Potential Problems

Department Spotlight: The
Operating Room (OR) Data Problem
As much as 40 percent of a hospital’s budget
goes to OR expenses, specifically, the cost of
medical and surgical supplies.
One of the main difficulties with capturing charges in
the OR is determining the methodology best suited
for your institution. There are two typical ways to
capture charges: inclusion and exclusion.
Inclusion: consists of documenting every item that
was used to perform the procedure and charging
Exclusion: involves listing all materials that could
possibly be used during a procedure, crossing off all
unused items, and billing for the remaining supplies.
Potential Problems
As with any process, there is a potential for
problems to surface. When charging for
procedures in the Operating Room, some items
may be left off the list of items used/unused,
some may be repeated multiple times and go
unnoticed, and some may be recorded under
different names, causing inaccurate records.
Capturing Success
That said, there are steps that facilities can take to resolve chargecapture inaccuracies and ensure a successful process in the OR:
• Maintain accuracy of the OR case schedule. Verify that the scheduled
number of cases coincides with the number of completed cases to avoid
discrepancies, taking into account any cancellations.
• Anticipate charges by reviewing surgical cases each day, and efficiently
capture expenses to process billing correctly and in a timely manner.
• Keep item numbers linked with the current contracts to maintain
effective pricing controls.
• Establish a system that ensures process controls for
billing procedures. For accurate charges, those
responsible for reconciling OR expenses should not also
be responsible for documenting costs to patients.
• Catch charge-capture errors early in the process so
they can be corrected before bills are sent to patients.
This is most effective when the staff is retrained regarding
charge capture and compliance sooner rather than later
to stop errors and inconsistencies.
In 2003, six key factors of best hospital materials management
practices were recognized at the AHRMM annual conference as ways
to reduce expenses and improve quality of care.
1. Control dollars, not just materials. Do not limit yourself strictly to
the materials side of the supply chain. Consider that materials must be
available at the right time, in the right place, and that there must be
an adequate, cost-controlled supply of these materials and
sufficient equipment to attend to patient needs.
2. Work together with physicians and nurses. Strong collaboration and
communication among purchasers, physicians, management, and staff
must be present if any process is to have significant, lasting, positive
3. Take into account total expenses, not just the rate. All
individuals involved in the decision-making process of materials
should be aware of the total expenses for supplies and
equipment. Determine the true cost of inventory rather than just
the dollar amount. One product may appear to have an affordable
price point and be within your budget, but make sure to identify
additional charges such as ordering costs, carrying costs, shipping,
delivery, etc.
4. Establish cohesive and organized policies and procedures. With
consistent and well-organized guidelines, you reduce the risk of
overspending and guarantee constant stock quality.
5. Have a unified and structured process instead of a department
emphasis. Similar to the previous item, your methodology should
be uniform across the hospital, rather than department-specific.
Inventory management practices in the ER should have the same
management practices as those in the pharmacy, surgical services,
radiology, and so on.
6. Create processes with a team mentality in mind, not
individually focused. Even though it is necessary to employ
specialists in materials management, goals should be teamoriented and should not reflect the preferences of an individual