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Purchasing video equipment for minimally invasive procedures can present a huge challenge. Standardization offers obvious advantages; however, it often is dismissed as an unattainable goal when dealing with physicians of multiple specialties. Standardization of video equipment throughout all specialties, however, is attainable. The keys to evaluating and selecting one product or vendor are clearly defined goals, the proper tools, and education. Although it might seem like an overwhelming task, it is possible to stay in control throughout this process and achieve the facility's goals.

Group purchasing organizations saw another year of increased volume in 1998, according to Modern Healthcare's annual survey of the sector. But in many cases, customers are going off on their own, becoming competitors to the large GPOs. Fledgling Internet firms also are offering new purchasing options.

No one is more capable of identifying problems related to health care than health care practitioners. Identifying a problem is the first step to every new product or invention. This article provides step-by-step information to help health care practitioners identify problems and possible solutions, look for a creative company to bring the solution to the marketplace, and present the product idea to potential industry partners. The author also discusses the legal aspects of product development and the advantages and disadvantages of licensing a new product or starting a business to develop a product.

The article reviews a team effort to reduce operating room costs by 25 percent. The team achieved this goal by participating in the Institute for Healthcare Improvement Breakthrough Series on adult cardiac surgery. The process improvements included standardizing practices, reevaluating equipment, and reducing operating room cycle time.

Laparoscopic supracervical hysterectomy (LSH) can be performed more easily with a powered morcellator for removal of the uterus. Available laparoscopic morcellators are expensive and may be difficult to use, but a new, powered, disposable instrument was developed (Diva; FemRx, Sunnyvale, CA) to morcellate the entire uterus for easy removal through a 15-mm cannula. Twelve consecutive women for whom subtotal hysterectomy was indicated underwent LSH by standard laparoscopic protocol and were monitored postoperatively for a minimum of 1 month. In the current trend of "less is more," LSH is an emerging option for less extensive hysterectomies and can be made more cost and time effective with a single-use powered morcellator.

The issue at hand, therefore, is not one of reusable versus disposable, but rather the cost-effectiveness and expense associated with use of barrier versus nonbarrier materials. As mandated by the Occupational Safety and Health Administration, the need and function of the surgeons' gown barrier is a given. Initially the gown was used to protect the patient from members of the surgical team; its role now is to protect the surgical team members from the patient and the hazards associated with exposure to bloodborne pathogens. As for barrier drapes (i.e., patient, Mayo stand, back table covers), considering the influence of today's antibiotics and the advent of minimally invasive surgical techniques on the incidence of postoperative infection, just how necessary are they? Initially the use of barrier drapes was viewed as a reasonable practice. The problem, however, with any reasonable type of practice of this nature is identifying the kind and quality of supporting evidence and testing the practice itself. If there is no evidence for or against a practice; its advocates make up the process as they go along. In the case of barrier drapes, there were individuals who assumed that there were studies that conclusively demonstrated their need, even though they never sought confirmation to that effect. In the process, whether the drapes were cost-effective escaped criticism, and their use survived over the years because of the "that's the way we've always done it" syndrome. In a comprehensive examination of draping practices written 60 years ago, a physician discusses the myriad sources of contamination that could contribute to postoperative infection. He concluded that "to minimize the chances of contamination, all of these sources must be separately and individually studied." In terms of the influence of barrier surgical drapes, there remains a need for unbiased, statistically valid, conclusive research. Until such data become available, their use cannot be indisputably defended.

This proposed rule would establish additional standards for an entity to qualify as a Medicare supplier for purposes of submitting claims for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). This proposed rule would establish additional standards that must be satisfied before a DMEPOS supplier could receive payment from the Medicare program. The Social Security Act Amendments of 1994 require that a DMEPOS supplier meet standards related to compliance with State and Federal licensure requirements, maintaining a physical facility on an appropriate site, proof of appropriate liability insurance, and other standards the Secretary may specify.

There is a paucity of research regarding the contribution of "low-cost" technologies to the escalation of medical costs in the United States. We examined total charges for medical and surgical supplies (MSS) among all hospitalized Medicare beneficiaries in 1994; a total of US $16.8 billion was spent on MSS, or $1,397 per hospitalization. For selected surgical procedures, both the proportion of total hospital charges attributed to MSS and the mean charge per hospitalization were considerably higher. Concerns regarding excessive payments for MSS and the lack of accountability by the Medicare program are discussed. Itemization of MSS supplies may serve to eliminate wasteful use and lead to decreased costs.

The healthcare system remains in a dynamic state of flux. We have all heard the story: the changing healthcare market brings reduced reimbursement for services, increased competition, and steadily increasing supply, maintenance, and equipment costs. Ambulatory surgery centers (ASCs) must keep in sync with this change or fail to survive the current market forces. However, because they represent a small contract to various vendors, many ASCs pay premium prices for inventory while receiving less from Managed Care Plans (MCPs) and Health Maintenance Organizations (HMOs). This dilemma makes control of supply costs a top priority for ASCs. In reality, purchasing is becoming more strategically connected to the ASC balance sheet than ever before. Apart from personnel costs, supply and pharmaceutical purchasing represents the greatest expense category on our financial statement. Harnessing these costs directly relates to bottom line profitability. In addition, while performing cost savings magic, ASCs must maintain patient and surgeon satisfaction with the superior outcomes and state-of-the-art technology their reputations are based upon. Sound impossible? This article details how Surgery Center Plus, Inc. (SCP) implemented a cost containment project.

Surgical smoke evacuation systems are high-flow vacuum sources used to capture, at the surgical site, the smoke aerosols and gases generated during the use of lasers and electrosurgical units (ESUs). In this study, we evaluated 16 evacuation systems, from 10 suppliers, designed and marketed for use in the operating room for general surgery. For our testing, we focused on the performance of the systems (particularly their ability to capture smoke particles under simulated surgical conditions) and their ease of use and quality of construction. We also examined the projected costs of each system over a seven-year life cycle. We rated the systems separately for two different evacuation applications (1) general-purpose applications, for which the system would, in many cases, be used with a handheld nozzle (the traditional capture device used with these systems), and (2) ESU-pencil-based evacuation applications only, for which the system would always be used with a pencil-based wand. (We report on ESU-pencil-based smoke evacuation wands in a separate Evaluation in this issue.) While we found most units to be Acceptable, we did rate two units Acceptable-Not Recommended for both applications and one unit Unacceptable for general-purpose applications. In addition to our findings for the evaluated models, this study features several sections providing generic information and guidance about smoke evacuation technology. The Technology Overview describes the basics: what these systems do and how they do it. The Technology Management Guide, "Clearing the Air-Should Surgical Smoke Be Evacuated?," discusses the issues healthcare facilities should consider when determining whether, when, and how surgical smoke should be evacuated. Finally, the Selection, Purchasing, and Use Guide offers guidance on how facilities can most effectively implement this technology, from identifying models that will meet their needs to ensuring that the systems are used properly to provide adequate staff protection.