Green Initiatives at Saint Luke’s Health System

By implementing a reprocessing program, Saint Luke’s Health System was able to save more than $480,000 in costs and divert 12,000 pounds of medical waste in 2009.The majority of savings came from the reprocessing of EP lab devices. Learn more about Saint Luke’s strategies here.

   Since opening its flagship hospital in 1882, Saint Luke’s Health System has received numerous top national honors for its wide range of service offerings and high level of specialty care. The awards and recognition bestowed upon its 11 hospitals serving the greater Kansas City area reflect the pride Saint Luke’s takes in its reputation for innovation, quality and compassion.    One notable innovation Saint Luke’s implemented is the use of a medical device sustainability program from Ascent. The cost-savings realized through reprocessing has allowed Saint Luke’s to meet its bottom-line targets, as well as prevent staff reductions that could be detrimental to patient care. Because of this, Saint Luke’s considers reprocessing a key strategy for achieving its overall operational goals.    Chris Rutherford, EP Lab Supervisor for Saint Luke’s Hospital, said that while the cost-savings realized through reprocessing is significant, the real benefit is that it aligns with Saint Luke’s core values for its hospitals, including good financial stewardship and, more importantly, providing safe and reliable care to patients.

Cutting Costs and Reducing Waste

   Today, Saint Luke’s Health System reprocesses between 100 and 200 individual stock-keeping units (SKUs). In 2009, this resulted in an overall cost-savings of approximately $490,000. Additionally, an estimated 12,000 pounds of medical waste is diverted from landfills each year as a direct result of Saint Luke’s reprocessing programs.     “We recognized that some devices marketed for single, one-time use could actually be restored to cut healthcare costs,” Rutherford said.    Eight of Saint Luke’s 11 hospitals utilize reprocessing in some capacity, and the programs are particularly successful for the system’s two EP labs. In fact, diagnostic EP catheters are the most commonly reprocessed device among all of Saint Luke’s hospitals.

Notable Success in the EP Lab

    “The lion’s share of our success with reprocessing has been in the EP lab,” Rutherford said. “In 2009, cost savings in the EP lab alone totaled $295,000.”    The EP lab is one of the key profit centers at many hospitals, including Saint Luke’s, in part because of the rapid growth of cardiac electrophysiology. In 2009, there were approximately 200,000 EP diagnostic catheter procedures in the United States, which represents an increase of 8 to 10 percent over the previous year. These procedures are increasing due to the growing acceptance of ablation catheter procedures as a treatment for cardiac arrhythmias.    As hospitals and EP labs examine their bottom line, reprocessing programs have grown because they provide a powerful solution for cutting costs without sacrificing the quality of patient care. Leading EP labs, including those among Saint Luke’s Health System, have turned to reprocessing to address these challenges in an effective manner. In fact, around 400 EP labs utilized Ascent’s reprocessing services in 2009, resulting in a combined estimated savings of more than $45 million. A new EP lab that begins reprocessing today can expect to save $25,000 - $50,000 in its first year, and reach an average of $100,000 after the first three years of engaging in reprocessing.    Because Saint Luke’s has a large EP program with an increasing number of procedures every year, it relies on reprocessing to contain costs. Each EP procedure requires many medical devices that Rutherford notes are unnecessarily labeled by the manufacturer as “single-use.”    In fact, the reprocessing and remanufacturing of single-use devices is cleared by the Food and Drug Administration (FDA) and thus, remanufactured devices are substantially equivalent to original ones. Saint Luke’s recognizes and appreciates this, and Rutherford adds that the EP physicians at Saint Luke’s have found no functional difference between a reprocessed EP catheter and a new catheter from the manufacturer, while the difference in price is significant.    Saint Luke’s EP labs have recently begun reprocessing ultrasound catheters, which provide significant savings; an original ultrasound catheter costs around $2,400, while a reprocessed one can be obtained for half the cost.

A 15-Year Partnership

   Saint Luke’s began its reprocessing program in the EP lab in the mid-1990s, just as the FDA was cracking down on in-house reprocessing programs and hospitals were turning to third-party reprocessors to meet the FDA’s stringent guidelines. The EP lab at Saint Luke’s was one of the first areas of the hospital system to realize the cost-savings and waste-reduction benefits that reprocessing offers.    While reprocessing in the EP lab at Saint Luke’s has been going strong ever since, other areas of the hospital system were more reluctant to get on board. That is, Rutherford said, until 2004, when staff members toured Ascent’s reprocessing facility in Lakeland, Florida. With the healthcare sector accounting for a large part of the U.S. carbon footprint — 8 percent, according to a 2009 Journal of American Medical Association (JAMA) report1 — the visit sparked interest among staff in collecting devices to divert waste from landfills.    In the future, Saint Luke’s expects to grow its reprocessing initiatives in areas outside of the EP lab, including general surgery. Leading the initiative are floor nurses, many of whom have been championing the cause as part of the health-care system’s overarching effort to be more environmentally conscious. Rutherford said many nurses have become passionate advocates of reprocessing, and this is significant because they have a sizable influence on the surgeons with whom they work.

Saint Luke’s Experience with Reprocessed Devices

   According to Rutherford, “A reprocessed device is the same reliable device that would come from an OEM (original equipment manufacturer). If we had any reservations about reprocessing, we simply would not make it a part of our healthcare system.”    In many ways, Saint Luke’s considers reprocessed devices to be more safe and reliable than devices from OEMs. “We’ve never had a reprocessed device fail, nor have we ever had any problems at all with reprocessed devices,” said Rutherford.“ However, I have seen original devices fail frequently enough that we have an entire file dedicated to correspondence with OEMs about the failures.”    Rutherford explained that a reprocessed catheter is individually tested and evaluated for safety and functionality, and must be proven to perform as it would in its original condition. On the other hand, a device from an OEM is only batch-tested. This difference in quality assurance only confirms Rutherford’s confidence in reprocessed devices.

Working with Ascent

   Saint Luke’s attributes much of the success of its reprocessing program to its relationship with Ascent. Rutherford said Ascent constantly seeks opportunities to add new devices to its reprocessing capabilities, which allows its customers, including Saint Luke’s, to grow their savings year after year. For example, Ascent recently recognized the potential for reprocessing ultrasound catheters for the EP lab and aggressively pursued the necessary approvals from the FDA.     “This was significant for St. Luke’s because it allowed us to achieve even more notable savings in our EP labs,” said Rutherford.    Ascent also helps Saint Luke’s by maintaining all necessary paperwork for its devices, issuing appropriate insurance policies and tracking history of device usage. This helps reduce the amount of manpower needed in areas outside of patient care.     “Prior to working with Ascent, staff members would be taken off the floor or out of the lab to pick up, clean, and package the discarded medical devices,” Rutherford said. “Now, we no longer have to take these staff members away from patient care priorities.”    Saint Luke’s also participates in Ascent’s EP Catheter Platinum Plus Program, which enables EP labs to recycle precious metal from medical devices and receive a rebate check in return. Not only does the program ease the burden on the hospital by allowing all catheters to be placed in one container, whether they are reprocessed or recycled, but it also frees up additional funding, which Saint Luke’s uses to offset continuing education expenses for its staff.

A Possible Strategy for All Hospitals

   Considering Saint Luke’s experience, Rutherford said they would recommend reprocessing to other hospitals seeking cost-savings and waste reduction.     “The single-use label is not a limitation,” said Rutherford. “If EP supervisors are not considering reprocessing, then they are allowing their hospitals to spend money that doesn’t need to be spent.”    Rutherford points out that all EP labs use EP cables, which are not one-time use products. “If they aren’t using a third-party reprocessor, then they’re either reprocessing in-house or throwing the cables away. If they’re throwing them away, you have to wonder why; what kind of green initiative do they have?”    An unexpected benefit of reprocessing for Saint Luke’s is the ability to rework contracts with original device vendors. “We strike any language from vendors’ contracts about one-time-use only,” said Rutherford. “If they don’t accept it, we don’t do business with them.”

About Saint Luke’s Health System

   The Saint Luke's Health System is a faith-based, not-for-profit aligned health system committed to the highest levels of excellence in providing health care and health related services in a caring environment. Saint Luke’s is dedicated to enhancing the physical, mental and spiritual health of the communities it serves. To learn more, visit www.saintlukeshealthsystem.org. Editor’s Note: This article underwent peer review by one or more members of EP Lab Digest’s editorial board.