Appendix E – Operating Room Preliminary Economic Assessment

PRELIMINARY ECONOMIC ASSESSMENT QUESTIONNAIRE – OR

Institution:                             

Location:                                

This questionnaire is designed to help OmniCell Technologies determine the potential

savings impact of the OmniCell^® system on your operating room.

1)   Information on Operating Room:

A.     Annual number of cases:                                                         

B.     Number of operating suites:                                                     

C.     Group purchasing affiliation:                                                   

D.     Systems vendors:      Inventory                    Billing                      

                        Scheduling                

E.     Where is the primary location where cases are picked:

In the OR:                                         Outside the OR:                  

2)   Supply Cost and Inventory Level Information:

A.     Annual supply cost of product used from sterile core & operating suites ($):    

B.     (%) Chargeable supply cost:               (%) Non-chargeable supply cost:       

C.     Annual cost of expired product ($):                                             

D.     Who absorbs the cost of expired product?  OR                    Vendor           

E.     Total number of line items in operating room:                                   

F.     Dollar value of on-hand inventory in operating room including suites ($):       

G.     Percentage of inventory on consignment:                                         

H.     Inventory carrying cost rate (hospital cost of capital):                        

3)   Charge Capture Information:

A.     Lost charge percentage (at cost):                                               

B.     Payer mix:     Medicare (%)                                                     

                        Medicaid (%)                                                     

                        HMO / PPO (%)                                                    

                        Commercial (%)                      

                        (%) of Commercial collected:     

                        Other (%)                                                        

C. Chargeable supply upcharge (average margin):                                    

4)   General Supply Management Information for OR:

A.     Hours to count on-hand inventory per week in OR:                                

B.     Who counts inventory:  ORN                          OR/CS tech                   

C.     Hours to restock on-hand inventory per week in OR:                              

D.     Who restocks inventory:  ORN                         OR/CS tech                 

E.     Hours spent on inventory data entry per week for OR inventory:                  

F.     Who enters inventory data:  ORN                        OR/CS tech                

G.     Hours spent on billing data entry per week for OR supply usage:                 

H.     Who enters billing data:  ORN                          OR/CS tech                

I.     Hours spent reordering supplies in the OR:                                      

J.     Who is responsible for OR supply reordering:  ORN           OR/CS tech          

K.     Salaries ($/hour including benefits): ORN                 OR/CS tech            

THANK YOU FOR YOUR INPUT

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