CMRP Overview Session Dave Hinkle, FACHE, CMRP Michael Moore, CMRP

1. CMRP Overview Session • Dave Hinkle, FACHE, CMRP • Michael Moore, CMRP

2. Your Presenter’s • Dave Hinkle • Principal, Healthcare Supply Chain Education & Consulting • AHRMM Approved CMRP Presenter • Director, Supply Chain Outreach, Providence Health & Services • Senior Director, Supply Chain Operations Practice, VHA Performance Services • Supply Chain Operations Assessments and Operations Redesign • Interim Materials Management Services • Materials Management Leadership Program (Outsourcing) • David.hinkle@providence.org • 425-525-3242 (office), 856-816-7150 (cell) • Michael Moore • Director of Sales / National Accounts, Welmed Inc. • President-Elect, WSHMMA / Newsletter Editor • Previous • Surgical Solutions Specialist, PHS [contracts, inventory planning, sales] • Product Manager, Devon OR Products, Covidien [product development, contracts, logistics, marketing, profit management]

3. Disclaimer • Please be advised that this is only an overview of the Materials Management Review Guide. • It should not be inferred that test items in the examination are selected from any single reference or set of references or that participation in this review session guarantees a passing score on the examination. • No portion of this presentation may be reproduced by an attendee without the expressed written permission of the presenter.

4. A Mark of Distinction CMRP status allows you to: • Have a premier credential based on a sound assessment to distinguish yourself in an increasingly competitive marketplace. • Enjoy the pride of recognition and knowing you are among the elite in the field of healthcare materials management.

5. Administration • American Hospital Association • Eligibility [education + experience] • Application for exam • Fees • Schedule Exam • Computer-based • 2 hours, 110 questions [10 pretest] • Immediate results [upon completion] Valid for 3 years

6. Exam Specifications The AHRMM role delineation study identified real-world tasks that were grouped into categories and weighted to produce exam specifications. • Purchasing, Procurement and Product Value Analysis • Inventory Distribution Management • Information Systems and Data Management • Finance • Strategic Planning and Leadership (Support Services) • Materials Management Definitions (non-AHRMM)

7. Exam Categorized • Recall • The ability to recall or recognize specific information • Application • The ability to comprehend, relate or apply knowledge to new or changing situations • Analysis • The ability to analyze and synthesize information, determine solutions and/or to evaluate solutions

8. Purchasing, Procurement and Product Value Analysis • Administer and direct the program to purchase materials, supplies, and capital equipment • 25 items • Recall – 5 items • Application – 15 items • Analysis – 5 items

9. Purchasing, Procurement and Product Value Analysis • 4 Steps of “Act of Purchasing” 1. Requisitioning 2. Sourcing 3. Negotiating 4. Ordering

10. Purchasing, Procurement and Product Value Analysis • Requisition / Purchase order types • Stock • Non-stock • Electronic • Traveling • Blanket • Standing • Open

11. Purchasing, Procurement and Product Value Analysis • Freight terms and title of goods • FOB destination • FOB shipping point • FOB destination, prepay freight, and add • FOB shipping point, freight allowed • Payment terms and conditions • 2% 10 days, Net 30 • COD • Credit card / purchase card

12. Purchasing, Procurement and Product Value Analysis • Legal aspects of purchasing • Product liability • Wrongful rejection • Failure to deliver • Liabilities and warranties • Uniform Commercial Code (UCC) • Robinson-Patman Act

13. Purchasing, Procurement and Product Value Analysis • Right of possession • “Absence of rightful rejection” • noted by agreement, delivery, use or payment • Unconscionable contracts • Unfair, one-sided but NOT illegal • Liabilities and warranties • Implied • Expressed

14. Purchasing, Procurement and Product Value Analysis • Safe Harbor • Published in 1991 as an Amendment to the 1972 Medicare Fraud regulation • Prohibits: • Knowing and willful solicitation, receipt, offer, payment of remuneration in return for referral of Medicare patient • Knowing, willful, payment, receipt remuneration to induce the purchase of goods/services which will be paid for by Medicare

15. Purchasing, Procurement and Product Value Analysis • Safe Harbor requires hospitals to: • Report all discounts, free goods, warranties in cost report, submitted to Medicare. • Discounts are acceptable as rebates, credits. Must involve goods sold. • Cannot rebate one item based on purchase of another. • Cannot link incentive to furnish goods at no charge if another item is purchased.

16. Purchasing, Procurement and Product Value Analysis • Uniform Commercial Code (UCC) • Established in 1952 • Governs purchases in 49 states • Excludes services associated with products • Purchase of goods > $500 must be confirmed in writing to be enforceable under the law • Statute of limitations is 4 years

17. Materials Manager’s “Tool Bag” • Activity Based Costing (ABC) • A cost management tool to identify and allocate overhead costs • Activity Based Management (ABM) • Minimize costs, eliminate duplication • Continually evaluate new supply chain process Using ABC/ABM procedures will help ensure maximum returns for efforts expended and costs that have been incurred.

18. Materials Manager’s “Tool Bag” • Value Added Opportunities • Additional services offered as incentives • Value Analysis • Functionally oriented process • Best and most economical procedures, products, equipment, or services • Meet the needs of the user while reducing the overall cost involved

19. Materials Manager’s “Tool Bag” • Total Delivered Costs • All aspects of the product cycle • purchase price, receiving, warehousing, delivery • holding, value of money, pilferage, obsolescence • Outsourcing • Reduce the overall cost • Increase the quality

20. Let’s Take 5… It’s time for a Quick Break!

21. Info & Data • Information Systems • Data Management Numbers, Numbers and more Numbers Systems [technology]

22. Information Systems and Data Management • Direct acquisition and implementation of an automated, system-wide materials management information system • 15 items • Recall – 3 items • Application – 9 items • Analysis – 3 items

23. Information Systems and Data Management • Materials Management Information System (MMIS) includes: • Purchasing, Receiving, Inventory • Interfaces to: • Accounts payable • General ledger • Patient accounts • Surgery • Other clinical departments (as determined)

24. Information Systems and Data Management • Selection Process • Multi-disciplinary taskforce • Identified processes • Research marketplace • Determine functionality requirements • Develop RFP • Demonstrations • Develop project plan

25. Information Systems and Data Management • Electronic Data Interchange • Transmit data between computer systems • Standard communication protocols • Health Industry Business Communication Council (HIBCC) • American National Standards Institute (ANSI) • ANSI x .12 • File Transfer Protocol (FTP)

26. Information Systems and Data Management • Bar-coding standards adopted by HIBCC • “Code 39” or “Code 3 of 9” • EDI data sets most commonly used: • 832-price catalog • 850-purchase order • 855-PO confirmation • 856-advance ship notice / auto receipt • 810-invoice

27. Information Systems and Data Management • The Internet and Business • WWW – World Wide Web • XML – Extensive markup language • HTTP – Hypertext transfer protocol • UML – Unified modeling language • URL – Uniform resource locator • LAN – Local area network • ERP – Enterprise resource planning

28. Purpose of CMRP Certification • Recognize individuals who meet eligibility. • Encourage continued personal and professional growth in the practice. • Provide a national standard of requisite knowledge required for certification. Our Standard of Excellence Be Proud of It!

29. Questions?

30. Samples Questions Which of the following is the correct sequence of stages in the process improvement cycle? • Improve • Measure • Control • Define • Analyze A. 1,4,5,3,2 B. 2,1,5,3,4 C. 4.2.5.1.3 D. 5,1,4,2,3

31. Sample Questions The Joint commission standards for Environment of Care require that the Materials Management department have which of the following? • A cost reduction plan • A value analysis program • An employee development plan • An emergency management plan

32. Sample Questions • An effective linen management program includes • 1.  monitoring and modifying linen PAR levels.2.  eliminating linen services on weekends and holidays.3.  tracking linen loss rates.4.  reporting linen utilization to customer departments. • A. 1, 2, and 3 only C. 1, 3, and 4 only • B. 1, 2, and 4 only D. 2, 3, and 4 only

33. Sample Questions • EXPLANATIONS: • (c) 1. Monitoring and periodically modifying periodic automatic replenishment (PAR) levels are essential to assuring customer departments have the appropriate selection and quantity of items given changes in demand. • (u) 2. Eliminating may be an option, but an effective linen management program would be adjusted based on demand and related cost/benefit analysis. • (c) 3. Tracking linen loss rates by linen item type, and understanding the means whereby items are lost, are pivotal to developing a loss minimizing or lost linen recovery program. • (c) 4. Reporting linen line item costs and utilization reports are key elements of an effective linen management program

34. Sample Questions • In the event of a positive biological indicator in a sterilized load, which of the following steps must be followed? • 1.  Check wrapping for integrity.2.  Isolate the load.3.  Rewrap and reprocess the load.4.  Notify infection control and risk management if any sets were used before the test was read. • A. 1, 2, and 3 only C. 1, 3, and 4 only • B. 1, 2, and 4 only D. 2, 3, and 4 only

35. Sample Questions • EXPLANATIONS: • (u) 1. Instrument wrapping will not affect the biological indicator. • (c) 2. Load isolation is part of the recall process. • (c) 3. Isolation and reprocessing of the load contents are parts of the recall process. • (c) 4. Notification of a positive biological indicator is part of the recall process

36. Sample Questions • Which organization develops manufacturing standards for surgical instrumentation? • A. AHA • B. AORN • C. ASHCSP • D. AAMI

37. Sample Questions • EXPLANATIONS: • (u) A. The American Hospital Association (AHA) develops policies and standards, but not those related to instrumentation. • (u) B. The Association of Operating Room Nurses (AORN) develops sterilization standards, and may make recommendations about instrumentation, but does not set instrumentation standards. • (u) C. The American Society for Healthcare Central Service Professionals (ASHCSP) does not develop instrumentation standards. • (c) D. The Association for the Advancement of Medical Instrumentation (AAMI) sets instrumentation standards

38. Sample Questions • Specify the parameters required to assure sterilization has been met.  • A. temperature, time, and pressure • B. steam, pressure, and chemical indicator • C. pressure, contact, and packaging • D. heat, humidity, and time

39. Sample Questions • EXPLANATIONS: • (c) A. Time, temperature, and pressure are parameters indicated on the sterilization chart/graph for each type of sterilizer for each cycle. • (u) B. Time, in addition to steam and pressure, is required for a complete sterilization cycle. • (u) C. Although pressure is required, there is not a manner in which contact can be determined, packaging is not required for flash sterilization. • (u) D. Heat is equivalent to temperature, humidity is not a measurable parameter, and time is required

40. Sample Questions • A Health Insurance Portability and Accountability Act (HIPAA) compliance program for a purchasing department should include a • 1.  vendor confidentiality statement covering protected information.2.  clause inserted into every contract that covers protected information.3.  statement reflecting the facility gifting policy.4.  statement describing actions taken if a policy is violated. • A. 1, 2, and 3 only C. 1, 3, and 4 only • B. 1, 2, and 4 only D. 2, 3, and 4 only

41. Sample Questions • EXPLANATIONS: • (c) 2. Hospitals must protect themselves from disclosure of protected information that a vendor may acquire. They must also articulate and disclose action steps for failure to comply with HIPAA-related policies. While a gifting policy should be part of a hospital's code of employee conduct, it is not essential and does not pertain to HIPAA. .

42. Samples Questions • The highest level of infection control that can be achieved with peracetic acid is • A. sterilization. • B. high-level disinfection. • C. decontamination. • D. disinfection.

43. Sample Questions • EXPLANATIONS: • (c) A. Peracetic acid kills gram-positive and gram-negative bacteria, fungi, and yeast in fewer than 5 minutes of processing time. The FDA has approved peracetic acid as a sterilant. • (u) B. See Explanation A. • (u) C. See Explanation A. • (u) D. See Explanation A

44. Sample Questions • If a vendor representative is involved in a surgical case, which of the following information may not be disclosed to the vendor's company under the Health Insurance Portability and Accountability Act (HIPAA)?  • A. items used in case • B. physician's name • C. case date • D. patient diagnosis

45. Sample Questions • EXPLANATIONS: • (u) A. The vendor representative will need the items used in order to bill the facility for the items used and restock the vendor-managed inventory (VMI). • (u) B. The physician's name is not considered confidential under HIPAA. • (u) C. The case date is not covered under HIPAA. • (c) D. Under HIPAA, patient information is considered confidential, and may only be disclosed to the particular parties involved

46. Which of the following waste separation strategies in the operating room will result in the lowest amount of red bag waste and be in compliance with (OSHA) Bloodborne Pathogens Standards? A. All waste coming out of an operating room suite must be contained in a red bag. B. Waste from an operating room suite that is generated before a patient enters the room can go in regular trash, but all waste generated after the patient comes into the room must be contained in a red bag. C. Waste from an operating room suite that is soiled, but not dripping, with blood or body fluids must be contained in a red bag and all other waste can go into regular trash. D. Waste from an operating room suite that is saturated with blood or body fluids must be contained in a red bag and all other waste can go into regular trash.

47. Sample Questions • EXPLANATIONS: • (u) A. See Explanation D. • (u) B. See Explanation D. • (u) C. See Explanation D. • c) D. According to OSHA Standards, only waste that is saturated with blood or body fluids must be contained in a red bag. Even if there is evidence of blood or body fluids on the items, they do not automatically need to be disposed in red bags. The amount of blood or body fluids must be enough that the item is completely saturated so that the fluid may drip off or flake off once dried

48. Sample Questions • Corporate compliance is a program that relates closely to an organization's  • A. ethics. • B. mission. • C. goals. • D. finances.

49. Sample Questions • EXPLANATIONS: • (c) A. The intent of a corporate compliance program is to observe the spirit of the law, and therefore closely relates to the ethics of the organization. • (u) B. Corporate compliance does not directly affect the mission of the organization. • (u) C. Corporate compliance does not directly affect the goals of the organization. • (u) D. Corporate compliance does not directly affect the finances of the organization although it influences the prevention of fraud.

50. Sample Questions • According to Dr. W. Edwards Deming, quality transformation rests on which of the following key tenets? • 1.  Decisions must be based on fact.2.  The people who know the work best are the ones who perform it.3.  Graphically displayed information determines best course of action.4.  Groups of people working in teams can be more successful than individuals working alone. • A. 1, 2, and 3 only C. 1, 3, and 4 only • B. 1, 2, and 4 only D. 2, 3, and 4 only