How To Integrate DME Into Treatment Protocols

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Secrets To Effective Inventory Management Of DME

Busy podiatry practices must make efficient use of the office space available in order to manage DME inventory.

   Select products that offer an opportunity to be used for multiple conditions. Depending on the frequency of need and space allowance, consider products that one can use on the left and right foot, and that require fewer sizes. For less common conditions, establish a protocol for items to be used and the vendor that will provide the products.

   The goal of maintaining inventory is to have on hand those items that are part of the treatment protocols, in sufficient quantity and sizes, given the physical confines of the available space. The practice should maintain a certain minimum quantity of products on hand, taking into consideration the rate at which they are used and the time for delivery. If the practice consistently runs out of products before the designated reorder time, increase the minimum quantity.

   The medical assistants and physician should periodically review how well the devices are working, how much patients like them and what they can do to improve application. Consider new products, different products as recommended by others and products presented at conferences.

   It is essential to designate a person in the practice who is responsible for organizing storage areas and determining maximum and minimum quantities for all products in all sizes.

   Create a designated frequency and day when the ordering person checks inventory and orders as appropriate. The practice manager should periodically review quantities of products in stock and prices paid. Ordering can be easier via the use of customized screens on the given distributor’s website. Distributors can also help practitioners to order in a timely fashion by sending customized order forms that indicate the quantity of products to keep on hand and the price paid.

By Josh White, DPM, CPed

Having established treatment protocols for common conditions one sees in practice can go a long way toward reining in costs and maximizing efficiency. This author offers insights on the benefits of these protocols and how to incorporate durable medical equipment (DME) into the equation.

A key impetus for reining in health care costs is based on the understanding that 50 percent of these costs go toward unnecessary administrative costs, excessive or unnecessary tests and other waste.

   Increasingly, large healthcare delivery systems are racing to reorganize their approaches to care as part of their ongoing efforts to rein in costs. Change can be difficult even when the benefits are obvious and the required actions are not complicated. For example, a tremendous amount of infection is still the result of health care professionals not employing well-documented hand washing procedures.

   Integral to this reform effort is the creation of practice protocols. An example of integrating practice protocols on a large scale comes from Intermountain Healthcare, which serves patients in Idaho and Utah.1 It determined that 90 percent of its caseload involves the treatment of 70 different conditions. For the majority of these conditions, Intermountain settled on established treatment approaches supported by robust scientific evidence.

   Intermountain officials understood that the recommended standardized approach is usually appropriate when patients present with one of the 70 conditions though the standardized approach does not apply in every instance.1 Such an approach allows for more consistent delivery of care, more predictable outcomes, better defense in the event of medical malpractice accusation, more consistent billing practices and more accurate documentation.

Four Pertinent Principles In Streamlining Health Care Delivery

Podiatrists can learn from Intermountain’s efforts to streamline its approach to care by adopting four key principles.

   1. Manage the care. Select the most common conditions and settle on a treatment approach. The successful adaptation of treatment protocols requires acceptance by all members of the service chain. Applying evidence to practice requires standardization not just of operational routines but of the rules for making clinical decisions. The more detailed the descriptions in a series of tasks, the less decision making along the path and the more predicable the actions and the outcome. One must identify and address every symptom, observations and lab result.

   2. Corral variability. Create mechanisms for addressing instances when the standardized approach is not appropriate or not successful. There are instances in which the presenting conditions are complicated, poorly understood and do not fit into expected protocols.

   It is essential that practitioners have a way of addressing such instances and not continue in a way that is not predictable. Such an approach may entail alternative protocols, further testing or referral to an expert in the field. It is important to examine the incidence and reasons for conditions that fall outside of established protocols.

   3. Reorganize resources. When practices redesign clinical protocols, they must also reconfigure the supporting infrastructure and routines. There must be a match of the staff, incentive systems, information technology (IT) systems, physical layout of the clinic and educational materials, all with the redesigned process in mind. When a practice does not adopt such a unified approach, podiatrists continue to perform work that they could delegate to medical assistants. Performance measures then remain focused on factors not critical to achieving desired outcomes.

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