Hospitals on cost-saving drive
Doctors switch to less expensive disposables when told the costs
During brain operations at Toronto Western Hospital, neurosurgeons used to squirt fibrin glue — a special anti-coagulant substance — to quickly staunch routine bleeding.
The cost of that squirt: $364. Now, except in emergencies, doctors apply pressure for five minutes to get similar results. It takes slightly longer, but it’s free.
The switch in techniques is part of a fascinating new cost-saving drive being instituted by hospitals across Canada, producing some dramatic results and paying dividends to wait-listed patients.
Single-use or disposable surgical supplies that range from sutures to scalpels and sterile drapes — not to mention pricey blood-clotting glue — can total thousands of dollars per case and add millions to the budgets of acute-care hospitals. By some accounts, the “massive” expense is second only to salaries.
Disposables range from relatively inexpensive scalpel blades and sponges to implants that can cost thousands of dollars and stay in the patient’s body. The use of much of it is non-negotiable, but not all.
A new Canadian study, though, suggests that many doctors have no idea what any of these items cost, a situation likened to grocery shopping at a supermarket devoid of price tags.
But now many hospitals are showing surgeons the stickers on their throwaway equipment — and calling out those who rack up unusually high bills for disposables. Physicians have been getting frugal in response, choosing products that can be hundreds of dollars less than an alternative.
In j ust f our months, neurosurgeons at Toronto Western — part of the city’s University Health Network — cut their disposables costs about 30 per cent, or some $750,000, moving from a department deficit to surplus.
“All you needed to do is give the surgeons, the people on the ground, the information they needed to be helpful, and they jumped at the chance,” said Dr. Michael Tymianski, head of the network’s neurosurgery division. “Doctors would look at their bill and say ‘Holy smokes, they charge $200 for that piece of foam? I don’t need to use that.’ ”
The savings have enabled the division to hire more surgeons and provide 150 additional operations a year. And reducing the cost of those disposable products has not affected patient outcomes at all, says Tymianski.
Similar cost transparency has been introduced at Vancouver Coastal Health facilities, leading to an ongoing dialogue between equipment managers and doctors, says Linda Lemke of Providence Health. Among the results: An ENT surgeon who stopped using a single-use, tissue-sealing device that cost $375 and replaced it with a $35 model. He felt the 10 minutes saved by the pricier one could not be justified, says Lemke.
Even so, some doctors are worried the push to use cheaper supplies could put a minority of patients at greater risk, with negligible long-term gain.
Severing an appendix by tightening little loops around it costs $18, for instance, compared to $300 for detaching the little organ with a surgical stapler — a disposable device itself, notes Dr. Chris De Gara, president of the Canadian Association of General Surgeons. But if the loop method has even a one per cent greater risk of complication, that could lead to some patients spending longer in hospital — and wipe out the cost savings, he warns.
“I tend to adopt a policy … that we use the best product that we believe works for the job,” said De Gara, “There are others who are driven by cost and will say ‘No, I don’t care what your product is, I want to do it more cheaply.’ ”