original manufacturer devices. Reprocessing SUDs helps hospitals extend the life of their single-use medical device investments, cutting device cost in half and reducing the amount of medical waste sent to landfills. The savings can add up quickly in the EP lab, especially for higher priced devices such as EP catheters and diagnostic ultrasound catheters. For both Duke and WakeMed, ensuring quality product performance while reducing costs is the number-one goal of their reprocessing programs.
More than 3,000 U.S. hospitals, including all of U.S. News & World Report’s “top hospitals”, purchase reprocessed SUDs, according to the Association of Medical Device Reprocessors. Ninety percent of the Thomson Reuters Top 50 Cardiovascular Hospitals reprocess with market-leader Stryker Sustainability Solutions, according to the company.
WakeMed’s Growing Savings
Reprocessing at WakeMed has come a long way since the early days when WakeMed reprocessed EP cables in-house — much like many labs across the country had done with both EP catheters and cables prior to FDA regulation in 2000. After every case, clinicians conducted an initial cleaning of the catheters before sending them to the sterile processing department to be sterilized for reuse. It was a labor-intensive process.
In 2011, WakeMed began outsourcing reprocessing to third-party vendor Stryker Sustainability Solutions. Outsourcing reprocessing not only saved WakeMed valuable time, but also gave WakeMed insight on how to optimize its program and streamline processes for savings growth. On a continual basis, WakeMed and Stryker evaluate ways to increase WakeMed’s utilization of reprocessed devices in the EP lab.
The partnership has paid off. The first year, program savings were just over $230,000. They’ve grown every year since, reaching a program high of $750,000 in 2014. Reprocessed devices purchased by WakeMed include EP catheters, EP cables, and diagnostic ultrasound catheters.
A Savings Setback at Duke
Duke University Heart Center has used third-party reprocessed SUDs in the EP lab since 2011. Having selected a different initial vendor than WakeMed, Duke achieved moderate savings results during the first two years of the program — not nearly at the same progressive pace of growth year-over-year as WakeMed’s program experienced. However, when Duke engaged a vendor that could reprocess a more complete portfolio of devices for its labs — including EP catheters and cables, diagnostic ultrasound catheters, and catheter introducer sheaths, Duke reached a record high $839,000 in savings in 2013.
Later that same year, Duke’s former vendor presented a proposal that promised greater savings in 2014 by combining reprocessed catheters and original catheters in the same contract. For every two reprocessed ultrasound catheters Duke purchased, one new ultrasound catheter would need to be purchased. Assuming minimum requirements were met, Duke would receive a discount on the new catheter purchase price — on top of the proposed savings offered on reprocessed SUDs. Duke entered the “combined” contract because of the attractive savings potential. Unfortunately, the savings didn’t materialize.
A few months into the contract, Duke saw its reprocessing savings decline. On top of that, the discount on new catheters wasn’t enough to make up the difference. The vendor’s promise of greater savings wasn’t being realized. When the savings continued to decline throughout the year, Duke’s sourcing department switched back to its 2013 reprocessor — a vendor that did not tie reprocessing savings to minimum purchase requirements for new devices. Since switching back this year, reprocessing savings through May have already surpassed the total savings achieved with the other vendor in 2014.
It’s not uncommon for hospitals to be offered contracts that combine reprocessed devices with original SUDs or other capital equipment. Like Duke, WakeMed has been offered similar contracts in the past, which were declined because they didn’t demonstrate long-term value. Duke learned first-hand that discounted purchase prices and combined contracts don’t always equate to greater savings. Reprocessing savings are a combination of purchase price and volume of units purchased from a vendor committed to maximizing the value of the program. Duke now avoids any contract stipulations that restrict the purchase of reprocessed devices.
Lessons Learned From the Lab
With more than eight combined years of experience implementing vascular reprocessing programs, Duke and WakeMed have learned a lot about what it takes to make the programs successful. At a high level, both systems agree that it takes strong internal engagement, including C-level buy-in, and strong vendor partnership to achieve success. Here are some other best practices adopted by both organizations:
1. Educate and drive engagement.
It’s important to ensure all team members — physicians, management, and staff members — fully understand your SUD reprocessing organizational goals and benefits, patient safety protocols, products included, and what’s required of them. Collective buy-in is key. Duke and WakeMed partner with a vendor that offers frequent training sessions where staff can ask questions and address any challenges in program implementation.
Identify internal champions who can be stewards for program engagement and utilization. Additionally, keep reprocessing top-of-mind for staff by tracking the program’s progress and providing regular updates on the program’s impact. Making the results visible reminds staff of the program’s purpose and helps them see how their actions help improve the organization’s bottom line.
2. Maximize utilization.
Establish goals and procedures for using and ordering reprocessed devices vs. original manufacturer devices. WakeMed believes so strongly in the benefits of reprocessing that its reprocessor has become the primary vendor for some devices. In fact, 100 percent of certain catheters that WakeMed uses are reprocessed. Across all device types, roughly 90 percent of the devices they use are reprocessed.
A critical factor that impacts your ability to meet utilization targets is having access to product. Choose a reprocessor that maintains 510(k) clearances for a multitude of vascular product lines from all major original manufacturers. Make sure the ordering process helps track product availability in real time, provides automated inventory alerts, and offers the ability to order on-demand to meet your fluctuating case needs. Finally, evaluate where and how reprocessed devices will be stocked on inventory shelves. If your goal is to pull reprocessed devices first (when available), like WakeMed, make sure reprocessed devices are placed on top of original manufacturer devices so they’re easy to locate.
3. Optimize collections.
Properly collecting devices after each procedure is a key component of SUD reprocessing program success. Sending devices to your vendor helps ensure a strong pipeline of future product inventory. Make sure staff understand how to collect devices to minimize device damage. Fewer damaged devices translates to greater program savings opportunities down the road. Finally, work with a vendor that offers robust field support, so they can make frequent visits to closely track and empty bins as they become full.
4. Evaluate the pros and cons of working with multiple vendors.
At Duke, it was difficult to work with two reprocessing vendors. With two vendors, there are three different bins in the lab for collecting used devices after a case — a red waste bin, and two or more reprocessing bins from different vendors. The more bins there are, the greater chance for confusion about how to collect devices and where they should go.
Future Savings Growth
While growth in your reprocessing program savings is not guaranteed, when you implement proven best practices and work with a vendor that is solely incentivized to help grow your savings, the potential for growth is very promising. WakeMed is on pace to grow its savings yet again in 2015. Duke is still rebuilding its program from the setback it experienced in 2014. However, just four months after moving the majority of its reprocessed devices back to one vendor, reprocessing savings are growing and will surpass their highest point from 2013.
Disclosures: The authors have no conflicts of interest to report regarding the content herein.