At 710-bed Greenville Memorial, "There was no other reason people used that (Epifoam) other than the fact that it was on the standing order, and nobody looked at how much it would cost," Demosthenes says. Even new mothers who didn't get stitches got Epifoam, a charge ultimately passed on charges to payers, she says.
After getting agreement that Epifoam wasn't a must-have expense, Demothenes successfully argued to "have it unchecked from standing orders, and we went from 222 Epifoam orders a month down to 18." She projects that the hospital's annual costs for the product will drop from $117,375 to $8,459, and charges, reflected in bills to payers, will drop from $411,321 to $33,350.
For reducing the use of Cervidil, the hospital is pushing for voluntary behavior change among physicians with expected costs to the hospital dropping from $118.433 to $51,036.
"This is low hanging fruit that doesn't hurt the patient or the doctor. It's a little thing, not all that much money. But if you could find five little things to save in your system without decreasing value, that's doing the right thing."
Demosthenes is part of a tiny but growing minority of providers who now consider cost and value when deciding how to treat patients and want their colleagues to start thinking more about it too.