Archive April 2014 XV, No. 4

Business Advisor: Your Crash Course in Case Costing

Replace expensive surgical supplies with less costly alternatives.

Susan Comp, RN, BSN, MS, CNOR


cost of top-volume procedures DO THE MATH Surgeons need to know how much their top-volume procedures cost your facility.

You can literally save your facility tens of thousands of dollars by switching out expensive surgical supplies for more economic options that will achieve the same clinical results. To do so, however, you must calculate your case costs for your highest-volume and highest-cost procedures, and then find affordable alternatives for high-priced items.

Case costing is hard work, but the results can be dramatic. We've lowered our case costs on laparoscopic appendectomies between last year and this year from $791 to $731. For laparoscopic cholecystectomies, we've dropped our case costs from $523 to $444. Here's how we saved:

  • $296 per case. Only using the harmonic scalpel for complex cases.
  • $165 per case. Substituting a reusable clip applier for disposable clips.
  • $136 per case. Switching stapling devices.
  • $121 per case. Reducing the use of closure kits.

Case costing requires dedication, hard work and constant communication with surgeons. Here's practical advice for getting there.

1. Drill down
You and your surgeons — especially your surgeons — need actual data to make the case for case costing. Surgeons are scientists who base their decisions on facts, not hearsay. Presenting black-and-white arguments to docs for reducing supply expenses is difficult. It's not that most managers and directors don't want to track supply expenses; they just might not have the tools to do it efficiently and effectively. You're in luck if you work with a robust finance system that can pull case costs for specific specialties and surgeons. If you don't, find a tool and a process that will let you drill down to the needed information.

Attack the 5 highest-volume procedures, regardless of which specialty they fall under, in order to compare costs between surgeons and procedures. Huddle with surgical services senior leadership to comb through the cost-per-case data and decide which numbers to present to surgeons during monthly meetings.

Then meet with surgeons as a group to show them how their individual case costs compare across the top 5 procedures. Break the data out to show high-cost surgeons the products that inflate their per-case expenses.

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