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Here to Stay The world has changed. So too has demand for and supply of personal protective equipment

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AUGUST 2020 • VOLUME 28 • ISSUE 8

Here to Stay The world has changed. So too has demand for and supply of personal protective equipment

24 PUBLISHER’S LETTER Why America’s Healthcare Distributors are the Unsung Heroes of the COVID-19 Crisis.........................4

PHYSICIAN OFFICE LAB References and Referrals Managing references and referrals effectively can pay big dividends................ 6

SERVICE COVID-19: The industry responds............... 10

Sales

The Success Triangle Tool How to overcome prospecting mistakes and increase your sales pipeline

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repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2020 by Share Moving Media. All rights reserved. Subscriptions: $49.00 per year for individuals; issues are sent free of charge to dealer representatives. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address. POSTMASTER: Send address changes to Repertoire, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. 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. Periodicals Postage Paid at Lawrenceville, GA and at additional mailing offices.

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AUGUST 2020 • VOLUME 28 • ISSUE 8

HEALTHY REPS Health news and notes.............. 54

WINDSHIELD TIME Automotive-related news....... 56

HIDA GOVERNMENT AFFAIRS HIDA Unveils Public-Private Framework for U.S. Pandemic Preparedness and Response.... 58

INDUSTRY NEWS

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Opening the Floodgates Can physicians use all that patient-generated data to actually improve care?

News ........................................................60

Post-Acute

COVID-19 and Nursing Home Safety New commission to assess the nursing home response to the COVID-19 pandemic

Trends

Back to School COVID-19 presents challenges to pediatricians, school nurses, parents and kids

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Longer length peripheral catheters help facilitate IV procedures involving: • • • •

INTROCAN SAFETY® DEEP ACCESS IV CATHETERS Help reduce the risk of complications associated with accessing deeper veins Visible under ultrasound3, the Introcan Safety Deep Access IV Catheters are designed to extend indwell time and prevent accidental needlesticks.

1 2 3

Stone, Phillip, RN, and Britt Meyer, MSN. “Ultrasound-guided Peripheral I.V. Access: Guidelines for Practice.” American Nurse Today. N.p., Aug. 2013. Web. 05 June 2014. Elia, Fabrizio, M.D., Ferrari, Giovanni, M.D., Molino, Paola, M.D., Converso, Marcella, M.D., De Filippi, Giovanna, M.D., Milan, Alberto, M.D., Apra, Fanco, M.D. “Standard-length catheters vs long catheters in ultrasound-guided peripheral vein cannulation.” The American Journal of Emergency Medicine. 2012. Vol. 30. Data on ﬁle (B. Braun ETR NPAK-AKRJQV)

18-6459_6/18

Ultrasound guidance 1 Access to deeper veins 1 Patients with diﬃcult access 2 Overweight/obese patients 2

PUBLISHER’S LETTER

Why America’s Healthcare Distributors are the Unsung Heroes of the COVID-19 Crisis I recently sat down with two exec-

utives from a national distributor to have a candid conversation and give them a voice about the distribution industry’s response to the COVID-19 crisis. Healthcare distribution has been America’s unsung hero during this crisis. The way they worked together to source PPE and move it in record time to hotspots will go down in history as one of the top reasons countless lives were saved. The way all distribution companies responded to the COVID-19 pandemic is a credit to the industry and many have never been prouder in their lives. It’s not just a catch phrase – what they do matters. They’ve never worked so hard and they’re humbled to serve America’s caregivers. “Distribution has tried bringing their customers exactly what they asked for, and until the pandemic struck, it was great to be lean with justin-time inventory. But because of that, it’s been nearly impossible to catch up with today’s PPE demands,” said one of the executives. Distributors are doing everything in their power to make sure doctors’ offices are open because their future depends on it. Providers can’t see patients if supply isn’t on the shelf, but the government

needs to take a deep breath and think logically on a path forward. “The logistics of carrying this much inventory at a physician’s office alone is simply not possible,” explained one of Scott Adams the executives. There is a huge chasm between supply and expectations. PPE used to be 2-3% of distributors’ business, but now it’s all that they’re selling and chasing. Allocation of PPE is just a start given the new normal. There are shortages of swabs now and when a vaccine hits the market, it will affect needle and syringe manufacturers. For those who think distribution is a simple business of moving boxes, that is far from reality. “There are expectations that distributors are starting to stockpile,” one executive said. “Providers want increased volume on hand, but there’s no supply available to do it. You can’t flip a switch overnight.” As distributors originally faced this challenge head on, PPE and other supply sources were shut down in Wuhan, China, but the distribution network was nimble and started sourcing from all over the world. By working

together with the federal government and each other, distributors pulled off the nearly impossible task of delivering PPE to hotspots in record time while taking care of their existing customers. I am overly impressed with the job that medical distribution has done. A back-to-business campaign should drive the conversation now. Supply chain leaders need to educate people in their facilities. If this coronavirus doesn’t come back due to a successful vaccine, people will forget about it. But there will still be a stockpile of supply due to COVID-19. Also, due to some government requirements, providers are supposed to have a certain amount of PPE on hand before they reopen. Even in normal times, there wouldn’t be enough PPE to meet some of the government standards for reopening. A factory does not want to add lines for products that are in demand today but may be in significantly less demand in 18 months. Dedicated to the industry, R. Scott Adams

repertoire is published monthly by Share Moving Media 1735 N. Brown Rd., Suite 140, Lawrenceville, GA 30043 Phone: (800) 536-5312, FAX: (770) 709-5432; e-mail: info@sharemovingmedia; www.sharemovingmedia.com

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Eddie Dienes: McKesson Medical-Surgical

Scott Adams

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Richard Bigham: IMCO Joan Eliasek: McKesson Medical-Surgical Ty Ford: Henry Schein

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art director

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Katie Educate

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PHYSICIAN OFFICE LAB

References and Referrals Managing references and referrals effectively can pay big dividends References and referrals are often critical to product decisions, particularly for large capital purchases. As every

experienced distribution account manager knows, without references it is nearly impossible to get a large prospect to agree to move all or a major portion of their med/surg or lab spend from one distributor to another. So, why do so many of us handle references and referrals as if they were “nice to have” rather than “need to have” elements of our business? In my personal experience, I can tell you my excuse is that I was too busy. However, after losing a couple of pretty easy lab instrument orders, I decided I was not that busy. Life got better after I made that decision.

had products sufficiently portable to permit So, this month I will share my thoughts “roll in demos,” but the real exciting lab capital on managing reference and referrals. While equipment purchases are associated with major they have some similar elements, they are quite pieces of lab equipment. Large scale chemistry, different and need to be managed differently. immunoassay and combined systems come to Hopefully my thoughts will help you learn the By Jim Poggi mind. They are too large and complex to perbasics without needing to experience a lost sale mit roll in demonstrations. Even where “roll-in or two. Handled as a critical element of your demos” can be done, there is always the risk of something business, references and referrals pay big dividends by going wrong, especially if you have not maintained your enhancing your reputation and providing you with oppordemo system in perfect condition. tunities to grow your business at the same time. In today’s The solution? Find friendly, articulate local customers vernacular, they are part of your “brand.” who use your products and are willing to host a personal References visit from you and your customer or are willing to take Let’s explore references first. What is their key value? customer calls to explain how your solution has helped For years when I sold lab capital equipment, I sometimes them with clinical, economic or work flow value. Their 6

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PHYSICIAN OFFICE LAB viewpoint adds instant credibility. And the peer-to-peer relationship your prospects has allows them to speak the same language. Knowing this, how do you go about getting references in your area? My first approach has always been to ask my key suppliers for references in my area for each of the major systems I sold with them. For well-established products, this is always the best first step. With the reference list in hand, I asked my suppliers for mutual meetings to introduce me and for me to ask for permission to use them as part of my sales process, with prior notice of course. In the lab business in particular, even in primary care, most of the folks I asked to be references willingly agreed. For new products, it’s all about you and your supplier treating your first group of customers to best in class service and providing them with an exceptional buying experience. Refer to the March issue of Repertoire for my tips on managing the post-sale experience.

Each referral you make is a reflection on you, your company and your supplier. Qualify them carefully, check their reputation with your customers and ask for a personal meeting before you make a choice. Once your new customer has been using your product for three to six months, you and they should know how satisfied they are and whether they would be willing to speak on your behalf. If you are confident, ask. You asked for the order, ask for the reference. How you ask and the “rules of engagement” you offer your potential references makes a big difference. Setting clear expectations and agreeing on some simple rules are important. Key items to agree upon: ʯ Customer visits or phone/webinar references ʯ How often can they be approached? ʯ Who is the key contact at the reference site? ʯ How much notice do they need? ʯ Do they expect an honorarium or some other compensation? ʯ What times of day work for them? ʯ What will they say about you, your product and service? 8

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ʯ You need honesty but need to know what they like and what they may indicate could be better ʯ Whether you would be welcome on visits and/or to log into calls or webinars ʯ My personal preference was to attend site visits to introduce the prospect and customer reference. I usually stepped out of the site visits to allow free dialogue after introducing the parties. I typically did NOT participate on telecons and webinars after introducing the prospect and reference to allow open dialogue as well. ʯ Follow-up on the reference visit or call ʯ Establish your follow-up timing BEFORE the visit or call and establish what you want to learn ʯ Also follow-up with the prospect in the same way

Referrals Referrals should be your network of experts and resources you use as quarterback of the sale. Whether they are personnel from your company, your suppliers or independent consultants, you need to have the best at your beck and call. The essential list of referrals you need should include leasing companies, CLIA/regulatory experts, EMR/LIS resources and subject matter experts on specific topics. In today’s world, this will probably include COVID-19, Emergency Use Authorizations and molecular testing experts. Your key suppliers are always your most logical referral sources outside your company, but keep an eye open for experts your customers mention. In my experience, every region of the country has well-known experts in each of these subject areas. It pays to meet them and find out how you may be able to work together. I found that that most referral experts only want you to introduce them to your customers and give them a chance to offer their product or service. Since this exposure enhances their reputation and market exposure, your referral of them has substantial value. Be careful who you select. I have picked some great ones and had a few not-so-good picks over the years. Each referral you make is a reflection on you, your company and your supplier. Qualify them carefully, check their reputation with your customers and ask for a personal meeting before you make a choice. Manage your references and referrals with utmost care. You will be glad you did.

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SERVICE

COVID-19: The industry responds The COVID-19 has had an unprecedented impact on Amer-

ica’s economy, organizations, communities and families. But the med/surg industry did not sit idly by. Whether working from home or working with an extensive list of protocols and safeguards, the industry’s med/surg reps, warehouse workers, truck drivers and more rolled up their collective sleeves and went to extraordinary lengths. The following is part two of a series of stories that delve into different facets of the industry’s response to COVID-19, and how it has impacted the marketplace.

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Henry Schein Field Sales Consultant: Adapting to meet customer needs As a Henry Schein Field Sales Consultant, Dave Massi’s Monday through Friday usually has him on the road no

later than 8:30 a.m. and home after 4:00 p.m. During COVID-19, he was home every day. “Not interacting with my customers face-to-face or being on the road was definitely different,” he said.

However, the demands of the job only intensified as the demand for personal protective equipment such as gloves, masks and gowns increased among healthcare providers. “I found myself glued to my computer screen for almost 10 hours a day due to the influx and demand for PPE and supplies,” Massi said.

“ The real challenge has been getting to all my customers throughout the day and ensuring I have stock available. The demand for supplies has been unprecedented.” – Dave Massi, Henry Schein Field Sales Consultant

Thanks to technology, Massi was able to connect with colleagues via Microsoft Teams, and participate in virtual meetings. “I’ve always been a people person and I enjoy the change of scenery when I go office to office or city to city so I certainly look forward to getting back out on the road and in front of my customers.” Because many of Massi’s customers had shorter office hours or were simply closed, he had to ensure they were able to receive their delivery of supplies. To do so, he worked closely with customers to place and track orders; many who asked to continually order as much as possible. “The real challenge has been getting to all my customers throughout the day and ensuring I

Dave Massi

have stock available,” he said. “The demand for supplies has been unprecedented.” Operationally, there haven’t been many issues, “as Henry Schein is such an efficient company and our technological infrastructure is easily adaptable,” Massi said. “Everyone at the company, especially those in Sales Support; our distribution center in Denver, Pennsylvania; and Frank Rivas, General Manager – Northeast, Henry Schein Medical have made this experience much smoother for not just me, but my customers.” www.repertoiremag.com

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SERVICE

American Medical Supplies and Equipment: Everything will work out Amid the COVID-19 pandemic, product sourcing became paramount. “Trying to source product has been our big-

gest challenge,” said Victor Amat, president and owner of Miami, Florida-based American Medical Supplies & Equipment, Inc., an IMCO member. “It has also been our biggest success.”

Indeed, everybody went on allocation amid the pandemic. PPE items like gloves, goggles, face shields and masks were difficult to secure, but so were other items like hand sanitizer and alcohol. “We’ve been able to source some of these products outside of the regular supply chain,” said Amat. While being based in a large metro area like Dade County with a population near 3 million comes with many advantages like a large amount of importers and exporters, during the pandemic companies faced trying to procure supplies from untraditional sources. “You’re going to have crazy characters out there that are going to try to

August 2020

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move PPE product,” said Amat. “I heard of a guy who has a truck parts company that was sourcing product out of China. I don’t know how he did it. He was coming over to us trying to sell masks. We’ve had a lot of characters come by or call us regarding PPE products.” Amat said American Medical Supplies didn’t buy from 99% of them. “I bought through people that I knew or that were recommended.” Unfortunately, not everyone went that route, he said. For instance, one customer gave a supposed PPE vendor money up front for an order of N95 masks and never heard from the person again. “There were a few of those

SERVICE

stories from our customers,” said Amat. “And that’s going to happen. I’ve heard of other distributors getting burned along with customers. You start going down rabbit holes chasing product and you may find a dead end, or worse. It’s very frustrating and annoying.” Amat said in one instance he gave a purchase order to an exporter that he knew, but canceled three days later when the exporter tried to raise the price. “I had to cancel the order because I’m not going to be a part of that.”

Making the most out of the situation Over and over, Amat would tell his team not to panic. “I told my sales guys, ‘If we don’t panic, if we do the

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best we can to fulfill our customer’s needs, everything will work out.’” Their larger customers during the pandemic were community health centers. “They were busier than regular doctor practices,” said Amat. “We hustled to get product for them and deliver it in a timely manner.” One customer had the Centers for Disease Control & Prevention set up a drive-thru testing location for COVID-19. Another customer set up a triage center outside so they could triage the very sick patients and funnel them to a different area and not the regular lobby. American Medical Supplies set them up with things like tents and screens. Because most customers were closed or not seeing clients in person, it reduced the amount of supplies being consumed. “It gave us a pause,” said Amat. American Medical Supplies was able to bring more product in stock so that when customers did open up, there would be enough product for them. American Medical Supplies also used the down period to do sanitize its facility, vehicles and products, and do a full inventory. “We decided everybody was going to do inventory,” Amat said. “We normally do cycle counts every quarter. So we did inventory in late April, and it was accurate and good. I had a rookie sales rep and it was good for him to see other items in the warehouse that he wasn’t familiar with.”

Tosoh A1c Is your A1c Method free from Fetal Hemoglobin Interference?

Tosoh G8 is the method of choice for superior A1c quantitation over immunoassays in the presence of HbF. Tosoh G8 employs ion-exchange HPLC methodology to not only accurately quantitate HbA1 for the diagnosis of diabetes but also provides a clear chromatographic visualization of the interferences like HbF. Fetal Hemoglobin (HbF) in some conditions like Hereditary Persistent Fetal Hemoglobin, sickle cell anemia or with some medications can cause higher than normal levels in adults. HbF levels can be as high as 30% in some cases.1,2 If you are using an immunoassay method, the tolerance to HbF is 10% or less in some analyzers. Tosoh G8 has no interference from HbF at levels as high as 22%. Choose an assay that will give you an accurate A1c result in the presence of HbF. Choose an assay that allows you to see the type of interference. Choose Wisely. Choose Tosoh. 1 Hereditary 2 Fetal

persistence of hemoglobin F is protective against red cell sickling. A case report and brief review. Gotlieb et. al. Hematol. Oncol. Stem Cell, 12(2019) 215-219

hemoglobin in sickle cell anemia. Steinberg et. al. Blood, 2011, 118(1):19-27

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SERVICE

Shared Service Systems: Above and beyond

The COVID-19 crisis did not come at an opportune time for any hospital or health system. But for some health-

care providers, the pandemic turned traditional transitions and transactions into unprecedented challenges amid supply disruptions.

Steve Rogers

August 2020

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For instance, Salina Regional Health Center, in Salina, Kansas, had just made a switch from one vendor to Shared Service Systems for its distribution needs. Shared Service Systems, an NDC member, offers distribution services for medical/ surgical supplies across the states of Iowa, Nebraska, Missouri and Kansas from their main distribution center in Omaha, Nebraska as well as a second distribution center in Lincoln, Nebraska. Under ordinary circumstances, that change would come with its share of challenges to work through. But amid COVID-19, the situation became dire. There was no usage history to work from, thus no allocation. “So our sales and purchasing teams went above and beyond to ensure that we got allocations from the larger distributors for Salina so they could stay in business,” said Steve Rogers, president of Shared Service Systems. Another customer, Grand Island Regional Medical Center, in Grand Island, Nebraska had not even opened yet when the COVID-19 pandemic hit. Their first inspection was set for April 22. In order to pass that inspection, they needed to have enough product stocked for 22 patients. “We’re talking about a brand new hospital with no usage to date,” said Rogers. “But our suppliers understood the

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SERVICE situation. We got Grand Island enough product to pass the inspection.”

Everybody ‘doing their part’ The last few months have been a tough road for both suppliers and customers, said Rogers. “Nobody was ready for the surge that was coming. Plus people were scared, and were trying to buy up more than they should.” Rogers said Shared Service Systems was up front with customers about the supply situation and the need to work through allocations of products. “So if you’ve bought 20 cases a month in the last six months, you’ll still continue to get that 20 cases a month, or to the best of our abilities. That kind of made everybody settle down.”

The outpouring of support from the community has been tremendous. “One thing that has kind of blown us away is how the Omaha, Council Bluffs and Fremont communities have really stepped up to help us in this time of need,” Rogers said.

into the local healthcare providers. A local middle school from Gretna, Nebraska even got into the act, with teachers and students gathering up all of the unused hand sanitizer from the school year that had been canceled and delivering it to Shared Service Systems to distribute where needed. Another school donated goggles and disinfecting cabinets from their chemistry classes. “It’s just been very humbling, and we are incredibly grateful for so many people that stepped up to provide us a little bit of cushion when it came to some of those supplies that we truly needed for our frontline staff,” said Rogers. Incidentally, Rogers stepped into the role of president of Shared Service Systems in January, months earlier than the initial plan. The original plan had been for him to go from the company’s COO to president in the fall. “It’s been a roller coaster trying to learn the business, trying to keep the staffing here, and on top of that, having the COVID-19 crisis hit and opening new hospital or large hospital contracts,” said Rogers. “To say the least it has not been boring.” Fortunately, Rogers said he has a really good team to work with. “We get along very well; everybody does their part. We communicate well, and communication and teamwork are your two biggest factors to success.”

Planning for the future Shared Service Systems was also in frequent communication with its outside distributors to gauge product availability. “Having a strong relationship with our outside distributors helped greatly as well.” As the conditions surrounding the COVID-19 pandemic evolved, the rules to abide by frequently changed. For instance, drivers used to arriving at a hospital at 3 a.m. to make a deliveries now found locked doors and changed hours. Flexibility was key. “We’d communicate the next day with those customers, and then resolve it and move forward because it was in everybody’s best interest to continue to get things on a timely manner,” Rogers said. The outpouring of support from the community has been tremendous. “One thing that has kind of blown us away is how the Omaha, Council Bluffs and Fremont communities have really stepped up to help us in this time of need,” Rogers said. “And not just us, but health systems around the area.” From individuals to organizations, donations of PPE-related supplies came flooding 18

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Rogers said he foresees two shifts in thinking from the industry as a result of the COVID-19 pandemic. The first is the critical need for contingency planning and procedures across all organizations, both providers and suppliers. “Going forward, I think you’re going to see a lot of hospitals changing their contingency plans and procedures regarding outbreaks like this.” Rogers also said that there should be more of an emphasis on standardization. Inventory levels at some hospitals resemble the shelves at Walmart or other retail stores where you may see 15 different choices for one product category, he said. “What ends up happening is you get too many choices and then you’re not ordering enough and sometimes those choices aren’t available anymore.” However, if providers can draw their supply down to a few choices and order more from those choices, the chances of having more product on hand increase.

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SALES

The Success Triangle Tool How to overcome prospecting mistakes and increase your sales pipeline By Sandler Systems, Inc.

Have you heard the saying, “If selling was easy, everyone

would be doing it”? The incredible income potential that comes from commission-based selling incentivizes many people to try this career path. But selling really isn’t easy! Many obstacles present themselves to novice and seasoned sellers alike, and both can agree there are roadblocks around prospecting. 20

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The prospecting landscape is littered with pitfalls and traps. If you’re not careful, you may succumb to them. However, Sandler has developed a Success Triangle tool to help navigate this rocky terrain. To fully realize its power, you must understand each of the three components involved, and how they’re connected.

booking first-time appointments with new prospects, you’re helping your business more than if you were only focusing on clients that already exist; new business brings new referrals, opportunities, and information to your pipeline.

ATTITUDE

Attitude

SUCCESS BEHAVIOR

TECHNIQUE

Behavior Behavior is often seen as one’s blueprint for success in sales. Seems pretty straightforward, right? It can be, but first you must get past three limiting mistakes. Behavior Mistake No. 1: Not maintaining proper schedule orientation. Successful salespeople maintain a proper schedule orientation. Time blocking is a time-management concept that allows you to accomplish your daily and weekly tasks, and make progress on your goals. Consider how you treat your time with clients, versus the time you allot for yourself. If you have poor schedule orientation, you may allow interruptions and distractions to hinder personal efforts when you would never let them interrupt a client meeting. Similarly, if you maintain proper schedule orientation, you don’t allow distractions to interrupt your prospecting time. Behavior Mistake No. 2: Not having a goal for meaningful conversations. Too often, meetings pass without accomplishing their purpose. When you talk with a prospect, you should have a goal in mind, and make meaningful progress in every conversation. These conversations should take place with decision makers, and your goal should be for them to enact a purchase decision. Bonding, building rapport, and strengthening the relationship with your client or prospect is extremely important in the long term. However, that cannot be the only thing accomplished on the call. Every call should have an agenda and an outcome. Behavior Mistake No. 3: Not placing importance on booking first time appointments. If you don’t pursue new business, your total book of business will stall or start to shrink. By placing importance on

Attitude is one’s belief system and determines how you act and that ultimately affects your results. Just like with behavior, it’s very easy to have a clouded view of your attitude and actions if you’re not diligent with your process. There are several common mental traps that salespeople fall into when engaging in prospecting activities. Attitude Trap No. 1: Having a scarcity mindset and not turning the ‘gumball machine’ enough. Picture a gumball machine filled with red, blue, green, yellow, and purple candies. You want green gumballs because they’re your favorite. You turn the handle once, and a red gumball pops out. You turn it again, and a purple one comes out. You turn it yet again, knowing there’s a green one coming soon. The green gumball pops out on the third try, and you pop it in your mouth and enjoy.

Too often, meetings pass without accomplishing their purpose. When you talk with a prospect, you should have a goal in mind, and make meaningful progress in every conversation. These conversations should take place with decision makers, and your goal should be for them to enact a purchase decision. The world of prospecting can work just like this gumball machine. If your ideal prospects are green gumballs, keep turning the handle until they come out. The more you prospect, the more chances you have at achieving an ideal prospect. You know not everyone you engage with is going to be a green gumball. For this gumball theory to work for you, you need to know what an ideal prospect looks like in your business. What is your green gumball? If prospects don’t work out, just turn the handle again and wait for your green gumball to pop out. www.repertoiremag.com

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SALES Attitude Trap No. 2: Believing you’re not worthy of your clients’ time. Successful selling has a lot to do with a positive mindset. Before you can be of value to your clients or prospects, you must know your own worth. Think about the goods or services you provide – have they been beneficial to clients in the past? Take to heart that you add value to those you engage with. You have equal business stature with your buyer. Don’t be intimidated by a CEO – you deserve to talk to the highest-ranking person on the buyer side regardless of your title.

The quickest way to solve your clients’ needs is to uncover their pain points and provide solutions. If you fail to realize what those pain points are, you’re doomed to struggle from the start Attitude Trap No. 3: Letting your ego alter your decision making. Before going into a meeting with a client or prospect, check yourself. Don’t try to show your audience how smart you are by dominating the conversation. Ask questions and discover their pain points before you save the day. Ego doesn’t only adversely affect you by bolstering your confidence. Alternatively, some individuals don’t want to prospect because they’re insecure and afraid of embarrassing themselves in front of prospects. It’s important to understand that this is part of the process. You will make mistakes the more you prospect – it’s only natural. Don’t let your ego get in the way of your dedication to prospecting.

Technique Technique is how sellers go about their business. Technique is what you say and how you say it, and the actions and words you use to have a positive outcome. Although

governed by different rules, poor discipline when it comes to technique can have just as many negative effects as bad behavior and attitude. Improper Technique No. 1: Being unfamiliar with your talk tracks. Salespeople should have a few things down pat, such as the words and phrases you use in a specific situation. You should be able to jump to the correct talk track at a moment’s notice, regardless of the scenario, beyond explaining the background of your company. You should have pre-determined language to help you overcome objections and lead any client or prospect towards purchase decisions. Improper Technique No. 2: Being unprepared for sales calls. Productive sales conversations that start well tend to end well and need participation from both sides. As soon as you engage with a prospect, cover the purpose of the meeting and the expected duration of your time together. Then lay the groundwork of your call and the topics you wish to cover. This will allow you to be sure you get through everything you want to cover and will let your target know why you’re heading down the conversational paths that you are. Improper Technique No. 3: Failing to uncover pain. The quickest way to solve your clients’ needs is to uncover their pain points and provide solutions. If you fail to realize what those pain points are, you’re doomed to struggle from the start. You need to ask good questions to determine what ails them. Never prescribe a solution before you completely understand the symptoms. Prospecting can be daunting for any seller, but it’s imperative if you want your career to grow and develop at the highest level. By following the Sandler Success Triangle® and maintaining proper habits surrounding your behaviors, attitudes, and techniques, you can avoid traps that the average seller may fall into, and you’ll be well on your way to redefining the way you add prospects to your funnel. Send your questions about improving Sales Development in your industry with a proven, systematic approach to selling to SalesTips@repertoiremag.com.

About Sandler Training

With over 250 local training centers around the globe, Sandler is the worldwide leader for sales, management, and customer service training. We help individuals and teams from Fortune 500 companies to independent producers dramatically improve sales, while reducing operational and leadership friction. ©Sandler Systems, Inc. All rights reserved. 22

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Here to Stay The world has changed. So too has demand for and supply of personal protective equipment

August 2020

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Almost overnight, the conversations changed.

For years the importance of infection prevention for suppliers and providers would be brought up in the healthcare market. It was never a sexy topic; there were always more interesting products to discuss.

However, COVID-19 changed all of that. The market woke up earlier this year and became familiar and compliant with PPE almost overnight. An industry-leading infection control expert recently talked with Repertoire Publisher Scott Adams on how the market has shifted to meet the unprecedented demand for PPE, and what the future may hold for med/surg companies. The following were insights gleaned from that discussion.

In the beginning of the pandemic, there was a focus on N95 masks in the marketplace. Everybody had to get an N95 mask, and no one knew where to get them. There was not enough production. Then the demand and attention shifted to all the other products that basically you use for same reasons, such as personal protection, or barriers or to kill a pathogen. The market is super strained across the board.

How drastic was the shift in thinking?

Demand has spiked to a degree that distributors need to watch service levels closely. They can’t think about new market opportunities because they have to service existing markets that are at that huge demand spike.

The sudden change was comparable to how the world reacted following the September 11 attacks. Everyone thinks of the world before 9-11 and after 9-11. This is a comparable event. It’s affected all areas of society. We all take personal protection and infection prevention very seriously.

Markets that never wore face masks are now expected to wear face protection The whole U.S. opened up to it. You see it every time you go to the grocery store. In the healthcare space, now both caregivers and patients are wearing face masks. New market segments like extended care are now wearing face masks, face shields, and N95 masks for the first time. Although there are new market opportunities opening, the focus for distributors must be their existing customers right now. Demand has spiked to a degree that distributors need to watch service levels closely. They can’t think about new market opportunities because they have to service existing markets that are at that huge demand spike.

The market is strained “across the board” Growth in product categories related to infection prevention has gone from incremental to explosive. It’s not like in the past where hand hygiene market growth would be 5% a year. Now the category is growing at 200% of what it was pre-COVID.

Supply chain pressures will shift PPE may be starting to get under control, but other areas have begun to fill the strain. For instance, with infection prevention, are there enough pumps for the hand sanitizer bottles? What about canisters for wipes, and the lids to those canisters? What about labels or packaging for N95 masks? It’s not just the supplier, but that supplier’s supplier. The supply chain branches out, it’s six degrees of separation. Testing for COVID-19 has put a strain on diagnostic supplies. When a vaccine is developed, there will be a surge in demand for all the products needed to administer the vaccinations. It’s the product you don’t think about, like alcohol prep pads. www.repertoiremag.com

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Personal Protective Equipment How much of the demand for caregivers varies due to state-by-state requirements of PPE they have on-hand in order to operate? Each state is on a different timeline, so there are 50 different answers to the question. Where to store all of it? Across the nation, distribution centers are filled with the influx of PPE products. The supply chain has to move faster, accelerate. Facilities are consuming this product quickly, which will be replenished faster through the supply chain, but nobody has space for it.

down Mexico, Malaysia, India – any place you’re sourcing product from. So to have the bulk of your supply coming from any sole geographic area is a risk. Even domestically, there could be issues. For instance, what happens if a manufacturer is in a hot zone and unable to produce product at normal levels?

Geographical diversity will be critical

State by state

The world is now going to be using a lot more personal protection. Med/surg companies all need to diversify their geographic sources of product. There have been several manufacturers that have or are in the midst of adding production lines of various types of PPE. There are also some very well-known manufacturers from outside of healthcare that have stepped up for the short term. People pick on China for the shortages, but you could apply that to any country. COVID-19 is everywhere. It shut down China. It could just as easily shut

How much of the demand for caregivers varies due to state-by-state requirements of PPE they have on-hand in order to operate? Each state is on a different timeline, so there are 50 different answers to the question.

How healthcare will look moving forward There is now a focus on infection prevention and a heightened awareness of personal protection. There will be greater compliance of these products because it’s now been part of everyone’s life for the past six months.

The anthrax scare COVID-19 is not the first time there has been a health scare that caused a massive demand in PPE. In 2001, anthrax attacks occurred in the United States over the course of several weeks beginning one week after the September 11 terrorist attacks. Letters containing anthrax spores were mailed to several news media offices and elected officials, killing five people and infecting 17 others. During the anthrax scare, the United States Postal Service (USPS) wanted PPE for the 500,000 people that

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handled the mail, according to the PPE business expert. “They said ‘We’re going to put nitrile exam gloves on anybody who touches the mail,’” the expert told Repertoire. “There isn’t that much production in the world that you can get to the USPS overnight.” Conceptually it sounds right and looks good on paper. “But those involved with PPE manufacturing understand there is just not that much product in the world to move that quickly to those who have never worn it before.”

PPE Past, Present and Future A supply chain leader examines how the spike in demand due to COVID-19 compares to other historical markers, and how it could reshape the industry moving forward. Editor’s note: Billy Harris, CEO of Sri Trang USA, Inc., spoke with Repertoire Publisher Scott Adams on the history of the glove business as it relates to public health scares, how demand spiked during COVID-19, the challenges of bringing manufacturing of gloves to the United States, and more. The following were ten insights from the interview.

This isn’t the first time we’ve faced a PPE shortage

Glove manufacturing didn’t leave the U.S. because of cheap labor

In 1989, the Food and Drug Administration (FDA) issued universal precautions because of AIDS. The universal precautions were just a simple statement: if you encounter bodily fluid, you should glove, gown, and mask. “That took the whole industry by a little bit of surprise,” said Harris. For the glove business, the universal precautions of 1989 meant explosive growth. In that particular year in Malaysia alone, the Malaysian government issued 300 permits for the manufacturing of gloves, Harris said, “though not all of those permits were fulfilled, or factories built.” At the time, there was still a fair amount of domestic production in the United States. However, since then, manufacturing has migrated to places like China, Indonesia, Thailand, and Vietnam.

When the gloves produced in the United States migrated to South Asia and China, it wasn’t because of cheap labor, Harris said. “Gloves left because that’s where the raw material is, and the raw material most in demand at the time would’ve been latex.” In the 1980s and up until about 2000, latex would have been the first choice of product, then vinyl, and then nitrile, Harris said. Today it’s nitrile, vinyl, and then latex.

Following the universal precautions in 1989, there’s been an event every few years that felt like it was going to have an impact on infection prevention and PPE For instance, in 2001, you had the anthrax scare with the U.S. Postal Service, Harris said. “At one point, the www.repertoiremag.com

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Personal Protective Equipment U.S. Postal Service wanted everybody to glove and have some form of protection, but that lasted for about three months. The U.S. Postal Service went out and bought millions of gloves. Three months later they were trying to return them because none of the workers would use them, and the whole anthrax scare went away due to good law enforcement practices to get to the root cause of it.” ʯ 2002: A West Nile Virus outbreak occurred, “but it really didn’t have an impact on the U.S. market in terms of any unusual demands outside of the normal demand.” ʯ 2003: SARS. “It didn’t really impact availability of product.” ʯ 2005: The system was challenged with bird flu. “When I say the system, I mean the manufacturing community,” Harris said, “which needed to make sure we had enough gloves not just in the U.S., but other hot spots of the world. So, there was a demand issue.” ʯ 2006: An E. coli scare, “but that did not negatively affect the glove business,” Harris said. ʯ 2008: An economic downturn. “Interesting enough, at least in the glove business, when there were tough economic times, we tended to thrive better both in volume to the market and in profitability for the company.” ʯ 2009: H1N1, or swine flu, “and again that was a global issue that we saw, and it created a higher demand for product. But the demand never really exceeded the capacities that were already installed.” ʯ 2014: Ebola made headlines. It was mostly in African regions with some hot spots in other parts of the world. “In the U.S. we had a couple of places, but that was really squashed out. It got so much attention from the healthcare community, the scientific community, that it became almost a nonissue. But it was a little bit of a scare.” ʯ 2015: Measles, which didn’t really challenge PPE at that time. ʯ 2016: Zika. ʯ 2019: Another outbreak of measles. ʯ 2020 will be remembered as the year of COVID. However, December 2019 was the discovery of the virus and analysis has found that first cases were likely November 2019, Harris said. 28

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Not surprisingly, during the peak of the COVID-19 crisis, demand was much higher than installed capacity Harris said at its peak on a global basis and even in the U.S., the demand for gloves was 70% higher than the installed capacity. “It’s a little bit difficult to really get a hard number, but we use 70%. Maybe you can discount some because you get three inquiries that might be for the same millions of gloves for some government agency, or some state agency, or just some local hospital,” he said. “But we just know that the demand is higher than the available supply.”

Producing masks, hand sanitizer and gowns in the United States is much more feasible due to the raw materials and equipment needed. “If it’s not here in the U.S., it’ll be nearby in Mexico or Central America. Some of that already exists.” Why gloves are harder to produce For masks, you can buy a machine that will make a mask and put it in your basement, your living room, or any empty building anywhere in the world and be in the business of making those products in relatively short order, said Harris. There is a raw material issue that you need, but that raw material is fairly available both domestically and abroad. Gowns are of a similar situation. “A little bit more higher tech in terms of the machine that you need to buy, but you can buy a machine, put it in your basement or an empty building, and in 60 to 90 days be making product domestically.” But gloves are very different, “because you don’t buy a machine and put that in your basement, your living room, or an empty building,” said Harris. The average single production line of making gloves is three

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Personal Protective Equipment stories tall and 100 yards long. For example, Sri Trang’s group has three manufacturing sites with seven production facilities. The largest of the group sits on 190 acres of land. “So, you don’t just go build a glove line,” Harris said. Plus, the raw material for gloves is still coming from either Korea, Taiwan, mainland China, Malaysia, Japan, or Thailand. “That’s where your nitrile raw material comes from, and you have 12 producers in total that are based in each of those countries.” For petroleum based – paste or pellets – readily available raw material is in China, and 99% of the world’s vinyl gloves come from China. While it’s possible that a new group, or even someone already in the glove business would set up manufacturing sites in different parts of the world, it would be challenging. “It’s really all about the raw material, because it’s always best to ship a finished good than it is to ship a raw material,” said Harris. “Of course, in times like this, people get a little bit energized, but then do they follow through and actually do it?”

The dental supply people were sitting on inventories and having inventories coming in, so they started selling gloves, masks, gowns and hand sanitizer to everybody. They even went to the market to try to get more. It takes a reasonable amount of space, and a reasonable amount of capital. If you invest somewhere around $30 to $40 million, that might build a 12-line production facility somewhere in the United States. “And then you’ve got regulatory challenges to navigate your way through, because when building a glove factory, it’s similar to that of a chemical plant even though you’re not making chemicals,” Harris said. “You need a lot of water. You must have holding ponds to return the water, and that’s the big 30

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challenge that you typically have here in the U.S. So, it’s a big investment. And then of course you’ve got to import all your raw materials.”

However, other PPE, like masks, hand sanitizer and gowns may come back to the United States for production Producing masks, hand sanitizer and gowns in the United States is much more feasible due to the raw materials and equipment needed. “If it’s not here in the U.S., it’ll be nearby in Mexico or Central America. Some of that already exists.”

China’s export problems with PPE supplies didn’t necessarily affect all glove manufacturers Harris said Sri Trang was fortunate because it is based in southern Thailand, and not dependent on any significant raw material or labor coming from China. “In the U.S. it’s all about nitrile gloves, and we have nitrile raw material that we can buy from Malaysia, Taiwan, Korea, Japan or Thailand, and those are our suppliers and we had no disruption in the supplies,” he said. “Packaging is all made and produced in Thailand, and we have the benefit of using 80% post-consumer recycled packaging, and that's been part of our program all along. No disruption there. Then the few other little chemicals and things, it was zero impact for us.”

Giving manufacturing capacity “110%” is a myth “Pre-COVID-19, we were running at about 93% capacity,” said Harris. “With COVID, we jumped full utilization of all assets, but the reality of manufacturing across any industry is that the theoretical capacity and actual capacity rarely equal.”

PPE demand has turned the supply chain upside down “All of us grew up in a time that everything was focused on just-in-time (JIT) delivery and single sourcing,” Harris said. “It’s not going out the window tomorrow, but it’s going to go out of the window eventually because COVID-19 is going to leave some deep scars and memories. People will be in the position to say, ‘Well that’s not going to happen to me ever again.’” Yes, there will be higher demand, because more people across all industries are going to glove, gown, and mask. Some will be more short-term. For instance, some

of the inquiries that Sri Trang received over the past few weeks are mostly coming from industry. “They’re trying to get their employees back to work, whether it be in a factory or a restaurant.” Another example was the cruise ship industry. When it was shut down during COVID, those companies buying gloves for cruise ships found themselves sitting on idle inventory. “Well, that idle inventory was only idle until somebody figured out that, ‘Oh, there’s some idle inventory, let’s go buy it because we can use it over here in other parts of the market.’” Anybody that was in the food service business saw a decline for a short period of time. But their glove sales and mask sales remained because they started selling it to customers who were not in their traditional wheelhouse. The dental market did the same thing, Harris said. For seven to eight weeks, they went from 100% utilization in dentistry down to maybe 15%. It was only the dentist and maybe one other person in the office during that period of time. The dental supply people were sitting on inventories and having inventories coming in, so they started selling gloves, masks, gowns and hand sanitizer to everybody. They even went to the market to try to get more. Some of the dental distribution business is now trying to figure out how to leverage that long-term in healthcare and the medical side, not just the dental side, Harris said. So, unless you were specializing in cancer treatments and

things of that nature, you saw no decline. But the general practitioner certainly saw a big decline. There’s going to be a change in the supply chain, Harris said. The market’s going to look very different, and the demand will probably jump from 70 billion to maybe 90 billion when it all starts to settle out, “because we’re all going to be doing more cleaning, deep cleaning, things of that nature.”

Market growth How much has the glove market grown? Around 1990, the U.S. market for disposable gloves and exam gloves was estimated to be about 15 billion pieces, said Harris. In 2019 pre-COVID, the estimate was about 70 billion gloves in the U.S. and 300 billion globally. “So, in a 30-year period, we went from 15 billion gloves to 70 billion in consumption.” The glove market isn’t exclusive to healthcare. Harris qualified the number as including disposable and exam gloves, and for markets that include the food service industry. “But it goes to show how just the hand protection and thin wall disposable gloves has grown in that 30-year period.”

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Personal Protective Equipment

Domestic Demand GPO, health systems acquire stake in domestic manufacturer of face masks

Premier Inc. and 15 health systems announced they

had acquired a minority stake in Prestige Ameritech, the largest domestic manufacturer of face masks, including N95 respirators and surgical masks. Under the agreement, Premier members commit to purchase a portion of all face masks they use annually from Prestige Ameritech for up to six years, inclusive of a threeyear renewal option. The arrangement with Prestige Ameritech is part of a Premier strategy to work with members to invest in domestic and geographically diverse suppliers of PPE and other medical equipment currently in shortage due to the COVID-19 pandemic, according to the company. “With past outbreaks such as SARS, H1N1 and Ebola, the nation talked about domestic manufacturing and expanding supply sources as the keys to preventing 32

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shortages, only to return to the same overleveraged overseas markets once the crisis was over,” said Premier President Michael J. Alkire. “This move is the latest step in our long-term commitment to changing the way we source critical products so that we never again experience shortages as a result of overreliance. Our economic prosperity can no longer be tied to things we buy – it must also come from things we make.” Share Moving Media, publisher of Repertoire Magazine and The Journal of Healthcare Contracting, reached out to Premier, as well as one of the health systems participating in the program, for insights into the agreement, PPE demand, and future of the market. Responding were Michael J. Alkire, President, Premier Inc.; and Raymond Davis, VP, Supply Chain, Universal Health Services.

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Personal Protective Equipment Universal Health Services Repertoire: Can you give us some perspective of how COVID-19 affected your PPE needs? What were your typical needs before COVID-19? What about during? Raymond Davis: Prior to COVID-19, at Universal Health Services (UHS), our typical supply usage was relatively consistent year over year. We would experience increased usage due to seasonality at certain times of the year. However, for the most part demand was both consistent and forecastable.

“ In mid-March, as new hotspots were emerging, our member survey showed that active cases of COVID-19 created surge demand of 17 times the typical burn rate for N95 respirators, 8.6 times for face shields, 6x for swabs, 5x for isolation gowns and 3.3x for surgical masks.” – Mike Alkire, Premier

COVID-19 created a substantial increase in demand for all personal protective equipment (PPE). We have experienced supply demand spikes in excess of 300% for a majority of PPE items. Due to these demand increases we have had to vet and partner with alternative vendors to ensure access to adequate supplies. Prior to COVID-19, PPE supplies were monitored and managed as one important area of many within the Supply Chain (other similar priorities would include blood products, trauma and surgical packs, etc.) but now it has become the highest priority. UHS owns and operates 26 Acute Care Hospitals in the U.S. and 200+ Behavioral Health Hospitals. We care for 3.5 million patients/year so our PPE supply requirements are significant. 34

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Repertoire: What are the long-term projections of what the need will be? Davis: The UHS supply chain team is modeling several scenarios based on our current demands and the potential ongoing increase needs due to COVID. In addition, we believe there will long-term implications on standards of care, specialized screening equipment needs, and changes in supply usage practices driving us to think differently about future needs. We are currently in the process of aligning new standards for temperature monitoring equipment, PPE usage, and evaluation of all current supplier channels to ensure we create redundancy within our supply chain. Repertoire: Why is it important for your organization to partner with an effort to have an expansion of domestic PPE production? Davis: Partnering with the largest domestic supplier is important to UHS for several reasons: it is vital for UHS to support U.S.-based companies, having a partnership domestically allows for less risk in the supply chain, and these types of partnerships create a platform for us to have a deeper level of influence and control. Repertoire: How will healthcare look different moving forward as a result of what has happened with supply/demand of PPE? Davis: There will be a substantial push for companies to partner with or create new types of relationships with domestic manufacturers, supply chain redundancy, visibility of inventory from end to end (manufacture to customer), and greater analytics around demand signals will all be areas of dynamic change and evolution across the healthcare supply chain.

Premier Repertoire: Can you give us a snapshot of PPE supply/demand before COVID-19 and during? How much did demand spike among Premier members? Michael Alkire: According to Premier’s purchasing data, hospitals and health systems across the United States typically buy 22-25 million N95 face masks each year. As COVID-19 cases grew across the U.S., Premier conducted several surveys of our members to understand their PPE inventory on hand, increasing consumption rates and unmet needs. Our data showed that during January and February, demand for N95s surged, up 400% and 585%, respectively,

and by mid-February, most healthcare facilities were receiving just 44% of the N95s and 82 percent of the surgical masks they ordered. In mid-March, as new hotspots were emerging, our member survey showed that active cases of COVID-19 created surge demand of 17 times the typical burn rate for N95 respirators, 8.6 times for face shields, 6x for swabs, 5x for isolation gowns and 3.3x for surgical masks. And as the pandemic heightened in April, when annual N95 usage was calculated to be more than 200 million masks per year, our survey data showed that isolation gowns replaced N95 masks as the top shortage concerns among hospitals and health systems treating COVID-19 patients. This was likely a result of conservation measures put in place to extend the use of N95s. In the post-acute setting, we found in March that more than two-thirds of skilled nursing and assisted living facilities could not obtain the necessary N95 masks, face shields and other PPE needed to care for current or suspected cases of COVID-19. In early April, we checked in again to find that 24% did not have N95 masks on hand, and the majority of respondents had fewer than two weeks’ supply of surgical masks, isolation gowns and face shields. Repertoire: What are the long-term projections of what the need will be? Why was it important to have a commitment of up to six years? Alkire: Sixty-eight percent of product disruptions occur due to poor demand signaling. It takes significant capital and resource investment by a manufacturer to effectively build and plan capacity to meet long-term demand, and to create adequate redundancy and the safety stock that is needed to ensure a continuous supply of product to customers. Manufacturers can do this if they have long-term, predictable demand that is provided by long-term agreements. To balance the risk of any potential disruption, Premier aims to work with manufacturers that have onshore, nearshore and off-shore options. With this specific agreement, Prestige Ameritech now has long-term, multiyear commitments from Premier and multiple members that give them certainty and allow them to dedicate the resources necessary to increase PPE production for the foreseeable future. Repertoire: Can you provide us some details of the agreement with Prestige?

PPE products critical for the daily operations of health systems are overwhelmingly sourced overseas, with approximately 80% coming from China and Southeast Asia, Premier said in a release. “The risks of this overreliance on Asia came into sharp focus as COVID-19 swept across the globe and these nations closed borders and prevented U.S. access to supplies, triggering widespread shortages of PPE needed to protect healthcare workers and patients. In contrast, Prestige Ameritech represents a domestic supply chain, with production completed in the United States. Prestige also sells 100% of its products to U.S. customers.”

Alkire: This agreement with Prestige Ameritech is part of Premier’s newly announced initiative to work with members to invest in domestic and geographically diverse suppliers of PPE and other medical equipment currently in shortage due to the COVID-19 pandemic. Prestige Ameritech represents a vertically integrated domestic supply chain, with production of raw materials and finished goods completed in the United States. Prestige also sells 100% of its products to U.S. customers. Prestige produces a range of PPE, including N95 respirators, surgical masks, face shields, surgical gowns goggles, tube holders and ear loop elastics. We plan to purchase a minimum of 46 million masks each year through the transaction, with the ability to scale for additional demand from the broader Premier membership. Repertoire: What are some other parts of Premier’s strategy to invest in domestic and geographically diverse suppliers of PPE? Alkire: Premier’s approach is about balance, ensuring that supplies come from diverse regions, countries and continents, and, for some critical products, demanding at least one domestic source. Our investment with our members in Prestige Ameritech is part of a larger, overarching Premier initiative to ensure a healthy supply chain through diversification, which we’ve been talking about for over a decade. As an example, we’ve operated a company called S2S Global for nearly a decade, and it is grounded in global and dynamic sourcing. Through S2S Global, our members have the ability to dictate the www.repertoiremag.com

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Personal Protective Equipment specifications of certain supplies or products, and we go factory-direct to the country of origin and work with manufactures to produce these products to their specifications. This creates an alternative sourcing channel for our members, while providing financial incentive and security to the manufacturers. In early 2019, Premier launched ProvideGx to address drug shortages. The ProvideGx model allows Premier to: 1. Utilize unique contracting mechanisms to incentivize manufacturers to enter the marketplace for shortage drugs; 2. Align a committed group of members with a manufacturer to effectively build and plan capacity to meet long-term demand, and create adequate redundancy and safety stock to ensure a continuous supply of product for customers; and 3. Invest alongside manufacturers to help alleviate the financial strain associated with bringing these older drugs to market. One key tenet of the ProvideGx program is prioritizing manufacturing of these drugs in the United States where possible. Sixteen of the 18 drugs brought back to market through ProvideGx in its first year were manufactured in the United States.

Premier members participating in the initial investment include: ʯ AdventHealth (Altamonte Springs, FL) ʯ Adventist Health (Roseville, CA) ʯ Advocate Aurora Health (Downers Grove, IL, and Milwaukee, WI) ʯ Ballad Health (Johnson City, TN) ʯ Banner Health (Phoenix, AZ) ʯ Baptist Health South Florida (Miami, FL) ʯ CommonSpirit Health (Chicago, IL) ʯ Genesis Health System (Davenport, IA) ʯ Henry Ford Health System (Detroit, MI) ʯ McLaren Health Care (Grand Blanc, MI) ʯ Riverside Health System (Newport News, VA) ʯ St. Luke’s University Health Network (Bethlehem, PA) ʯ Texas Health Resources (Arlington, TX) ʯ Universal Health Services, Inc. (King of Prussia, PA) ʯ University Hospitals (Cleveland, OH)

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Repertoire: How will healthcare look different moving forward as a result of what has happened with supply/demand of PPE? Alkire: The pandemic has shed a light on how the United States is overly reliant on overseas markets for a host of goods, with less than 10% of isolation gowns made in the U.S. and less than 10% of disposable PPE products made in the U.S. Going forward, Premier will ensure that our nation is going to have access to a healthier and more predictable supply chain, which will include domestic capacity and geographic diversity for critical medical supplies. Many healthcare providers rely on a “just-in-time” inventory process that is going to change, whether due to federal guidelines, state regulations or more sophisticated supply chains. Providers will work more closely with their supply chain partners and group purchasing organizations to ensure diversified sourcing, as evidenced by Premier’s investment with its members in Prestige Ameritech.

EMR

Opening the Floodgates Can physicians use all that patient-generated data to actually improve care? By Mark Thill

Ask your physician customers: “How do you like your EMR?” Better yet, don’t.

Researchers reported in the March 2020 issue of Mayo Clinic Proceedings that the usability of current EHR systems received a grade of F by physician users. Physicians spend one to two hours on EHRs and deskwork for every hour spent in face-to-face contact with patients, and they spend an additional one to two hours on EHR-related activities outside of office hours every day, they reported.

Now add to that the plethora of patient-generated data finding its way into the medical record from mobile devices, apps and wearables. It’s a lot of data to manage. Doctors say they are up for the challenge, in the name of better patient care. Research published by the American Medical Association this year shows that among digital health tools, “remote monitoring and management for improved care” has seen the biggest increase in adoption since 2016. (Televisits and virtual visits ranked second.) What’s more, remote care tools have the highest likelihood of adoption (among digital health tools) within the next three years. But physicians do have concerns. Researchers from the New York University School of Medicine noted last year in the Journal of Medical Internet Research, “Although wearables have the potential to transform patient care, issues such as concerns with patient privacy, system interoperability, and patient data overload pose a challenge to the adoption of wearables by providers.” 38

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Two years ago, Steven Walden, M.D., made the following comment when he was appointed vice president and chief medical informatics officer for the American Academy of Family Physicians: “The doctor is the main generator now of records, but in the new paradigm, which we are calling the self-documenting record, the computer staff and patient would be the main data enterers. The physician will have to enter only those things needing a physician – and do it by speaking rather than typing. “We are making progress on the integration of external data with EHRs,” he told Repertoire. “We have seen movement in the API space, which is needed to share data back and forth.” In addition, information-blocking rules – which prohibit IT developers, networks or providers from interfering with access, exchange or use of electronic health information – will likely lead to more information-sharing. But many issues must still be addressed before patient-generated data reliably and consistently contributes to better patient care, he says. “I think the biggest hurdle is the integration of wearables data into the medical decision-making process, which includes integration and managing the large volumes of data.” Waldren believes that providers of wearables need to understand how the data generated by their devices can contribute to better medical decision-making. Specifically, they should: ʯ Consider how that data must be aggregated and summarized to provide actionable insights. ʯ Understand what additional data is needed to determine the best course of action. ʯ Consider how they can help the physician or other clinician take the appropriate action.

“Many physicians are innovators and entrepreneurs, and companies could hire or engage with them to get the first version of the clinical interface to a place that supports a good user experience,” he says. “Companies should engage with physician users to refine their clinical user experience, just as they engage customers to improve their patient-facing user experience. With more transition to value-based payments in

healthcare, companies will see a growing interest from physicians on how to incorporate wearables to help patients live healthy lives. At least, I have hope of such.”

COVID-19 Robert Tennant, director of health information technology policy for the Medical Group Management Association,

Ten action steps for physicians Incorporating data from patient wearables into an EHR 1. Establish if your patient population would benefit. Those with ongoing primary care relationships (e.g., family medicine, pediatrics, gerontology) and those with certain ongoing chronic care relationships (e.g., cardiology, endocrinology, rheumatology, pulmonology) may be more likely to realize the value of an interface between wearables and health tracking apps and an EHR. 2. Discuss availability and cost with your EHR vendor. Determine if your EHR vendor offers an interface with wearable devices. How will the system incorporate external data into the patient’s medical record, and how will the clinicians see the information displayed? Can the vendor analyze and correlate the information or have a recommendation for a third-party application? Also, determine the upfront and ongoing costs to the practice for implementing a wearable device interface. 3. Consider targeting certain patients. Patients with chronic conditions such as diabetes and those focused on weight-loss may be the best candidates for wearableEHR interfacing. Capturing data such as blood sugar levels, daily steps taken, and weight can link a patient activity with health outcomes more effectively. 4. Determine the implications on clinical workflow. Once data from wearables is imported into the EHR (potentially in voluminous amounts), the practice must decide who will review and make a determination on next steps. Does the data warrant, for example, a follow-up call from clinical personnel or the scheduling of an appointment? 5. Review care coordination opportunities. Practices increasingly are participating in pay-for-performance programs such as Patient-Centered Medical Homes and accountable care organizations, which reward care coordination and improved patient outcomes. Managing patients with chronic illnesses and identifying patients with emerging health issues is imperative.

Customizing treatment plans based on data analytics better positions the organization for success in these new payment models. 6. Leverage wearables when participating in MIPS with 2015 CEHRT. The Advancing Care Information component of the Merit-based Incentive Payment System (MIPS) permits clinicians to count patient-generated data toward their performance score, but only when using 2015 Edition Certified Electronic Health Record Technology (CEHRT). 7. Test the reliability of the data. If data from wearables is to be relied on during staff decision-making, it is imperative that clinicians have confidence in its reliability. As a test, have patients on occasion transmit data such as weight or blood sugar level right before an appointment, and then match those numbers with what is captured during the appointment by practice staff. 8. Recognize and address security risks. Receiving data from any external source comes with an increased risk of unauthorized disclosure. Practices, as part of their required HIPAA Security Risk Analysis, should assess and document the risks associated with transmitting data from wearables to an EHR, -and how those risks were mitigated. 9. Engage patients. Engaging patients will maximize the opportunities afforded by incorporating wearable data into your clinical workflow. Remind patients that selftracking key health metrics, especially with the aid of a wearable device, can allow them to be better stewards of their healthcare. 10. Market your capabilities. In a competitive physician practice economic environment, marketing your ability to engage patients with the use of consumer technology can be an important market differentiator, particularly with younger patients and those with chronic illnesses.

Source: “Integrating Data from ‘Wearables’ into EHRs,” Medical Group Management Association, www.mgma.com/data/ data-stories/integrating-data-from-wearables%E2%80%9D-into-ehrs.

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EMR believes that COVID-19 could stimulate the use of wearables and home monitoring among people with chronic illnesses. “The ability to move data from the patient’s home to the physician’s office is becoming more critical,” he says. “But there is a caveat. There has been a lot of talk about patient-generated data being integrated into the EHR. The goal is clearly to have patient data flow seamlessly from the wearable device – such as a fitness device, blood pressure cuff or A1c monitor – directly into the EHR. But the reality is, healthcare hasn’t yet achieved that widespread level of interoperability.” Three years ago, Tennant co-authored an article with Brendan Fitzgerald (then director of research for HIMSS Analytics) titled “Integrating Data from ‘Wearables’ into EHRs,” in which they noted, “An increasing number of patients now use wearables to help them track important metrics and better manage their health. Collecting that information, however, is only the first part of the solution. Transferring health data from the patient’s technology – electronics worn on the body – to the clinician’s EHR is critical if the information is to be effectively incorporated into the patient care delivery and care management process.” In the article, the two authors list 10 action steps for physician practices that want to incorporate wearables data into the EHR, among them: 1) establishing which patients would benefit most, 2) determining the implications on clinical workflow, and 3) discussing the availability and cost with the EHR vendor. Those action steps are still valid today, says Tennant. “Many practices have really looked at the first step, which is ‘Establish if your patient population would benefit,’”

he says. “Physicians have to ask themselves, ‘How can our patients benefit if we move in this direction?” Some mobile or home monitoring devices may be more expensive than others, he says. But for patients with chronic conditions, the cost is well worth it. “For people with diabetes, for example, tracking and managing A1c levels leads to better patient care and a better quality of life.” Remote monitors can also be used to “nudge” postoperative patients toward a better recovery, whether they are orthopedic patients who need to be on their feet and moving around, or post-surgical patients who need to make sure their dressings are changed promptly. Physicians participating in risk-based contracts – that is, contracts that reward physicians on the basis of quality and cost of care – will probably gravitate toward remote monitoring as well, he adds. “Think about the implications if just one visit to the ER can be avoided thanks to remote monitoring.” Some EHR companies are working aggressively to promote integration of patient-generated data into the EHR, says Tennant. “Give it five years and I think any company that wants to be competitive in the environment will be offering it. “Consumers have increasingly higher expectations regarding leveraging technology for their healthcare,” he says. Many are turning to telemedicine, but without interoperable remote monitoring, its usefulness is limited. “Physicians will have to look at this issue more seriously if they want to remain competitive, he adds. “They will realize the advantages that remote monitoring can bring not just to the patient, but to their practice.”

EMR: Maximizing the caregiver’s time In the following Q&A, Chad Darling, senior product manager, EMR Business Development, Midmark Corpora-

tion, provided Repertoire with insights on EMR solutions and its importance in today’s current environment for healthcare providers.

Repertoire: How can EMR solutions improve workflow? Chad Darling: A well-integrated EMR solution can save time. Our customers can see this time savings in the EMR-connected Midmark® Digital Vital Signs solution. When using the EMR-connected Midmark Digital Vital Signs Device and the Midmark 626 Barrier-Free® Examination Chair with Digital Scale, customers can bring all 40

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vital signs acquisition including weight to the point of care and import patient data directly to the EMR saving the practice more than a minute per patient. Customers can also see time savings when using a Midmark connected digital diagnostic device through the reduction of clicks. A Midmark® ECG or Spirometer test can be easily launched directly from the EMR, eliminating the time it takes to manage a paper workflow or disparate systems.

Midmark is the leader in integrated solutions and the only company that offers ECG, Spirometer, Holter and vital signs offerings that integrate into the EMR. Midmark has partnered with leading EMRs to solve workflow and interoperability issues, providing an integrated workflow that makes device interoperability easy to adopt. Repertoire: What about patient safety? Reduced staffing? Darling: Studies have shown that manual transcription of vital signs data produces a 17% rate of error on average.1 Assuming six vital signs are taken on 20 patients a day, that equates to approximately 20 errors each day – and that’s just relating to vital signs capture. When using the EMR-connected Midmark® Digital Vital Signs solution, patient vital signs data can be imported into the EMR eliminating manual transcription errors.

The Midmark Clinical Education team, led by registered nurses, is available to help customers understand how to properly use their diagnostic devices and effectively incorporate them into their existing workflow both in-office and remotely. Repertoire: Why are these benefits important in today’s current environment of COVID, and even for post-COVID health care? Darling: It’s important in today’s current environment and post-COVID to provide customers with timely and effective support. Midmark provides a robust technical support and training program. Our goal is to fix the

customer’s need on the first call every time. Our average technical support wait time for customers is 30 seconds. The Midmark Clinical Education team, led by registered nurses, is available to help customers understand how to properly use their diagnostic devices and effectively incorporate them into their existing workflow both inoffice and remotely. Repertoire: What are common challenges and pitfalls as it relates to deploying EMR platforms? Darling: Midmark works with customers and the EMR system to make the experience as seamless as possible. Our technical support team of Microsoft, HDI and CompTIA Healthcare IT certified specialists are available by phone, email or live chat to assist customers with any issues they may have. While our clinical education team is available to ensure the practice understands how to use the devices within their new workflow. Repertoire: How can reps help providers with EMR challenges? What questions should they ask clients? Darling: Q: Do you know that studies have shown manual transcription of vital signs data produces a 17% rate of error on average?1 Assuming you take six vital signs on 20 patients a day, that equates to about 20 errors each day and that’s just relating to vital signs capture. The Midmark® Digital Vital Signs Device helps eliminate errors by importing data directly from the device to the EMR. Q: Do you know it takes approximately 69 seconds longer per patient if vital signs are acquired manually using multiple devices compared to capturing all vital signs at the point of care using a single EMR-connected, automated device like the Midmark Digital Vital Signs Device? Q: Do you know that 69 seconds equates to 5% of wasted time per medical assistant or $1,440 per year?2 For only five medical assistants, automated vital signs capture can save as much as $7,200 a year. Using the EMR-connected Midmark Digital Vital Signs Device with a Midmark Barrier-Free® exam chair with digital scale allows the customer to bring all vital signs capture to the point of care, including weight, and reduces wasted time and the associated expenses.

1: Source: Fieler, V. K., Jaglowski, T., & Richards, K. (2013). Eliminating errors in vital signs documentation. Comput Inform Nurs, 31(9), 422-427; quiz 428-429. doi:10.1097/01.NCN.0000432125.61526.27 PMID:24080751 2: Based on $15/hr, 8 hr/day and 48 weeks/yr

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EMR

EMR: An easier way to manage patient care EMR is about the ease of capturing and accessing information, said Karen Bornstein, president, Medicus, a labo-

ratory information systems company. “One of the main benefits is the ability to consolidate all the lab results for the clinical staff. Distributor sales representatives should be able to offer tools like Laboratory Information Systems (LIS) to document, manage, monitor and send all completed and accurate test results to patient chart in EMR.”

This can be done with an LIS partner or a manufacturer partner that offers tools to help customers move data electronically to the correct patient chart in EMR. In the following Q&A, Bornstein provided insights on how EMR can improve workflow, patient safety, and EMR’s importance amid COVID-19. Repertoire: How can EMR solutions improve workflow? Karen Bornstein: EMR solutions improve workflow by moving patient care information electronically vs. manually charting and printing information for provider and patient review. ʯ Reduces paper and printing of patient information. ʯ Providers can review patient lab, radiology, occupational and physical therapy results all in one chart vs. multiple pages of paper. ʯ Patients have access to web portals to view information. Reduces provider or callbacks to patients.

Repertoire: How was EMR used by frontline care givers amid the pandemic? Bornstein: We have heard that there are many challenges without the ability to manage results electronically, especially at testing sites. There were patient information mix-ups due to manual processes vs. the ability to record information electronically and process information to the correct patient chart in EMR.

Reduction in staff: By eliminating multiple manual steps, paper reports, and tasks that are unnecessary due to electronic pathways, staff can be reduced.

Repertoire: What are common challenges and pitfalls as it relates to deploying EMR platforms? Bornstein: ʯ Selecting the EMR that “best fits” provider/ patient requirements. ʯ Ensuring that the EMR selected has all the features necessary to communicate and manage all immediate and ongoing requirements of the patient care facility. ʯ Add-on costs – it is important to address shortand long-term goals upfront when selecting the EMR platform. ʯ Implementation and support – ensuring that the EMR company can expedite implementation and provide excellent ongoing support.

Repertoire: Why are these benefits important in today’s current environment of COVID, and even for post-COVID health care? Bornstein: Creating an electronic record environment

Repertoire: How can reps help providers with EMR challenges? What questions should they ask clients? Bornstein: Reps can help providers by offering products and tools that will make managing patient care easier.

Repertoire: What about patient safety? Reduced staffing? Bornstein: Patient safety: Ensures accurate information is posted electronically to the correct patient record. The information is secure and only shared as per patient provider agreement.

to accurately and efficiently manage lab test results and other patient care requirements is paramount and necessary. Patient web portals allow for remote review of results and provider information. Providers save time and money.

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POST -ACUTE

COVID-19 and Nursing Home Safety New commission to assess the nursing home response to the COVID-19 pandemic

In June, a new commission was announced with the directive of identifying and communicating best practices

for protecting nursing home residents throughout the COVID-19 pandemic and beyond. The commission, made up of 25 members to the independent Coronavirus Commission for Safety and Quality in Nursing Homes, was announced by MITRE. Commission members include resident advocates, infectious disease experts, directors and administrators of nursing homes, academicians, state authorities, clinicians, a medical ethicist, and a nursing home resident. Dr. Jay J. Schnitzer, MITRE’s chief medical and technology officer, will serve as the moderator of the commission.

“The commission members are leaders who bring decades of experience in nursing home management as well as safety and quality,” said Schnitzer. “This diverse group will act quickly to identify and communicate best practices for protecting nursing home residents throughout the COVID-19 pandemic and beyond.” The commission will convene via teleconference in June and will meet regularly using virtual collaboration tools to conduct a comprehensive assessment of the nursing home response to the COVID-19 pandemic. This work will inform efforts to safeguard the health and quality of life of vulnerable Americans, as well as prepare for future threats to nursing home residents’ safety and to public health. Specifically, the commission is tasked to: ʯ Identify best practices for facilities to enable rapid and effective identification and mitigation of transmission of COVID-19 and other infectious diseases in nursing homes; ʯ Work to recommend best practices as exemplars of rigorous infection control practices and facility resiliency that can serve as a framework for enhanced oversight and quality monitoring activities; ʯ Identify best practices for improved care delivery and responsiveness to the needs of all nursing home residents in preparation for, during, and following an emergency; and ʯ Identify opportunities to leverage new sources of data to improve existing infection control policies 44

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and enable coordination across federal surveyors, contractors, and state and local entities to mitigate coronavirus and future emergencies. ʯ Recommendations made by the commission will encompass both immediate and long-term actions. The Centers for Medicare & Medicaid Services (CMS) announced the formation of the Coronavirus Commission for Safety and Quality in Nursing Homes on May 14. MITRE, an independent, not-for-profit organization, is standing up the commission and facilitating its activities and will independently author and deliver a report on the commission’s findings and recommendations to CMS on September 1. Mark Parkinson, president and CEO of The American Health Care Association and National Center for Assisted Living (AHCA/NCAL), representing more than 14,000 nursing homes and long term care facilities across the country that provide care to approximately 5 million people each year, released a statement after members of the newly-formed Coronavirus Commission for Safety and Quality in Nursing Homes were announced. “We are pleased to see a variety of stakeholders named to the Commission, including dedicated providers and valued partners Debra Fournier, Camille Jordan, Dr. Rosie Lyles, Neil Pruitt, Jr., and Janet Snipes. These professionals have devoted their lives to serving our nation’s seniors and improving the quality of care in America’s

long-term care facilities. Their leadership at the national level, including with AHCA/NCAL, will serve the Commission well as it evaluates ways to protect our most vulnerable from COVID-19. “Bringing providers, residents, families, experts and policymakers together is essential in fostering a more collaborate approach to addressing this once-in-a-century crisis. Nursing homes cannot beat this pandemic alone, and focusing on enforcement and penalties neither recognizes the nature of the virus nor solves the problem. Providers need the support of public health officials to prioritize our residents and help facilities acquire the necessary resources. We hope the independent Commission will address this critical need. “As the Commission begins its work, nursing homes and other long-term care facilities are still in the day-today battle of keeping the virus at bay. Providers continue to face ongoing challenges in accessing and affording surveillance testing, personal protective equipment and

The commission members are:

ʯ Roya Agahi, RN, MS HCM, WCC;

Chief Nursing Officer, formerly of NYC Health + Hospitals, soon to be of CareRite, New York ʯ Lisa M. Brown, PhD, ABPP; Professor of Psychology, Palo Alto University, California ʯ Mark Burket, CEO, Platte Health Center Avera, South Dakota ʯ Eric M. Carlson, JD; Directing Attorney, Justice in Aging, California ʯ Michelle Dionne-Vahalik, DNP, RN; Associate Commissioner, State Health and Human Services Commission, Texas ʯ Debra Fournier, MSB, BSN, ANCC RN-BC, LNHA, CHD, CPHQ; COO, Veterans’ Homes, Maine ʯ Terry T. Fulmer, PhD, RN, FAAN; President, The John A. Hartford Foundation, New York ʯ Candace S. Goehring, MN, RN; Director, State Department of Social and Health Services, Aging and Long-Term Support Administration, Washington ʯ David C. Grabowski, PhD; Professor of Healthcare Policy, Harvard University, Massachusetts

additional staff support. Meanwhile, many states are reopening portions of society, which is contributing to an increase in cases in some areas of the country. We want to get residents out of isolation and adapt visitations, so they can safely see loved ones again. But we must remain vigilant as research indicates that community spread is correlated with outbreaks in nursing homes, and we have yet to receive the level of resources we need. “We look forward to working with the Commission as it conducts this important work, but long term care facilities need immediate assistance now. Public health officials at every level can help in this effort by prioritizing long term care for testing, PPE, staffing and funding. Let’s work together now and in the coming months to rally around our nation’s Greatest Generation and our frontline heroes.” Learn more about the Coronavirus Commission for Safety and Quality in Nursing Homes at https://sites. mitre.org/nhcovidcomm.

ʯ Camille Rochelle Jordan, RN, BSN,

MSN, APRN, FNP-C, CDP; Senior Vice President of Clinical Operations & Innovations, Signature Healthcare, Kentucky ʯ Jessica Kalender-Rich, MD, CMD, AGSF, FAAHPM, FACP; Medical Director, Post-Acute Care, University of Kansas Health System, Kansas ʯ Marshall Barry Kapp, JD, MPH; Professor Emeritus of Law, Florida State University, Florida ʯ Morgan Jane Katz, MD, MHS; Assistant Professor of Medicine, Johns Hopkins University, Maryland ʯ Beverley L. Laubert, MA; State Long-Term Care Ombudsman, State Department of Aging, Ohio ʯ Rosie D. Lyles, MD, MHA, MSc, FACA; Director of Clinical Affairs, Medline Industries, Illinois ʯ Jeannee Parker Martin, MPH, BSN; President and CEO, LeadingAge California ʯ G. Adam Mayle, CHFM, CHC, CHE; Administrative Director of Facilities, Memorial Healthcare System, Florida ʯ David A. Nace, MD, MPH, CMD; President, AMDA – The Society for

Post-Acute and Long-Term Care Medicine, Pennsylvania ʯ Lori Porter, LNHA, CNA; CEO, National Association of Health Care Assistants, Missouri ʯ Neil Pruitt, Jr., MBA, MHA, LNHA; Chairman and CEO, PruittHealth, Inc., Georgia ʯ Penelope Ann Shaw, PhD; Nursing Home Resident and Advocate, Braintree Manor Healthcare, Massachusetts ʯ Lori O. Smetanka, JD; Executive Director, National Consumer Voice for Quality Long-Term Care, Maryland ʯ Janet Snipes, LNHA; Executive Director, Holly Heights Nursing Home, Colorado ʯ Patricia W. Stone, PhD, MPH, FAAN, RN, CIC; Professor of Health Policy in Nursing, Columbia University, New York ʯ Dallas Taylor, BSN, RN; Director of Nursing, Eliza Bryant Village, Ohio In addition to the official Commission members, there may be additional members added and guests invited to provide additional viewpoints and insights.

www.repertoiremag.com

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August 2020

TRENDS

Back to School COVID-19 presents challenges to pediatricians, school nurses, parents and kids Patient visits to all kinds of doctors dropped markedly after the COVID-19 national emergency was declared in

March. Pediatricians were no exception.

“Practice managers around the country report that their caseloads are as low as 20-30% of their practices’ typical caseloads due to social distancing, shelter-inplace, and families delaying or foregoing care,” wrote Sally Goza, MD, FAAP, president of the American Academy of Pediatrics, in a letter to HHS Secretary Alex Azar in April. “At the same time, pediatricians are facing higher costs, including personal protective equipment 46

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and workforce training, as they transform their practices to meet the needs of their patients and families. “The dramatic drop in revenue compounded with higher costs is forcing practices to confront furloughs and layoffs, cancel vaccine orders, and in many cases, consider permanent closure.” At the same time, pediatricians can anticipate an influx of patients this fall, as parents and school administrators

make sure their kids get the vaccinations they missed in the spring and summer. To accommodate them, practices will have to adjust their workflows and their workplaces for social distancing, isolation of patients with potential viral infections, etc. They may be called on to treat kids who, after months of staying at home and experiencing the frustrations of virtual learning, suffer from high levels of anxiety.

Mental health issues The primary objective of annual physicals for kids – including “back to school” visits – is to monitor their social, emotional and physical well-being, Goza told Repertoire. But this year’s back-to-school checkup will be different. “Mental health will be a big issue this year because of the pandemic and sheltering at home. Kids will have been out of school a long time. Did they miss much of their academics? How far behind are they? What kind of stress will that cause? Are they prepared for their schools to close again should a second wave arise? Change brings stress, and all of that will play into pediatric visits this year.” Pediatricians will share that stress. Practices will need to enforce physical distancing in their offices, thoroughly wipe down exam rooms between visits, and stagger or extend office hours, says Goza. They may need to step up their efforts to communicate to families and schools the importance of keeping vaccinations up to date, and about keeping an eye on the social and emotional health of their children. Flu vaccines will remain a priority. “And we will have to figure out how to manage COVID-19 vaccinations, if they are available,” she adds. What’s more, the Centers for Disease Control and Prevention cautions that given declines in routine pediatric vaccine ordering and doses administered during the pandemic, U.S. children and their communities face increased risks for outbreaks of vaccine-preventable diseases. Telemedicine may help. The American Academy of Pediatrics strongly supported the use of telehealth during the COVID-19 pandemic. The technology is well-suited for monitoring mental, social and emotional wellness, but not for hearing/vision tests, physical exams or vaccinations, says Goza. “In the future, we may conduct more

combination visits, with some being done over the phone, and the rest done in a shorter visit to the practice.” Still, the pediatric community wonders what will happen when the pandemic ends. “Will telehealth be reimbursed at parity with all visits?” she asks. The issue could become important should a second wave strike.

The school nurse As they do every year, school nurses will play an important role in keeping kids and their communities healthy this fall, says Laurie Combe, MN RN NCSN, president of the National Association of School Nurses. “School nurses are sentinels who identify wellness and illness in the school community,” she says. “We engage in early identification of communicable disease; we collaborate with health departments to report and manage those illnesses to protect the entire school community. We manage immunization compliance and student access to immunizations. We use our health expertise to inform educational professionals about best practices and how to keep communities safe. We engage in health education. We coordinate care, and we translate medical plans for disease management for the classroom. And we collect and track data about students’ health.”

Part of the challenge facing school nurses and staff is the fact that most of the symptoms of COVID-19 are the same symptoms kids display during non-pandemic times. NASN members have some anxiety about the coming school year, says Combe. They question when schools will reopen, and the guidance from health and public authorities about safety precautions is in a state of flux. Teachers, custodians and other school staff share that anxiety, as do parents. “All this will probably result in more visits than ever to the nurse’s office this fall,” she says. Part of the challenge facing school nurses and staff is the fact that most of the symptoms of COVID-19, as listed by the CDC, are the same symptoms kids display www.repertoiremag.com

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August 2020

TRENDS during non-pandemic times, says Combe. Students come to the clinic with stomachache for lots of reasons, many of them having to do with emotions they haven’t recognized or acknowledged, she says. Throwing up is not necessarily a sign of ongoing illness. “The school nurse takes the health history, learns about the factors that might bear on that symptom presentation, and then, based on nursing education and training, makes the determination whether the student is fit for class or not,” she says. In light of COVID-19, that health history will address whether the student or someone in their family was exposed to the virus. The Centers for Disease Control advises daily temperature and symptom screening of school children when feasible. “‘Feasible’ is the big question,” says Combe. “When I last worked on a school campus, I had 3,600 students. What will that screening look like? How will schools reinforce social distancing while students wait to be screened? How much instructional time will be lost as schools conduct daily mass screenings?”

But if parents find it difficult to leave their children at home while they go to work, will they under-report symptoms for the sake of the family’s economic survival? Meanwhile, teachers and staff may be asked to respond daily to an online survey before entering the building, verifying that they checked their temperature and do not display any symptoms of COVID-19. “It’s efficient, and it creates ownership and collegiality among school staff,” says Combe. Once students are seated, teachers will be challenged to manage physical distancing and the wearing of face masks while carrying on vibrant instruction. School nurses always need PPE on hand in the course of their duties, for dealing with emergency situations, medication administration, diabetes care and help with toileting, says Combe. Because of COVID-19, they may need N95 respirators, face shields, even gowns if they are called on to perform a procedure that aerosolizes pathogens. The American Academy of Pediatrics’ Goza says that pediatricians will have an increased need for gloves, face shields, cleaning supplies, needles and syringes, and more during this year’s “back to school” season. And they may ask their distributors for payment extensions, given the financial impact of COVID-19. “What I would ask distributors to do is to see how they can help practices stay viable,” she says. “If pediatricians and other doctors can’t stay open to take care of the needs of children, we will be in big trouble.”

‘When is the best time to check temperature? Is it when students arrive at school? Is it before they get on the school bus? The logistics are confounding.” As they prepare for the school year, each school system will have to make decisions about screening based on the needs of their community, enrollment and availability of personnel. “Then there are the questions, ‘When is the best time to check temperature?’ Is it when students arrive at school? Is it before they get on the school bus? The logistics are confounding.” School nurses also have concerns about maintaining the confidentiality of students during mass screenings. “If students are pulled out of line, will they be subject to stigma or bullying?” asks Combe. “I know schools will be addressing these issues.” Some school systems may rely on parents to assess and be accountable for their children’s health, she continues. 48

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VIRTUAL

Reverse Expos & Business Exchanges

COVID-19 Supply Chain Summit

Education

THE PATH FORWARD

For the health of attendees, the Streamlining Healthcare Expo & Business Exchange will be presented 100% virtually in September 2020. Now more than ever it is important for our industry to come together to plan the path forward.

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Business Exchanges

Live Online Education Sessions Get a forecast for the coming economic recovery from Alan Beaulieu

Learn what to expect from the next waves of COVID-19 from nationally renowned epidemiologist Michael Osterholm Transform your business with a management system called EOS®, introduced in the popular business book Traction – presented by Tom Bouwer

Take advantage of reduced rates– sign up your whole team! Register Today: HIDAStreamlining.org

Understand The Impact Of COVID-19 On The Healthcare Supply Chain And Discover The Strategies To Move Forward Two days of short, information-packed live sessions for your entire team.

COVID-19 SUPPLY CHAIN VIRTUAL SUMMIT

TUESDAY, SEPTEMBER 22

GENERAL SESSION

Preparing For Recovery In A Post-COVID World

Stockpiles And Shortages: Improving Pandemic Coordination With Government Partners

11:00am–12:00pm EDT

2:30–3:00pm EDT

Alan Beaulieu, President, ITR Economics This session from Alan Beaulieu will help you determine the best course of action for the most important part of the economy – you and your business. Beaulieu will:

Representatives from FEMA, DoD, and ASPR will participate in a candid dialogue about how to improve pandemic coordination. This session will address questions such as: • What’s the role of the Strategic National Stockpile (SNS) and how can it be strengthened?

• Look at a system of leading indicators proven to signal cyclical turns in the economy and markets

• How do federal and state agencies better coordinate their emergency response?

• Present the outlook for the market segments most important to your industry

Stabilizing The PPE Supply Chain: Health System Perspectives

• Assess interest rate and other financial market trends, including the latest information on stock market performance

4:15–4:45pm EDT

GENERAL SESSION

How will recent PPE shortages impact hospital and IDN supply chain leaders’ sourcing and logistics strategies moving forward? A panel of health system supply chain executives will address:

1:30–2:15pm EDT

• How they are creatively partnering with their vendor partners to ensure a reliable flow of PPE for their frontline workers

How COVID-19 Will Change Healthcare — And The World Michael Osterholm, Ph.D, Director, Center for Infectious Disease Research and Policy, University of Minnesota

• What worked and what didn’t at the height of the crisis

Nationally renowned epidemiologist Michael Osterholm has been warning for decades that the world was dangerously unprepared for a pandemic. His talks at past HIDA conferences helped to inform HIDA’s efforts to partner with the federal government to improve preparedness. In this conversation, hear his latest expert insights on:

Nursing Homes In Crisis: Post-Acute Leaders’ Views On The Path Ahead

• What to expect from the next waves of COVID-19

• How and whether nursing facilities will be able to weather the negative financial impacts of COVID-19

• How we can apply what we’ve learned about ongoing shortfalls in our system to be better prepared for the next wave, or the next pandemic

4:45–5:15pm EDT In this session, hear real-life perspectives on how nursing facilities have been impacted and what the industry may look like post-COVID. Discussion topics will include:

• What industry leaders have learned about improving the supply chain serving nursing homes

A Virtual Conference For: Distributors | Manufacturers | GPOs | IDNs | Providers www.repertoiremag.com

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August 2020

Virtual Made Easy With One Platform No technical skills required | No software to download or install It’s easy as opening a web page | Easily schedule meetings and visit Expos

COVID-19 SUPPLY CHAIN

WEDNESDAY, SEPTEMBER 23

VIRTUAL SUMMIT

GENERAL SESSION

CEO Perspectives: Leadership And Culture In A Global Health Crisis

HIDA Thought Leaders: COVID 19’s Long-Term Impact On The Supply Chain 2:30–3:00pm EDT

11:00–11:45am EDT

Lisa Hohman CEO, Concordance Healthcare Solutions

Ed Pesicka CEO, Owens & Minor

Joe Reubel CEO, Kerma Medical

The COVID-19 pandemic has challenged distributor leaders like nothing before. Hear from a diverse panel of distribution CEOs about the qualities of leadership and culture that have helped their teams get through this crisis and emerge stronger. In this lively conversation, you’ll gain insights on:

Bill Abrams President, Distributed Products, Medline

Marisa Farabaugh VP & Chief Supply Chain Officer, AdventHealth

Chaun Powell Group VP, Strategic Supplier Engagement, Premier

The pandemic brought healthcare supply chain into the spotlight, in good ways and bad. In this session, a panel of supply chain leaders will consider: • What pandemic experiences and news coverage could mean for supply chain’s role in the future

• Establishing and instilling foundational values

• How the flood of unknown suppliers highlighted the value of trusted supply chain partners

• Empowering a great team, even when every team member is in a different location

COVID + Flu: Are We Ready?

• Understanding, communicating, and creating buy-in for your vision

Advancing Distribution’s Role In Pandemic Response 11:45am–12:15pm EDT Distributors have played a key role in COVID-19 response and they remain ready to be part of the solution moving forward. In this session, hear about HIDA’s vision for a more resilient supply chain. • Understand current policy proposals and what they mean for the healthcare supply chain • Get the latest on problematic 90-day stockpile requirements • Gain insights on how distributors and their trading partners can help the industry move to a higher level of preparedness

3:15–3:45pm EDT The flu season that begins this fall will be like no other. In this session, expert panelists will share insights on what will be different and what the industry must be ready for. Topics will include: • Why COVID is likely to impact vaccine demand and vaccination sites • How the pandemic combined with flu season could exacerbate PPE shortages

What’s Ahead For Healthcare Demand 3:45–4:15pm EDT Healthcare demand has been on a rollercoaster since the beginning of the pandemic. In this session, get expert opinions on what’s ahead for the coming months: • Which metrics to watch as elective procedures make a comeback • What a second wave really means, and how it could impact already-imperiled healthcare providers

August 2020

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POST-CONFERENCE

SESSIONS

THURSDAY, SEPTEMBER 24 PWH Leadership Session A Candid Conversation About Gender Equality In The Workplace 10:00–11:00am EDT

Healthcare Strategic Accounts Summit Selling In The New Healthcare Environment 11:00am–12:00pm EDT

Selling Safely: Best Practices For Field Reps As Healthcare Facilities Reopen 12:15–1:00pm EDT

Independent Distributors Summit Are You Running Your Business Or Is It Running You? (Traction) 2:30–3:15pm EDT Have you read the book Traction? If so, you must attend this interactive and engaging session with Tom Bouwer. Join owners and leaders of independent distributors to learn how to use EOS® concepts to transform your business. The system helps entrepreneurs and their leadership teams get better at three things: Vision, Traction, and Health.

Independent Distributors Q&A With Tom Bouwer 3:15–3:45pm EDT

Independent Distributor Panel

More Ways To Connect VIRTUAL

EXPOS Live chat with Expo exhibitors immediately and access company information online.

Innovation Expo: Connect with manufacturers and service providers September 22 | 12:00–1:30pm EDT

Distributor Reverse Expo:

Connect with distributors September 22 | 3:00–4:00pm EDT

GPO & IDN Reverse Expo:

Meet GPOs and IDN executives September 22 | 5:15–6:15pm EDT

PRIVATE BUSINESS

MEETINGS

Schedule private video conference meetings with fellow registrants via the virtual platform.

PARTNER

MEETINGS Pre-schedule virtual meetings with your strategic business partners.

Distributor Executive Business Exchange: September 23 | 12:30–2:30pm EDT

GPO & IDN Executive Business Exchange: September 23 | 4:15–6:15pm EDT

3:45–4:30pm EDT Hear from a panel of distributor executives who have implemented EOS®. Learn about their experiences and understand how EOS® transformed their leadership teams and businesses. Panelists: • Chris Fagnani, Lynn Medical, Inc. • Cara Skowronski, Delasco • Lynn Patterson, Gericare Medical Supply • Dennis Clock, Clock Medical Supply, Inc.

VIRTUAL

NETWORKING Connect with attendees in an informal setting online. September 22 | 6:15–7:15pm EDT September 23 | 6:15–7:15pm EDT

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HEALTHY REPS

Health news and notes

Hitting the gym In a health blog, the Cleveland Clinic offered safety tips for workout warriors as they begin to head to gyms and fitness studios again. The tips included: ʯ Know your gym’s rules and safety protocols before you go. Some facilities are doing temperature checks when entering the gym or mandating when certain groups of people (or how many) can work out at one time. ʯ Wear a face mask if you can. Several gyms are asking members to wear a face mask, so be sure to ask your gym what the protocol is. ʯ Bring your own towel and water bottle. Many states have required cities and businesses to turn off public water fountains, including in gyms. ʯ Distance yourself. Most gyms and health clubs are required to space out machines and equipment so that people are farther apart, but pay attention to how close you are to others throughout the gym at all times. ʯ Wipe down everything. Many facilities have provided more sanitation stations throughout the gym. Clean and wipe down everything you touch 54

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before and after – from dumbbells, to treadmills and resistance bands. ʯ Go in with a plan, but be flexible. Before COVID19, it was OK to wander around the gym or wait (patiently) for the squat rack. These days you’ll want to minimize your time in the gym to reduce your exposure. ʯ Tread carefully with group fitness classes. Find out if your gym has minimized class size and what the protocol is for equipment. ʯ If you have any symptoms whatsoever – stay home!

Wear a face mask if you can. Several gyms are asking members to wear a face mask, so be sure to ask your gym what the protocol is.

ʯ Don’t settle for being uncomfortable or unsafe. Don’t be afraid to speak up or move to another area of the gym or health club if you’re not comfortable. Read more at: https://health.clevelandclinic.org/headedback-to-the-gym-after-quarantine-heres-what-to-consider.

A strategic plan for nutrition What if each of us had individualized dietary recommendations that helped us decide what, when, why, and how to eat to optimize our health and quality of life? This precision nutrition approach – developing targeted and effective diet interventions in a diverse population – is among the ambitious goals set out by the 2020-2030 Strategic Plan for National Institutes of Health Nutrition Research, according to a release. NIH, guided by its Nutrition Research Task Force (NRTF) and armed with the insights from the nutrition science community, practitioners, the public, and others, has created a bold vision to advance nutrition science discoveries over the next 10 years. With a focus on precision nutrition, the plan reflects the wide range of nutrition research supported across NIH – over $1.9 billion in fiscal year 2019. The strategic plan calls for a multidisciplinary approach through expanded collaboration across NIH Institutes and Centers to accelerate nutrition science and uncover the role of human nutrition in improving public health and reducing disease. The strategic plan is organized around four strategic goals that answer key questions in nutrition research: 1. S pur Discovery and Innovation through Foundational Research: What do we eat and how does it affect us? 2. I nvestigate the Role of Dietary Patterns and Behaviors for Optimal Health: What and when should we eat? 3. Define the Role of Nutrition Across the Lifespan: How does what we eat promote health across our lifespan? 4. Reduce the Burden of Disease in Clinical Settings: How can we improve the use of food as medicine? The plan has five cross-cutting areas relevant to all these strategic goals, including minority health and health disparities; health of women; rigor and reproducibility; data science, systems science, and artificial intelligence; and training the nutrition scientific workforce.

The strategic plan aligns with the National Nutrition Research Roadmap 2016-2021 created by the Interagency Committee on Human Nutrition Research, a trans-federal government committee charged with enhancing the coordination and communication among multiple federal agencies conducting nutrition research. As the plan is put into action, NIH will continue to seek input from the nutrition community and others. The task force will guide the plan’s application through implementation working groups that will pursue opportunities to: ʯ Advance the priorities identified in each of the strategic goals and cross-cutting research areas ʯ Catalyze nutrition research at NIH-funded universities and institutions and in NIH labs The task force will track the progress of the plan and post information on its website.

Rate of metabolic syndrome rising among under-40 group According to HealthDay News, U.S. News & World Report, a new study finds that 1 in 5 people under age 40 now have metabolic syndrome, a group of risk factors that together increase the odds for many serious conditions, including diabetes, heart disease and stroke. The rate of metabolic syndrome is rising in all age groups – as many as half of adults over 60 have it. But among 20- to 39-year-olds, the rate rose 5 percentage points over five years, the study reported. Metabolic syndrome is a group of heart disease risk factors that occur together. They include: ʯ A large waistline, ʯ High blood pressure, ʯ Higher-than-normal blood sugar levels, ʯ High triglyceride levels (triglycerides are a type of blood fat), ʯ Low levels of good (HDL) cholesterol. “The trends for metabolic syndrome are very alarming. A huge proportion of the adult population is affected – overall, 37% of adults in the United States. In young adults, the prevalence was remarkably higher than in our previous study through 2012,” said study co-author Dr. Robert Wong, from the Veterans Affairs Palo Alto Health Care System in California. Read more at: https://www. usnews.com/news/health-news/articles/2020-06-23/ more-young-americans-developing-unhealthy-predictorsof-heart-disease. www.repertoiremag.com

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August 2020

WINDSHIELD TIME Chances are you spend a lot of time in your car. Here’s something that might help you appreciate your home-away-from-home a little more.

Automotive-related news Jump start Having a reliable portable car battery charger is important for vehicles with older batteries, inclement weather and unforeseen circumstances that might require a jump start, according to CNET. Car battery jump-starters were developed as a safer, more convenient alternative to traditional cables for jump-starting a car with a dead battery. “Car battery jump-starters and chargers are also dense little storage bins for electrical energy, and many come with useful built-in accessories. They’ll recharge with standard extension cords, wall-plug adapters, USB ports in running vehicles or cigarette lighter-style 12-volt male adapters. Most offer some combination of the four 56

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recharge options.” CNET offered a list of the best car battery jump-starters: ʯ The best compact jump starter battery: Antigravity Batteries XP-10 Micro-Start ʯ The best compact jump starter battery with a bit more kick: Antigravity Batteries XP-10 HD Micro-Start ʯ The best all-in-one car jump starter battery: Black & Decker Portable Power Station Jump Starter PPRH5B ʯ The best big cranker jump starter battery with a compressor: DeWalt Digital Portable Power Station DXEJ14

reported. Removing the passenger from the equation will only speed up adoption of robo-delivery vans, said Langan who gave an overview of his study in a webinar for the Society of Automotive Analysts. He released his findings on the day that VW closed its deal to invest $2.6 billion in Argo AI, joining Ford in funding Argo’s development of self-driving technology. Argo will take over VW’s self-driving unit in Europe.

A Wells Fargo spokeswoman confirmed that the bank, which only makes auto loans through car dealerships, will no longer accept loan applications from most independent shops. Wells Fargo dropping independent dealer loans

ʯ The best basic compact jump starter battery with cool graphics: NOCO Genius Boost Plus GB40 UltraSafe ʯ The best power bank battery for a camping trip: Schumacher ProSeries 2250 Jump Starter For the full list, visit www.cnet.com/roadshow/news/ best-portable-jump-starter-for-your-car-in-2020.

The case for self-driving delivery vehicles While most autonomous vehicle startups and their automaker partners have focused on rideshare, there is a more compelling case to focus first on fleets of self-driving delivery vehicles, Colin Langan, auto analyst with UBS, told Motor Trend. There are lower technological hurdles and better economics behind driverless delivery vans, Motor Trend

CNBC reported in early June that Wells Fargo, one of the biggest lenders for new and used car purchases in the U.S., sent letters to hundreds of independent auto dealerships in May telling them that the San Francisco-based company was dropping them as a customer. A Wells Fargo spokeswoman confirmed that the bank, which only makes auto loans through car dealerships, will no longer accept loan applications from most independent shops. Independent dealerships typically sell used cars, unlike franchise dealerships that focus on new vehicles from specific manufacturers. The bank had “an obligation to review our business practices in light of the economic uncertainty presented by COVID-19 and have let the majority of our independent dealer customers know that we will suspend accepting applications from them,” Natalie Brown, the spokeswoman, said in an email. “The independent dealers we will continue doing business with are those with deep, long-standing relationships with Wells Fargo.” Read more at: www.cnbc.com/2020/06/02/wellsfargo-cuts-back-from-making-loans-to-independent-cardealerships.html. www.repertoiremag.com

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August 2020

HIDA GOVERNMENT AFFAIRS

HIDA Unveils Public-Private Framework for U.S. Pandemic Preparedness and Response HIDA has recommended to the government a pan-

demic framework that builds on the lessons learned from the spread of COVID-19. Policymakers, healthcare providers, manufacturers and distributors have learned that they need to prepare now for future pandemics by working to ʯ make the supply chain more robust; ʯ diversify sourcing; ʯ expand and support surge manufacturing infrastructure; and ʯ prevent development of a fraudulent, opportunistic marketplace.

A national strategy must support, not supplant, the commercial supply chain. We must make available and continuously replenish medical products to satisfy massive, sustained demand from healthcare providers, consumers, first responders, states and essential workers. Planning should build on the strategy to support and leverage private infrastructure to develop a “whole supply chain” effort to leverage every global and domestic manufacturing source, medical distributor and distribution center in the U.S. to contribute in partnership with government before and during a pandemic. The future pandemic response infrastructure should be built on a foundation of four key components: Forward-Deployed Personal Protective Equipment (PPE) Reserve: Create stocks of federally funded and controlled pandemic supplies in up to 500 commercial distribution locations throughout the U.S., positioning inventory close to every healthcare provider and designed to meet their “first-call” needs until surge manufacturing capability can be mobilized. Diversified Surge Manufacturing Capability: Identify and establish a strategic blend of U.S. manufacturing facilities capable of surging to meet pandemic level demand, coupled with established near-sourced and global sources of low-cost, high-volume manufacturers that can increase volume to keep customers and stockpiles supplied. Sustainable And Replenished Stockpiles: Require centralized

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stockpiles to be replenished, as needed, by the surge manufacturing infrastructure to support state and local government needs during a crisis and serve as a backstop to the commercial supply chain.

a time of crisis. Fortunately, there is already a model for deploying this type of partnership: the Pandemic and AllHazards Preparedness and Advancing Innovation Act of 2019 (PAHPAI). PAHPAI addressed all aspects of pandemic preparedEnd-User Aligned Supply Chains: Align distribuness. It establishes a public-private partnership to assist the tion channels to categories of end users to avoid surgeAssistant Secretary for Preparedness and Response (ASPR) driven competition for products that drives up prices and in the development of various preparedness response proencourages profiteering brokers to enter the marketplace. grams. This includes the Strategic National Stockpile, the Hospital Preparedness Program and for hospitals, healthcare facilities, and A Public-Private Framework Designed To Leverage other public and private sector entiThe Logistical Expertise Of Health Industry ties in order to increase medical surge capacity before, during, and after pubDistributors With Planning, Prioritization And lic health emergencies. In the beginResources Of The Federal Government ning of 2020, HHS was in the initial stages of pursuing the mandates set out in PAHPAI when the COVID-19 pandemic struck. It was already taking advantage of a productive partnership with HIDA and its members through various work groups.

A call for new legislation building on the PAHPAI model

We must coordinate every global and domestic manufacturing source, medical distributor and distribution center in the U.S. to contribute in partnership with government agencies and planners before and during a pandemic.

Putting the framework into action: National legislation building on PAHPAI This framework is a public-private partnership that draws on the respective strengths of the federal government and the private sector. On the public side, before a crisis, the government can set priorities regarding which products to stockpile and where to source them. It can provide the resources for “flex” reserves that can be drawn upon when a crisis suddenly drives up demand. On the private side, distributors are equipped to do what the government is not: handling the logistics of producing, managing and delivering billions of units of PPE and supplies during

New legislation would require a more comprehensive public-private partnership than is currently provided by PAHPAI. The establishment of a forward-deployed PPE Reserve, maintenance of dynamic national stockpiles and development of surge manufacturing capacity are interconnected issues that would require a commitment of resources and multiyear planning. Using the workgroup model, an ongoing public-private partnership would assist the ASPR and the Strategic National Stockpile to identify 1) how much of which products to have in the distributor-managed PPE Reserve 2) which products and quantities should be in Strategic National Stockpile and 3) how to work with manufacturers to develop additional capacity and production diversification. The Medical Supplies For Pandemics Act of 2020 : H.R. 6531, the Medical Supplies for Pandemics Act of 2020, and its companion in the Senate, S. 2827, provide for the establishment of the public-private framework described in this paper. Both bills were introduced with bipartisan sponsors and support, and HIDA and its members are working for their passage. www.repertoiremag.com

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August 2020

NEWS

Industry News

BD launches rapid point-of-care antigen test to detect COVID-19 in 15 BD (Becton, Dickinson and Company) (Franklin Lakes, NJ) announced that the U.S. Food and Drug Administration (FDA) has granted Emergency Use Authorization (EUA) for a rapid, point-of-care, SARS-CoV-2 diagnostic test for use with the company’s BD Veritor Plus System. This new assay delivers results in 15 minutes on an easyto-use, highly portable instrument, which enables realtime results and decision making while the patient is still onsite, the company says. BD is leveraging its global manufacturing network and scale and expects to increase capacity to be able to produce 2 million tests per week by the end of September. The company already expects to produce up to 10 million tests from July through September. The launch of the BD Veritor Plus System for Rapid Detection of SARS-CoV-2 Assay is the latest effort in the company's comprehensive response to address critical health needs related to the global pandemic. The new immunoassay test joins a portfolio of three molecular solutions for COVID-19 testing that have been registered for use with the BD MAX Molecular System, including two with EUAs and two with CE mark. BD intends to pursue 510(k) clearance for the BD Veritor Plus SARSCoV-2 assay from the FDA at a later time.

Telehealth claims increase by more than 8,335% According to FAIR Health’s Monthly Telehealth Regional Tracker, telehealth claims have increased by more than 8,335% between April of last year and April of this year. The Northeast region of the United States saw the largest increase at 26,209%. The top diagnosis of telehealth claims in the U.S. was for mental health conditions. FAIR Health has tracked monthly telehealth 60

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usage since January of this year using its database of more than 31 billion privately billed medical and dental claims.

Shawn Ashcraft named vice president of information technology for Midmark Midmark Corp., announced Shawn Ashcraft was named vice president, information technology. In this leadership position, Ashcraft will lead the strategy and execution of delivering global technology services solutions and propelling IT along its digital transformation journey. Ashcraft Shawn Ashcraft comes to Midmark from Johnson & Johnson, where he most recently focused on building digital solutions for surgical robots in the position of digital surgery senior program manager and lead systems engineer. During his tenure with Johnson & Johnson, Ashcraft held multiple positions and was responsible for enterprise application delivery, medical device engineering and implementing software engineering practices such as Agile Scrum, DevOps and automated testing.

Ochsner Health System teams with Ready Responders on in-home care efforts Ochsner Health System (Louisiana) has teamed with Ready Responders (Louisiana) to reduce preventable emergency department visits and support patients during the COVID-19 outbreak. The collaboration is the latest in Ochsner’s in-home care efforts. Ready Responders provides on-demand urgent care, in-home testing services, post-hospital care and more, and has raised roughly $53 million since launching in 2016.

MidmarkÂŽ Workstations + Telehealth Enabling Healthcare from Anywhere

It is predicted that there will be 1 billion telehealth visits in the US in 2020, yet as of January, 76% of healthcare organizations in the US lacked a virtual care program.1 We can help. Midmark Workstations are made to order with customization that can assist with the integration of technology at the point of care, wherever that may be. Learn more at: midmark.com/virtualhealthcare

Cameras not included. 1 https://go.forrester.com/press-newsroom/us-virtual-care-visits-to-soar-to-more-than-1-billion/ ÂŠ 2020 Midmark Corporation, Miamisburg, Ohio USA

Together at Hospital Together at Home Masimo SafetyNet™ Remote Monitoring > Seamlessly extends care beyond hospitals walls—and even into the home > Combines tetherless Masimo SET® pulse oximetry, respiration rate, and temperature monitoring with a secure patient surveillance and care pathway platform > Clinically proven Masimo SET® has been shown in more than 100 independent and objective studies to outperform other pulse oximetry technologies and is used to monitor more than 200 million patients a year1

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