Tu1172 MILLIONS! YES, WE CAN SAVE: OPTIMIZING ENDOSCOPY SERVICES

Abstract

The volume of endoscopic procedures is rising nationwide. Institutions are aiming to standardize services, reduce wastage, and optimize costs. However, the optimal approach remains unclear in endoscopy. Our tertiary care academic center has developed a method to enhance delivery of endoscopic services across 14 sites (8 hospitals, 6 ambulatory centers) using an Enterprise Endoscopy Council (EEC). Staff at multiple sites, including administrators, nurses, and endoscopists were brought together to create an EEC in May 2018. Individuals were recruited and communications were made using an existing network operations vice president. Each specific site had a representative to engage in fundamental discussions. The areas of focus were to enhance quality and value of endoscopic services with standardization throughout the enterprise, without compromising patient care and outcomes. Areas of interest included maximizing endoscope utilization and reprocessing, optimizing endoscope inventory, and reducing costs. Any savings produced would subsequently be reinvested in endoscopy. The EEC also tracked utilization of equipment at the various sites and had the ability to re-allocate equipment. All data were collected and maintained prospectively. This quality control protocol was exempt from institutional review board. Several areas of optimization were noted and implemented by the EEC. Using previously published benchmarks, initial assessment demonstrated a surplus of endoscopes at certain hospitals and a shortage at others. Redistribution was conducted avoiding capital expenditures creating a savings of $825K. In addition to surplus inventory reallocation, service contract consolidation on endoscopes and supply contracts were performed as a single network with independent vendors. Additional savings included $1,003,965 in annual service support, $184,384 in capital, and $45,000 in annual supplies. Quality control as a component of the EEC provided for standardization of policies, procedures, and reprocessing which optimizes value of endoscopic service delivery. Additionally, monitoring of adenoma detection rates was implemented through the EEC resulting in 100% compliance network wide. Overall, the introduction of an EEC resulted in greater than $4M savings projected over a 3-year timeline (table 1). Future potential savings were also evaluated. Optimizing endoscopic services through a multidisciplinary council reduces capital, avoids unnecessary costs, and increases quality compliance thereby enhancing value. Future initiatives of the EEC include: 1) standardizing privileging and re-credentialing for all providers and sites in endoscopy, 2) implementing an enterprise wide endotherapy education program, 3) tracking equipment, and 4) developing strategic growth modeling to avoid competitive services within the system.