After COVID-19 throttled supplies of personal protective equipment, fallout from the pandemic has created chronic shortages across a broader range of healthcare supplies.
Health systems have stockpiled masks, gowns, gloves, face shields and other PPE that were scarce during the height of the pandemic. But they are now dealing with lingering shortages across the entire supply chain, a problem expected to persist amid the war in Ukraine and related gas supply restrictions, transportation slowdowns and workforce issues.
The number of items now in shortage is roughly five times higher than pre-pandemic levels, said David Hargraves, senior vice president of supply chain at Premier, a group purchasing and consulting organization. In January, the number of products in shortage was 10 times higher than pre-pandemic levels.
“Each one of those requires work to identify a substitute product and changing the item master data in the enterprise resource planning system. That means that supply chain executives are not spending time on other cost-reduction strategies,” Hargraves said. “We have heard from supply chain executives at a number of healthcare systems that it has been a tremendous drain on resources.”
Health systems such as Tampa General Hospital, a 1,040-bed inpatient hospital with 21 affiliated imaging centers in the Tampa, Florida, area, and University of Utah Health in Salt Lake City have been dealing with ongoing shortages of contrast used for imaging. GE Healthcare, a leading contrast supplier, announced in April that it was rationing orders after a COVID-19 lockdown temporarily shut down its production facility in China.
Tampa General Hospital has not had to limit procedures because it conserved supplies and found an alternative manufacturer. While the market has improved, the hospital must remain vigilant, said President and CEO John Couris. “We have had to move some of our supply of contrast for cardiac imaging around,” he said.
China’s zero-tolerance policy on COVID-19 may result in more shortages because GE Healthcare hasn’t significantly changed its production model, said Erin Fox, senior pharmacy director at University of Utah Health. “What we saw earlier this year could happen again,” she said. Local anesthetics like lidocaine and epinephrine have been frustratingly short, Fox added.
Contrast media will likely remain in shortage over the next month, according to Premier’s predictive analytics, which forecasts scarcities based on fulfillment data from about 5% of the country’s acute-care hospitals. Roughly 15% of contrast media for medical resonance imaging and X-rays products will likely be in short supply over the next three to six weeks, according to a report Premier provided to Modern Healthcare ahead of its publication Thursday.
More than 20% of surgical automatic tourniquet systems are expected to be in shortage. Manufacturers of contrast media and automatic tourniquet systems are vulnerable to oil and natural gas restrictions in Eastern Europe.
Fifteen percent of emergency medicine products, such as needle stabilizers and stabilization devices for catheters, and more than 10% of interventional specialty diagnostics are projected to be in shortage over the next month, although neither of those categories is exposed to European energy suppliers.
In total, 120 categories of commonly used hospital supplies are likely to experience shortages soon, Premier found. “It is like a Whac-A-Mole problem across a broad set of products,” said Matt Bossemeyer, Premier's director of supply chain analytics and IT service.
For pharmaceuticals alone, the Food and Drug Administration lists around 125 drugs currently in shortage. One of those is the widely used antibiotic amoxicillin, which is hard to source due to the rise in pediatric respiratory illnesses.
Predictive analytics can help supply chain executives and clinicians prepare for shortages. A week’s notice can allow them to vet alternative suppliers and integrate them into their systems. But shortage projections also have the potential to spur hoarding, Fox said. Not all hospitals can buy up product and some will hear about a shortage before others, she said.
The FDA is working on a rating system that would evaluate the robustness of a manufacturing facility's quality system and reward high performers, Fox said. “We need a functioning supply chain with more transparency to allow more risk-based assessment and potential fixes,” she said.
Meanwhile, supply chain disruptions will squeeze hospital finances, which already are challenged by high labor costs and inflation, said David Dobrzykowski, an associate professor of supply chain management at the University of Arkansas and director of the university's Walton College Healthcare Initiatives. Health systems and hospitals often to have to pay premium prices for substitute products, he said.
The producer price index was up to 14.3% as of end the August, but manufacturers only passed on 4.2% of that cost to hospitals, according to a white paper written by Dobrzykowski and his peers. Supply manufacturers will likely pass on more of those higher costs in the coming months, he said.
“There is still a lot of pent-up inflation in the supply chain. A very small percentage of producers’ higher costs have been passed on so far,” Dobrzykowski said. “While time has been tough on health systems financially, there is no sign of it easing.”