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

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]

2

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.

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.

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

Exam Specifications

The AHRMM role delineation study identified real-world tasks that were grouped into categories and weighted to produce exam specifications.1. Purchasing, Procurement and Product Value

Analysis2. Inventory Distribution Management3. Information Systems and Data Management4. Finance5. Strategic Planning and Leadership (Support

Services)6. Materials Management Definitions (non-

AHRMM)

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

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

Purchasing, Procurement and Product Value Analysis

4 Steps of “Act of Purchasing”1. Requisitioning

2. Sourcing

3. Negotiating

4. Ordering

Purchasing, Procurement and Product Value Analysis

Requisition / Purchase order types Stock Non-stock Electronic Traveling Blanket Standing Open

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

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

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

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

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.

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

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.

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

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

Let’s Take 5…

It’s time for a Quick Break!

Info & Data Information Systems Data Management

Numbers, Numbers and more NumbersSystems [technology]

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

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)

Information Systems and Data Management

Selection Process Multi-disciplinary taskforce Identified processes Research marketplace Determine functionality requirements Develop RFP Demonstrations Develop project plan

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)

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

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

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 ExcellenceBe Proud of It!

Questions?

Samples Questions

Which of the following is the correct sequence of stages in the process improvement cycle?

1. Improve2. Measure3. Control4. Define5. Analyze A. 1,4,5,3,2

B. 2,1,5,3,4C. 4.2.5.1.3D. 5,1,4,2,3

Sample Questions

The Joint commission standards for Environment of Care require that the Materials Management department have which of the following?

A. A cost reduction planB. A value analysis programC. An employee development planD. An emergency management plan

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

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

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

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

Sample Questions Which organization develops

manufacturing standards for surgical instrumentation?

A. AHA B. AORN C. ASHCSP D. AAMI

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

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

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

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

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.

.

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.

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

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

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

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.

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

Sample Questions

Corporate compliance is a program that relates closely to an organization's 

A. ethics. B. mission. C. goals. D. finances.

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.

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

Sample Questions

EXPLANATIONS: (c) 1. Deming's work focuses on people,

processes, and workflow. (c) 2. Deming's work focuses on people,

processes, and workflow. (u) 3. Graphically displayed information

is a tool to illustrate concepts and is not a key tenet.

(c) 4. Deming's work focuses on people, processes, and workflow.

Sample Questions

The purpose of a SWOT analysis is to A. understand current strategic

position. B. identify safety hazards in the

environment. C. determine appropriate staffing levels. D. assess the needs of customers.

Sample Questions

EXPLANATIONS: (c) A. Examining the aspects of an

institution's strengths, weaknesses, opportunities, and threats during a SWOT analysis is intended to give information about strategic positioning and possible tactics to attain objectives.

(u) B. See Explanation A. (u) C. See Explanation A. (u) D. See Explanation A.

Sample Questions

Which of the following is a strategic objective?

A. Reduce inventory by the end of the fiscal year.

B. Reduce inventory by 15% and maintain customer satisfaction.

C. Reduce inventory by 15% by the end of the fiscal year.

D. Reduce inventory by 20% and increase customer communication

Sample Questions

EXPLANATIONS: (u) A. This response lacks a quantitative

standard. (u) B. The inventory reduction target is

clear and measurable, but there is no time reference.

(c) C. The objective and the time frame are clear and able to be measured.

(u) D. The objective of reduction is clear, but there is no time reference.

Sample Questions

Total capital equipment life cycle costs include the:

A. Depreciation expense B. Initial purchase price C. Future replacement price D. Manufacture’s standard warranty

price.

Sample Questions

What does FOB destination mean?A. The buyer pays all freight chargesB. The seller pays all freight chargesC. The seller retains ownership in transitD. The buyer retains ownership in transit

Sample Questions

A basic stock out ratio is calculated by dividing the

A. Reorder point by the lead timeB. Average usage by the monthly receiptsC. Number of lines out by the number of

lines orderedD. Number of stock outs by the number of

receipts

Samples Questions

To maximize return on investment for a new MMIS, implementation processes should do which of the following?

A. Encourage and act on user feedbackB. Utilize the system’s “best practices.”C. Incorporate customization of the

system as part of the overall planD. Map business processes to system

processes immediately after activation

Sample Questions

Which of the following is the LEAST effective strategy for a hospital surviving a prospective payment system?

A. Laying off staffB. Increasing efficienciesC. Reducing budgetary costsD. Maximizing payment from contractual

payers

Sample Questions

A hospital is considering developing a sterile custom pack program. To help offset initial start-up costs, the hospital may market its services to smaller facilities within a 50-mile radius. The hospital’s MM department should consider which of the following before making this decision?

1. A market review of other facilities to determine if there is interest

2. A cost analysis of equipment, supplies and labor needed for the venture

3. A comparative analysis of in-sourcing and out-sourcing to determine cost benefit ratio

4. A report stating how much expansion would be possible for the MM department

continued

A. 1,2 and 3 only B. 1,2 and 4 only C. 1,3 and 4 only D. 2,3 and 4 only

Samples Questions

Turns are defined as a basic measure of efficiencies in:

A. Management B. Vendor delivery C. Financial control D. Inventory control

Sample Questions

To establish accurate product data in the MMIS, data synchronization requires common manufacturer name, manufacturer product number and

A. Expiration dateB. Packaging dataC. Latex indicatorD. Lot number

Sample Quesitons

Early Steps when choosing a replacement computerized MMIS are to

1. Define current cost of operations2. Select a task force3. Define functional requirements4. Select a vendorA. 1,2 and 3 onlyB. 1,2 and 4 onlyC. 1,3 and 4 onlyD. 2,3 and 4 only

Sample Questions

When a capital requisition has been generated, a buyer needs to take which of the following criteria into account to determine the best method of procurement?

A. Shortages in the industryB. Lease or purchase decisionC. Whether an item is in stockD. Economic events in the industry

How did you do? Questions?

Additional Ways to Prepare for the Exam

AHRMM CMRP Candidate Handbook and Application (Light Blue Book, free) http://www.aha.org/aha/Certification-Center/files/2008CMRPhandbook.pdf

AHRMM Materials Management Review Guide/CMRP Examination Review Guide, third edition, 2009, (Dark Blue Book, $$)

VHA’s proprietary instruction presentation [or check with your GPO] CMRP presentation [this presentation will be posted on-line] AHRMM, National Meetings AHRMM Webinars Other AHRMM Regional Chapters Optional purchase of the “pre-test” from AHRMM Optional purchase of the Webinar CD Develop internal study sessions (brown-bag-lunch) with your peers or

at your member site Contact either of us or any WSHMMA board member