- At most institutions, a value analysis or product review committee evaluates new products and services requested for patient care.
- The committee's primary focus is to ensure that every product purchased provides a unique value proposition.
- Understanding your hospital's process is critical to getting the products and services you need to perform at your best.
Scenario: You finished CT surgery residency last June and are the newest assistant professor at Perfect University. You just returned from the STS Annual Meeting and saw the GeeWhiz Gadget in the Exhibitor Hall. You know GeeWhiz will fix all the issues you’ve been having with X procedure at your new institution. But how do you get this new technology into your hospital? Can you simply ask the GeeWhiz company representative if you can use it for your next case?
At most institutions, there is a committee that evaluates new technologies and other products used for perioperative patient care, often with the terms “value analysis” or “product review” in the committee’s name. It is the responsibility of this group to assess new products. Until I participated in my institution’s perioperative value analysis committee, I thought the committee’s main purpose was to be obstructionist in making surgery more efficient. However, once on the committee, I realized how many important issues need consideration regarding a new product for patient care.
Generally, it is the charter of these committees to evaluate new products for:
1. Use/purpose of the new item
2. Patient and employee safety
3. Improvement from currently used product OR new benefit
4. Regulatory requirements
5. Initial costs and return on investment
6. Service and maintenance costs
7. Environmental stewardship/Sustainability
The above criteria will differ depending on whether the new product to be purchased is equipment/hardware, software, instrumentation, or a disposable item. As the surgeon making the request, you will be asked to provide the value analysis committee with basic information about the product to ensure it provides a unique value proposition. Purchase of equipment may require justification by showing how it adds to programmatic development (see Dr. Robert Van Haren’s blog). Planning, patience, and persistence may be needed to acquire equipment/hardware.
The FDA regulates the sale of medical device products in the US. The committee will check for current FDA approval or clearance of a new product, or if it will be used in a circumstance or application that does not require FDA approval or clearance, known as “off-label” usage. If your hospital already owns the equipment used for the same purpose as the new product, projections about its benefit to the patient, medical staff or both will be requested. The more surgeons or surgery services that can use the equipment, the more potential return on investment.
There may be a separate “cost bucket,” such as the “capital budget,” from which funding for hardware, equipment, or other items exceeding a set amount is allocated. If the funds from the capital budget have been depleted or assigned for the current fiscal year, a request will need to be placed for the next fiscal budget or in several years.
The value analysis committee and administration will prioritize competing capital requests. Additionally, institutions often have a competitive bid policy requiring a “request for proposal” (RFP) for equipment over a certain cost. Included in the RFP should be service agreements for routine maintenance or repair; in-service and staff training for use of the equipment; the number of on-site licenses for software products; and cost as upgrades or improved generations of the equipment become available.
Some institutions may choose to lease equipment rather than outlaying the whole cost to purchase. For state or federal institutions (e.g., State University Hospitals, Veterans Administration Medical Centers) this may be a government requirement. The mobility, portability, and footprint of the equipment is also considered as they may need to be used in multiple places within the hospital (interventional radiology suite and operating room suite).
Other considerations that factor into product purchasing decisions include:
- New functionality needed for existing equipment, such as video screens and processors or electronic medical records
- Cleaning or sterilization procedures
- Special energy sources or protective gear
- Product components needed to sustain equipment, such as batteries, laser protection, CO2 sources
- Disposable medical supplies and devices to help prevent cross-contamination
Outlining features that make a new product safer, easier, or better than the one your hospital already uses provides the value analysis committee with helpful information. Contracting due to the predicted volume of use or use of other products manufactured by the same company also is an important consideration. Keep in mind that group purchasing organizations (GPO) allow discounted pricing. Restocking fees for products that expire and need to be exchanged should be vetted prior to purchase. Consider specific storage needs, such as temperature control for biologic products, quality checks, and paperwork for tracking after implantation.
Sustainability - choosing equipment with fewer emissions, recyclable packaging, and recycling or reprocessing supplies, is another important focus of decision-making regarding new products. Reprocessing of disposable supplies may result in cost savings in addition to supporting decreased carbon footprint.
Medications or biologic agents likely will need to be assessed by a hospital’s pharmacy and therapeutics committee.
In summary, requesting new products or technologies effectively at a hospital may be the catalyst for clinical growth, supply improvements, and innovation benefiting patients, yourself and other surgical colleagues and perioperative staff.