Do GPOs’ cost limit safe needle device choices?

New law requires workers to evaluate choices

Are cost pressures and group-purchasing contracts keeping the safest needle devices out of some hospitals? It may be up to employee health professionals to make sure that’s not the case. The influence of cost on the selection of needle devices may be more complex than presented in a recent segment of the television show 60 Minutes, which portrayed giant needle manufacturer Becton-Dickinson as forcing smaller manufacturers out of the marketplace.

There is no clear best needle device, and health care workers should judge for themselves which devices they prefer, experts say. However, employee health professionals need to be sure their evaluations aren’t limited by materials managers who seek to keep costs in check, they say.

"Certainly, there are some hospitals being told by their materials management, You can only look at these products, [due to price],’" says Cindy Fine, RN, MSN, CIC, infection control and employee health program consultant with Catholic Healthcare West in San Francisco. "It’s a matter of saving money," she says. "They are told, You have to standardize; contract with one company, and save money that way.’ Materials managers haven’t quite learned that this is different, that we have to have health care worker input."

In truth, group-purchasing organizations (GPOs) do not require hospitals to purchase only their products. However, a hospital may miss out on certain rebates or special prices for selecting off-contract devices. At the same time, inspectors from the U.S. Occupational Health and Safety Administration (OSHA) usually would not cite a hospital for failing to buy the "cutting edge" in needle safety technology, says Craig Moulton, an OSHA industrial hygienist. Rather, the bloodborne pathogens standard and OSHA’s compliance efforts focus on the involvement of frontline health care workers as they evaluate various safety products, adequate training, and proper use. "The key to use of the device is acceptance by the people who are using it," says Moulton.

The nation’s largest GPO, Novation, currently offers a sole source for blood collection devices from Becton-Dickinson. Yet the GPO is considering expanding its options to member hospitals in the wake of the recent Needlestick Safety and Prevention Act. "Federal law and new states laws have definitely increased member demand for safety products and therefore increased demand for additional options, in light of capacity issues in the marketplace," says spokesman Lynn Gentry

"Four or five years back, it was feasible for a single manufacturer to offer safety devices to the marketplace because the demand was not that significant," he says. "We recognize it’s really not feasible for one company to provide the needs of an entire market at this point." Gentry also notes that group purchasing contracts just offer a way for hospitals to reduce costs on supplies. Hospitals are free to spend more on a device they believe is more effective.

In the 60 Minutes segment, Tom Shaw, founder of Retractable Technologies Inc. (RTI) of Little Elm, TX, asserted that his company’s representatives have been unable even to show their safety needles to hospital staff due to group-purchasing contracts and have been excluded from some needle safety workshops.

The segment did not explore the experiences of numerous other small manufacturers, or the impact of the recent Needlestick Safety and Prevention Act and the revised bloodborne pathogens standard on the marketplace. RTI’s web site indicates the company’s products currently are offered through five group purchasing organizations, including Premier.

An ongoing challenge

For Bio-Plexus, a Vernon, CT-based maker of internal blunting devices, getting into hospitals with GPO contracts that don’t include the product is an ongoing challenge. "We were able to get into several university hospitals [which are members of Novation] because of their desire to protect their workers," says John Metz, president and CEO. "Since there is overriding pressure in hospitals to reduce costs, it’s harder to compete without being on contract," he says. "It is an extra hurdle for us. It takes extra resources to get over that hurdle."

Not long ago, needle safety devices were scarcely on the radar screen for most hospitals. But state and federal mandates have changed that. Along with the greater attention to needle safety has come innovation in needle design. The web site of the International Health Care Worker Safety Center at the University of Virginia in Charlottesville lists more than 80 vendors of safety devices.

"The United States medical device market is the largest and most open medical device market in the entire world," says Janine Jagger, PhD, MPH, director of the worker safety center, who is credited with bringing the needle safety issue to the forefront of occupational health. Jagger notes that no device can be considered the best, and that device choice depends on factors related to its specific use. "You can get very different product evaluation results with the same device in different hospitals," she says.

But Bill Borwegen, MPH, occupational health and safety director of the Service Employees International Union in Washington, DC, worries that innovation won’t make it to the device selection committee due to group purchasing contracts. "The people in purchasing in these health care facilities, regardless of what kind of exemption they have [from contracts], continue to buy the products where they get the [price] rebates," he says. "Our members are not seeing the best safer products," asserts Borwegen. "This 60 Minutes story is an accurate reflection of the types of obstacles our members are facing to get their hands on the best lifesaving technology."

Ultimately, it is up to employee health professionals to ensure that frontline health care workers have a variety of designs to consider, regardless of cost, says Fine. "When we had our [evaluation] committee, we didn’t allow our vendors to even talk about price," says Fine. The health system’s individual hospitals and materials managers still brought price into their decisions, she says. "It’s impossible to ignore it as an issue."

"We’ve purchased a lot of items that are off-contract because we think they’re better," Fine adds. Meanwhile, the needle safety device market continues to evolve as demand picks up in the wake of the new federal law and revised standard, which mandate their use.

"Cost will continue to be a very significant pressure on this market," says Jagger. "The effect of that will be in the long run to bring prices down.

The rate of conversion to safety devices varies considerably, says Jagger. She estimates that 90% of hospitals use needleless IVs, but only 35% to 40% of IV catheters in use have safety devices. "We can see that there’s a big surge in the conversion from conventional to safety devices. The companies in this field are reporting a surge in demand for those products. There is definitely a lot of movement. "We need to keep the momentum going," says Jagger. "We need to follow up the new law with compliance activities on the part of OSHA to make sure the law is fully implemented."