The Healthcare Leadership Experience

Purchased services is often the most overlooked expense in healthcare yet offers opportunities for cost savings. Brian Bartel shares his best practices for effective contract management, with Jim Cagliostro.

Episode Introduction

Brian explains the unique challenges of purchased services, why a centralized contract repository is the first step to successful purchased services management, and why hospitals should never allow contracts to auto-renew. He also explains why ‘’red flags’’ aren’t always necessarily malicious and why it’s vital to question the line-item details of your purchased services invoices.

Show Topics

• Purchased services present a unique challenge in healthcare

• #1 tip: Create a centralized contract repository

• Review your contracts on a minimum annual basis

• Don’t assume all red flags are malicious

• The hidden cost savings in your line-item details

• Be inquisitive, be patient, be strategic – and build relationships

06:35 Purchased services present a unique challenge in healthcare

Brian explained the difference between supplies and purchased services.

‘’…When you're talking about supplies, it's pretty easy. You've got a specific item number, you've got your power set, your requisitions, everything is very orderly. So things are coming in, you can track it, you've got the data behind it, there's a contract with that line item pricing. And then when you get confirmations back, usually people are using some form of EDI, which makes it relatively easy, and you can track that. Item A is item A, item B is item B. Purchased services is different because it typically is not on a PO. Again, I've worked places where it is, but that comes with its own challenges. It's very department specific, so you've got usually a department manager or leader that's kind of running that point with it. We don't have as much interaction on the supply chain side of this either. Communication is usually kind of sparse between supply chain and a purchased service provider as compared to a typical supply vendor. And again, the data is just, it's more difficult. When you start looking at how things are being invoiced because there's no PO line, it gets very challenging to try to figure out, "Okay, what's actually happening with this spend?" Typically, an invoice will come in, the department manager signs off on it, it gets paid, and that's it. So a lot of opportunity there.’’

08:30 #1 tip: Create a centralized contract repository

Brian said a centralized contract repository was the essential first step to successful purchased services management.

‘’I think that at square one, I think the biggest thing you can do is if your organization or your hospital, your ASC, your clinic, whatever it is, if you don't have a centralized contract repository, that's step one. Again, stepping into certain roles in my past, you've got contracts that might be down in admin. You've got department managers that have signature execution authority and they've got them in their files, and then you realize three years later that there's been this contract that nobody's really paying attention to because it's just a paper copy. Really I think that that's the biggest thing for me is getting your hands around it. Number one, you've just got to have that centralized repository. Again, that doesn't mean that you need to use software. Software obviously makes things easier. I'm a big proponent of that. But again, even just saying, "All right, nobody can sign contracts except for," whether it be your CEO, your CFO. "Send all these down and we're going to put them in a file cabinet." At least then you can go and try to find where those contractual documents are.’’

10:07 Review your contracts on a minimum annual basis

Brian said it’s important not to let contracts auto-renew.

‘’It’s always good to have that check-in annually, even if it’s just pulling the contract, making sure when does this contract terminate? That’s the other thing about automated systems through contract software is that you can set those flags. “Hey, something’s coming up 180 days later.” Again, with things that are just auto-renewing, that’s an issue too. If you miss that window to terminate something that you do want to go out to bid for, or maybe it’s a contract that you don’t need anymore. And I’ve seen, you’ve probably seen it too, 180 day out clause, some of these things. So if you miss that, that’s going to be a problem. As far as reviewing, it depends too on the type of service. Some of them are much more important, and so having a quarterly business review or a semiannual business review is important, and that gives the vendor time to come and showcase what it is that they’re doing too, because at the end of the day, sometimes these people are coming in, they’re doing great work, but nobody really knows except for that department or specific area that they’re there too. So giving that face time opportunity for the vendor, especially on those critical contracts, is important as well.’’

12:21 Don’t assume all red flags are malicious

Brian said reaching out to the vendor is important if you notice an invoice discrepancy.

‘’I think that that's where you've got to have a little finesse, again, realizing that some of these contracts, there's a lot of relationships built in. Again, if you've got somebody that's on site providing this, odds are they built those relationships. So I always take the approach when I notice that something's not going well on my side, if I notice an invoice discrepancy or something, it's an automatic red flag, but don't assume that it's malicious, right? So the first thing that I recommend is definitely reaching out to the vendor, the supplier, the individual, whoever it is that's your point of contact and just have that conversation. Say, "Hey, we noticed that there's a deficiency here," or, "We have a question about this invoice," and give them a chance. Because again, remember, on their side, I think it's probably maybe not quite as complex as it is on ours, but I know that just the conversations that I've had with suppliers in the past is that there are mistakes made when they're sending out invoices on a monthly basis or whatever it is. Again, give them that opportunity to rectify, at least bring it to their attention, and don't assume a malicious intent, even though that's probably from a supply chain standpoint, something that we might tend to do a little bit too much, right?’’

14:22 The hidden cost savings in your line-item details

Brian said a detailed review of purchased services invoices can uncover significant cost savings opportunities.

‘’At the end of the day, we're paying for whatever it is that we've signed up contractually for. And so having that actual invoice in front of you will tell you a lot of different things. Number one, you get the contract. Number two, you get the invoice. And then you start going through, does this make sense? Are things lining up? And I found some just very easy wins, things that they've been charging for, like an EVS vendor that was charging for restroom service, thousands of dollars a year, nobody knew what it was, and all they were doing is just bringing in little scent pads and not even going into the restrooms. But that was a line item that nobody had really questioned before. And so by seeing that actual invoice, again, now you're not just seeing it as X amount, now you can actually go in and see what it is that they're invoicing for. Again, correlating back to the supply chain side, we know that. We know each individual widget, case, box, each, but until you see that invoice a lot of times, if you're looking at it from a GL perspective or an expense, you don't see that line item necessarily all the way down to that detail. So it just tells you a lot. And again, maybe I'm just a nerd, but I like doing that. I like pulling those occasionally and just making sure, do the sniff test. Does this seem like everything that it should be? And then ask those questions. And again, you learn through that too. Some of the services that we have, it's like, "Oh, I didn't know that that was included." So again, that goes back to the communication with the vendor or supplier, give them opportunity to explain what it is that they're invoicing as well.’’

19:05 Be inquisitive, be patient, be strategic - and build relationships

Brian said building relationships is vital in leadership.

‘’I think the biggest thing is just like I mentioned before, be inquisitive, have patience, and be strategic. A lot of the things that we would like to get done, whether it's supply chain or in our personal lives, it takes a while. So build those relationships, know what you want to do and know that it will take time. Rome wasn't built in a day. And so when you have those opportunities come up, if you're strategic about it, that door opens a little bit, you've got all your ducks in a row, then you can walk through and say, "Hey, I've got a solution to try to fix this, because I've been working on it in the background." So I wish that there was more that I could say than that, but I know personally that's what it is. Be inquisitive, be patient, be strategic, and build those relationships.

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You’ll also hear:

From critical care to materials management, Brian’s journey in healthcare: ‘’No day is the same. Hopefully we can bring efficiencies and streamline processes to avoid some of these chaotic fires that pop up, but again, every day brings this new challenge.’’

A straightforward definition of purchased services: ‘’I just keep it simple. Is it a service that we're purchasing and that's usually typically some sort of a purchase or a contract or an outsource of some service that we're taking advantage of.’’

The benefits of a mentor in effective contract management: ‘’If you would've just stuck me in purchased services when I left the critical care access hospital, I would've had no idea, but I had a mentor, I had somebody that was teaching me that. So rely on those people and ask those questions. Ask the department managers, your GPO. Again, I know that there are pros and cons of GPOs, but that's a great place to look too.’’

What To Do Next:

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• Benchmark a vendor contract – either an existing contract or a new agreement.

• We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.

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3. If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at [email protected] or directly at 732-319-5700.