It's great to see such a great audience and participation as well, and thanks to ASGE for inviting me to participate on this leadership course. Fantastic to be here. Great talk so far. I would like to delve a little in the next 10-15 minutes on the supply chain part of it. As Neil mentioned, this is one of a significant portion of what we do every day, especially endoscopy unit, or could it be clinic, could it be infusion center that we run, our pharmacy, whichever ancillary that you have. Let's dive a little into it. There we go. So I thought we would talk briefly, these are the agenda items. What is the importance in the supply chain management, and what are the challenges we get through, and what are the effective strategies that we go along with it, and what kind of technology do we want to use to overcome these challenges and how to bring the effective strategies. Importance of the supply chain management, as Neil mentioned, endoscopy unit efficiency, turnover time, throughput, a lot of that is dependent on the supply. When you look at supply management, it doesn't have to be just a scope or a device or medication. It could be physicians, it could be staff, different thing, but in this particular portion of it, I'm going to concentrate mostly on the devices, medications, utensils that we use regularly. The role of efficiency, effective supply chain management is essential in maintaining the operational efficiency of the surgical center, whether it's ASC or the endoscopy center within a hospital. And the impact on patient care is extremely important. There are so many times we have gone through, especially through COVID and recently through some medication shortages, whether it could be propofol or IV fluids, whatever, whatnot, it does affect the flow of our surgical procedures. And the availability of the supply, how do we do effective supply management ensures that medical supplies are readily available for the anticipated procedures that we come across in the next few weeks or months, and that doesn't delay the patient treatment and so improving the outcome. Key aspects in GI itself, how do we procure the devices? Choosing the appropriate is what company's scopes do we want to use? What is their backlog? What are they getting into any issues down the road? Are they innovative? How advanced do we want to be in the ongoing continuum of innovation? Trying to see where do we go with it and how much, what are our clinical needs depending on the population that we serve? Obviously, quality, none of us want to be low on the quality. You want it to provide the best services possible, but at the most cost effective way. And what is compatible with the equipment that goes? There are newer devices and newer technologies that come in place, but is it compatible with the stuff that we have already? Do we need to change the equipment that we have? Obviously, that comes with a significant cost. Coming to inventory management, tracking, noting the stocking levels, forecasting the needs, obviously, sometimes our practices are cyclical. What I mean by that is if particular months are slow or high, depending on your physician vacations, our patient population, or there's a flu outbreak, obviously, with flu, we don't see as much, but if there's any GI illness that are going on around, hopefully, we won't see pandemics anymore. Any other local epidemics that are happening, how do we forecast what's going on and see how do we staff them appropriately? Sterilization and reprocessing, including cleaning supplies, disinfection supplies, sterilization process and its materials. What are the safety protocols for the patient? What is compliance with the infection control standards that we have locally in our centers? Coming to logistics and distribution, necessary supplies for each procedure room. It could be ranging from multitude million of things. When things don't go wrong, we don't realize how many things are stocked in the room because everything goes peacefully, but when we do not have one particular supply available at the start time of a procedure, that's when the panic can start. Having the effective supply procurement team who constantly is in touch with the endoscopy unit or wherever the management is being going on, keeping ties on what's coming, what's probably going to go into shortage. All these things need to be actively looked into. Cost optimization, definitely negotiating better pricing with the vendors and using alternate cost-effective models. I mentioned here single vendor versus multiple, extremely important, especially as we learned from the recent shortages that we see. It's beneficial to have multiple vendors so that you're not bottlenecked just because of the single vendor. From whatever reason, the supplies they provide, or if they are a middle market person, we're not dealing just with one person. Having to deal with only one vendor gives you more leverage to say exclusively we are going with you, so you may negotiate a better price, but there are several cons that comes with it. Having several vendors definitely helps so we don't get into trouble when the shortage happens. Then a new product trial needs to happen. We all see new things coming upon in the market. How do we trial that? How does that help? What are the pros and cons in our particular ASC versus the health center that we work on? Whom do we need to get involved or get permission from? What kind of financial performer do we want to show it to them? If we are the leader or if we are the shareholder in the particular unit that you're working, how do I convince my leader to get this new? Obviously, RCM team need to be involved too. We all work in the industry as part of providing services, but at the same time, we need to be treated and supplemented well with financial gains too. What is the safety of the product? What's the current practical guideline? Does this go along with it? Or if we do not use this particular product, are we not following the guideline? Obviously, we wanted to do the best possible to our patients. We are the gatekeepers for whatever new technology comes. We are responsible to provide it to the patient. We wanted to be ahead of the scale, trying to figure out what's coming new. How should I get this in the hands or the care of my patient? Enhancing patient care obviously comes with timely procedures. We don't want to delay procedure just because you don't have a scope available or your first scope broke or whatever reason it could be. So thinking ahead of time on your supplies. Essential instruments need to be available. It's critical for delivering high-quality care. Operational workflow. I know Neil talked a lot about operations part of it. They lead to better coordination among healthcare teams so that we can improve the outcome of our patients. Cost efficiency coming to that. When Neil was talking and he said cost per procedure or cost per patient, it's so hard to determine sometimes that particular cost. There are some fixed costs. There are some variable costs that go with each care that we provide to the patient. So understanding that process. What are the different portions that are involved? Is extremely important so that we minimize the waste too and prevent any stock out. Usually I learn when I go talk to different groups. What do they do? How long do they keep their stock available? How many weeks of procedure time that you want to keep the stock on just in case anything happens? At least you have this lead time to work on to deal with the challenge that comes in the future. Cost savings per surgical center. Significant savings can be achieved through supply chain management while maintaining high standards of care. And I want to talk a little bit about the GPOs, which are the group purchasing organizations, whether it's the ASE or a health center. Usually these provide cost savings to the unit. Usually these are formed as a big group of a similar company or multiple single units be part of this GPO, which in turn have single, multiple vendors who they procure the supplies from. So because they are dealing with a big group of people, they get bulk discounts and economies of scale are given to all the participants that are part of it. They help with unique purchasing agreements too. This could be scopes, pharma, infusion, devices and supplies, or even including capital for purchasing the scopes. Manufactured and distributed partners can be part of this GPO. You see multiple organizations in between that we deal with that are part of this. Healthcare GPOs are usually funded by the vendors as a percentage of administrative costs, usually used by hospitals, nursing homes, home healthcare agencies, and consolidated ASEs. And the biggest advantage of being part of a GPO, you can learn from each other. What is other person doing better than me? How are their supply needs different than mine? In different ways, whatever benchmarking you wanted to do. Challenges, some of them fluctuating demand, predicting this fluctuating demand sometimes is tricky. So you wanted to learn and be ahead of your game in your particular area, because we may learn from others, but our scenario may be different from your colleague who practices in a different state, and their needs might be different. And obviously limited storage space. I mean, we're not at the luxury of having a big supply chain area. If it's a bigger hospital, you may be having a big brick and mortar place. But coming to ASE where I practice, for example, in a private practice, space is money. We're trying to utilize every much space available to try to utilize. So we're trying to maintain this storage space in different areas. So we're not at luxury to keep and avoid stockpiles with large amount of supply. So it's tricky trying to see how much do I need to do. I'm tracking complexities between different departments, who is using what, for example, even IV fluids. If it's a bigger healthcare system, it's not just GI that's using it. It's multiple other people that are doing it. It's complicated to track on all of this. And obviously, we use technology to help simplify these complex problems, specialized endoscope with different features and requirements. And obviously, we need to be stringent with all the regulatory compliance that we need to do with any of the devices and techniques that we do, especially when we're dealing with high-cost devices like endoscopic ultrasound or any of the high-cost items, we want to make sure because we cannot store an extra scope or third scope or fourth scope, depending on the need, we're trying to allocate the expenses towards those. I spoke about the limited storage space, especially in ASE because of the restricted storage. Inventory management strategies, effective planning and management strategy is crucial and ensuring availability of supplies with careful monitoring and scheduling to help ensure critical items are readily available, especially critical items. For effective management of this streamlining supply process, bigger companies may use a procurement officer or a team of people. A small endoscopy center may have one person that's manually going through and checking on all these quotes, trying to see what do I have of how many. So depending on what resources and capital that we could put for this management, utilizing technology, especially AI, as everybody is using AI in every area that we are looking at this time, trying to reduce the waste and improve the accessibility. Especially important is training staff. Training staff on old methods that we use and also the newer ones that are coming in. Or when you are hiring new people that have no clue of how to use some of the devices that we have, ongoing training throughout the time, especially with the regulations on newer devices. Coming to inventory optimization, regular inventory assessments need to be done and adjusting purchasing strategies, identifying trends by predicting what's the cyclical nature in your area. Just-in-time inventory techniques help reduce waste and ensure. But if you're trying to use the just-in-time inventory, you want to be sure that you'll be able to get the supplies and the relationship with the vendor is extremely important at that time. Coming to the supplier relationships, I see this as one of the important parts when I'm trying to deal with supply chain logistics. I don't do them personally, but I'm in close contact with our procurement person and I keep talking to them on how they maintain relationship with the different vendors that they have. Having strong relationship definitely helps with better pricing. It's not just the better pricing that you're looking for. Obviously, that's important. But in case of any shortage that's going to come, how are you being notified? And are you top on the list for that particular vendor to supply your drug? Why should you be on top of the list? Obviously, we are all human beings and relationships matter. Collaboration with suppliers is extremely important to develop good communication and trust, paying them on time. We don't want to keep the accounts receivables longer so that both succeed. Your vendor succeeds and you succeed and you try to create ways how we can do better in the future. Always think of continuing innovation and staying informed, engaging with suppliers to know what's coming down the road. What are the emerging products and technologies in the market? How do you get access to them and so on and so forth? Role of technology, transformative impact, definitely when we can access the technology with a reasonable cost. Obviously, that's an important feature too. Implementing digital solutions, I would think many of the centers are digitized by now and supply chain is on a digital platform to allow for better decision making. Efficiency improvements, including technology in supply chain management, operations and logistics especially. Coming to data analytics, extremely important. Trying to predict what's coming. What's your normal need every day or in a week or in a month? How prepared are we? What are the insights we have in this surgical center? If you have two or three surgical centers, they may differ differently so we need to have different insights into each center. And predicting the future needs, we talked about that already. And minimizing errors, implementing tracking systems definitely help. I forgot to see if it's a manual process that you're being done. Oh, she's off. She didn't check last week so that's why we didn't know what's coming this week and unfortunately, we don't have it today. We need to minimize this or looking forward ahead of time trying to see where we can avoid. Improving inventory accuracy by tracking systems surgical centers can maintain. There are multiple ways we track different systems. It could be barcode, it could be RFID tags, whether it could be warehouse management. This is usually done through the cloud with bigger companies. It could be robotics. None of us use robotics. Not that I'm aware of in a GI endoscopy center but you see in bigger companies. Internet of Things, AI, automated inventory tracking systems, extremely beneficial in investing what works for you. Obviously, you wanted to see what's the return on investment by investing in these technologies to help. Automated supply ordering is one of the important things. Just like you do auto payments to our loans, our debts, whatever it could be. Automated supply ordering definitely helps so that even if somebody's sick or that person is not here, definitely helps. Timely replenishment of what supplies are needed. Real-time inventory monitoring. Operational efficiency. I have seen different new companies coming in for this real-time inventory monitoring. Some are doing by weight-based, some are doing by AI-based. It screens the whole room trying to see how many of these, for example, catheters we have or snares we have and it automatically replenishes, put the order in and replenishes. We are not there. Our unit is not quite there yet but I would love to see that coming upon. Operational efficiency, automated supply monitoring definitely increases that efficiency. In conclusion, the importance of supply chain management is critical for operational success of the surgery centers, especially to run it smoothly so there's no chaos, there's no confusion. I'm saying this but we all go through one or two little things here and there every day. Then we wanted to learn back from that to see what happened. Was it a supply chain issue? It could be many times. It may not be just we started late. What else could have went wrong because we started the case late? Going and dissecting and doing the post-mortem later on, trying to learn from what has happened. Addressing those challenges, identifying and addressing what happened in the supply management leads to improved patient care and definitely leveraging technology. I'm a big proponent of leveraging technology. Maybe I can get carried away sometimes but we need to make our lives better by utilizing technology better to improve our patient care. I think they deserve it. That's all I have. Thank you.

supply chain management

healthcare technology

inventory monitoring

group purchasing organizations

predictive analytics