JHC Jan 2020 by BOC design Inc

January 2020 • Vol.11 • No.1

Mobile Medical Apps and Wearables It’s no easy task for physicians to make use of data from their patients’ wearables and apps

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CONTENTS »» JANUARY 2020

2 Respiratory care: PDPM implications for post-acute providers 8 Mobile Medical Apps and Wearables It’s no easy task for physicians to make use of data from their patients’ wearables and apps

14 Coming up short?

Supply disruption related to EtO plant closures difficult to measure

16 Oral medication for type 2 diabetes approved

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PUBLISHER John Pritchard

EDITOR Graham Garrison

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MANAGING EDITOR Daniel Beaird

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The Journal of Healthcare Contracting (ISSN 1548-4165) is published bi-monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2020 by Share Moving Media All rights reserved. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors. The Journal of Healthcare Contracting | January 2020

POST-ACUTE CARE

Respiratory care: PDPM implications for post-acute providers said Michael Hess, president of the Michigan Society for Respiratory Care, an affiliate of the American Association for Respiratory Care, in an email to JHC. “Unfortunately, the U.S. healthcare system doesn’t seem to be making much progress with these conditions, particularly in the post-acute setting,” said Hess, referring to respiratory illness. A recent study published in “JAMDA: The Journal of the Society of Post-Acute and LongTerm Care Medicine” found approximately 20% of people in long-term care had a diagnosis of chronic obstructive pulmonary disease, or COPD, he said. “Data from the National Heart, Lung, and Blood Institute’s ‘Learn More, Breathe Better’ program suggests that roughly half of those people with symptoms go undiagnosed, so the number of Recent regulatory changes could lead to greater reimbursement for post-

people dealing with breathing problems

acute-care operators that provide respiratory care to their residents – and, consequen-

in the post-acute setting is likely to be

tially, a greater demand for respiratory therapy equipment and supplies.

much higher,” especially factoring in other respiratory conditions, such as asthma, pulmonary fibrosis, pneumonia

Under the Patient Driven Payment

and lung cancer.

Model (PDPM), implemented Oct. 1,

of hours they spent providing physical

providers that treat people with greater

therapy, occupational therapy or speech/

other research that tells us that people

clinical complexity – and whose care is

language pathology therapy.

with respiratory issues tend to have a

“The JAMDA article also supports

especially resource-intensive – will be

variety of comorbid conditions, adding to

compensated for that care.

the complexity of their care and mark-

An uphill battle

edly increasing their risk of readmissions

ment system, RUG-IV, which calcu-

The need for respiratory care in the post-

and complications, and the overall cost of

lated reimbursement for post-acute-care

acute-care setting was high prior to PDPM,

their care.

PDPM replaces the prior reimburse-

providers based largely upon the number

January 2020 | The Journal of Healthcare Contracting

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POST-ACUTE CARE

Respiratory care: A technology-centric practice “Respiratory therapy continues to advance at the speed of technology across the healthcare continuum, and the SNF setting is no exception,” says Michael Hess, president of the Michigan Society for Respiratory Care, an affiliate of the American Association for Respiratory Care. “Clinicians in this setting are called upon to manage ventilators (both invasive and non-invasive) to improve quality of life and assist breathing; monitor high-flow oxygen systems to facilitate respiration; administer a variety of nebulized medications; perform chest physiotherapy with high-frequency chest wall oscillation vests and cough-assist devices; and a variety of other highly specialized modalities using advanced technologies. This will absolutely continue into the next decade, as

“Finally, the JAMDA article highlights an issue that plagues chronic disease management in many other outpatient settings, i.e., the fact that many clinicians are unfamiliar with best practice recommendations and/or don’t have the time or resources needed to implement them,” said Hess.

Reimbursement changes “Ventilator and tracheostomy care automatically put residents in the highest reimbursement case-mix groups for the Nursing component of PDPM,” explains

healthcare research continues to push the boundaries of what is possible outside the hospital, and as established technologies become even more portable.” The need for skilled respiratory therapists in post-acutecare settings will increase, Hess predicted. “By recognizing respiratory therapy as resource-intensive and requiring a unique, specialized skill set (and enhancing reimbursement accordingly), PDPM will empower SNFs to bring in dedicated respiratory therapists, rather than asking other clinicians to work outside their normal scopes of practice,” he said. “This is a win-win that will improve patient outcomes, enhance satisfaction (both patient and employee), and create vast new opportunities for interprofessional collaboration, all while reducing the cost burden on the SNF.”

“ If an operator can offer ventilator and tracheostomy services, it has a much greater chance of capturing all 100 days of Medicare eligibility for skilled nursing coverage.” –Melissa Sabo

Melissa Sabo, chief operating officer, Gravity Healthcare Consulting, Cumberland, Maryland. In the “Special Care High” nursing case-mix group, either one of the following would qualify a resident for the second-highest nursing reimbursement under PDPM, she says:

ʯ COPD with shortness of breath while laying flat.

of 15 minutes of face-to-face time provided each day by a

ʯ Respiratory treatment seven days per week, with a minimum

respiratory therapist or an RN with respiratory training.

January 2020 | The Journal of Healthcare Contracting

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POST-ACUTE CARE

“If an operator can offer ventilator and tracheostomy services, it has a much greater chance of capturing all 100 days of Medicare eligibility for skilled nursing coverage, as not all operators in a given market typically can accept such patients,” she says. Moreover, other respiratory modalities also boost a resident’s overall payment score in the nontherapy ancillaries (NTA) category. (Per CMS, “nontherapy ancillary services” refers to any ancillaries a provider uses other than therapy services, such as drugs, supplies and equipment – but not labor.) According to Sabo, residents with respiratory conditions and services could see increased NTA points for:

ʯ Ventilator or respirator post-admit care.

ʯ ʯ ʯ ʯ ʯ

Asthma, COPD, chronic lung disease. Cystic fibrosis.

How PDPM works In the patient-driven payment model (PDPM), each patient is classified into one group for each of five case-mix-adjusted components: physical therapy (PT), occupational therapy (OT), speech/language pathology (SLP), non-therapy ancillaries (NTA) and Nursing. In other words, each patient is classified into a PT group, an OT group, an SLP group, an NTA group, and a Nursing group. For each of the case-mix adjusted components, patients are assigned to one group, based on the relevant MDS 3.0 data for that component. There are 16 PT groups, 16 OT groups, 12 SLP groups, six NTA groups, and 25 nursing groups. PDPM classifies patients into a separate group for each of the casemix adjusted components, each of which have their own associated case-mix indexes and base rates. Additionally, PDPM applies variable per diem payment adjustments to three components – PT, OT, and NTA – to account for changes in resource use over a stay. The adjusted PT, OT, and NTA per diem rates are then added together with the unadjusted SLP and Nursing component rates and the noncase-mix component to determine the full per diem rate for a given patient. Source: PDPM Calculation Worksheet for SNFs, Centers for Medicare & Medicaid Services, https://www.cms.gov/Medicare/Medicare-Feefor-Service-Payment/SNFPPS/Downloads/SNF_PDPM_Classification_ Walkthrough_20190208_508.pdf

Tracheostomy care post-admit. Respiratory arrest. Pulmonary fibrosis and other chronic lung disorders.

ʯ Suctioning post-admit. “More and more providers are

It’s true that caring for residents with a higher clinical acuity, including respira-

unless ventilators are being used, in which

tory conditions, can result in increased

showing interest in pursuing a variety

case the facility must have a respiratory

reimbursement, says Sabo. “However,

of ancillary services under PDPM to

therapist onsite at all times,” says Sabo.

quality continues to be at the forefront of

help drive appropriate and accurate

successful organizations. So communities

reimbursement, improve the quality of

must be able to treat efficiently, prevent

services being provided to residents,

Quality first

rehospitalizations during and after the

promote outcomes, and help reduce

“However, in either case, the nurs-

skilled stay, and facilitate a safe and effec-

liability and risk through improved

ing team must also be educated and

tive transition to the next level of care for

documentation completed by the

equipped to handle the treatments and

these higher acuity residents.

experts from the ancillary service ven-

interventions that need to be provided

dors,” says Sabo. “Respiratory therapy

outside of the time that the respiratory

is that it does a great job of fairly reim-

is a key ancillary service that many

therapists are onsite or available.” Many

bursing the ‘good ones’ in our industry,”

providers are pursuing under PDPM

respiratory vendors provide inservicing

she says. “Putting the resident first has

with a renewed focus.”

to staff to improve the clinical acuity and

always been the right choice, and under

capability of the onsite nursing teams,

PDPM, this approach usually leads to

she adds.

increased reimbursement as well.”

Some providers rely on third-party respiratory vendors to help.

“Often, [respiratory vendors] are onsite for four to eight hours per day,

“One of the best things about PDPM

January 2020 | The Journal of Healthcare Contracting

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PATIENT CARE

INTERVENTIONAL CARE

ENVIRONMENT OF CARE

January 2020 | The Journal of Healthcare Contracting

Mobile Medical Apps and Wearables It’s no easy task for physicians to make use of data from their patients’ wearables and apps

Fitbit says that 14 million U.S. adults subscribe to a digital health/wellness

accurately measure steps -- but is that a

service, and pay an average $174 annually for different apps.

modality worth measuring? “On the other hand, as part of a plan determined jointly by the patient and

So … we can probably all agree on

“The eagerness to incorporate mobile

physician, there are certainly physicians

one thing: Wearables, or mobile medical

medical apps and wearables varies with the

willing to utilize the ‘encouragement’

apps, are popular with consumers. But

individual physician,” says Poterack, whose

functions of fitness trackers,” he adds.

how about their doctors?

research interests are primarily directed

“In 2016 the American Medical As-

toward the use of wearable devices. “There

sociation conducted a survey to examine

is a lot of appropriate reluctance to do so,

Swimming in data

physician receptivity to various digital

for multiple reasons.” Among them:

In October 2018, the American Medical

health modalities and determined there

ʯ Very few practices have the

Association unveiled its Digital Health

was considerable interest on the part of

infrastructure to import and sift

Implementation Playbook to present key

physicians,” says Michael Hodgkins, M.D.,

through the massive amounts of data

steps, that is, “best practices and resourc-

chief medical information officer for the

these devices can generate.

es to accelerate the adoption and scale

AMA. “Specifically, physicians believed

ʯ Physicians lack control over wearables,

these tools could contribute to better

with no ability to perform quality

patient care.

control, and even no visibility into

“However, recent studies have shown considerable variability in the

who is actually wearing the device.

ʯ Physicians have concerns about

of digital health solutions.” Step No. 1? Identifying the need. “The predicate for innovation is to always ask ‘What problem am I trying to solve?’” says Hodgkins. “Many well-

accuracy of data from wearables, such

the liability and responsibility for

meaning entrepreneurs develop a passion

as Fitbit, and there is an absence of evi-

reviewing the data – something that

for an idea but don’t necessarily have

has not been clearly defined.

the background in healthcare to really

dence supporting the actual contributions these tools can make to improving health outcomes.”

ʯ Physicians have questions about what some of the data even means clinically.

Clinic, echoes some of those misgivings.

addresses a real need.” Poterack says that wearables histori-

Karl Poterack, M.D., medical director of applied clinical information for Mayo

understand if that idea is something that

“What if my patient walks 5K vs. 10K vs. 15K per day?” he asks. “A device can

The Journal of Healthcare Contracting | January 2020

cally have proved most valuable when used on a temporary or semi-permanent

MOBILE MEDICAL APPS AND WEARABLES

basis, e.g., to identify arrhythmia. “There’s

provide resources to monitor data

standard API that is the focus of activity

a purpose to it, a question to be answered,

and escalate as needed. This allows

among EMR vendors is the Fast Health-

and implications to the answer. There

physicians to only receive data that is

care Interoperability Resources (FHIR)

is good, solid equipment and a good

required for decision-making related to

API. But implementing this will still take

reporting system. And at the end, you feel

a patient plan of care.

considerable effort on the part of mHealth

confident you’ve gone through the data

“Finally, practices have also contracted

developers and EMR vendors.”

and you’ve got the information you need

with other third-party data analytics and

to make a decision.

monitoring companies if their vendor

‘medical grade,’ physician-provided

does not provide these services.”

devices, there is usually the ability to

“It’s purpose-built and has a defined question to be answered.” But as developers of mobile apps race

Even before the provider team can act

Says Poterack, “With regard to

generate a ‘summary page’ of key data

on the data generated from mobile medi-

that can easily be incorporated into the

to introduce new technologies, are they

cal apps, they have to be able to access it.

record. With regard to consumer-grade

addressing these fine points?

Which begs the question, How can the

devices, other than a couple of isolated

practice incorporate all this data into the

examples that probably work better in

electronic medical record?

theory than practice, I’m not aware of

Hodgkins says that physician practices can take steps to protect themselves from the influx of data that can accompany these new technologies.

“There is very little standardization

this occurring.”

among EMR databases, which presents

Workflow

“ Physician practices aren’t all created equal, so they will likely have different workflows and processes for incorporating digital health technology.” – Michael Hodgkins, M.D.

To accommodate the influx of data that comes from mobile devices, providers may have to reconfigure the roles and responsibilities of the office team. “There’s a lot of variation here,” says Poterack. “This is a big part of the difference between a device ‘prescribed’ and provided by the physician, where the workflow can be designed from the ground up, versus a consumer-grade device controlled by the patient, which is much more problematic.” Cardiology practices may be out front on this, he says. They tend to have more experience with wearables – many

an obstacle to easily incorporating data

of which monitor the cardiovascular sys-

at the time of implementation, practices

from mobile solutions—both wearables

tem – than other types of providers. But

can empower other members of the care

and apps,” says Hodgkins. “Much of

vendors of digital systems can help.

team to take the lead on monitoring and

what is occurring is at large healthcare

“Some of these [devices] come with

only involve physicians when there’s an

institutions and is often accomplished

the ability to collect data, sift through it,

abnormality or question,” he says.

through ‘brute force.’

find important things in it, and report

“First, by designing specific protocols

“Second, some practices have

“The most promising opportunity

that data,” says Poterack. “In a sense,

partnered with the vendor to help limit

going forward is the use of standard ap-

it is ‘prepacked’ with the device, or the

the amount of data coming into the

plication programming interfaces, or APIs,

developers provide a very solid interface

practice and/or EHR. [S]ome vendors

which are now being mandated. One

with your system.”

January 2020 | The Journal of Healthcare Contracting

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MOBILE MEDICAL APPS AND WEARABLES

Says Hodgkins, “Physician practices

Practices that successfully redesign

“Specifically, with remote patient

aren’t all created equal, so they will likely

workflow are those that fully understand

monitoring (RPM), we’ve talked with

have different workflows and processes for

their current method of operating, and

practices that have had success staff-

incorporating digital health technology.

then map out what areas require change

ing RPM activities both internally (with

with the integration of a new technol-

medical assistants, nurses and advanced

ensure that the first six steps of the [Digital

ogy solution, says Hodgkins. “They have

practice providers) and with external

Health Implementation] Playbook are

identified where internal resources can be

companies,” he continues. “Sometimes

thoughtfully considered. If they are, then

used and if/when external resources and

the vendor can support monitoring the

redesigning the workflow has likely already

support are needed.

patient data that comes into the system

“Planning is key, so it is important to

been considered, so practices are better

“Again, planning and involving all

and alerting the practice when abnormali-

prepared for when it’s time to do that work.

necessary team members is key for

ties arise. Some can also support training

For example, they’ve already decided that

long-term success. It’s also important

patients and serve as customer support.”

technology is the right solution to achieve a

to not think of this as a one-time

specific goal. And they know what level of

activity. Practices should be prepared

support the vendor can provide related to

to continue iterating and improving as

Success?

training, EHR integration, etc.”

they learn.

How would a practice define “success” in its ability to incorporate data from wearables and mobile medical apps? “That’s very context-dependent,” says Poterack. But he offers this defini-

Digital playbook for docs

tion: The ability to “receive data that

The American Medical Association’s “Digital Health Implementation Playbook” offers physician practices 12 steps to follow to build a strong foundation for success in digital health.

you have identified.”

Step 1: Step 2: Step 3: Step 4: Step 5: Step 6:

contributes to fulfilling whatever need

Identifying the need. (“What’s the problem?”) Forming teams. (“Who needs to be involved and when?”) Defining success. (“What are we trying to achieve?”) Evaluating the vendor. (“What’s the right technology?”) Making the case. (“How do we get political and financial buy-in?”) Contracting. (“What’s our expected timing, budget and plan with our vendor?”) Step 7: Designing the workflow. (“What will we need to integrate this technology?”) Step 8: Preparing the staff. (“Does everyone know what they need to do to make this successful?”) Step 9: Patient relationship. (“What does the patient need to know?”) Step 10: Implementing. (“How does it work in practice?”) Step 11: Evaluating success. (“Did it work?”) Step 12: Scaling. (“What’s next?”) Source: Digital Health Implementation Playbook, American Medical Association, https://www.ama-assn.org/amaone/ama-digital-healthimplementation-playbook

“There is a tremendous amount of data that’s out there for the taking,” he says. “Vendors are collecting this data, and there are indications they understand the importance of it. But I’m not sure they know what to do with it. There’s a lot that can be done with the data out there. We have to figure out what that is.” Says Hodgkins, “In the Playbook, we have proposed that practices view success as coming from some positive impact towards achieving the quadruple aim of healthcare -- improved outcomes, improved patient experience, reduced costs, and increased professional satisfaction.” “More broadly, at the AMA, we also aim to make technology an asset, not a burden, by providing resources to help practices implement effective, validated and trusted digital health solutions the right way.”

January 2020 | The Journal of Healthcare Contracting

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NEWS

Coming up short? Supply disruption related to EtO plant closures difficult to measure

Questions remained in late October about the capacity of commercial EtO

request information from the public and

sterilization facilities.

commercial sterilization companies about proposed EtO control technology options and costs for more than 100 commercial

The anticipated reopening of the

EtO sterilizers nationwide. The agency is

based contract sterilization firm announced

addressing EtO emissions as part of its re-

still on hold at press time due to drawn-out

in September that it would permanently

view of two National Emissions Standards

discussions with Cobb County officials

close its suburban Chicago plant.

for Hazardous Air Pollutants (NESHAP).

about fire codes and other regulations. There was no firm date for its reopening.

Meanwhile, the Oak Brook, Illinois-

Atlanta, Georgia, facility of Sterigenics was

And on Sept. 13, the Environmental Protection Agency announced it would

Through it all, getting a grip on exactly how â&#x20AC;&#x201C; or if â&#x20AC;&#x201C; these disruptions

January 2020 | The Journal of Healthcare Contracting

were affecting the supply chain was no

sounded the alarm about emissions in

Responses

easy task. Several distributors and man-

their communities.

Sterigenics’ plant closures are further proof

ufacturers contacted by JHC declined to

Sterigenics says its nine facilities (not

of the need for the healthcare industry to

comment. Only one – Medtronic – of-

counting the shuttered Chicago-area

improve its preparations for product disrup-

fered a statement, and it lacked specif-

facility) meet or exceed EPA standards

tion, says Chaun Powell, group vice presi-

ics: “We use a diverse mix of steriliza-

for EtO emissions. Likewise, Medline

dent, strategic supplier engagement, Premier

tion sources to ensure adequate supply

maintains that EtO emissions from its

Inc. In the past year, Charlotte, North

of our therapies for patients, mitigate

plant in north suburban Chicago – also

Carolina-based Premier has assembled a

risk, and ensure business continuity.

the subject of local scrutiny – “have

product disruption team in response to the

We are well positioned to continue to

always been at or below the standards set

“rampant increase” of disruptions seen

serve patients.”

by regulating bodies.”

in recent years, including those caused by

Sterigenics’ Sept. 30 announcement

The scientific debate will continue:

weather-related events, says Powell. Six months ago, Premier interviewed

of the Chicago-area closure reflected the

Are the controls currently in place in

firm’s frustration with local regulatory

EtO sterilization firms around the coun-

15 major manufacturers to learn about

bodies, while reassuring the industry that

try adequate to prevent incidences of

their emergency preparedness procedures.

products would continue to flow.

cancer in surrounding communities?

More recently, the GPO contacted close

“Hospitals and patients around the United States and the world depend on Sterigenics for vital, sterilized medical products, and we cannot provide them with the certainty they require while operating safely in a state that will suspend operations of a business despite the company’s compliance with applicable rules and regulations,” the company said. “We are actively taking steps to ensure customer and patient needs continue to be met by our other facilities, and are working with our employees throughout

“ Sterigenics’ plant closures are further proof of the need for the healthcare industry to improve its preparations for product disruption.” – Chaun Powell, group vice president, strategic supplier engagement, Premier Inc.

this transition.”

What happened? The buzz is about ethylene oxide, or EtO,

One thing seems clear: A ban on

to 600 suppliers about their sterilization

a gas used to sterilize billions of medical

EtO – though highly unlikely – would

protocols, to help Premier identify how

devices every year.

result in a public health crisis. Medline

and why product disruptions might occur,

For decades, hospital central sterile

estimates that more than 50 percent –

and what remedies or workarounds exist.

departments and ORs have recognized

or 20 billion – healthcare products are

In addition, Premier said it is working

the health hazards of chronic EtO

sterilized with EtO every year in the

with the Healthcare Supply Chain As-

exposure – including cancer – and have

United States alone. And, at this point

sociation, the Health Industry Distribu-

taken steps to protect their workers. But

in time, there’s no better sterilization

tors Association, and hospitals and health

over the past six months or so, the issue

agent that can effectively sterilize the

systems to improve demand planning

has caught the public eye, as neigh-

myriad of materials found among to-

and to prevent hoarding and panic when

bors of commercial EtO facilities have

day’s medical devices and surgical packs.

disruptions are announced.

The Journal of Healthcare Contracting | January 2020

NEWS

Oral medication for type 2 diabetes approved Patients have a new oral option to treat their type 2 diabetes. Rybelsus®

“Recent studies have shown GLP-1

(semaglutide) is the first glucagon-like peptide (GLP-1) receptor protein treatment ap-

agonists achieve positive insulin secretion;

proved for use in the United States that does not need to be injected. The approval of

can induce weight loss, which tends to be

Rybelsus was granted to Novo Nordisk in September.

a good thing for many people with type 2 diabetes; and may have a positive effect on heart disease,” said Philipson. “So

Until now, GLP-1s have only been

we’re in a very new space in the diabetes

available as injectables, said Louis H.

world. Now we have two classes of drugs

Philipson, M.D., PhD, FACP, president

for people with type 2 diabetes that are

of medicine & science at the American

considered beneficial for heart disease

Diabetes Association and the direc-

and weight loss – GLP1 agonists and

tor of the Kovler Diabetes Center at

SGLT2 inhibitors.

the University of Chicago, where he

“That’s a very positive development.”

is also the James C. Tyree Professor

Rybelsus® will be competitively priced

of Diabetes Research and Care in the

within the GLP-1 category, a Novo Nor-

departments of Medicine and Pediat-

disk spokesperson told Repertoire. “Novo

rics. “The impact of [Rybelsus] could

Nordisk is committed to working with

be very high, if it is as effective as other

health insurance companies and phar-

GLP-1 agonists,” he told JHC. And

macy benefit managers to ensure broad

early indications are, it is. “This could

coverage and patient access for Rybelsus.

really change the game.”

In addition, a comprehensive Rybelsus savings card program will be available to

In placebo-controlled studies, Rybel-

reduce copays for eligible commercially

sus as a stand-alone therapy resulted in a significant reduction in blood sugar (he-

insured patients.” Rybelsus is approved for once-daily

moglobin A1c) compared with placebo,

achieve their target blood sugar levels

said the FDA.

with diet and exercise, while many others

use in two therapeutic doses, 7 mg and

More than 30 million Americans

take medications, including metformin

14 mg, and will be available in the U.S.

(about one in 10) have diabetes, and 90%

(often the first drug of choice), SGLT2

beginning in Q4 2019, according to Novo

to 95% of them have type 2 diabetes,

(sodium-glucose cotransporter 2 ) inhibi-

Nordisk. The FDA is still reviewing Novo

according to the Centers for Disease Con-

tors, GLP-1 agonists and insulin.

Nordisk's new drug application (NDA)

trol and Prevention. Type 2 diabetes most

Some people with type 2 diabetes can

GLP-1, which is a normal body hor-

for Rybelsus seeking an additional indica-

often develops in people over age 45, but

mone, is often found in insufficient levels

tion to reduce the risk of major adverse

more and more children, teens, and young

in type 2 diabetes patients, says the FDA.

cardiovascular events, such as heart attack,

adults are also developing it. Type 2

Rybelsus slows digestion, prevents the

stroke, or cardiovascular death, in adults

diabetes occurs when the pancreas cannot

liver from making too much sugar, and

with type 2 diabetes and established

make enough insulin to keep blood sugar

helps the pancreas produce more insulin

cardiovascular disease. The manufacturer

at normal levels.

when needed.

expects a decision in Q1 2020.

January 2020 | The Journal of Healthcare Contracting

PROFORMANCE™ CLEANING VERIFICATION CLEARLY VISIBLE, EASY TO INTERPRET, OBJECTIVE TESTS OF CLEANING METHODS

SONOCHECK™ When the ultrasonic cleaner is supplying suﬃcient energy and condi�ons are correct, SonoCheck™ will change color. Problems such as insuﬃcient energy, overloading, water level, improper temperature and degassing will increase the �me needed for the color change. In the case of major problems the SonoCheck™ will not change color at all.

TOSI® Reveal the hidden areas of instruments with the TOSI® washer test, the easy to use blood soil device that directly correlates to the cleaning challenge of surgical instruments. TOSI® is the ﬁrst device to provide a consistent, repeatable, and reliable method for evalua�ng the cleaning eﬀec�veness of the automated instrument washer.

LUMCHECK™ The LumCheck™ is designed as an independent check on the cleaning performance of pulse-ﬂow lumen washers. Embedded on the stainless steel plate is a specially formulated blood soil which includes the toughest components of blood to clean.

FLEXICHECK™ This kit simulates a flexible endoscope channel to challenge the cleaning efficiency of endoscope washers with channel irriga�on apparatus. A clear flexible tube is a�ached to a lumen device with a test coupon placed inside; the en�re device is hooked up to the irriga�on port of the endoscope washer.

HEMOCHECK™/PROCHEK-II™ Go beyond what you can see with all-in-one detec�on kits for blood or protein residue. HemoCheck™ is simple to interpret and indicates blood residue down to 0.1μg. The ProChek-II™ measures for residual protein on surfaces down to 0.1μg.

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