A national IV fluid shortage expected to affect the healthcare landscape through the remainder of the year has some spine surgeons thinking about how stay prepared when unexpected supply chain issues strike.
Note: Responses were lightly edited for clarity.
Question: What are your strategies for staying ahead of potential supply chain issues overall?
Brian Fiani, DO. Spine surgeon. (Birmingham, Mich.): To mitigate potential supply chain issues in spine surgery, practices can adopt several strategies:
- Diversifying Suppliers
- Inventory Tracking Management Systems
- Educating Staff
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: We can scale up or down as needed, and I think most ASCs are adaptable. It does still depend on WHEN the facilities come back online. I think our medical infrastructure can tolerate longer, not that we want to, but it exposes the real weak links in our supply chain. Going forward, as a nation, we have to do 2 things: stockpile supplies that can potentially last for a time, such as critical IV fluid types, and encourage other manufacturers to join the supply chain in other parts of the country that can step in when needed. The ability to repurpose different factories dates back to the second world war. We need to heed those lessons and in this age of one-day deliveries, and signing important documents on-line, figure out a way to pivot and backfill our needs as a nation. While companies need to compete, we also need to be able to get it together when things go sideways.
Vladimir Sinkov, MD. Sinkov Spine. (Las Vegas): Having extra supplies saved "just in case" could certainly help, but there is only so much "hoarding" a hospital or a surgery center could do in anticipation of potential supply shortages in the future. It is an added expense and most of the supplies have fairly short expiration dates or stringent storage requirements.
More importantly, the medical supply industry needs to be much more decentralized and resilient to natural or man-made disasters. It is mind boggling to me that the entire US healthcare system is so strongly dependent on a single facility (that is located in a hurricane-prone area) to produce IV fluids. It is not just a poor business decision; it is a matter of national security to have such vulnerability in the most "expensive" healthcare system in the world. Simple (yet effective) medications have already been in shortage for years, such as injectable bupivacaine with epinephrine or IV caffeine. There are also intermittent shortages of simple oral pain medications that are needed for postoperative pain control.
I don't quite understand why, in a free-market economy, another company can't start manufacturing and selling medications and supplies that are in chronic shortage and take advantage of such business opportunities. My best guess is that the regulations surrounding manufacturing and selling medications and medical supplies are so onerous that it is not worth it for another company to do it. Another possibility is anti-competitive business practices by the current large medical supply manufactures that do not allow the competitors to exist. These are the issues that could and should be changed.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Larger, multi-hospital systems are capable of absorbing/sharing supplies when cataclysm strikes and is much better off than free-standing surgery centers from a supply chain availability. However, it has been reported that Baxter's more than 2,500 onsite employees will work with another 1,000 contractors who are bringing the facility back up to speed.