Abstract:
Systems and methods for refining repetitive purchases using historical feedback and contractual data are disclosed. For example, parties to a pharmaceutical purchase transaction typically include one or more of a Group Purchasing Organization (GPO), vendor or manufacturing drug company, wholesaler, and a purchaser, such as a hospital or hospital group. In a typical pharmaceutical purchase transaction, several (possibly inconsistent) agreements can be in place between the parties to the transaction. Disclosed are methods and systems to collect, from a plurality of data sources, information pertaining to negotiated contract prices of pharmaceutical and surgical supplies. Also disclosed is a periodic process to provide purchasing suggestions and receive further feedback from purchasers and suppliers to refine the activities of the purchaser and/or supplier. For example, a purchaser could be informed of a different order placement option which could result in a cost savings based on currently available pricing/purchase agreements.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a divisional of U.S. patent application Ser. No. 13/193,869, filed 29 Jul. 2011, entitled “Purchasing Trading Partners Feedback Process for Purchase Practice Refinement” and also related to U.S. Provisional Application No. 61/454,377, filed 18 Mar. 2011, entitled “Pharmaceutical Purchasing Trading Partners Feedback Process for Price Verification and Purchase Practice Refinement” each by Wertz et al. and which are incorporated herein by reference in their entirety and to which priority is claimed. 
     
    
     FIELD OF INVENTION 
       [0002]    This disclosure pertains to a method and system for providing a cost improvement feedback process (i.e., feedback loop) between different parties involved in the purchaser/supplier process (purchasing trading partners). For example, purchasers could include entities buying pharmaceutical drugs, surgical supplies, and other health care supplies. The feedback process could be used to potentially reduce purchaser costs or improve stocking practices of suppliers. 
       BACKGROUND 
       [0003]    Tracking pharmaceutical and other medical supply costs within an organization can be a complex undertaking. Reasons for this complexity include a variety of interrelated contracts, packaging options, incentives, rebates and interaction requirements between multiple parties involved in each transaction. 
         [0004]      FIG. 1A  illustrates a process flow  100  related to setting up purchasing agreements between parties of a typical medical supply transaction. Initially, at block  102 , a group purchasing organization (GPO), identifies purchasing entities for representation. A GPO will typically represent a plurality of individual purchasing entities or groups of related purchasing entities to negotiate a better price (block  105 ) from one or more vendors. After negotiations are complete and a pricing contract is in place a vendor informs wholesalers and possibly their distributors of contract terms (block  107 ). The currently negotiated pricing and terms are utilized for purchasing entity purchases (block  109 ) until another cycle of negotiations and contracts are in place. It should be noted that one GPO may renegotiate at a different periodic cycle from other GPOs and data communication regarding which purchasing entities are covered by certain negotiated pricing contracts can be a complex undertaking. 
         [0005]    Some of the complexities of both contract interaction and data communication mentioned above will now be described in more detail and explained with reference to  FIG. 1B . Block diagram  110  illustrates a matrix of interaction paths between the four types of parties typically involved in pharmaceutical and other medical supply transactions. 
         [0006]    In a typical pharmaceutical purchase transaction, several (possibly inconsistent) agreements can be in place between the parties to the transaction. Parties to a pharmaceutical transaction typically include one or more of a Group Purchasing Organization (GPO)  111 , vendor or manufacturing drug company (acting as its own vendor)  120 , wholesaler  130 , and a purchaser, such as a hospital or hospital group  140 . Each of these four parties is involved in product procurement and contractual agreements for the purchase of pharmaceuticals, and each could have a different approach to pricing. Connecting and correlating information from these different disciplines provides the information required as input to determine price accuracy and identify potential billing errors eligible for refund. Further, comprehensive knowledge across these disciplines could provide guidance toward proper purchasing practices at any given time. Each of the agreements between interested parties may be in flux and may change based on a different periodic schedule (e.g., monthly, quarterly, annually, or even every several years). This flux leads to a situation where a purchaser should not necessarily order the same item repeatedly because what may have been an optimal order previously is not currently the best manner to order the same pharmaceutical. 
         [0007]    Prior art systems in this field are directed only to determining historical billing errors relating to past purchases. Pricing errors and non-optimal purchasing practices can often be traced to the differences in operation that exist between distributors (which are normally related to wholesalers  130 ) and manufacturers  120 , which affect the integrity of contract prices received by purchasers  140 . Drug wholesalers  130  obtain their price data from multiple sources and must synchronize the source data from various systems. Meanwhile, GPOs  111  negotiate contracts on behalf of their many health care provider customers (i.e., purchasers  140 ). Pricing problems can arise when the manufacturers  120 , GPOs  111 , purchasers  140 , and wholesalers  130  have different active information about the correct contract price. Another point of contention is timing (i.e., when the contractual agreement and specific price take effect). Compounding the pricing model further, the eligibility of certain facilities to receive a specific price may have an effect as determined by the type of practice, types of patients served, and various legal aspects relating to class of trade. For example, all parties must agree on how a facility will be categorized (e.g., as an ambulatory care clinic), because some manufacturers offer different prices to different classes of trade. 
         [0008]    The contracting process explained above with reference to  FIG. 1A  can be supported by a communication flow as outlined in  FIG. 1B . After a contract is in place, GPO  111  offers a product line to its membership (as depicted by bidirectional relationship  116 ). Additionally, in some cases, solicitation occurs directly between a manufacturer and a hospital group or individual health care provider (purchaser)  140 . Once two parties reach an agreement (as depicted by bidirectional relationship  112  or  124 ), information pertinent to that agreement is communicated to wholesaler  130  ( 114 ,  122 , and/or  135 ). Wholesalers  130  can then load information into its database and enable specific purchasers  140  to purchase the contracted products at the contract price. 
         [0009]    Contracts between GPO  111  and manufacturer  120  usually identify the term of price protection and any limit on price increases outlined by the agreement. In some cases, price protection could extend for the entire life of the contract. In other cases, the contract may offer no price protection. There may be firm price limits, often expressed as an annual price increase cap, or no price limits at all. Usually, these factors vary from contract to contract (even between multiple contracts involving the same two parties). A manufacturer may seek to increase/decrease product prices for a multitude of business reasons (e.g., costs, competition, and volume purchases). When a price is changed, the changed pricing information must be communicated ( 112 ,  122 ,  124 ) to wholesalers  130 , purchasers  140  and GPOs  111 . Synchronization is important to ensure a customer pays the negotiated prices as reflected in the wholesaler  130  and GPO  111  databases. However, synchronization errors or timing delays, either in data transmittal or effective date of new price, can be a contributing source to billing errors and to non-optimal/non-compliant purchasing. As explained further below, non-optimal purchasing includes purchases that are on contract but may not be a best priced purchase method and non-compliant purchasing includes purchases that were made outside of an existing price reduction contract (i.e., “off-contract”). 
         [0010]    There are several different types of pricing models for pharmaceutical purchasing. Examples include: fixed manufacturer, discounted manufacturer, and rebates. Details of each pricing model are known to those of ordinary skill in the art and may change over time. Actual details of these specific pricing models are not discussed further, but the concepts of this disclosure could be applied to these or other pricing models. Similarly, there are several types of pharmaceutical agreements (e.g., wholesaler supply agreements, participation agreements, tiered contracts, individual contracts, etc.). Details of each type of agreement are not discussed further because the concepts of this disclosure could be applied to purchases based on any type of agreement. 
         [0011]    Unrelated to any specific type of contract or purchasing agreement, there exist other complexities concerning pharmaceutical purchases. One such complexity stems from the fact that similar or identical drugs may be available in either brand name or generic brand(s) as well as for purchase in different quantities, packaging styles, or administering methods. For example, a purchaser  140  may need to order ibuprofen. There are many different strengths, quantities, and styles of ibuprofen. For example, there are 50 mg tablets packaged in quantities of 10 or 100 per package; oral solutions of different strength or flavors; and many other different packaging options or administration styles that may or may not be important for a given order. Additionally, doctors and surgeons may have personal preferences or specific medical reasons why a particular type of pharmaceutical or surgical supply should be purchased. Sometimes these “preferences” are strict (e.g., because of actual medical reason) and sometimes these “preferences” have factors that should be weighed because the rationale behind the preference is less important (e.g., doctor personal preference). As should now be apparent, each of these and other factors, in addition to price contract complexity, make it difficult for a purchaser  140  to make an optimal purchasing decision at time of order placement. 
         [0012]    As explained above, prior art techniques exist to historically analyze actual purchases against contracts in place at the time of purchase; however, prior art techniques do not utilize a feedback loop to refine purchase recommendations. Prior art techniques offer a “one-time-period” analysis as opposed to a continual refinement process. Therefore, what is needed is a system and method to normalize data (e.g., determine a unitized cost) of pharmaceuticals and to use the normalized data and existing contract information in a feedback loop to identify possible purchasing alternatives possibly resulting in reduced costs. The feedback loop can utilize purchase information and analysis of non-compliant/non-optimal purchases from previous buying periods to affect suggested purchasing alternatives in current or future buying periods. Additionally, the feedback loop could provide information to wholesalers and their distributors regarding potential changes in stocking practices to accommodate purchasing entities supplied by one or more distribution centers. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0013]      FIGS. 1A-B  illustrate, in flow chart and block diagram form respectively, an example of parties to pharmaceutical and surgical supply purchasing and their interactions in the contracting, purchasing and data exchange process. 
           [0014]      FIGS. 2A-B  illustrate a flow chart  200  depicting a periodic monitoring process of pharmaceutical and surgical supply purchasing and feedback loop according to one disclosed embodiment. 
           [0015]      FIG. 3  illustrates a contract compliance conversion report, presented at a corporate level (e.g., a consolidated roll-up of purchases across all hospitals in a hospital group). 
           [0016]      FIGS. 4A-C  illustrate a contract compliance report (with feedback fields) for a particular purchasing entity (i.e., Santo Domingo Community Hospital) representing detail at a lower level than  FIG. 3 . 
           [0017]      FIGS. 5-7  illustrate different views of corporate level and purchasing entity level information indicating potential savings available through altered purchasing practices according to a disclosed embodiment. 
           [0018]      FIGS. 8-9  illustrate reports, at a corporate and regional level, reflecting how purchasing entities responded to identified optimization of purchases for the current reporting period. 
           [0019]      FIGS. 10-11  illustrate reports, at purchasing entity level and a regional level, reflecting feedback information from purchasing entities according to a disclosed embodiment. 
           [0020]      FIG. 12  illustrates a reply report suitable for feedback loop processing at a corporate level relative to information received from purchasing entities in one periodic cycle of a feedback loop according to a disclosed embodiment. 
           [0021]      FIG. 13  illustrates a report identifying purchases which a purchasing entity has asserted were on manufacturer back order during a reporting period, however, other purchasing entities successfully ordered an identical purchase within the same reporting period. 
           [0022]      FIG. 14  illustrates a report of potential savings if vendors or distributors and their distribution centers would adapt stocking practices, the report including an indication as to how to adapt stocking practices. 
           [0023]      FIG. 15  illustrates, in flow chart form, an embodiment of more detailed flow steps, according to one embodiment, for  FIG. 2  blocks  265 - 275 . 
           [0024]      FIG. 16  illustrates, in block diagram form, an example computing device comprising a program control device. 
       
    
    
     DETAILED DESCRIPTION 
       [0025]    The present disclosure is described in the context of pharmaceutical drug purchases. However, concepts of this disclosure could relate to any purchases covered by a plurality of purchasing contracts or methods at a given point in time. For example, transactions consisting of: pharmaceuticals, medical supplies, surgical supplies, laboratory supplies and services (e.g., outsourced laboratory services), radiological supplies, and/or other health care consumables, or transactions comprising a combination of one or more of these, etc. Additionally, electrical supply, automotive supply, and hardware supply items have similar supply chains and alternate item purchase properties (i.e., Original Equipment Manufacturer (OEM) vs. alternative equivalent) and should not be considered outside the scope of this disclosure. 
         [0026]    With reference to  FIGS. 2A-B , a process flow of a general feedback loop according to a disclosed embodiment will first be described and then more detail about particular portions of the feedback loop will be described with reference to example information reports. A feedback loop according to a preferred embodiment could take place at a monitoring center “external” to any of the parties directly involved in the purchasing process. The monitoring center of this embodiment would provide a service to one or more of a GPO  111 , Manufacturer  120 , Wholesaler  130  or Purchasing Entity  140 . The service provider would be communicatively coupled for automatic data exchange between one or more of these parties. Additionally, the service would normally be of most benefit to a purchasing entity  140  and is therefore described in that context (i.e., a service provided to a purchasing entity  140  from an external party) for several embodiments of this disclosure. 
         [0027]    Referring now to  FIGS. 2A-B , process  200  illustrates a periodic process of monitoring purchases over a given time period; providing information regarding specific purchases which appear to be non-optimal; receiving feedback, from a purchasing entity  140 , regarding non-optimal purchases; and providing information to corporate management and possibly manufacturers/distributors ( 120 / 130 ) regarding potential changes in business practices to reduce future costs to purchasing entities  140 . The periodic feedback loop of this disclosure will be described in the context of a monthly review provided by an external service provider; however any particular time period or an internal operational environment may be suitable for the concepts disclosed. 
         [0028]    Beginning at block  205 , current contract information applicable to a particular purchasing entity  140  can be periodically obtained from a GPO  111 . Next, at block  210  a purchase history for a corresponding period may be obtained from a wholesaler  130  or other suppliers to the purchasing entity  140  being analyzed. Information regarding contract portfolio data can be collected and correlated in a management database ( 215 ), normalized as necessary to a unit comparison price and quality checked for any recognizable errors ( 220 ). After quality assurance and normalization, purchase data can be compared with applicable contract data ( 225 ). Next, at block  230 , conversion recommendations (representing possible alternate purchases) can be computed, quality checked, and product back order status (may be cause of non-optimal purchase) can be determined. After accurate input data for a period has been collected, flow can continue to block  235  to generate a contract compliance and optimization report for a particular purchasing entity  140 . Contract compliance and optimization reports indicate information specific to a particular purchasing entity  140  (e.g., hospital) and composite information about non-optimal purchasing by hospitals in a hospital group (e.g., corporate or regional level) can be correlated into reports which may later be used to provide initial information (block  240 ) and receive further information for later use in the feedback loop. Additionally, a report (block  241 ), based on content similar to the content sent to the purchasing entity  140 , could be automatically sent to a distributor  130  to define automatic substitution of items purchased with recommended alternative purchases. 
         [0029]    At block  245 , individual purchasing entities  140  and corporate level management can review applicable reports. Each purchasing entity  140  can document a reason code for each line item in their report to explain a reason for the non-compliant purchase ( 250 ). Based on the periodicity, purchasing entities  140  have a time period to analyze and document their individual reports and should return completed reports with reason codes ( 255 ) within the allowed time period. Immediately upon receipt of a detail report, a purchasing entity  140  can alter their internal purchasing practices ( 260 ) so that current period purchases do not again show as non-optimal in the next reporting period. 
         [0030]    At block  265  of  FIG. 2B , a secondary phase of feedback loop  200  begins with a compilation of all completed reports for further analysis and generation of other corporate and regional level reports. High value action items, either for individual purchasing entities  140  or for action from a corporate level, can be identified ( 270 ). A corporate level action item report can be generated ( 275 ) and sent to corporate management for review and action ( 280 ). Finally, responses from purchasing entities  140  concerning non-optimal/non-compliant purchases can be analyzed and, if applicable, utilized to update a recommendation trend archive to possibly prevent future non-applicable recommendations. For example, if a purchasing entity  140  reports a valid reason for a non-optimal/non-compliant purchase, the trend database could be used to prevent future flagging of identical purchases from showing up as non-optimal/non-compliant purchases. Feedback loop processing can then begin a next periodic cycle as indicated at block  290 . 
         [0031]    Referring now to  FIG. 3 , a corporate (e.g., “ABC Health”) level “Contract Compliance Conversion Report”  300  is shown. In this example, ABC Health represents a hospital group (e.g., corporate) with a plurality of purchasing entities  140 . The report reflects line items of individual items purchased across an entire corporation in a reporting period. The left portion of the report PURCHASED  310 , lists, by National Drug Code (NDC) number, items actually purchased in one or more purchasing entities  140  of ABC Health. The right portion of the report “BID BOOK CONVERSION” (“BBC”)  320 , lists, also by NDC number, items under contract which may represent a more cost effective purchase opportunity. In the PURCHASED  310  portion there are also columns for description, average price, quantity purchased, extended price, column “B,” and column “MC.” BBC  320  portion has columns for NDC, description, multiplier, BID, extended price for BID, and potential savings. Although report  300  keys purchases to an NDC, many other unique product identifiers could be used to key this type of report. For example, Universal Product Code (UPC) numbers and barcode numbers along with other product identification numbers could be used. 
         [0032]    One purpose of report  300  is to indicate, for each actual purchase, a corresponding purchase (or possible purchase for consideration) which was available, under contract, believed to be medically equivalent and would have cost less for the purchasing entity  140 . For example, the first item (line  330 ) identifies an alternative NDC for CIPROFLOXACIN which would have resulted in a savings of $8,082 for ABC Health even though the item(s) actually purchased was under contract (contract indicated by check mark in column B). Looking further at line  330  notice that a quantity of 15 CIPROFLAXCINs were purchased and the average price paid for these 15 purchases was $576.97 for a total cost of $8,655. The BBC portion of line  330  identifies two potential alternative purchases (one believed to be available and another which may be on back order) and the savings associated with the alternative purchasing method. A multiplier of 1 indicates no adjustments must be made for different packaging configurations between the actually purchased NDC and the suggested NDC. In this example, there simply appears to be a much better alternative purchase that could have been made by one or more purchasing entities  140  of ABC Health. 
         [0033]    The BID column of the BBC portion of line  330  represents a normalized price at a unit level as adjusted by a multiplier. As stated above, the multiplier for line  330  is 1 and therefore there is no adjustment currently applied for this particular item. However,  340  indicates a multiplier of 0.4 which indicates a packaging difference (250% more) must be accounted for when calculating the BID. The multiplier is calculated by taking into account the fact that the actual NDC purchased comes in a quantity of ten (10) whereas the recommended purchase item comes in a quantity of twenty five (25). To calculate an accurate per unit price we must multiply the actual price of the recommended NDC by 0.40 ( 10/25) to calculate a proper BID price. After a proper BID price is calculated it can be multiplied by the actual quantity purchased (37 in this case) to determine a cost for comparison and estimation of potential savings. 
         [0034]    Referring now to  FIGS. 4A-C , report  400  shows an example of a “Contract Conversion Opportunity Report” at an individual purchasing entity  140  level. Report  400  is split into a left ( 4 A) center ( 4 B) and right ( 4 C) portion for readability. In this example, the purchasing entity  140  is identified as Santo Domingo Community Hospital as shown by line  410 . As mentioned previously, a report is sent to each individual purchasing entity  140  detailing identified non-optimal purchases. Report  400  is an example of information contained in such a report. In addition, to facilitate an automated feedback loop, an electronic report containing data entry fields (such as those shown in  FIG. 4C ) to explain non-optimal purchases could be sent to each purchasing entity  140 . Reason codes ( 420 ) and explanations ( 430 ) (examples are discussed below) could allow for enhanced management oversight of individual purchasing entities  140  as well as further refinement of data for future feedback reports. 
         [0035]    Referring now to  FIGS. 5-7 , different presentation levels of corporate summary reports ( 500 ,  600 ) and an example purchasing entity  140  summary report ( 700 ) are shown. Report  500  illustrates a tabular view of a plurality of purchasing entities  140  with a summary of information for each purchasing entity  140  along with an indication of the percentage  510  of overall potential savings allocated to that particular purchasing entity  140 . From a corporate perspective, report  500  could be used to identify which purchasing entities  140  need attention. Report  600  illustrates a single page rollup of all purchases in a reporting period for ABC Health. 
         [0036]    As indicated in report  600 , ABC Health could have saved $92,855 in “Potential Conversion Savings” if each of the purchases made with no contract (i.e., “off contract”) were replaced with purchases of pharmaceuticals currently on contract. As stated above, details of each non-compliant purchase are identified and summarized at the purchasing entity  140  level in corresponding reporting period reports (e.g., reports  400  and  500 ). Further, report  600  indicates ABC Health could have saved an additional $54,718 for purchases that were already on contract but were purchased utilizing a different NDC number also already on contract. In summary, ABC Health (at a corporate level) could have saved $147,573 if purchases had been made differently during this reporting period. Additionally, report  700  illustrates a single purchasing entity&#39;s  140  (i.e., Santo Domingo Community Hospital) corresponding data related to the information presented in corporate level report  600 . 
         [0037]    Having the information of reports such as  400 - 700 , each purchasing entity  140  of ABC Health can alter their purchasing practices for the next period (i.e., current purchases) and eliminate repetition of non-optimal purchases. As will be apparent to those of ordinary skill in the art, an optimal feedback loop may be implemented at different frequencies and altering of actual purchasing practices by purchasing entities  140  may have some inherent delay. Additionally, optimal purchases may change over time, at least in part, because contracts and other data underlying the purchase analysis change. Therefore, a continuous and cyclical feedback loop with potentially varied periods may be desirable. 
         [0038]    Referring now to  FIGS. 8-9 , reports  800  and  900  illustrate, at a corporate and regional level respectively, a summarization of response types (explaining non-optimal purchases) from purchasing entities  140  for the current reporting period. Reports  800 - 900  are examples of “actionable items” reports which could be generated at block  275  of process  200 . Each of reports  800  and  900  identify “In Stock Not Purchased” (ISNP) items indicating a purchasing entity  140  has determined they simply made an incorrect purchase and presumably will alter the purchase practice for corresponding items going forward. 
         [0039]    Report  800  also breaks down percentages of ISNP items into subparts of “Compliance Savings” (indicating future purchases should be on contract) and “Optimization Savings” (indicating another on contract item should be purchased going forward). Additionally, report  800  classifies purchasing entity  140  responses for each response in which a purchasing entity  140  asserted the reason for a non-optimal purchase was a MBO (i.e., Manufacturer Back Order). Classification codes for a distribution center  130  (DC Codes) include type A, type B and type C. Type A indicates that another purchasing entity  140  purchased the exact same NDC at the same distribution center  130  during the same reporting period. Type B indicates that another purchasing entity  140  purchased the exact same NDC at a different distribution center  130  during the same reporting period. Type C indicates that no purchases of the exact same item were made at any distribution center  130  during the same reporting period. Obviously, Type C supports an indication that the item was in fact on MBO as reported. However, Types A and B indicate that the item may not have really been on MBO as reported. 
         [0040]    Both of reports  800  and  900  identify items not stocked at a distribution center  130 . This information identifies a potential savings that may be realized by ABC Health and may be useful to encourage change in the manner in which a distribution center  130  stocks its products. Also, both of reports  800  and  900  identify a percentage of purchases that were non-optimal because of a “Hospital Preference” which will be discussed further below. Finally, each of reports  800  and  900  indicate a percentage of non-compliant purchases which were reported to purchasing entities  140  but for which no explanation was provided (i.e., HDNR Hospital Did Not Respond). 
         [0041]    Referring now to  FIGS. 10-11 , report  1000  corresponds to report  800  however, information here is reported at a regional level (i.e., Central Region). Information reports at this level may be useful in implementing a feedback loop according to disclosed embodiments because a large corporation of hospitals may have regional management which may be able to more effectively utilize specific information. Report  1100  corresponds to a corporate wide view of information explained above relative to report  900 . Again, providing (possibly redundant) information at different granularities could provide necessary information to optimize embodiments of a purchasing feedback loop. 
         [0042]    Referring now to  FIG. 12 , report  1200  illustrates line item responses (for each non-compliant/non-optimal purchase) from purchasing entities  140  received in response to reports such as report  400 . Each line item response has been analyzed after receipt and categorized and grouped based on this analysis. Analysis typically includes comparison against responses received for the same reporting period from other purchasing entities  140  to identify potentially inaccurate explanations for non-optimal or non-compliant purchases. As shown in report  1200  at line  1210 , a set of responses may be categorized as reasonable and used as an indication to suppress future identification of purchases of the same item as non-compliant. Suppression of this future identification can be used to prevent unnecessary repetitive action by any purchasing entities  140  in future reporting periods. For example, a purchasing entity&#39;s  140  response could indicate that a functional or clinical difference may exist between the purchased product and the suggested product. Once verified, this difference is an indication to no longer suggest that same product as an alternative product for any purchasing entity  140 . Additional categories could include, but not be limited to: reasonable for a particular purchasing entity  140  and only suppressed for that purchasing entity  140  in the future; comments not provided by purchasing entity  140  so no action taken; comments provided by purchasing entity  140  that may require additional follow up because supplied comments are questionable. Categorized report  1200  could be provided to a corporate or regional manager to identify actionable items for particular purchasing entities  140 . 
         [0043]    Referring now to  FIG. 13 , report  1300  illustrates items which were either not stocked at a distribution center  130  or may not have actually been on MBO status (as was reported by a purchasing entity  140 ) during the reporting period being analyzed. Report  1300  therefore indicates actionable items from a supervisory level to potentially request adjustment of stocking procedures or to determine if explanations provided by purchasing entities  140  were accurate. Note DC CODE  1310  (already explained above) and HOSPITAL COMMENTS  1320  provide further information to help in this determination. 
         [0044]    Referring now to  FIG. 14 , report  1400  illustrates (per distribution center  130 ) items that were not in stock at a distribution center  130  but were purchased from other distribution centers  130  in the same reporting period. Report  1400  could be used by corporate management to provide information to wholesalers and distribution centers  130  as to how they might alter their stocking procedures in the future. Report  1400  further indicates a suggested stocking amount  1410  for each particular distribution center  130  using historical purchasing information. Additionally, report  1400  indicates potential savings at a corporate level  1420  if a distribution center  130  is convinced and agrees to alter their stocking practices. 
         [0045]    Referring now to  FIG. 15 , flow chart  1500  illustrates one possible embodiment of blocks  265 - 275  of  FIG. 2 . Beginning at block  1510 , a processing center practicing one or more disclosed embodiments receives a completed feedback report from one or more purchasing entities  140 . At block  1520  the received report is analyzed and responses can be grouped by reason code for further analysis. When the reason code reported by the purchasing entity  140  is “not stocked at distribution center” (block  1530 ), a potential cost saving across one or more purchasing entities  140  in a group of related purchasing entities  140  can be determined (block  1534 ) and reported to centralized management for the group of related purchasing entities  140  (block  1538 ) to possibly recommend to the distribution center  130  a change in stocking rules and/or practices. The stocking changes requested could also indicate a predicted quantity for stocking based upon historical needs across purchasing entities  140  utilizing a particular distribution center  130 . A report identifying potential stocking changes could be automatically sent to a wholesaler  130  to alter stocking practices at distribution centers  130  (block  1539 ). 
         [0046]    Continuing with process  1500 , when the reported reason code is “manufacturer back order” (MBO) as in block  1540 , a plurality of completed reports from different purchasing entities  140  for a corresponding purchasing period can be compared to determine possible inconsistent reports of MBO (block  1544 ). A summary report can be prepared (block  1548 ) with different DC codes like A, B, and C explained above. When the reported reason code indicates “hospital preference” a comment field provided in the report and completed to explain the reported preference can be further checked to determine a course of action (block  1550 ). If the comment does not indicate a reasonable or valid reason (NO branch from block  1555 ) flow can continue to block  1557  to recommend a possible corporate follow up. However, if the comment explains a valid medical reason or valid preference reason (YES branch from block  1555 ) future flagging (e.g., suppression) of this particular recommendation can be entered into the report analysis system (block  1558 ) because this particular item purchase should not be deemed non-compliant/non-optimal. Finally, when the reported reason code indicates “in stock not purchased” (block  1560 ), the purchasing entity  140  has admitted that the recommendation should be adopted and presumably takes steps necessary to alter future purchasing practices for the corresponding item purchased (block  1565 ). 
         [0047]    Referring now to  FIG. 16 , example computing device  1600  is shown. One or more example computing devices  1600  may be included in a mainframe or distributed computer (neither shown). Example computing device  1600  comprises a programmable control device  1610  which may be optionally connected to input devices  1660  (e.g., keyboard, mouse, touch screen, etc.), display  1670  and/or program storage device (PSD)  1680  (sometimes referred to as a direct access storage device DASD). Also, included with program control device  1610  is network interface  1640  for communication via a network with other computing and corporate infrastructure devices (not shown). Note network interface  1640  may be included within programmable control device  1610  or be external to programmable control device  1610 . In either case, programmable control device  1610  will be communicatively coupled to network interface  1640 . Also note, program storage unit  1680  represents any form of non-volatile storage including, but not limited to, all forms of optical and magnetic storage elements including solid-state storage. 
         [0048]    Program control device  1610  may be included in a computing device and be programmed to perform methods in accordance with this disclosure. Program control device  1610  may itself comprise processing unit (PU)  1620 , input-output (I/O) interface  1650  and memory  1630 . Processing unit  1620  may include any programmable control device including, for example, processors of an IBM mainframe (such as a quad-core z 10  mainframe microprocessor). Alternatively, in non-mainframe systems examples of processing unit  1620  include the Intel Core®, Pentium® and Celeron® processor families from Intel and the Cortex and ARM processor families from ARM. (INTEL CORE, PENTIUM and CELERON are registered trademarks of the Intel Corporation. CORTEX is a registered trademark of the ARM Limited Corporation. ARM is a registered trademark of the ARM Limited Company.) Memory  1630  may include one or more memory modules and comprise random access memory (RAM), read only memory (ROM), programmable read only memory (PROM), programmable read-write memory, and solid state memory. One of ordinary skill in the art will also recognize that PU  1620  may also include some internal memory including, for example, cache memory. 
         [0049]    Aspects of the embodiments are described as a method of control or manipulation of data, and may be implemented in one or a combination of hardware, firmware, and software. Embodiments may also be implemented as instructions stored on a machine-readable medium, which may be read and executed by at least one processor to perform the operations described herein. A machine-readable medium may include any mechanism for tangibly embodying information in a form readable by a machine (e.g., a computer). For example, a machine-readable medium (sometimes referred to as a program storage device or a computer readable medium) may include read-only memory (ROM), random-access memory (RAM), magnetic disc storage media, optical storage media, flash-memory devices, electrical, optical, and others. 
         [0050]    In the above detailed description, various features are occasionally grouped together in a single embodiment for the purpose of streamlining the disclosure. This method of disclosure is not to be interpreted as reflecting an intention that the claimed embodiments of the subject matter require more features than are expressly recited in each claim. 
         [0051]    Various changes in the details of the illustrated operational methods are possible without departing from the scope of the following claims. For instance, illustrative flow chart steps or process steps of  FIGS. 2A-B  and  15  may be performed in an order different from that disclosed here. Alternatively, some embodiments may combine the activities described herein as being separate steps. Similarly, one or more of the described steps may be omitted, depending upon the specific operational environment the method is being implemented in. In addition, acts in accordance with  FIGS. 2A-B  and  15  may be performed by a programmable control device executing instructions organized into one or more program modules. A programmable control device may be a single computer processor, a special purpose processor (e.g., a digital signal processor, “DSP”), a plurality of processors coupled by a communications link or a custom designed state machine. Custom designed state machines may be embodied in a hardware device such as an integrated circuit including, but not limited to, application specific integrated circuits (“ASICs”) or field programmable gate array (“FPGAs”).