A comprehensive look at the breaking news topics that affected the U.S. healthcare system throughout 2024.
New requirements for medical diagnostic equipment p. 40
Winter can be full of fun and games
Until you get hit with a respiratory infection. Accurately diagnosing our friends Flora, Spike, Sniff and Streppy here can be a challenge as clinical symptoms overlap, which is why rapid tests have many advantages. Getting the correct diagnosis and treatment to your patients in minutes lets them get back to fun.
Save money with our unique QC Inside® feature; two extra tests for external QC at no charge.
Be prepared with the OSOM® Flu SARS-CoV-2 Combo, OSOM® COVID-19 Antigen, OSOM® Ultra Plus Flu A&B and OSOM® Strep A Tests.
Sniff
Streppy
Spike
Flora
A Year in Review
A
How Melissa James’
New Requirements for Medical Diagnostic Equipment New regulations have been issued for medical diagnostic equipment. Are your customers aware, and compliant?
46 Manufacturers Weigh in on New MDE requirements What the rules will mean for providers, manufacturers and distributor reps moving forward.
` TRENDS
50 The Team Up How distributor reps can discuss the financial aspects of capital equipment sales with customers.
` CHPs
Top-Heavy Return to Profitability Kaufman Hall report shows top hospitals separate through outpatient services.
` TRENDS
When the Numbers Tell the Story What’s in store for the global healthcare supply chain in 2025?
HIDA
56 The Disruptors Disrupted Retailers find primary care tough sledding. ` TECH TALK 59 Pressure Rising How proper blood pressure measurement techniques can help contribute to more accurate hypertension diagnosis. ` IDN INSIGHTS
Defending Healthcare from Cyberattacks: Strategies, Resources, and Legislation
HEALTH NEWS
Health News
THE CURE
From the Baseball Diamond to the Boardroom
What You Do Matters
As we close out the year, many of us are focused on finishing strong, both in our own goals and for the teams and customers we support. The end of the year always brings a mixture of reflection and planning, and this year is no exception. For those of us in medical distribution, the work we do is part of a larger mission to improve healthcare delivery and ensure providers have what they need, when they need it. At this time of year, it’s worth taking a step back to recognize the importance of our industry, the relationships we’ve built, and the people who make this work so fulfilling.
Healthcare in the U.S. is in a period of rapid growth and transformation. Currently, annual spending on healthcare is about $4 trillion, and projections show that by 2030, this figure will reach $6.2 trillion. A significant part of this increase is tied to the aging population, particularly as Baby Boomers continue to require more healthcare services. By 2030, every Baby Boomer will be at least 65 years old, and this demographic shift is already impacting demand across all areas of healthcare – from hospital beds and diagnostic services to outpatient care and home health support.
This means that as medical distribution reps, the work we do to ensure the efficient and timely distribution of products has never been more critical. It also means we are looking at serious growth in the near future. The team here at Repertoire is poised to support you through content in the magazine, training videos in RepConnect, and podcasts.
However, while our work drives positive change in healthcare, this season is also a great time to reflect on what matters most outside of our professional goals. It’s easy to get wrapped up in the rush to hit year-end targets or tackle last-minute challenges, but the holiday season is about more than just numbers. It’s about family, friends, and the moments that make life meaningful. Take time to connect with those who support you, both in your personal life and in your career. Often, it’s the people we share our lives with who truly motivate us to work harder and do better.
Wishing you and your families a wonderful holiday season. May you enjoy every moment, reflect on all you’ve accomplished, and return in the new year ready to make an even greater impact. Happy holidays!
Dedicated to the Industry,
R. Scott Adams Publisher
editorial staff
editor Graham Garrison ggarrison@sharemovingmedia.com
publisher Scott Adams sadams@sharemovingmedia.com (800) 536.5312 x5256
founder Brian Taylor btaylor@sharemovingmedia.com
Subscriptions www.repertoiremag.com/subscribe or (800) 536-5312 x5259
Repertoire is published monthly by Share Moving Media 350 Town Center Ave, Ste 201 Suwanee, GA 30024-6914 Phone: (800) 536-5312, FAX: (770) 709-5432; e-mail: info@sharemovingmedia.com; www.sharemovingmedia.com
More breathing room this respirator y season
It’s holiday season, which means flu and strep are back in season, too. Be prepared for all your patient testing needs with advanced diagnostic solutions from QuidelOrtho.
Compact and versatile testing with proven lateral-flow technology and advanced fluorescence chemistry. Accurate and objective flu and strep results automatically reported in as few as three minutes.
Benchtop molecular diagnostics platform with capacity to run one to 12 tests at a time. Uses proprietary helicase-dependent amplification with fluorescence detection to make diagnosing flu and strep faster and easier.
Scan to learn more, or to order contact, your QuidelOrtho representative
Prevention Season
Why this time of the year often presents the greatest risk to public health and the greatest opportunities to showcase our skills and abilities as consultants.
 By this time each year we have already been involved in multiple activities intended to help our customers effectively prepare for the late fall and early winter patient visits and to provide effective preventive services to their patients.
As temperatures drop, this typically signals an annual increase in cardiac illnesses and the rise of an increasing variety of respiratory diseases. Most of us have already been providing our customers with flu and COVID vaccines and helping them prepare for the rise in annual school physical exams. It is also likely that your customers have asked you about your respiratory testing portfolio this year and your recommendations to help them prepare for respiratory testing for their patients. Make sure to have comprehensive discussions with your trusted respiratory testing manufacturers to understand available platforms, tests, current reimbursement and testing trends.
By Jim Poggi, Principal, Tested Insights
This year, I am seeing more interest in RSV testing for older adults than in previous years. This trend mirrors an increased level of RSV vaccination utilization for older adults. As the pharmaceutical companies that offer RSV vaccines create awareness of the incidence of RSV in older adults and the seriousness of RSV in this patient group, they create opportunities for us to expand our discussion of respiratory testing. If you need a refresher on overall respiratory testing options, please refer back to my August 2024 Repertoire column which describes typical respiratory tests, their CPT codes, reimbursement, waived status and available lateral flow and molecular testing platforms.
Hopefully we have the foresight to plan for these annual experiences, but if we have not so far, it is not too late to prepare to be an active and well-informed consultant for the balance of the fall prevention season. What do I mean by this? In this column I plan to help you think about late fall and early winter the way your customers do. We need to go beyond talking about the patient conditions and concerns they will face. Not all their patient visits will involve specific clinical conditions. Some will involve questions about which vaccines are appropriate for them. Others will involve questions about health insurance, including which plans the practice will cover in the coming year.
This year there are changes in Medicare Advantage program coverage by many commercial insurance companies that your customers’ patients may ask about. Many Medicare Advantage (Part C) plans will increase in cost and some will offer reduced benefits or increases in deductibles. As we approach the end of the calendar year, a number of patients will schedule appointments and request tests to make sure they take advantage of all their current year benefits, before annual deductibles go into effect in January.
Looking more broadly than just the clinical side of your customers’ businesses will pay dividends at this time of year. Understanding the types of questions and patient visits your customers will encounter this time of year will allow you to consult more effectively. Let’s take a look at some of these scenarios together.
Preparing for end-of-year patient visits
As the calendar year comes to a close, many patients schedule physical exams to make sure they obtain these benefits before the start of the new benefit year when deductibles will need to be satisfied all over again. Some may be changing plans, which adds urgency to their desire to schedule their physical.
While we know this trend typically increases end-of-year patient visits and daily use office consumables like gloves, masks and table paper, are you thinking about increased testing? If not, you should be. Patients with a history of diabetes, hypertension, heart disease and other conditions should have testing conducted to
Transfusion Medicine
With over 6,000 Ortho Vision® Analyzers installed worldwide1 and over 1,600 in the U.S.,2 QuidelOrtho is the #1 global choice for blood bank laboratories.
Offering an integrated suite of products to maximize the efficiency of your blood bank, optimize your valuable resources and trust your results.
ID-MTS™ Gel Test and traditional reagents
As the largest manufacturer of reagent red blood cells in the world, our wide-ranging, competitively priced menu includes a combination of manual and automated reagents, including the ID-Micro Typing System™(ID-MTS) Gel Tests and Ortho Sera reagents, as well as reagent red blood cells and liquid antisera.
Ortho Connect® 2.3.4 Software
Taking lab productivity to the next level
Confidently manage your blood bank and its data. Through a single connection, Ortho Connect software provides a seamless flow of information that centralizes lab management activities across multiple instruments and labs.
Ortho Sera® Reagents
Ortho Sera reagents offer the most comprehensive menu of antisera for phenotyping, available in a gel testing format, covering more than 99 percent of the most commonly tested antigens.*
Learn more about the Ortho Vision® Swift Platform by scanning the QR code, visiting quidelortho.com, calling us at 800.874.1517 or reaching out to your QuidelOrtho representative.
*Sources: Hamilton JR_Common and Frequently encountered Antibodies_Transfusion and Apheresis Science 2009_40_189_194 Walker RH etal Alloimmunization Following Blood Transfusion_ 1989 Archives of Pathology and Lab medicine_ 1989_113_254_268
2. Installed Base Report dated 12.31.2023. New QuidelOrtho branding may not be available in all markets, subject to country-specific regulatory approval. Please confirm with your local commercial team.
2024 QuidelOrtho
VITROS® Systems
Find the right solution for your lab
Power up your lab with the built-in intelligence and efficiency of our VITROS systems, designed to make it easier to do more with less. VITROS systems complete the analytical process the first time without intervention or repeat testing for 96.5 percent of tests conducted.1
Ensure high-quality results
Trust the results of every test, every day with intelligent technologies and patient-focused design that deliver the highest quality and precision.
Count on reliable performance
Keep your lab powered up and ready when you are with high-performance systems and industry-leading uptime.2
Flex to enable what's next
Expect consistent quality results across your network with flexible, scalable and connected solutions.
Drive operational efficiency
Power your lowest total cost of ownership with purposefully designed solutions.
Learn more about VITROS systems by scanning the QR code, visiting quidelortho.com, calling us at 800.874.1517 or by reaching out to your QuidelOrtho representative.
ascertain any key changes in their lab test values. Lipid testing, glucose and hemoglobin A1c, CBC, urinalysis and metabolic testing panels are all likely to increase at this time of year.
At the same time, patients previously diagnosed with cancer, or having a family history of it, should be tested for tumor markers including PSA and fecal occult blood or FIT. Comparing current values for all these tests to baselines is sound and sensible preventive medicine and can discover trends important to the patient and care giver. This can be good news, or result in more intensive follow up, depending on the results of the trends. Knowing the patient’s lab result status means knowing how their current values stack up against their values over time and how well their treatment program is working.
From your perspective, knowing which lab tests your customer frequently performs should lead you to ask about their end-ofyear testing needs. If they have thought about a seasonal spike, you are on the same page and can easily help. If not, it is likely you have created a valuable reminder that can help them to be prepared and have the test kits and reagents on hand to make sure they are ready for anticipated patient visits. Either way, your consulting skills can be a benefit that sets you apart from others.
What about end-of-year Medicare visits?
This year, in particular, there is a lot going on here. Medicare annual enrollment is coming to a close in early December. But annual Medicare wellness visits are a year long activity. While they are mostly comprised of “vital signs” measurements and an optional questionnaire regarding physical and emotional safety issues, they can also lead to preventive measures which are also covered by Medicare. Knowing more about both the annual Medicare wellness exam and the covered preventive services will help you expand your knowledge and provide useful information with your customers. I am providing links to both home
pages. Note that most Medicare preventive services, which are typically based on patient history or an assessment of patient risk, are covered at no cost to the patient.
Planning for the typical respiratory season patient visit spike
In days gone by, this was simply a reminder to order flu and strep tests NOW in anticipation on the coming surge of patients ill with respiratory disorders. We also presented our usual “stock up and save” promotions offered by our trusted respiratory test manufacturers.
But as times change, so has the complexity of preparing for respiratory season. Is the customer using a lateral flow testing reader or a molecular testing reader? If not, are they thinking about one or should they be? If they have expressed questions about test results not matching patient symptoms, mentioned possible false negatives, challenged the skill of their staff to properly collect the specimen or perform the test or are looking to expand their respiratory testing portfolio, NOW is the time to discuss the testing platform BEFORE discussing the individual tests. Having the right testing platform can mean increased confidence in results, reduced concerns about staff skills, the ability to perform all the respiratory tests they need and even the possibility of increases in revenue.
If I were preparing to discuss respiratory testing with my key customers, my first question might well be “How satisfied are you with your current respiratory testing platform? Do you have specific concerns? Are you looking for options?”
It’s worth probing for concerns about result quality, especially for both strep and RSV where a false negative can have serious adverse results. For customers with these concerns, introducing a molecular platform can provide a valuable solution and assure they feel prepared to confidently test and treat their patients this season. Be sure to enlist the help of your trusted respiratory test manufacturers to provide the best solutions.
Medicare annual visit
View the Medicare patient preventive service listing
Scan QR codes
Respiratory season makes all comorbidities worse
No matter where we are in the annual progression of respiratory season or how severe any specific respiratory season is, all co-morbidities associated with respiratory illnesses make the patient situation and prognosis more dangerous. What this means is that any patient with any preexisting condition has a higher risk of more severe outcomes if they develop a respiratory illness. This can include serious complications including pneumonia. Typical co-morbidities your customers are concerned about include pre-existing respiratory conditions including asthma and COPD, diabetes, hypertension and osteoarthritis. As always, both the very young and the elderly have a higher risk profile when they develop a respiratory illness and need to be monitored closely.
Respiratory season CDC information
While your trusted respiratory test kit manufacturer is an outstanding resource, the CDC also provides a large range of information for you. It ranges from an overview of the respiratory season to date to an analysis of the incidence of specific seasonal pathogens to community specific incidence data on the respiratory season. Each of these resources helps you to stay well informed and is also likely to make sure you are viewing the same information source many of your customers use to stay informed. This helps you and your customers to “speak a common language” about respiratory season. ( See sidebar for CDC respiratory illnesses data channel. )
It is also well established that heart disease incidence has a seasonal spike associated with late fall and winter weather. Reduced activity levels in combination with other seasonal factors cause an increase in heart attacks at this time of year. For a more detailed summary of the cardiac risks at this time of year, you may want to re-read my January 2024 column
“Home is Where the Heart Disease is”. It discusses age, nutritional, lifestyle and other factors that are implicated in the development of cardiac illnesses at this time of year. There is no doubt your customers are intimately familiar with this information, but it pays you to be well informed. A little research here can add to your reputation as a wellinformed consultant.
Wrapping it all up
The pathway to better health in the fall and winter is prevention. While being well informed and able to “speak a common language” with our customers is critical, we must never forget to continue to ask specific and appropriate questions to continue to know them and their concerns as well as possible.
The example of respiratory testing platforms mentioned earlier should be part of your customer dialogue at this time of year. Other conversation starters I am thinking about include:
`
“There is a lot of discussion about continuous glucose monitoring currently. What is your current viewpoint on CGM? Which patients could have the most benefit? Are you actively using it or waiting for more information?”
` “I heard very little about RSV in adults until the past few years. Now it seems that availability of RSV vaccines has caused concern about RSV in older adults. How are you managing your elder adults regarding RSV vaccination and testing? Are you recommending vaccination? Is testing for RSV in adults part of your current respiratory practice? My company offers multiple options. How can I help you?”
It’s not just how much you know but more often how much you know about your customers that makes all the difference in your success. Be well informed on the issues but be better informed about your customers’ concerns.
the CDC respiratory season website
Save on tests this season!
Save on tests this season!
Buy 4 kits and get one at no additional cost! †
Take advantage of these limited time offers!
Take advantage of
Mix & Match: Promotional offerings available in any combination.
BD item number Mix & Match: Promotional offerings available in any combination.
advantage of these limited time offers! BD item number Mix & Match: Promotional offerings available in any combination.
BD Veritor™ System for Rapid Detection of SARS-CoV-2 & Flu A+B* kits and get a kit at no additional cost
256088 Buy 4 BD Veritor™ System for Rapid Detection of SARS-CoV-2 & Flu A+B* kits and get a kit at no additional cost
BD Veritor™ System for Rapid Detection of SARS-CoV-2** kits and get a kit at no additional cost
256088 Buy 4 BD Veritor™ System for Rapid Detection of SARS-CoV-2 & Flu A+B* kits and get a kit at no additional cost
256082 Buy 4 BD Veritor™ System for Rapid Detection of SARS-CoV-2** kits and get a kit at no additional cost
256082 Buy 4 BD Veritor™ System for Rapid Detection of SARS-CoV-2** kits and get a kit at no additional cost
BD Veritor™ System for Rapid Detection of Respiratory Syncytial Virus CLIA-waived kits and get a kit at no additional cost
256038 Buy 4 BD Veritor™ System for Rapid Detection of Respiratory Syncytial Virus CLIA-waived kits and get a kit at no additional cost
BD Veritor™ System for Rapid Detection of Flu A+B laboratory kits and get a kit at no additional cost
256038 Buy 4 BD Veritor™ System for Rapid Detection of Respiratory Syncytial Virus CLIA-waived kits and get a kit at no additional cost
256041 Buy 4 BD Veritor™ System for Rapid Detection of Flu A+B laboratory kits and get a kit at no additional cost
256041 Buy 4
BD Veritor™ System for Rapid Detection of Flu A+B CLIA-waived kits and get a kit at no additional cost
Veritor™ System for Rapid Detection of Flu A+B laboratory kits and get a kit at no additional cost
256045 Buy 4 BD Veritor™ System for Rapid Detection of Flu A+B CLIA-waived kits and get a kit at no additional cost
Learn more about the BD respiratory season stocking event at: go.bd.com/veritoroffer
256045 Buy 4 BD Veritor™ System for Rapid Detection of Flu A+B CLIA-waived kits and get a kit at no additional cost Learn
Learn more about the BD respiratory season stocking event at: go.bd.com/veritoroffer
† Valid through December 31, 2024. Promotion may not offer additional discounts for BD Veritor™ Plus System users under existing pricing contract/ agreement. Offer is applicable to new and current BD Veritor™ Plus System users. The value of any rebates, discounts, or incentives provided may constitute a “discount or other reduction in price” under Section 1128B(b)(3)(A) of the Social Security Act (42 U.S.C. Sec.1320a-7b(b)(3)(A)). Customer shall satisfy any and all requirements imposed on buyers relating to discounts or reductions in price, including, when required by law, to disclose all discounts or other reductions in price received from BD and to accurately report under any state of federal healthcare program the net cost actually paid by customer.
† Valid through December 31, 2024. Promotion may not offer additional discounts for BD Veritor™ Plus System users under existing pricing contract/ agreement. Offer is applicable to new and current BD Veritor™ Plus System users. The value of any rebates, discounts, or incentives provided may constitute a “discount or other reduction in price” under Section 1128B(b)(3)(A) of the Social Security Act (42 U.S.C. Sec.1320a-7b(b)(3)(A)). Customer shall satisfy any and all requirements imposed on buyers relating to discounts or reductions in price, including, when required by law, to disclose all discounts or other reductions in price received from BD and to accurately report under any state of federal healthcare program the net cost actually paid by customer.
† Valid through December 31, 2024. Promotion may not offer additional discounts for BD Veritor™ Plus System users under existing pricing contract/ agreement. Offer is applicable to new and current BD Veritor™ Plus System users. The value of any rebates, discounts, or incentives provided may constitute a “discount or other reduction in price” under Section 1128B(b)(3)(A) of the Social Security Act (42 U.S.C. Sec.1320a-7b(b)(3)(A)). Customer shall satisfy any and all requirements imposed on buyers relating to discounts or reductions in price, including, when required by law, to disclose all discounts or other reductions in price received from BD and to accurately report under any state of federal healthcare program the net cost actually paid by customer.
* In the USA, the BD Veritor™ System for Rapid Detection of SARS-CoV-2 & Flu A+B has not been FDA cleared or approved but has been authorized by the FDA under an Emergency Use Authorization for use by authorized laboratories; use by laboratories certified under the CLIA, 42 U.S.C. §263a, that meet requirements to perform moderate, high, or waived complexity tests. The product is authorized for use at the Point of Care (POC), i.e., in patient care settings operating under a CLIA Certificate of Waiver, Certificate of Compliance, or Certificate of Accreditation. This product has been authorized only for the detection of proteins from SARS-CoV-2, influenza A and influenza B, not for any other viruses or pathogens; and, in the USA, the emergency use of this product is only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection and/or diagnosis of COVID 19 under Section 564(b)(1) of the Federal Food, Drug and Cosmetic Act, 21 U.S.C. §360bbb-3(b)(1), unless the declaration is terminated or authorization is revoked sooner.
* In the USA, the BD Veritor™ System for Rapid Detection of SARS-CoV-2 & Flu A+B has not been FDA cleared or approved but has been authorized by the FDA under an Emergency Use Authorization for use by authorized laboratories; use by laboratories certified under the CLIA, 42 U.S.C. §263a, that meet requirements to perform moderate, high, or waived complexity tests. The product is authorized for use at the Point of Care (POC), i.e., in patient care settings operating under a CLIA Certificate of Waiver, Certificate of Compliance, or Certificate of Accreditation. This product has been authorized only for the detection of proteins from SARS-CoV-2, influenza A and influenza B, not for any other viruses or pathogens; and, in the USA, the emergency use of this product is only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection and/or diagnosis of COVID 19 under Section 564(b)(1) of the Federal Food, Drug and Cosmetic Act, 21 U.S.C. §360bbb-3(b)(1), unless the declaration is terminated or authorization is revoked sooner.
** In the USA, the BD Veritor™ System for Rapid Detection of SARS-CoV-2 has not been FDA cleared or approved but has been authorized by the FDA under an Emergency Use Authorization for use by authorized laboratories; use by laboratories certified under the CLIA, 42 U.S.C. §263a, that meet requirements to perform moderate, high, or waived complexity tests. The product is authorized for use at the Point of Care (POC), i.e., in patient care settings operating under a CLIA Certificate of Waiver, Certificate of Compliance, or Certificate of Accreditation.
* In the USA, the BD Veritor™ System for Rapid Detection of SARS-CoV-2 & Flu A+B has not been FDA cleared or approved but has been authorized by the FDA under an Emergency Use Authorization for use by authorized laboratories; use by laboratories certified under the CLIA, 42 U.S.C. §263a, that meet requirements to perform moderate, high, or waived complexity tests. The product is authorized for use at the Point of Care (POC), i.e., in patient care settings operating under a CLIA Certificate of Waiver, Certificate of Compliance, or Certificate of Accreditation. This product has been authorized only for the detection of proteins from SARS-CoV-2, influenza A and influenza B, not for any other viruses or pathogens; and, in the USA, the emergency use of this product is only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection and/or diagnosis of COVID 19 under Section 564(b)(1) of the Federal Food, Drug and Cosmetic Act, 21 U.S.C. §360bbb-3(b)(1), unless the declaration is terminated or authorization is revoked sooner.
** In the USA, the BD Veritor™ System for Rapid Detection of SARS-CoV-2 has not been FDA cleared or approved but has been authorized by the FDA under an Emergency Use Authorization for use by authorized laboratories; use by laboratories certified under the CLIA, 42 U.S.C. §263a, that meet requirements to perform moderate, high, or waived complexity tests. The product is authorized for use at the Point of Care (POC), i.e., in patient care settings operating under a CLIA Certificate of Waiver, Certificate of Compliance, or Certificate of Accreditation.
This product has been authorized only for the detection of proteins from SARS-CoV-2, not for any other viruses or pathogens; and, in the USA, the emergency use of this product is only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection and/or diagnosis of COVID 19 under Section 564(b)(1) of the Federal Food, Drug and Cosmetic Act, 21 U.S.C. §360bbb-3(b)(1), unless the declaration is terminated or authorization is revoked sooner.
This product has been authorized only for the detection of proteins from SARS-CoV-2, not for any other viruses or pathogens; and, in the USA, the emergency use of this product is only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection and/or diagnosis of COVID 19 under Section 564(b)(1) of the Federal Food, Drug and Cosmetic Act, 21 U.S.C. §360bbb-3(b)(1), unless the declaration is terminated or authorization is revoked sooner.
** In the USA, the BD Veritor™ System for Rapid Detection of SARS-CoV-2 has not been FDA cleared or approved but has been authorized by the FDA under an Emergency Use Authorization for use by authorized laboratories; use by laboratories certified under the CLIA, 42 U.S.C. §263a, that meet requirements to perform moderate, high, or waived complexity tests. The product is authorized for use at the Point of Care (POC), i.e., in patient care settings operating under a CLIA Certificate of Waiver, Certificate of Compliance, or Certificate of Accreditation. This product has been authorized only for the detection of proteins from SARS-CoV-2, not for any other viruses or pathogens; and, in the USA, the emergency use of this product is only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection and/or diagnosis of COVID 19 under Section 564(b)(1) of the Federal Food, Drug and Cosmetic Act, 21 U.S.C. §360bbb-3(b)(1), unless the declaration is terminated or authorization is revoked sooner.
BDVeritor.com
A PSS Family Reunion
A group of PSS alums came together recently for a night of reminiscing and to raise money for a worthy cause.
 Although the company is a memory, the spirit of PSS is alive and well, judging by a recent industry gathering. A PSS Reunion and fundraiser for Pat Kelly’s Broad Street Children’s Foundation took place on Sept. 13, 2024. Former colleagues from PSS World Medical came together for a night of memories and celebration, and to give back to children in need of a loving home.
Several former PSS employees still keep in touch with each other, and the idea for the reunion came about through a shared desire to reconnect with the broader PSS family and honor the unique culture that was PSS. Pat Kelly’s Broad Street Children’s Foundation, a 501(c)(3) nonprofit that supports children’s homes across the country, became the natural beneficiary for the event, adding a meaningful philanthropic aspect to what was already set to be a memorable night.
“Many PSSers maintained deep ties over the years, and this event offered the perfect platform to celebrate those bonds while making a difference,” said Mara Kelly Webb, Pat Kelly’s daughter, and head of Broad Street Children’s Foundation.
The reunion brought the med/surg community back together but also showcased the current careers and hobbies of many former PSSers. A great example of this was the entertainment for the evening, provided by the Chris Todd Band – led by Chris Todd, a former PSSer from the Birmingham branch and one of his band members who actually worked on many of the PSS National Sales Meetings over the years.
The sponsorships, BBQ, t-shirts, and desserts were also supplied by businesses owned by former employees or those with strong ties to PSS, making the night a true reflection of the PSS community.
Throughout the evening, everyone enjoyed an incredible mix of great food, drinks, and a lively atmosphere that, despite the September heat, kept everyone laughing and smiling. The wine pull was a huge hit, adding a bit of fun and excitement to the night, but the true magic was in the sense of camaraderie that filled the room, Webb said.
“It felt like a true family reunion, with everyone reconnecting, sharing memories, and having a fantastic time,” she said. “The highlight, though, was the generosity of our attendees. Their contributions allowed us to raise significant funds for the Broad Street Children’s Foundation, showing once again how much the PSS family cares about making a difference while having a memorable night together.”
Family forever
PSS was much more than just a company; it was a family, Webb said. “What made the culture special were the values and the work hard, play hard attitude that permeated every level of the organization.”
For example, the PSS Top Twenty was essential to each employee. At any time you could be asked to show your Top Twenty card. Beyond just words listed on a card, the values represented truly defined the quality and character of the PSS company. “It is what made PSS different,” Webb said. “It is not a coincidence that the final Top
Twenty stated, ‘Recognize PSS as a family that cares.’”
PSS was undoubtedly a unique company that, in many ways, broke away from the traditional corporate model, Webb said. But it was the employees who truly made PSS so special.
“My father, Pat Kelly, understood this and focused on not only finding the best people but also giving them the freedom to either succeed or fail on their own terms: He said: ‘We tell our people to think and act as if they’re all chief executive officers. We put CEO
on truck driver’s business cards ...We literally want everyone to see himself or herself as top dog in the company.’ He genuinely believed that anyone could succeed if given the chance and strived to build a company that allowed for that opportunity.”
The relationships formed at PSS were based on more than just business; they were forged through shared industry, but also challenges, trust, lots of fun, and a common understanding of being part of something greater than oneself. These bonds have endured because the values and experiences that brought PSSers together didn’t fade when the company did, Webb said. Over the years, many have stayed connected, supporting each other through both personal and professional milestones.
“This reunion was a testament to these deep ties, reinforcing that once you’re part of the PSS family – whether as a former employee or even a manufacturer representative in the medical industry who worked closely with PSSers – you remain part of that family forever.”
With the excitement from this year’s reunion, the event organizers are exploring the possibility of hosting a 2025 event. “We’re hoping to expand and reach an even larger group of PSSers to join us for what promises to be an unforgettable evening,” said Webb. “If you’ve ever been a part of the PSS story, this is your chance to reconnect, relive old times, create new memories, and have lots of fun.”
Look for updates and ways to get involved by following the PSS Family pages on Facebook, Instagram, and LinkedIn or by visiting www.broadstreetfoundation.org.
See what’s possible
Distributors and self-distributing health systems now have complete transparency of their Dukal products’ from purchase order to delivery.
Product Assigned at the Factory Level
Product Tracking at the Item Level
Worldwide Tracking Compatible Excel Reporting
Automated Communication
Scan here to learn more or visit dukal.info/insight
Dukal is working with healthcare professionals around the world in manufacturing and supply chain solutions, to mitigate disruptions that impact business and patient health. Helping you manage everything from product to patient.
> Learn more at dukal.info/insight
A Rewarding Career
How Melissa James’ interest in all things lab led to an eventual leadership position at Thermo Fisher Scientific.
By Pete Mercer
 A significant part of what makes the leadership journey so powerful to behold is how different it can look from person to person. For every individual who feels like they were always meant to hold a position of leadership and manage a team, there is someone who makes an unexpected discovery about themselves and what they are capable of.
Melissa James is a senior district sales manager for Thermo Fisher Scientific, but she did not necessarily plan for that. Repertoire Magazine recently spoke to James about her leadership journey in clinical laboratory sales, developing a team of high performers, and the industry’s future.
Moving into sales
James was not always in sales. In fact, a sales role was not even on her radar of possibilities until she was introduced to Thermo Fisher while working at a molecular research lab. “In the lab, I took an interest in learning about new products and different test methods,” she said. “The Fisher Scientific catalog was where I would go when I wanted to explore my options.”
She quickly found that she enjoyed those explorations just as much as she enjoyed the science that goes into testing. When a Fisher Healthcare sales representative position opened up in her area, she decided that it could be an exciting new step in her career.
“While I enjoy the science behind testing, I became even more excited about the opportunity to spend more time learning
Melissa James, senior district sales manager, Thermo Fisher Scientific
ZOLL AED 3 ®
Real CPR Help®
Proven Real CPR Help guides rescuers in delivering high-quality CPR consistent with current guidelines. Real-time feedback on depth and rate of compressions is displayed on the enhanced colored bar gauge.
SMART. READY. TRUSTED.
Long-life Consumables
Five-year battery and pad life means fewer replacements and the benefit of the lowest total cost of ownership.
Integrated Pediatric Rescue
The universal design of the CPR Uni-padz™ electrodes gives rescuers a single, versatile solution for both adult and pediatric victims of SCA.
“QUICK! GRAB THE ZOLL!”
Mission Focused
Our AED technology innovations provide rescuers with the tools to act quickly and confidently to help save lives.
Legacy of Excellence
A pioneer in resuscitation technology, ZOLL has been empowering first responders and unexpected heroes around the world for more than 25 years.
about innovative products that can improve testing and patient care,” she said.
After working as a sales representative for Thermo Fisher for 20 years, she transitioned to a role where she could work with a much larger group of customers and lead a team. James and her team work to stay on top of the latest innovations in new products, services, and other general interests of their customers to better understand their market. When they do their job well, they can implement specific business plans based on the needs of those customers.
and achievement of forecasted sales goals while working effectively with cross-functional teams of suppliers and internal resources. I am also responsible for managing tasks and behaviors to meet the company goals and provide the best possible experience for our customers.”
Part of what makes her perspective in the industry unique is her background in the molecular research laboratory. When she is looking to promote or hire for her team, she seeks a similar technical expertise in the laboratory setting, which gives her team the edge to providing a better customer experience.
“All of my previous managers played a part in shaping how I approach leadership.”
“I really enjoyed the transition from a sales representative to a leader. There is a lot of responsibility that comes with a position of leadership. While you will likely have some difficult conversations and decisions to make, the end-result is very rewarding.”
Leadership development
Opportunities for growth abound in leadership positions because leaders are not born with all the answers – they might have a deeper drive to get things done, but those skills must be developed over time to be effective. For James, it is all about finding what motivates her team, removing the barriers that make executing goals possible, and making herself available to provide support.
James said, “I currently support and lead a team of sales professionals driving strategies
“We pride ourselves on being technical experts in the lab and servicing our customers to a higher level for the best experience. When hiring or promoting, I look for technical experience, which can either be someone who has worked in a lab or has experience selling into the lab space, relationship building skills, and the ability to meet and manage sales goals.”
The customer experience is such an integral part of what makes Thermo Fisher Scientific unique, so James understands the importance of cultivating and maintaining those long-standing relationships. While it can be challenging to stay at the forefront of what her customer base is interested in, James found that being challenged was a significant motivating factor for her, giving her the push she needed each day to be better at her job.
“All of my previous managers played a part in shaping how I approach leadership,” she said. “Knowing what I liked and disliked and listening to the feedback from my co-workers in those moments as well. I found that it brought out my best when I had someone who would really challenge me and make me feel like there was not anything I could not accomplish.”
The future of the industry
The healthcare industry is in a constant ebb and flow from challenges to opportunities, which makes med/surg sales no different. Finding a way to navigate those challenges is critical to your success as a leader.
James said, “This industry’s dynamic nature gets me excited about the future. With an everchanging environment and challenges, I am constantly learning new things and have a chance to contribute to healthcare advancements by getting new products out into circulation.”
As for the challenges that healthcare is facing, James is focused on staying up to date on the most accurate and current information available. She sees how everyone is having to do more with less with financial, staffing, and supply challenges her customers are facing each day.
James and the rest of her team at Thermo Fisher are constantly looking to grow through acquisitions and investments, while focusing on innovation in the healthcare industry. “It is making us stronger, more competitive, and helping us to fulfill our mission to enable our customers to make the world healthier, cleaner, and safer.”
One Company to Protect Them All!
Wimpy Words Are Killing Your Message
Why it’s time to toughen up.
By Brian Sullivan
 If you’re in sales, especially medical distribution, you’ve probably sat through more than your fair share of sales training. You’ve likely been told a million times that your words matter. But here’s the thing: how you use them matters even more.
I’m here to talk about a sneaky little saboteur in your sales pitch: wimpy words. You know the ones – those meek, non-committal phrases like “sort of,” “kind of,” or “maybe.” If you’re slipping these into your calls, emails, or meetings, you’re killing your own message before it even has a chance to get off the ground.
Let’s be real – if you’re saying you “sort of” recommend a product, why should anyone “definitely” buy it? Sales is all about confidence, clarity, and conviction. If you’re hedging your bets with weak language, you’re losing that crucial edge that separates the closers from the chumps.
1 Why Do We Use Wimpy Words?
We use weak language because we don’t want to sound too aggressive or be wrong. We want to leave ourselves an escape hatch in case the prospect isn’t interested. But in reality, we’re just sabotaging our message.
Let me give you a recent example: I had a virtual meeting with a guy trying to sell me some software product. We jump on the call, and what do I see? This guy has his baseball hat on backward like he’s about to drop some bars instead of closing a sale. And every other sentence? “Well, we sort of
help companies streamline their process” or “I kind of think this might work for you.” It got so bad I started thinking I should’ve taken a shot of booze every time he said sort of. By the end, I wouldn’t have remembered the product, but at least the call would’ve been entertaining. Point is, if he didn’t believe in what he was selling, why on earth would I?
2 Words to Avoid Like the Plague
Here’s a quick hit list of words and phrases you need to exterminate from your sales vocabulary immediately.
` Sort of ` Kind of ` Maybe ` I think ` Probably ` I guess ` Just (as in “I just wanted to check in…”)
If you catch yourself using any of these, take a deep breath, and say what you mean. The only thing these words accomplish is to soften your message. It’s like trying to land a punch in a pillow fight – no impact, no power.
3 Cut to the Chase
One of the best ways to rid yourself of wimpy words is to practice cutting your sentences down. We often use weak language because we’re dancing around the point, trying not to offend, or we’re unsure. Sales isn’t the place for that.
Try this: When you’re prepping for a sales call or email, write down exactly what you want to say. Then, take a red pen to it like it’s your ex’s last text. Cut out any word that doesn’t add real value.
Example:
` Wimpy: “I think our product might be a good fit for your practice, if that makes sense.”
` Strong: “Our products/services have driven real results for organizations like Mayo and Cleveland Clinic.”
5 Use Fewer Words, Make More Impact
The fewer words you use, the more powerful your message becomes. So, if you’re thinking, “Well, I guess this product sort of improves patient outcomes,” stop. Instead, try: “This product’s main benefit is it improves patient outcomes by __________” (back it up with real data and now you’re really “showing off.”)
Trim the fat. Your audience cares about clarity, confidence, and results.
6 Own Your Statements
Let’s be clear. Questions are almost always more effective than statements. But when it’s time to use statements, here’s the golden rule: if you don’t believe what you’re saying, no one else will either. Weak
Sales is all about confidence, clarity, and conviction. If you’re hedging your bets with weak language, you’re losing that crucial edge that separates the closers from the chumps.
4 Flip the Script on Doubt
If you’re worried about coming off as too aggressive, flip the script by turning uncertainty into curiosity.
Instead of saying, “I think this might work for you,” try, “Based on what you’ve shared, this solution seems like a strong fit – what do you think?” Now you’ve taken the focus off your insecurity and opened the door for dialogue.
language communicates doubt and lack of authority. In sales, authority matters. You’re the expert. So, own your statements.
Let’s try this on for size: ` Wimpy: “I think this probably might work for you.”
` Strong: “Based on what I have learned, I believe this product would be able to _______. And here’s why.
Or even better: ` Wimpy: “I was just hoping to check in and see if you might be interested.”
` Strong: “Let’s talk about how this can make an impact for you.”
7 How to Practice Confidence
So, how do you get rid of wimpy words for good? Practice. Start paying attention to your language in everyday conversations, not just during sales calls. The next time you say, “I kind of want pizza,” catch yourself. Do you want pizza or not? If you do, say it like you mean it.
Then, bring that confidence into your professional life. Record yourself practicing a pitch. Are you hedging? Are you using phrases like “just wanted to” or “maybe”? If so, cut them. You’ll be amazed at how much stronger your message sounds.
Final Thoughts: Toughen Up
Sales is tough, and it’s not for the faint of heart. If you want to succeed, you need to toughen up your language. Wimpy words are like throwing soft punches – they might get you a “nice try,” but they won’t land you the sale.
So, the next time you’re on a call or writing an email, ask yourself: Am I communicating like a sales champion or am I hedging my bets? If you’re hedging, go back and rewrite. Your message should be sharp, direct, and full of confidence –just like you. Brian Sullivan, CSP, is the author of “20 Days to the Top” and a leading voice
A Personal Touch
How MedPro and Metrex offer dealer reps a trusted partnership and superior products to meet the infection prevention needs of their non-acute clients.
The first thing Amy Empric noticed was the smell. Empric, a territory manager for MedPro Healthcare Sales Solutions, was visiting a non-acute provider that had been using two different wipes to clean their chairs and equipment at several of their facilities. Because the wipes’ chemistries were incompatible, their interaction created an odor which smelled like rotten eggs. The provider wanted to go from two wipes to one without sacrificing efficacy, so a trial was set up for a Monday. MedPro and Metrex team members arrived a day early. For the trial to be a fair comparison, they took microfiber cloths and wiped down chairs and surfaces at three different facilities so that when the client started with the Metrex wipes on Monday, they wouldn’t be mixing with the previously used chemicals. They’d have a clean slate and the fresh almond scent of the Metrex wipe product to go with it.
The trial was a success, and the client would convert their wipes at several facilities. That kind of support in trials and ultimately conversions is important because every facility has a different workflow, Empric said. “When it comes to infection prevention, some clinics are stricter than others, and if you’re comparing products on a surface and there’s a residue left, you may not have a positive outcome,” she said. “The high level of support also shows the customer that we care and are there to support them, even if it’s on the weekend, to make sure that their patients are safe and their health is not compromised, and we’re not disturbing the workflow of a very tight, delicate schedule.”
Best-in-class products and customer service
Today’s non-acute healthcare professionals don’t have time to sit around and wait for their disinfection products to dry, much less go about reapplying the product if it doesn’t remain wet for the required contact time. But with some of the older products on the market, that’s exactly what they must do.
Metrex CaviWipes™ family of disinfecting wipes provide fast and efficacious solutions with a complete portfolio of chemistries including a fast 1-minute universal contact time from their
alcohol-free hydrogen peroxide formulation. All of their “Easy As 1-2-3” line-up of wipes are fully qualified for the EPA’s rigorous Emerging Viral Pathogen Claim on EPA List Q. The EPA’s Emerging Viral Pathogen Claim is a designation that allows certain disinfectant products to be used against viruses that are not yet listed on the EPA’s approved list but are similar to known viruses. This claim is particularly relevant during outbreaks of new viral pathogens, such as novel coronaviruses.
Indeed, offering local support to ensure product is where it needs to be and when it needs to be there is a big differentiator in the Metrex/MedPro experience. The trusted relationships from the end user to the distributor rep are key in making sure the right level of support is provided. Empric said those on-site visits provide the opportunity to have open conversations with clients to clearly understand what’s important to them and what their pain points are, “because we’re not the ones
The trusted relationships from the end user to the distributor rep are key in making sure the right level of support is provided.
But for clients who make the conversion to Metrex, the product’s superior clinical benefits are just the start of the value proposition. When dealer reps partner with Metrex and MedPro in converting a client, they can expect several benefits: ` Top quality infection prevention products to meet end-users’ needs when it comes to surface disinfection, high level disinfection and instrument reprocessing. ` Access to national and/or local agreements (where applicable) to ensure competitive pricing.
` Educational materials, in-servicing, and clinical support as detailed as needed to ensure compliance with infection prevention standards and protocols.
taking care of the patients like they are every day,” she said. “It establishes a relationship, shows professionalism and passion, and allows for dialogue that makes us better because we can learn something and take it to the next meeting. Going above and beyond shows the passion we have for what we do and the products that we support.”
A reliable partnership
Dealer reps also receive several benefits of partnering with MedPro and Metrex on infection prevention conversions. McKesson Account Manager Kyle Jarma said distributor reps face a wide array of challenges and are spread very thin. As such, relationships with manufacturer partners are more important than ever. “My partnership with Metrex and
MedPro Associates allows me to keep focus, knowing I have a reliable partner,” Jarma said. “My MedPro rep, David Rawls, has always been available for customer presentations and is eager to help in any way he can. He has helped to make my job easier and that is valuable in this industry.”
Steve Schroeder, an account executive for McKesson, said the partnership with a manufacturer and their reps is an opportunity to bring new products and ideas to the end user. “It allows the customer to make informed decisions and provide better care to their patients. A partnership with Metrex and MedPro Associates allows me to focus on other projects knowing that they will handle it.”
Severin M. Chambers, a McKesson Medical Supplies, Pharmaceuticals, Lab and Equipment rep said life as a distributor rep encompasses quite a bit, from understanding pricing, to contracts, and then having a catalog of 400,000plus items for clients to choose from. The job gets difficult sometimes, but the relationship he has with Metrex and MedPro makes everything much easier. He also works with David Rawls, and Rawls has assisted on multiple occasions to not only find the right fit for Chambers’ customers, but also to help build relationships.
“We can’t be everywhere at once, and so David is able to meet with our customers and give them a level of personal attention rarely found these days,” said Chambers. “He is my first contact for every request that comes through my inbox, and always the first to respond.”
Hydrogen peroxide suitable for sensitive patient populations.
Future-proof
Fully qualified for the EPA Emerging Viral Pathogen Claim for all virus types (enveloped, large and small non-enveloped viruses) to meet current and potentially future infection prevention needs. 2
Effective
Disinfection against 67 pathogens including multidrugresistant organisms (MDRO).
Part No. Description
16-1100 CaviWipes HP (6” x 6 75”) 160 towelettes per canister
16-1150 CaviWipes HP XL (9” x 12”) 65 towelettes per canister
Neutral pH, low alcohol/quat formulation agreeable with healthcare surfaces and materials.
Future-proof
Fully qualified for the EPA Emerging Viral Pathogen Claim for all virus types (enveloped, large and small non-enveloped viruses) to meet current and potentially future infection prevention needs. 2
Effective
Disinfection against 60 pathogens including MDRO
Part No. Description
14-1100
CaviWipes 2 0 (6” x 6 75”) 160 towelettes per canister
14-1150 CaviWipes 2 0 XL (9” x 12”) 65 towelettes per canister
1. Always follow product label for special precleaning and PPE instructions.
Fully qualified for the EPA Emerging Viral Pathogen Claim for all virus types (enveloped, large and small non-enveloped viruses) to meet current and potentially future infection prevention needs. 2
Effective
Disinfection against 43 pathogens including MDRO and Clostridioides difficile spores.
Part No. Description
13-9100 CaviWipes Bleach (6” x 10.5”) 90 towelettes per canister
13-1175 CaviWipes Bracket Fits all CaviWipes canisters
A Year in Review
A comprehensive look at the breaking news topics that affected the U.S. healthcare system throughout 2024.
Editor’s note: Every week, the dail-eNews, a real-time email newsletter for those involved in the business of healthcare, covered the people, trends and topics that made headlines for the industry. The following are several stories of note for 2024.
Change Healthcare cyberattack
Change Healthcare, a data processing firm owned by UnitedHealth Group, was the target of a cyberattack by a ransomware group on February 21, 2024. The cyberattack knocked Change Healthcare offline, resulting in stolen patient personal health information, payment details, and insurance records.
After the cyberattack, some hospitals across the nation were largely unable to submit insurance claims and receive payments. The attack also made it harder for certain hospitals to provide patient care, fill prescriptions, and more, according to a statement from Rick Pollack, president and CEO of the American Hospital Association. Change Healthcare is one of the largest health payment processing companies
in the world, and the cyberattack significantly impacted the cashflow of hospitals and health systems across the nation.
The cybersecurity incident served as a reminder of the interconnectedness of the U.S. healthcare system and the urgency of strengthening cybersecurity resiliency, according to the U.S. Department of Health and Human Services (HHS). The HHS has continued to work with the healthcare industry to close all remaining gaps from the Change Healthcare attack and prevent future incidents.
The cyberattack on Change Healthcare in February 2024 resulted in thousands of physician practices, hospitals, and pharmacies left unable to submit claims or receive payments. Many healthcare facilities found
themselves unable to deliver care and facing financial collapse in the weeks following the incident, according to a September 2024 Journal of the American Medical Association (JAMA) report titled “Lessons from the Change Healthcare Ransomware Attack.”
In cyberattacks on health care facilities, downtime after an incident due to malware locking the system can significantly disrupt the delivery of care, posing a risk to patient safety. Facilities that do not have the reserves to ease the cash flow issue until
payments resume may be forced to close permanently, according to the report.
Healthcare organizations hurt by CrowdStrike
This summer, a faulty CrowdStrike update took millions of Microsoft systems offline, including those used by healthcare organizations.
A global technology outage began in the early morning of July 19, 2024, and went on to affect many industries and systems across the nation from aviation, private business, and much more. The
By the Numbers: Change Healthcare
2.5 billion
UnitedHealth Group (UHG), parent company of Change Healthcare, recorded $2.5 billion in total impacts from the February 2024 cyberattack (according to the company’s third quarter earnings), based on data from Healthcare Dive. UHG has continued to deal with the fallout from the cyberattack on its subsidiary Change Healthcare throughout Fiscal Year 2024. The company decreased its adjusted net earnings outlook to $27.50 to $27.75 per share for this year, compared with its previous $27.50 to $28 range, according to an October 2024 report.
94%
94% of hospitals experienced financial impacts from the Change Healthcare cyberattack in February 2024, with more than half reporting a significant, serious impact to their operations and financials, according to an American Hospital Association (AHA) report released in March 2024. The AHA survey additionally found that 74% of hospitals reported direct patient care impacts as a result of the cyberattack.
1/3
Estimates from UnitedHealth Group CEO Andrew Witty revealed in May 2024 that the data breach resulting from the Change Healthcare cyberattack may have impacted approximately one-third of all Americans. The incident took “several months of analysis,” according to Witty, to determine all of the impacted parties and notify them. The Change cyberattack sheds light on the healthcare industry’s reliance on online technology systems and the need for better data protection systems for patient’s personal information.
outage had varying impacts on hospitals and health systems across the country. The outage, caused by a faulty software update issued by the cybersecurity firm CrowdStrike, is widely used by health systems that run on Microsoft computers, according to the American Hospital Association (AHA).
Some hospitals experienced little to no impact from the outage, while others had significant disruptions to medical technology, communications and third-party service providers. The disruptions resulted in some clinical procedure delays, diversions or cancellations. Impacted hospitals worked to implement manual restoration of systems and the CrowdStrike patch, according to the AHA, and affected hospitals implemented downtime procedures to ensure that disruptions to patient care were minimized.
The unprecedented IT outage revealed that all industries must better prepare for third-party technology disruptions. Within healthcare, the outage caused many healthcare providers across the nation to lose access to electronic health records and other critical healthcare systems.
Global disruption to the scale of the CrowdStrike update serves as a lesson to the healthcare industry specifically of the vulnerability of technology and raises ongoing questions about our health system’s operational preparedness during mass outages.
Navigating the physician shortage
The United States is expected to have a shortage of up to 64,000 physicians by the end of 2024, according to a McKinsey & Company and AAMC survey. Current
Smooch
projections indicate that the physician deficit could grow to 86,000 by 2036. The COVID-19 pandemic exacerbated the already substantial levels of burnout among physicians, contributing to unprecedented departure from the industry. Healthcare organizations must find new ways to attract and retain physicians to keep up with patient demand.
The Physicians Foundation issued data in 2024 showing that the state of well-being remains critically low for physicians, with healthcare consolidation exacer-
bating the issue. Its latest survey, 2024 Survey of America’s Current and Future Physicians , unveils the urgent need to improve physician well-being and center physicians’ perspectives in today’s rapidly evolving healthcare landscape. Key findings include six in 10 physicians and residents, and seven in 10 medical students reported often experiencing burnout. Additionally, more than half of physicians know of a physician who has ever considered, attempted or died by suicide, according to the report.
By the Numbers: CrowdStrike
8.5 billion
8.5 million Windows devices went back online in late July 2024 after a global outage caused by a faulty update from the IT company CrowdStrike, associated with Microsoft. Microsoft confirmed that nearly 8.5 million Windows devices were taken offline by a faulty update sent out from CrowdStrike in July. 8.5 million devices represent less than one percent of all Windows devices, according to Microsoft, but CrowdStrike products are used by some of the world’s most critical organizations including airlines, federal agencies, hospitals, banks, emergency services and more, and were significantly impacted by the outage.
911
Some states reported that their 911 call centers were impacted by the CrowdStrike outage in July 2024, impacting the ability to make critical medical emergency calls. The U.S. Emergency Alerts Systems said during that during the incident, 911 lines in multiple states were down because of the outage. Impacted states included Alaska, Arizona, New Hampshire and Ohio, wherein downed 911 lines severely impacted patient services before they were ultimately restored, according to Forbes.
$20 billion
In early August of 2024, CrowdStrike stock was down almost 14%, shaving $20 billion off of the company’s marketing capitalization, according to business news source Quartz. The impacts of the July 2024 CrowdStrike technology outage likely also caused widespread negative financial impacts on the outage’s affected businesses across the U.S.
Safeguards for physician burnout identified by physicians, residents and medical students in the report included preserving physician autonomy, maintaining patient standards, increasing transparency and disclosure, and assessing long-term impact of healthcare consolidation.
The potential of AI
Artificial intelligence continued to make gains in its usage with healthcare, not only clinically but in the supply chain as well.
New research reveals more hospitals and health systems are investing in artificial intelligence (AI) to improve RCM. Sage Growth Partners (Sage), a healthcare growth strategy and marketing firm with expertise in market research, released data findings indicating that health systems and physician practices plan to invest in AI for future revenue cycle success.
Sage conducted a survey, showing results that overwhelmingly revealed that more health leaders indicated that they are planning to invest in AI for RCM within the next 1-3 years, and are expecting AI to be widespread in revenue cycles in 5 years.
Survey participants also indicated that the power of AI effectively addressed some of the most pressing RCM issues including patient payment estimations, coding, charge capture, cash flow, payer payments and denials prevention/management.
Meanwhile, BD announced new data that highlights how advanced artificial intelligence technology can help health systems better identify controlled substance diversion in the operating room. Hospital drug diversion occurs when a health care worker “diverts”
opioids or other controlled substances away from patients for personal use or sale, according to BD. The operating room is one of the highest risk areas for the diversion of controlled substances, such as narcotics used for anesthesia and pain management.
A new research study conducted at an Ochsner Health medical center and published in the American Journal of HealthSystem Pharmacy (AJHP) shows that the use of artificial intelligence in BD’s AI software can help highlight blind spots about the movement of medication in the operating room that often go undetected by current processes.
The BD system uses artificial intelligence and advanced analytics to provide visibility into the behaviors of individuals interacting with medication storage and management and pharmacy systems. There is a critical need in these spaces for AI to manage large, complex health systems with hundreds of points of controlled substance dispensing.
RhythmX AI and Sentara Health built a revolutionary hyper-personalized primary care platform in 2024 for clinicians and patients. Through RhythmX AI’s predictive and generative AI platform, Sentara Health primary care clinicians have access to clinical actions directly from the relevant clinical and payor guidelines, earlier disease detection, underlying EMR data analyses, Artisight, Inc. first implemented its AI software at WellSpan’s Surgery and Rehabilitation Hospital in August 2023 and announced an expansion of its collaboration with WellSpan Health this year in 2024. The new program will bring the remote
By the Numbers: AI
Three
Artificial Intelligence (AI) is now being used as a vital technology across the continuum of healthcare, according to the Mayo Clinic. A report from the National Academy of Medicine identified three potential benefits of the use of AI within healthcare, including improving outcomes for both patients and clinical teams, lowering healthcare costs, and benefitting overall population health. AI has been shown effective in preventative healthcare, according to Mayo Clinic, such as producing cancer screening results faster, and also as a risk assessment tool for identifying potential health conditions.
2025
The U.S. Food and Drug Administration (FDA) has now authorized nearly 1,000 new AI-enabled medical devices. The healthcare industry, however, still has many unanswered questions about the technology, including how to monitor the performance of algorithms that can adapt over time, and how to regulate generative AI tools. One of the FDA device center’s top priorities for its fiscal year 2025 is a draft guidance on AI lifecycle management and market submission recommendations for AI-enabled device software functions within healthcare.
90%
The results of a University of California San Diego School of Medicine study, published in October 2024, found an AI system using large language models (LLMs) can accurately process hospital quality measures, achieving 90% agreement with manual reporting, which could lead to more efficient and reliable approaches to health care reporting. Study researchers found that advanced artificial intelligence (AI) could potentially lead to easier, faster and more efficient hospital quality reporting while retaining high accuracy, which could lead to enhanced health care delivery overall.
nursing, remote observation, and AI services through Artisight’s Smart Hospital Platform to just over 1,000 total beds across the WellSpan Health system.
WellSpan worked with Artisight to train algorithms to respond to these specific needs in the hospital’s unique setting. The subsequent pilot program produced surprisingly positive results, according to a February 2024 press release, including a 15% decrease in patient falls, 21% improvement in patient experience scores related to nurse communication, and an 11% improvement in RN turnover.
Owens & Minor, Inc. announced a partnership with Google Cloud in September 2024 that combines Owens & Minor’s healthcare supply chain expertise with Google Cloud’s Vertex AI platform, and is aimed to enhance QSight®, a cloud-based clinical inventory management system from Owens & Minor. The partnership between Owens & Minor and Google Cloud allows QSight to help hospitals and health systems optimize how they manage the thousands of medical-grade supplies, high-value surgical implants and human tissue products required for patient care.
The technology also allows providers to more efficiently manage inventory with real-time visibility and predictive capabilities that are needed to effectively oversee complex healthcare supply chains. This technology serves to lower costs, decrease workloads for clinical staff, and help physicians make more data-based healthcare decisions
Inflation
The pressure on health systems to manage costs continued through
By the Numbers: Inflation
2.2%
Prices for medical care increased by 2.2% between March 2023 and March 2024, and the prices of all goods and services increased by 3.5%, according to an updated analysis from KFF and the Bureau of Labor Statistics (BLS) data. Prices for hospital services and related services rose – both inpatient (6.9%) and outpatient (8.3%) – as well as for nursing homes rose faster than for prescription drugs and physicians’ services (0.4% and 0.7%, respectively), according to KFF.
$25,500
The cost of employer health insurance rose 7% for a second year, according to The Wall Street Journal and a survey from the healthcare nonprofit KFF. Back-to-back years of healthcare insurance cost increases have impacted the average cost of health insurance for U.S. families. In 2024, average healthcare insurance costs reached roughly $25,500 for employees and workers across the U.S.
7.1%
The average age of capital investments for medical equipment and infrastructure, after years of remaining relatively flat, increased by 7.1% for all hospitals in 2023, according to data from Strata Decision Technology and an American Hospital Association May 2024 report. Increasing costs of critical supplies continue to impact patient care within hospitals and further contribute to rising inflation levels seen during 2024.
2024, while they navigate regulatory changes and focus on delivering high-quality patient care. The current state of healthcare value analysis (HVA) was revealed in a healthcare industry-wide survey from Global Healthcare Exchange (GHX) and the Association of Healthcare Value Analysis Professionals (AHVAP).
One of the critical challenges revealed in the survey is the persistent gap in physician engagement. Despite efforts to involve physicians in value analysis processes, 85.11% of respondents reported “less than strong” engagement. Strengthening collaboration with physicians by facilitating evidence-based discussions is essential to achieving both clinical and financial alignment.
The survey also highlighted challenges, such as the potential knowledge drain within the HVA workforce. With nearly 20% of HVA professionals possessing over 16 years of experience and many approaching retirement, this knowledge drain could create a significant experience gap. Nearly a third (29.69%) of respondents have 0-3 years of experience in the field, emphasizing the urgent need for mentorship and knowledge-sharing programs to sustain the sector.
Vizient, Inc. released its summer Pharmacy Market Outlook in July 2024, estimating the 2025 overall drug price inflation rate for pharmaceuticals to be at 3.81%. This estimate is based in part on expanding indications of previously approved medications, such as semaglutide, which increased 77% in spend since the summer 2023 Outlook.
The report also urges providers to prepare for an increased number of high-cost cell and gene therapies entering the market that
will significantly impact provider budgets and operational processes. Currently, FDA-approved gene and cell therapies range in annual wholesale acquisition cost (WAC) from $250,000 to $4.25 million for a single dose, according to Vizient. Vizient’s Outlook notes that there are close to 300 cell and gene therapies currently in clinical trials across several disease states.
to provide basic supplies, such as food, water, and toiletries, and more necessities, and colleagues at multiple Baxter sites across the U.S. have initiated clothing drives to collect cold weather gear and other items for the North Cove team, according to a Baxter press release.
The Baxter International Foundation has also donated nearly $3.7 million to support
With nearly 20% of HVA professionals possessing over 16 years of experience and many approaching retirement, this knowledge drain could create a significant experience gap.
Hurricanes and port strike
In the fall of 2024 the U.S. healthcare supply chain had to respond to two natural disasters – Hurricanes Helene and Milton – and a man-made one –a worker’s strike at U.S. ports. Hurricane Helene brought tremendous damage to several states in the Southeastern United States, including North Carolina, where a Baxter facility that produces a significant portion of the U.S. IV fluid supply was temporarily closed due to storm damage. Baxter and several other manufacturers of IV solutions announced plans to ramp up production, while healthcare providers executed conservation strategies. Baxter announced in mid October that more than 2,500 North Cove employees returned to work at normal pre-hurricane staffing levels. The Baxter team was working alongside more than 1,000 remediation contractors that have been engaged for site recovery. An employee support center established near the North Cove site continued
employees and communities impacted by Hurricane Helene, including $1.5 million in grants to three humanitarian partners and more than $2 million in funding to employees through Baxter’s Employee Disaster Relief Fund.
Meanwhile, the Longshoremen’s Association and the United States Maritime Alliance announced in early October they had agreed to a tentative deal on wages, ending a nervewracking port strike that affected businesses throughout the nation, according to CNBC. The existing contract between the organizations has been extended through January 15 to provide time to negotiate a new one. The strike was the first by the ILA since 1977, and it impacted operations at 14 different ports.
The strike had already started to impact the U.S. supply chain, with thousands of containers being brought to the wrong ports, and billions of dollars worth of goods anchored offshore because ports were not operational, according to CNBC.
From Our Share Moving Media Family to Yours
Access to Care for All
How physicians play a role in reducing healthcare barriers for individuals with disabilities.
By Jenna Hughes
 Health equity refers to all individuals having the access to care needed to be as healthy as possible. The healthcare industry plays an important role in ensuring the equitable care of people of all ages with disabilities. As of 2016, an estimated one in four (61 million) adults in the U.S. reported a disability, according to the Centers for Disease Control and Prevention’s Division of Human Development and Disability (DHDD).
There are numerous definitions of a disability; the Americans with Disabilities Act (ADA) defines a person with a disability as someone who “has a physical or mental impairment that substantially limits one or more major life activities, such as walking, hearing, seeing, has a record (or past history) of having such an impairment, or is regarded as having such an impairment.”
People with disabilities often face increased barriers to healthcare access. According to the CDC, studies show that individuals with disabilities are more likely than people without disabilities to report having poorer overall health. CDC data from 2019 also shows that compared to those without disabilities, people with disabilities have less access to health care, increased rates of depression and anxiety, and are more likely to engage in risky health behaviors more often such as smoking, or engaging in less physical activity.
Research further reveals that within healthcare, people with disabilities are less likely to receive comprehensive preventive healthcare, diagnostic imaging, and cancer screenings, according to the Centers for Medicare & Medicaid Services (CMS).
Additionally, secondary conditions such as pain, fatigue, obesity, and depression can occur because of having a disabling condition, according to the CDC, overall decreasing an individual’s overall health and quality of life and making them more susceptible to preventable health problems.
Physicians play a significant role in addressing these barriers to care by creating more accessible hospital and in-office environments.
Physical accessibility barriers
Accessibility within healthcare encompasses both doctor and patient communication and physical ability to access care. Specific patient needs should be addressed by healthcare professionals before a patient visits the doctor’s office or has a telehealth appointment.
Adults with disabilities are almost twice as likely as other adults to report unmet healthcare needs related to the physical accessibility of a doctor’s office or clinic, according to CMS. A survey from CMS of U.S. physicians found that among those seeing patients with significant mobility limitations, only 40% always or usually used accessible exam tables or chairs.
CMS, considerations for facility modifications include evaluating the entire in-office experience for patients, such as updating public transportation, parking, universally recognized symbols on signage, addressing any specific patient needs at check-in, and installing any needed safety features or office modifications in advance.
Assessing and addressing common barriers to healthcare for patients with disabilities, according to CMS, also requires eliminating any potential physical barriers within the office, discussing a patient’s in-office needs at check-in, and addressing the accessibility of exam rooms with exam tables that can be adjusted
Another way the CDC supports individuals with disabilities is by providing funding to the National Centers on Health Promotion for People with Disabilities, also known as the National Centers on Disability, to prevent disease and promote health and wellness for people with disabilities.
Inaccessible exam tables, weight scales, infusion chairs, mammography machines, and radiology equipment can impact a patient’s treatment outcomes and care quality, according to CMS. Even when an office has accessible medical equipment, patients with disabilities may still experience disparities due to lack of physician awareness about individually required accommodations, varying office rules and procedures, and physician bias.
To ensure physicians’ offices are accessible, according to
to different heights with transfer supports, lift equipment, and clear floor space next to the exam table for ease of access.
Simplifying communication
Proper communication is a key component of accessibility. Reasonable accommodations refer to any changes that a healthcare organization can provide to better serve patients with different communication needs, according to CMS.
Healthcare organizations should conduct a needs assess-
ment to understand the needs specific to their patient population, engage in active planning to more effectively meet patient communication needs, and periodically update these plans. This process helps ensure that organizations have auxiliary aids and services necessary to serve all patient populations.
Healthcare providers themselves play a significant role in the equitable care of all people with disabilities through patient communication. According to the Surgeon General’s report titled, “ Call to Action to Improve the Health and Wellness of Persons with Disabilities ,” healthcare staff should support the equitable treatment of all patients by giving each individual, including those with disabilities, all of the information needed to live a long and healthy life, listen and respond to each patient’s health concerns, give prevention and treatment advice, communicate clearly and directly to all patients, and take the time needed to meet a patient’s healthcare needs.
Taking action
There are numerous programs currently in place in support of health equity for all patients. Both the CDC and CMS have implemented a variety of programs aimed at making healthcare more accessible for patients with disabilities.
The CDC’s Division of Human Development and Disability (DHDD) monitors recent public health data to reduce the nation’s health disparities. DHDD also promotes healthy living through inclusive programs for those with disabilities and provides information to the
public and healthcare providers through the collection of data through the Disability and Health Data System (DHDS), which contains the latest data on U.S. adults with cognitive, mobility, vision, self-care, independent living, and deafness or difficulty hearing, and more. The DHDD additionally provides state-level disability data on 30 health indicators such as smoking, heart disease, receiving the flu vaccine, and more.
diabetes, asthma, and high blood pressure), and ultimately strive to increase the quality of life for people with disabilities. Each program customizes its activities to meet its state’s needs. These state programs represent a network of standardized programs committed to helping people with disabilities benefit from public health services. The states serve as communities of practice and play a much-needed role in identifying effective practices,
The states serve as communities of practice and play a much-needed role in identifying effective practices, policies, and services for people with disabilities.
Another way the CDC supports individuals with disabilities is by providing funding to the National Centers on Health Promotion for People with Disabilities, also known as the National Centers on Disability, to prevent disease and promote health and wellness for people with disabilities. Through this initiative, the CDC works with state-based disability public health programs to improve the health of populations as a whole and develop and implement public health programs for people with specific conditions. This public health strategy employs prevention efforts to help make the broadest health impact possible on the health of populations, in this case, people with disabilities.
Nineteen of the state-based programs that the CDC assists promote equity in health, prevent chronic disease (such as
policies, and services for people with disabilities.
The CMS Office of Minority Health (OMH) also offers technical assistance for health care organizations working to advance health equity, and serves as the principal advisor and coordinator to the Agency for the needs of minority and disadvantaged populations. The CMS OMH consults with Human Health and Services (HHS) Federal agencies and other organizations to collaborate on addressing health equity.
CMS additionally offers a resource inventory which provides compiled accessibility topics for physicians such as “Opening Doors to Everyone” , “Accessible Medical Examination Tables and Chairs”, “Access to Medical Care for Individuals with Mobility Disabilities,” and more from the ADA for healthcare professionals to access to better serve all patient populations.
Is Your Scale NTEP Approved?
We’ve all used scales that are NTEP certified when buying bananas at the store, since it’s critical for the weight to be accurate between the buyer and seller of the bananas. And yet a pediatric scale weighing our baby or a physician scale weighing us before surgery for assigning dosages isn’t held to the same criteria as a bunch of fruit or vegetables.
DETECTO has received NTEP (National Type Evaluation Program) approval administered by the National Conference on Weights & Measures for most of our major medical scales. How does this help you as the consumer? This verifies from a regulated governing body that our scales are manufactured to the highest accuracy and quality possible for medical scales used to treat patients.
New Requirements for Medical Diagnostic Equipment
New regulations have been issued for medical diagnostic equipment. Are your customers aware, and compliant?
 This summer, new regulations were issued that will require some evaluation of – and possible investment in – medical diagnostic equipment for healthcare providers.
On July 26, the 34th anniversary of the Americans with Disabilities Act (ADA), Attorney General Merrick B. Garland signed a final rule under Title II of the ADA to improve access to medical diagnostic equipment (MDE) for people with disabilities. The rule was published on August 9, 2024 and adopts the MDE Standards that the Access Board issued in January 2017.
Previously, on May 1, 2024, the Department of Health and
Human Services published a Final Rule under Section 504 of the Rehabilitation Act that, among other things, adopts the Access Board’s 2017 MDE Standards for health care providers who receive federal financial assistance.
The reasoning behind the regulations is to ensure that any person with a disability can receive medical treatment as conveniently, safely, and comfortably as any other patient within a healthcare setting.
Congress charged the Access Board with developing and maintaining minimum technical criteria. The Access Board is an independent federal agency responsible for developing accessibility guidelines and standards under various laws to ensure that individuals with disabilities have access to and use of buildings and facilities, transportation vehicles, and information and communication technology.
The DOJ and the HHS have adopted the Access Board’s guidelines and standards as mandatory requirements for entities subject to their jurisdiction and will be handling the implementation and enforcement of the requirements.
Bobby Stinnette, Accessibility Specialist, and Wendy Marshall, Attorney Advisor, on behalf of the Access Board, shared insights on why these regulations were implemented and what they mean for providers.
Reasons behind the regulations
All people, regardless of physical ability, should be able to receive
Building exam tables that meet the needs of more patients is behind everything Brewer does. This includes complying with the latest 17"–19" low transfer height regulations adopted by the Department of Justice (DOJ) and Department of Health and Human Services (HHS). Every Brewer power exam table meets these requirements, and can help your healthcare environment meet 2026 compliance requirements.
New regulations mandate a 17"–19" low transfer height for exam tables. All Brewer power exam tables meet these standards.
18"
medical services, the Access Board said. “Our rulemaking and the most recent Department of Justice (DOJ) and Department of Health and Human Services (HHS) rulemakings adopting the Medical Diagnostic Equipment (MDE) Standards describe the importance of accessible medical diagnostic equipment and provide firsthand accounts of instances where individuals with disabilities were unable to receive healthcare or received substandard care due to a lack of accessible exam tables, weight scales, radiological or other diagnostic equipment,” the Board said. “People with disabilities are frequently unable to receive prostate exams, mammograms, skin
Key dates
biopsies, or gynecological exams, or received incomplete physical exams because they could not transfer to an exam table.”
Congress charged the Access Board with developing and maintaining minimum technical criteria to ensure that “medical diagnostic equipment used in or in conjunction with physician’s offices, dental offices, clinics, emergency rooms, hospitals, and other medical settings, is accessible to, and usable by, individuals with accessibility needs[] … and ... allow[s] independent entry to, use of, and exit from equipment by such individuals to the maximum extent possible” 29 U.S.C. § 794f.
The MDE Standards address independent access to, and use of,
The following are dates that Repertoire readers should be aware of:
Access Board:
DOJ final rule on Accessibility of Medical Diagnostic Equipment
Used by State and Local Governments
` All MDE that state and local government entities purchase, lease, or otherwise acquire after October 8, 2024, must comply with the MDE Standards until the entities have met the amount of accessible MDE specified in the rule.
` By August 9, 2026, state and local government entities that use examination tables and weight scales must have at least one examination table and one weight scale that meets the MDE Standards.
HHS final rule under Section 504 of the Rehabilitation Act.
` All MDE that recipients purchase, lease, or otherwise acquire after July 8, 2024, must meet the MDE Standards until they have the required amount of MDE specified in the rule.
` By July 8, 2026, at least one examination table and one weight scale that meets the MDE Standards must be acquired for any facility in which such MDE is used.
MDE by people with disabilities to the maximum extent possible and set forth the minimum technical criteria to ensure that medical diagnostic equipment used in (or in conjunction with) ‘‘physician’s offices, clinics, emergency rooms, hospitals, and other medical settings, is accessible to, and usable by, individuals with accessibility needs.”
MDE covered includes examination tables, examination chairs (including chairs used for eye examinations or procedures, and dental examinations or procedures), weight scales, mammography equipment, X-ray machines, and other radiological equipment commonly used for diagnostic purposes by health professionals. This list is not considered exhaustive but is illustrative of types of medical diagnostic equipment, the Access Board noted.
The MDE Standards address diagnostic equipment by the position in which it is used by the patient. The four types are: supine, prone, or side-lying position; seated position; seated in a wheelchair; or standing position. The MDE Standards also provide technical requirements for supports, communication, and operable parts.
For MDE that is intended for the patient to transfer onto, such as equipment used in the supine, prone or side lying position or used in the seated position, the MDE Standards require the transfer surfaces to be height adjustable from a high height of 25 inches to a low height of 17 – 19 inches. There must be four intermediate heights between the high and low, with a minimum separation of one inch. (Note: The Access
Board issued a final rule, effective September 23, 2024, setting the low transfer height to 17 inches, however, this change has not yet been adopted by the enforcement agencies.)
Scoping requirements
According to a Department of Justice notice on the Federal Register, the scoping requirements for the final rule state that where public entities’ services, programs, and activities use MDE, at least 10% of the total number of units, but no fewer than 1 unit, of each type of equipment in use must meet the MDE Standards.
However, in rehabilitation facilities that specialize in treating conditions that affect mobility, outpatient physical therapy facilities, and other services, programs, or activities that specialize in treating conditions that affect mobility, at least 20%, but no fewer than 1 unit, of each type of equipment in use must meet the MDE Standards, the DOJ said.
“The rule allows public entities to use designs, products, or technologies as alternatives to those prescribed by the MDE Standards, as long as the alternatives provide substantially equivalent or greater accessibility and usability than the MDE Standards require,” the notice in the Federal Register states.
“Facilities with multiple departments, clinics, or specialties must disperse their accessible MDE proportionately. The rule also requires public entities that use examination tables or weight scales to acquire at least one accessible unit of each such category of equipment within two years after this final rule is published.”
Key points
The MDE Standards published by the Access Board in 2017, have recently been adopted as enforceable by DOJ and HHS.
For MDE that is intended for the patient to transfer onto, such as equipment used in the supine, prone or side lying position or used in the seated position, the MDE Standards require the transfer surfaces to be height adjustable from a high height of 25 inches to a low height of 17 – 19 inches. The Access Board provided the following key points to Repertoire:
` There must be four intermediate heights between the high and low, with a minimum separation of one inch.
` The Access Board issued a final rule, effective September 23, 2024, setting the low transfer height to 17 inches; however, this change has not yet been adopted by the enforcement agencies.
` On August 9, 2024, the DOJ issued a final rule on the accessibility of medical diagnostic equipment (MDE) under Title II of the Americans with Disabilities Act (ADA), applicable to state or local government entities that offer services, programs, or activities through use of MDE. 28 CFR Part 35, 89 FR 65180.
` On May 1, 2024, HHS adopted the Access Board’s technical standards for MDE as part of its recent final rule under Section 504 of the Rehabilitation Act prohibiting discrimination against individuals with disabilities by federally funded health care providers. 45 CFR 84, 89 FR 40066.
` DOJ and HHS have adopted the low-transfer surface height of 17 – 19 inches.
` DOJ and HHS have indicated, in the preambles accompanying their final rules, that they will consider issuing supplemental rulemakings under title II and Section 504 proposing to adopt the Access Board’s 17-inch low transfer height standard.
Additional resources
For additional resources or questions, the Access Board provides free technical assistance on its accessibility guidelines and standards through its helpline at 1-202-272-0080, extension 3, from 10:00 a.m. to 5:00 p.m. (ET) weekdays. For technical assistance specifically on the accessibility of medical diagnostic equipment, email mde@access-board.gov.
The Access Board has a webinar “Medical Diagnostic Equipment Final rule” that provides
detailed information on the MDE final rule.
Also, DOJ final rule is available for review on the Federal Register’s website at www.federalregister.gov.
A fact sheet that provides information about the final rule is available on ada.gov.
The HHS final rule under Section 504 of the Rehabilitation Act may be viewed or downloaded at: www.federalregistar.gov
A fact sheet on the rule is available here: Fact Sheet.
The new rulings require that any examination chair acquired must meet accessibility standards until their facility requirements 1 are met.
MTI has 8 unique chair models, the most in the market, that meet all requirements for compliance.
Contact your MTI Solutions Advisor to understand the requirements and best advise your providers.
in the standards.
solutions@mti.net 800-924-4655 mti.net/ada Transfer Surface Minimum 21” wide and 17” deep.
Entry Height Uncompressed upholstery at the highest point to floor.
1
Manufacturers Weigh in on New MDE requirements
What the rules will mean for providers, manufacturers and distributor reps moving forward.
 Repertoire spoke to several manufacturers about the MDE Standards that healthcare providers will have to adhere to following the recent final rules issued by the Department of Justice and Department of Health and Human Services.
Brewer commends DOJ and HHS on adopting recommendations
Brewer commended the DOJ and HHS for adopting the 2017 Access Board recommendations, which enhance accessibility in healthcare settings for patients with mobility challenges.
“All our power exam tables – including the FLEX High-Low Exam Table, Access High-Low Exam Table and Assist procedure table – are fully compliant with these important standards, ensuring greater access for all patients,” the manufacturer said.
Clearing up confusion about low seat height standards
There has been some recent confusion regarding low seat transfer heights that Brewer wanted to address.
“To clarify, the Department of Justice (DOJ) and Health and Human Services (HHS) have adopted the 2017 Access Board standards, which require a 17-19 inch low transfer height,” Brewer noted.
Additionally, these standards specify that only 10-20% of covered medical equipment needs to meet compliance requirements, not all equipment.
“However, contrary to some claims, the DOJ and HHS have not adopted the newer 2024 Access Board recommendation of a 17-inch height,” Brewer said. “This updated 17-inch recommendation carries no legal enforcement by any government agency at this time. If the DOJ and HHS ever do adopt the 2024 Access Board recommendation, we will ensure our products fully meet those new standards.”
Midmark: New Regulations Present Opportunity for Innovation
The new US Access Board Standards for Accessible Medical Diagnostic Equipment (MDE) will significantly impact healthcare providers, particularly in terms of providing accessibility to all patients, said Brian Vierra, Vice President, Medical Sales, Midmark Corporation. Providers will need to ensure that their examination and procedure chairs meet the new minimum required specifications, which include having a low seat height of no more than 17 inches to facilitate transfers for individuals with disabilities.
“Most examination and procedure chairs in use in the market do not meet this standard,” Vierra said. “The Midmark 626 Barrier-Free ® Examination Chair is currently the only chair available that meets the new requirement.”
Providers will need to assess their current equipment and
plan for new chairs that comply with these standards. It is also recommended that training for their staff take place to educate them on using the new equipment and ensuring a safe, accessible and positive experience for all patients.
Meanwhile, manufacturers will need to align their product designs with the new Access Board standards, Vierra said. “This creates an opportunity for manufacturers to innovate and develop new products that prioritize accessibility requirements, ultimately enhancing the experience between patients and caregivers.”
Equipment manufacturers may also want to consider increasing marketing and communication efforts to educate healthcare providers about the new standards and the products that are compliant.
1 Are you aware of the new US Access Board standards for Accessible Medical Diagnostic Equipment that went into effect in September?
2 Have you evaluated your current examination chairs and diagnostic equipment for compliance with the new seat height and transfer support requirements?
3 Are your current examination chairs able to lower to a low seat height of 17 inches or less?
4 Do your examination chairs have the required transfer supports that meet the new design specifications for accessibility?
5 Have you made plans to replace or upgrade to equipment that complies with the new standards?
6 What training have you implemented for your staff to ensure they can safely and effectively use compliant equipment?
Brian Vierra
Pelstar: Take Steps Now to Ensure Compliance
Pelstar LLC, the manufacturer of Health o meter® Professional Scales, said the new MDE regulations define standards for providers to follow that ensure equal care across a patient population. “This means they should have medical equipment that meets the new MDE standards as well as follow new guidelines for how the patient approaches the equipment.”
For example, a piece of equipment that meets the MDE standards would be an exam table with a lower transfer height or a wheelchair scale that has ramps with easy egress. A facility’s layout should also ensure there is sufficient room around a piece of equipment to be able to wheel the patient up to and around it.
Budgets will be affected as customers may need to purchase new equipment or adjust equipment purchases for future builds and allocate space differently. Though not in the regulations,
providers should also make efforts to train staff to be able to support and work safely with disabled patients to ensure a comfortable healthcare experience, Pelstar said. “These new regulations apply to all types of medical facilities including public hospitals, whether state or federally funded, and any facility receiving Medicare or Medicaid assistance.”
For facilities that do not already comply, the rules state, “Beginning October 8, all MDE (Medical Device Equipment) that state and local government entities purchase, lease, or otherwise acquire must be accessible until the entities have the amount of accessible MDE that the rule requires.” Facilities have until Aug. 9, 2026 to have at least 10% of their equipment units meeting the standards. For example, a hospital with ten scales must have at least one unit that meets the standards. If
the facility has patients that are primarily struggling with mobility issues, such as a rehab center, the % required is higher at 20% of units.
To help ensure customers are compliant with the new rule, Pelstar said distributor reps should take the following steps: ` First, the rep can ask the customer if they are aware of the new regulations. If not, they should be educated on the requirements and the upcoming deadlines.
` Next, they can discuss if the facility has evaluated its equipment and the space requirements to determine what new equipment needs to be purchased or what plans need to be modified.
` Reps can alleviate their customers’ fears, assuring them there is adequate time to meet these deadlines and that they should take their time planning before making any impulsive purchases. The equipment market will take some time to develop new products to meet the MDE standards, and buyers should be patient. To be certain if a product is compliant, buyers should look for third party certification assuring the product meets the new MDE standards.
` Most importantly, the facility needs to check with its own legal and regulatory teams before making any decisions.
The Team Up
How distributor reps can discuss the financial aspects of capital equipment sales with customers.
 Capital equipment sales take patience, preparation, asking the right questions, and – perhaps most important of all – collaboration.
In the November issue, Repertoire highlighted how distributor reps can make the most of their conversations with customers in this product category with the proper preparation and planning, understanding current market dynamics, how conversations with customers about equipment differ from other product categories, and collaborative best practices between distributor and manufacturer reps.
Part II examines how to approach the financial aspects of the conversation with customers
and follow up needed to ensure continued success.
Participating in this story are:
` Kyle Allan, territory manager, MedTech MedCare
` Kevin Barefoot, partner and director of Point-of-Care Lab and Primary Care for MedTech MedCare
With capital equipment, people like to buy from those they trust, said Dominic Seymour, MedPro Healthcare Sales Solutions. “So building those relationships, having impactful meetings – not just check-in meetings – but being able to bring something to the table for a certain facility upon every meeting is really important, such as introducing a new piece of technology that might offer them an additional revenue stream. That’s a great way to build trust.”
Trust is also built from presenting customers with frank conversations on deliveries and delays. “If I’m sitting in a capital distribution rep’s shoes, offering lead times on capital equipment is important, but so is understanding the shortages that are out there.”
It’s important to know what’s important to your client. You might have one customer that’s a research hospital that cares a lot about having the latest and greatest piece of technology, and price is no object. But, down the street, you’ve got a different hospital that’s more price conscious. “One size doesn’t fit all; understand each of your customers in depth, how they pay for things, how they budget for things, all of the above,” Seymour said.
Don’t start with price
Probably the biggest pitfall Seymour sees in capital equipment sales is when a rep starts with price, whether it’s the lowest price or the highest price. “I’ve seen certain reps go in super low to just try to win the business, only to have the customer not get their needs satisfied,” he said. “I’ve seen other reps go in with the highest because they want a higher commission, but they are totally overselling it. They still might get the deal, but in the end, the customer is going to be feeling that pain on the back end.
“I don’t want to talk about price right away,” Seymour continued. “I tell them these things are pretty intricate. There are lots of levels and options.”
If a customer is demanding price right away, Seymour recommends offering a ballpark figure with multiple levels – a high, mid and low option. “Offer them some aspects of each and then explain that you’d like to have a deep dive into what their needs are so that you can figure out what the appropriate solution is for them.”
Usually that’s a great starting point, as long as the customer knows that you’re trying to work with them to get them to the right spot. It adds to their level of trust with the rep, that you’re not just in it for a quick sale, but you’re in it for the betterment of their facility and oftentimes their community. “Some of these hospitals are very small and their community relies on them,” Seymour said. “So, some of these are big purchases for these facilities, and it’s got to feel good for them to know that their rep and/or their distributor is looking out for their best interests rather than their own.”
More than just price
It is important to understand that the financial discussion is more than just price. That is of course part of it, but ROI, operational efficiency, regulatory compliance, patient satisfaction, patient outcomes, staff engagement, total cost of ownership, reliability/ up time, reducing waste and risk avoidance are critical components in the total financial picture of the customer’s equipment purchase decision that must be considered, said Jake Barga, Midmark.
with an easily digestible email containing all necessary details: product numbers for distribution to quote, images, lead times and links to product landing pages. The manufacturer representative takes on the responsibility of explaining the rationale behind design choices and the price differences among various product offerings and options to the client. This is accomplished in a follow up, in-person or virtual meeting to agree on the details prior to order placement.”
Price transparency is critical to mutual customers. Whether they are considering a replacement purchase or planning a new build, it’s essential to make sure that contracts are current.
“Manufacturing reps can provide tools and content that empower the customer to make well-informed, data-driven business decisions through various means such as detailed proposals, ROI and TCO calculators, case studies, white papers and executive summary proposals as well as in-person and virtual sessions to share market insights and trends,” he said. “Thoughtful questioning and zeroing in on what’s going to make the customer’s facility more efficient and profitable is ultimately what we’re looking to accomplish together.”
Price transparency is critical to mutual customers. Whether they are considering a replacement purchase or planning a new build, it’s essential to make sure that contracts are current.
“At Midmark, we typically follow up initial discussions
Finances: Do your homework
When it comes to preparing for the financial details of the discussion, customers understand that equipment costs money and that the purchase is essentially an investment. “Yes, the conversation can be challenging, but going in with a confident mindset in the product and the preparation you put in will give the end user confidence that your product is worth listening to and hearing about,” said Kyle Allan, MedTech MedCare. “If you’re just focused on selling the product and blabbering about features and benefits, your win rate is going to be lower. If you approach a sale by uncovering the end user’s needs and winning their trust, the conversation is going to become a lot easier.”
Reps must understand the customer’s budget and their internal approval process to get
a sense of how interested they are. “There are a lot of backend things that we’re not privy to right away, but if you do some investigative work to understand those aspects better, it will help you better guide the sales conversation.”
reputation. “Going above and beyond I believe is necessary to differentiate yourself,” said Allan. “Constant communication and follow up with the manufacturer, distributor, and/or end user is necessary from the procurement
Reps must understand how providers are planning to pay for a piece of equipment. “Whether it’s a third-party financing, whether they’re going to pay cash for the whole thing, who’s got to approve it?”
Homework and due diligence matter. Resources like trade magazines, local news reports, hospital directories, LinkedIn, and construction reports can help reps uncover what it is about the customer that makes them who they are, find out where they went to school, find out their background, etc. “Those are little things, but important, because at the end of the day it’s relationship building,” Allan said. “You don’t want just one order, right? You want to develop a long-term relationship that is almost like a friendship, so when that customer becomes close to you, your success rate goes up. You can’t go wrong with a deep knowledge base.”
Knowing where your product pricing falls into the market is also key. Financial constraints are real, so if your product is more expensive than your competitors, does the end user know why that is? Is there a better warranty? Are there clinical benefits?
Love the logistics
Mastering the logistics of the entire sale is going to help your
periods and timelines of delivery, dates and installment methods –all these things work successfully in tandem to build a full successful sales story.”
If a new install renovation build is successful, customers can trust you with a project of any size. You need to also understand where your product falls in the market. “As a manufacturer rep for a multitude of capital product lines under MTMC, we represent top names and compete against top names,” he said. “Knowing how to sell against your competitors via the GPO advantage, actual clinical advantages and the features is so important.”
Understand their options
Reps must understand how providers are planning to pay for a piece of equipment. “Whether it’s a thirdparty financing, whether they’re going to pay cash for the whole thing, who’s got to approve it?”
A lot of times there are category managers, value analysis managers, and multiple levels of people involved in the purchase, Seymour said. “Ask
the right questions up front, and always go into those meetings super prepared with a full list of questions already thought out,” he said. “I would never fly by the edge of my seat and just say what comes to me. I would always go in very prepared with questions that get me to the spot where I think I could actually offer them a set of quotes.”
How does the customer like to buy?
The financial part of the sale starts in the pre-call planning phase of the discussion.
“Unfortunately, this is the area most salespeople gloss over,” said Jonathan Bowman, ZOLL. “Knowing how the customer typically makes purchases is key.” With CRM’s today, there is no reason why a salesperson should not be prepared with past purchasing from the customer.
As an example, Bowman recently needed a part for his RV immediately. He called three places. The first two provided no options other than he should call another one of their stores. The last one Bowman called not only found what he was looking for at another location, but they offered to get it the same day. While on the phone, the customer service rep asked this question when cost came up: “To make things easier on both of us, what are you seeing on Amazon?” Bowman was driving and couldn’t look, so the service rep did it for him and matched the price instantly. “What’s the lesson? Be prepared, know your customers better than they know themselves,” Bowman said. “This comes from asking questions, I can’t stress that enough.”
“Quote less. Sell more.”
Bowman said he learned this phrase from one of the best big deal closers he ever worked with. It simply means try and avoid giving a price before demonstrating your product. This will be difficult to do in most cases. “But again, asking good questions and helping the customer to see that a quote is not the first step but rather the last step,” he said.
The quote should summarize all that was agreed upon during the sales process. “If we are just an order taker in the eyes of the customer, then our strategy will be ‘quote and hope,’ and hope is not a strategy.”
Therein lies the key. Have a plan (strategy) with each customer and each rep you work with. Don’t assume they will buy your product because they have purchased from you in the past. “You can’t avoid all pitfalls, but not having a plan/ strategy is like taking a trip cross country and only using a foldout map,” Bowman said. “Use all the modern resources you have. Most GPS today will tell you what to avoid, construction areas, accidents and weather. Having a good plan and executing on that plan by using all the resources available to you today is tantamount to being successful.”
Be honest
There are times when, to gain trust, Kevin Barefoot, MedTech MedCare said he isn’t afraid to refer the competition. “There are times when we just don’t have a fit and I know it could cause a problem for them,” he said. “It could be for a scale, it could be for a certain kind of table, it could be a certain kind of diagnostic device, but I know that’s going to make
the customer trust me more and understand that I have their best interest at heart.”
Learn from your mistakes
Do not over promise and under deliver. “I kind of chuckle, because we as manufacturers or distribution reps can agree, we all mess up sometimes,” said Allan. “We’re never perfect. Nobody’s perfect. Especially in this job where we’re pulled in so many different directions and we only have so many hours. We get very eager in the beginning stages of a big sale.”
reps, show up on site for a big shipment to make sure everything is good and nothing is broken,” Seymour said. This also allows the rep to leverage new meetings because of their on-site presence. They’ve just helped them with the project successfully, so it opens up additional discussions about future projects, he said.
“Strike while the iron is hot. Once you’ve helped them with something, don’t let it go. Try to figure out how you can be of more service.”
“It sounds cliche but walking out of an account knowing you have a satisfied customer, and the potential earnings that comes with results like that ... it’s an empowering feeling.”
Allan said he has been victim to letting the excitement and eagerness carry over into the post-sale process where it created unnecessary problems. “So, whether it is miscommunication on delivery timelines, installment requirements, or missing parts needed to make our equipment run, learning from our mistakes is key,” he said. “I’ve learned that slowing this process down and being thorough is the best way to go about it. Yes, a quick turnaround time or a deadline is important to meet, but if you blindly quote before finding out a customer’s true wants and needs, you sometimes can find yourself in a sticky situation that really could have been avoided.”
The power of presence
“Some of the best reps that I see, both reps and distributor
Do your part
Allan said he treats his distributor partners like customers. “When it comes to distribution, they have an array of equipment they can touch and sell,” he said. “Why should a distributor rep push my equipment? Find out how they’re incentivized and find out if your equipment can increase their bottom line, but also be someone they can rely on and trust. Response times, quick access to your product information and SKUs, being there for the delivery or training – these are all things that you should include in your approach.”
Get the details right, he said. “When we’re delivering tables, for instance, I wipe them down, all the dust is cleaned off and everything is all good, so I know the delivery is clean. When it comes to the end users, we’re brought
in as the clinical experts on our product, so that is our chance to show why our product can meet their clinical needs. Sometimes the product can sell itself, but they’re also investing in your reliability and service. You have to do your part as a rep to make sure that not only the equipment is up to speed, but everything pre and post is intact.”
Ear to the ground
MTMC represents a lot of lines from well-known brands, and not just in capital equipment. “Those lines can help me gain an audience,” said Barefoot. Barefoot will often be in front of the customer to discuss a well-known brand
a COVID/flu combo test.’ Next thing you know, we’re talking to them about equipment.”
The joy in a job well done
The hunt for equipment sales is fun, but the satisfaction of helping somebody with a really big solution and knowing you did a good job is extremely rewarding over things like disposable sales, said Seymour. “Some of these projects can be extremely rewarding, but they can also hurt. You could work on a project for three years, only to lose it in the end. There are no points for second place.”
But finally getting to the finish line, establishing firm relationships and then helping
“ It is satisfying to know your customer is going to be sitting nice with your product in there. Some of those relationships that you cultivate over big deals are the ones that last the longest.”
when the opportunity comes up to propose product lines he has for other categories. It could be autoclaves, colposcopes, women’s health equipment, AEDs, etc. “It could turn out that I’m in a meeting with them about a more aggressive tier for, say, their flush syringes or safety hypo needles, and then we start talking about their sites and need for AEDs,” he said. “With the portfolio we have, it’s amazing. I could have somebody that I talked to just checking in to see if they need COVID/flu combo rapid test. I may call their distributor rep and say, ‘Hey, I’m going to reach out to this person and just see if they are looking at doing an early stocking request of
them through a high dollar sale, “there’s really not much more gratifying in sales because of the amount of effort that you’ve had to put in and oftentimes a lot of your own money,” he said. “Being an independent rep, we have to spend our own dollars to cultivate these. So sometimes over the course of a two-year deal, you’re spending a lot of time and money traveling to help customers. It’s important to put your best foot forward up front and make sure that you’re doing everything you can to get that sale for you and your family, for your manufacturer.
“But also, we believe in what we sell,” Seymour continued. “It
is satisfying to know your customer is going to be sitting nice with your product in there. Some of those relationships that you cultivate over big deals are the ones that last the longest. There are people I met eight plus years ago that I helped with a big deal, and they’re still good customers today because we had to meet so often about some of those projects. So just like fishing, catching the big one is always very nice, but sometimes it takes a lot of time to do so.”
How to be dangerous
Equipment sales brings something new every day. “It sounds cliche but walking out of an account knowing you have a satisfied customer, and the potential earnings that comes with results like that ... it’s an empowering feeling,” said Allan. “It’s why most of us are in the business, to earn for our family, and for me personally, it’s part of my competitive nature. As a rep, it’s exciting to work with so many different types of positions and people, from c-suite executives to an admin in an office or clinic and everyone in between.”
Reps have to learn how to call on all these different markets and people and call points. “But that can make us really dangerous in our role, because we have the diversity and ability to sell to different markets and people,” he said. “You become a jack-of-alltrades, and in reality that’s what makes us successful as manufacturer reps – we have a knowledge base with so many different products and we’ve learned so much over the time that we really can be trusted for all different types of sales situations.”
The Disruptors Disrupted
Retailers find primary care tough sledding.
By Daniel Beaird
 Entities trying to disrupt the healthcare industry is nothing new. But consumerism, digital innovation, labor shortages and rising costs have driven more to enter the space in efforts to offer value-based care. These include commercial healthcare providers (CHPs) like tech companies, payers, retailers and senior-focused primary care providers.
Some of the most recognizable names in retail like Walmart, Walgreens, CVS Health and Amazon have tried to disrupt the primary care industry recently only to see considerable challenges. This year’s shortcomings were led by Walmart Health’s closing of
all 51 of its primary care health centers across five states. That was a marked difference from what the retail giant said in 2023 when it announced it was expanding and would have almost 80 Walmart Health primary care centers in seven states by the end of 2024.
For those in primary care, Walmart referenced a familiar refrain – a challenging reimbursement environment and rising costs – that led to closing all of its health centers within a 45- to 90-day span from its announcement last April. Locations closed
in Arkansas, Florida, Georgia, Illinois and Texas. Other retailbased CHPs saw difficulties too. Walgreens closed many of its VillageMD clinics, CVS Health cut its earnings outlook for 2024 amid spending billions of dollars on its Oak Street Health seniorbased clinics and Amazon cut hundreds of roles in its healthcare division, including in its primary care company One Medical.
Walmart admitted in a press release that there wasn’t a sustainable business model for it to continue. The complexity of scaling a clinical operation proved harder than anticipated, but the big box retailer continues to operate its pharmacies and vision centers. The timing of the pandemic and rising labor costs and real estate
costs, along with health insurance burdens like complex billing, prior authorizations, denials and appeals, all played a factor in the perfect storm of closures.
More primary care closures
Walgreens is considering fully selling its stake in VillageMD as the company is evaluating its options amid VillageMD’s ongoing and expected future cash requirements, Walgreens Boots Alliance disclosed in a filing with the Securities and Exchange Commission (SEC). It invested $5.2 billion to acquire a controlling stake in VillageMD in 2021, doubling its stake in the primary care provider at the time.
But it lost almost $6 billion in the second quarter of 2024 as
VillageMD’s value plummeted. Like Walmart, Walgreens had originally planned to expand VillageMD with more locations inside existing Walgreens stores. It had over 200 such locations in 2023 but reevaluated its position in primary care after its healthcare division experienced $1.7 billion in operating losses.
Last fall, it announced plans to close 60 underperforming VillageMD clinics and exit five markets. But after the second quarter numbers this year, Walgreens planned to cut over 160 clinics and focus on locations in heavily populated areas where patients can be treated by a single doctor.
Positioned differently
CVS Health owns major insurance plan Aetna, and has large health services, pharmacy and wellness divisions. It’s positioned a little differently than Walmart and Walgreens. But media reports have said that CVS management has discussed the idea of breaking up the company to improve its operations, while being pushed by a major hedge fund investor. That includes its drug stores and its pharmacy benefit management company Caremark and Aetna. It also includes its clinic operator Oak Street Health, a senior-focused primary care provider that’s become a scalable model serving the over age 65 population.
CVS Health bought Oak Street Health in 2023 for over $10 billion and is rolling out a new format in U.S. markets featuring Oak Street Health clinics next to CVS pharmacies in reformatted drug stores. Oak Street Health’s success has been built around the Medicare Advantage product while also using
technology in conjunction with in-person care. However, it’s faced its own challenge as it’s agreed to pay $60 million to resolve allegations that it violated the False Claims Act by paying kickbacks to third-party insurance agents in exchange for recruiting seniors to Oak Street Health’s clinics.
Retailers are learning painful lessons about the healthcare industry, according to the AHA. It’s expensive and primary care can’t be viewed as just a profit center. Providing patients highquality primary care doesn’t leave much room for profit. Building a positive primary care relationship is key to higher quality, personalized care with early
identification of risk factors for disease and coordination and continuity of care.
But CVS Health and Amazon both continue to invest in their healthcare strategies, and their healthcare aspirations extend beyond primary care. Amazon has invested heavily in the healthcare supply chain, cloud services, pharmacy and artificial intelligence (AI). It also acquired One Medical in 2023 for $3.9 billion for its primary care model, which has close to 250 clinics in over 20 U.S. markets and expanded a year after Amazon’s acquisition.
CVS Health has been an aggressive investor, but it recently announced plans to cut $2 billion
in costs over the next few years due to rising medical expenses. Its health insurance subsidiary Aetna has performed poorly, including a 39% dip in second quarter operating income. But its health services sector continues to drive significant revenue with over $42 billion in the second quarter and near analyst expectations.
More than 100 million Americans lack access to primary care, according to the National Association of Community Health Centers. Addressing this group and their needs is open for disruption. But it’s difficult and it must be met where the patients are to excel. Only the most committed disruptors can succeed.
Cleveland Clinic and Amazon One Medical announce collaboration to expand access to care
Cleveland Clinic and Amazon One Medical recently announced the organizations are collaborating to deliver seamless primary and specialty care in Northeast Ohio. Amazon One Medical, a hybrid virtual and in-person primary care organization, will open its first primary care office in affiliation with Cleveland Clinic next year, offering same and nextday appointment availability, onsite lab services and wrap-around virtual care support for members.
This new relationship will ensure that patients have increased access to seamless coordinated care through Amazon One Medical’s innovative care model and Cleveland Clinic’s high-quality network of specialists, hospitals, and facilities, according to a release.
“This collaboration demonstrates a shared commitment from both organizations to meet the needs of our patients and to enhance the care we provide to our communities,” said Tom Mihaljevic, M.D., Cleveland Clinic CEO and President, who holds the Morton L. Mandel CEO Chair. “Amazon One Medical will complement our current primary care offerings, enabling patient access to essential health services.”
Amazon One Medical is designed to improve the patient experience at every touch point, including thoughtfully designed offices, convenient appointments and ample time between patients and their providers. Members also enjoy 24/7/365 virtual care services through the Amazon One Medical mobile app, including on-demand video visits, secure provider messaging, “Treat Me Now” digital assessments for common health concerns, easy vaccine and medical record access, prescription renewals and proactive reminders for follow-up care and referral needs.
“We look forward to collaborating with Cleveland Clinic to deliver a high-quality patient experience and seamless continuation of care across all settings to deliver the highest levels of health, care, and value,” said Trent Green, Chief Executive Officer at Amazon One Medical. “Teaming up with Cleveland Clinic advances our mission of improving the health care experience, bringing our human-centered and technology-powered model to individuals and employers in the greater Cleveland area.”
Pressure Rising
How proper blood pressure measurement techniques can help contribute to more accurate hypertension diagnosis.
 High blood pressure, also known as hypertension, is a critical, nationwide issue. Nearly half of U.S. adults have hypertension, according to the American College of Cardiology (ACC) and the American Heart Association (AHA). Hypertension occurs when the force of blood flowing through an individual’s blood vessels is consistently too high. If left untreated, the condition can cause heart disease, stroke, and other serious health complications.
Guidelines from the American Heart Association/American College of Cardiology outline four blood pressure (BP) categories that are based on the average of two or more in-office BP readings for a patient. These include normal BP (less than 120 mm Hg systolic BP (SBP) and less than 80 mm Hg diastolic (DBP), elevated (120-129 mm Hg SBP and less than 80 mm DBP), stage 1 hypertension (130-139 mm Hg SBP or 80-89 mm Hg DBP), and stage 2 hypertension (greater than 140 mm Hg SBP or less than
90 mm Hg DBP). High BP is typically symptomless and can quietly damage blood vessels, leading to severe health issues including heart failure, stroke, peripheral artery disease (PAD), abdominal, aortic aneurysm, CVD incidence and angina, myocardial infraction, and more.
After diagnosis in a hypertensive category, physicians should establish best practices to address a patient’s uncontrolled or high BP, according to the AMA, and create an action plan for further treatment.
Combatting hypertension
Timely diagnosis is key to addressing and treating high blood pressure. Hypertension can present in an individual in a variety of different ways, including sustained hypertension, white-coat hypertension, and masked hypertension.
Sustained hypertension occurs when an individual’s blood pressure is elevated regardless of the setting or circumstances, while white-coat hypertension is elevated blood pressure in a medical setting, but normal blood pressure when it is measured at home/ during the day. On the other hand, masked hypertension occurs when an individual’s blood pressure is normal in a medical setting, but high when taken at home. Whitecoat and masked hypertension are inaccurate blood pressure readings caused by the external environment. Of the hypertensive population, 77.5 percent have sustained hypertension, according to the Centers for Disease Control and Prevention and Baxter, which is why it is important to regularly measure BP both at doctor’s appointments and at home.
The positive is that hypertension is manageable, but only one in four adults in the U.S.
have hypertension under control, according to the CDC and a Baxter infographic titled “Combatting Hypertension Misdiagnosis with Your Technique.” Following the recommended guidelines for accurate blood pressure measurement includes maintaining proper measurement technique, averaging several readings over time, and using tools such as automated blood pressure devices. These “Three T’s:” technique, time, and tools, according to Baxter, serve to help improve the accuracy of blood pressure readings.
Blood pressure accuracy starts with proper technique when taking a patient’s vital signs. The wrong cuff size, incorrect cuff placement, improper patient positioning, not allowing the patient to rest, verbal conversation while
the appointment, and have the patient use the restroom prior to the measurement. When measuring BP, the individual should be instructed to roll up their sleeve, refrain from talking and remain still, sit in a chair with back support, and uncross their legs with their feet flat on the floor.
Physicians should also choose the right cuff size for each individual patient and ensure the cuff’s proper placement. About 39 percent of people misclassified for hypertension were wearing a cuff size that was too small, and 22 percent missed as being hypertensive were wearing a cuff size that was too large, according to Baxter and an American Heart Association study titled “One size does not fit all: impact of using a regular cuff for all blood pressure measurements.”
A small reduction in systolic blood pressure can be beneficial to a patient’s overall health. Just 20 mm Hg higher SBP and 10 mm Hg higher DBP are associated with doubling the risk of death from stroke, heart disease, or other vascular disease according to the CDC and Baxter.
testing, and measuring a patient with a full bladder, can all lead to incorrect BP measurements. Proper technique and the right tools can help physicians achieve more accurate BP results.
Proper BP technique
For better blood pressure readings, clinicians should prepare the patient in advance by asking them to avoid smoking, exercise, and caffeine for 30 minutes before
Clinicians should start a BP measurement by first allowing the patient to rest for five minutes, then place the middle of the cuff on the patient’s bare upper arm over the brachial artery. Leave room for no more than two fingers between a patient’s arm and the cuff and rest the patient’s arm on a flat surface with the cuff at heart level. Then, select the best method for the reading, as utilizing the proper tools reduces error associated
with BP measurements, according to Baxter. Options include an automated office blood pressure (AOBP) device with BP averaging, as recommended by the AHA. Take at least three BP readings, one to two minutes apart.
Some AOBP devices can automatically take multiple readings or take unattended readings without a clinician in the room, allowing for those patients with white-coat hypertension to have a more comfortable environment. AOBP devices also allow for automated data collection and faster results for patients.
Finally, physicians should record each BP reading, calculate the average (under or overestimating BP can result in misdiagnosis), and share the results with the patient.
Physicians should consistently observe and reinforce the proper
techniques for BP readings, be conscious of white-coat hypertension, check recorded BP reading for a terminal digit pattern, and consider trying automated vital sign readings.
Prevention and treatment
A small reduction in systolic blood pressure can be beneficial to a patient’s overall health. Just 20 mm Hg higher SBP and 10 mm Hg higher DBP are associated with doubling the risk of death from stroke, heart disease, or other vascular disease according to the CDC and Baxter.
However, just a slightly lower systolic BP has a significant health impact, according to Baxter, as 5 mm Hg lower systolic BP resulted in a 16.3% reduction in age-adjusted hypertension rates among adults 18+.
Physicians can encourage patients to reduce their hyperten -
sion risk by exercising regularly, eating healthily, and treating and controlling other conditions such as diabetes mellitus, dyslipidemia and hypercholesterolemia.
Patients should also quit smoking, limit alcohol consumption, and get enough sleep for their cardiovascular health. Early prevention, detection, and treatment can reduce an individual’s risk of hypertension, and healthy lifestyle choices such as these can help reduce the overall lifetime risk of high blood pressure.
Editor’s note: Repertoire would like to thank Baxter for its assistance with the article.
Notes: US-FLC45-240066 (v1.0) 10/2024
Baxter is a trademark of Baxter International Inc.
A Top-Heavy Return to Profitability
Kaufman Hall report shows top hospitals separate through outpatient services.
By Daniel Beaird
 Four years after the Covid-19 pandemic ravaged hospital finances, some are starting to return to profitability, although unevenly. Growth has accelerated for the top one-third of hospitals and significantly outpaced the rest, which have stagnated or worsened.
Repertoire recently spoke to Erik Swanson, senior vice president of data and analytics with Kaufman Hall about its recent National Hospital Flash Report that sampled both actual and budget data over the last three years from more than 1,300 hospitals on a recurring monthly basis. It partnered with Syntellis Performance Solutions, now part of Strata, on the report, which is a representative of all hospitals in the U.S. both geographically and by bed size.
Data shows relatively stable margins as patient volume has increased, but once adjusted for volume, revenue and expenses have also declined. While
expenses are still high compared to previous years, the growth rate is slowing down.
“But the spread between the top performers and the bottom ones has really grown,” Swanson said. “However, it’s not broadly based on geography and size plays less of a role than one may think.”
Size still matters slightly, and some larger health systems outperform those that are smaller, but it’s not universally clear cut that as size and scale increases performance does too. It plays a role at the upper echelon, according to Swanson, but more importantly health systems that have a large or mature ambulatory footprint outperform those that do not.
“Outpatient revenue composition is probably the largest indicator of performance,” Swanson said. “Those that have outpatient-type departments really outperform.” He adds that keeping labor costs down particularly through contract labor utilization also plays a key role in an organization’s performance.
“Labor rates have increased continuously over the last several years, but organizations that raised their employee rates early were able to outperform those that didn’t because they were able to retain their talent better than others,” he explained.
However, he returns to outpatient footprints and those
Erik Swanson
that offer ancillary services like laboratory, imaging centers, pharmacy and more that have seen better performance. “Post acute care has helped mitigate pressures related to inflation and those systems that have at least some connections to their own post-acute sites of care tend to outperform,” he said.
Stabilization, utilization
As conditions continue to stabilize, health systems are beginning to get a better idea on what might happen in the future.
“That’s been a little unpredictable over the last few years,” Swanson said. “But organizations are starting to take steps toward future planning, capital needs, strategic deployment of capital, management of expenses and utilization. Then, care pathways and care transitions are incredibly important right now for organizations.”
Price challenges related to goods and services remain sticky due to inflationary pressures. But while prices are still high, utilization is better.
“We’re returning to normal patterns and acuity of patients, which is good,” he said. “But as patients continue to seek more care in ambulatory settings, the acuity of the patients coming into the hospital is going to continue to rise. So, the sicker acute patients will be cared for in those hospital settings and that requires a greater utilization of goods and supplies, including drugs, that are more expensive.”
Swanson says an aging population with chronic conditions will require more specialty pharmaceuticals that cost more, so those challenges will persist for hospitals.
“The name of the game will be organizations understanding how they put patients into the appropriate sites of care to treat them and hopefully at the lowest cost,” he said. “But recognizing that hospitals will continue to have some real pressures as patient populations age and the acuity rises.”
Ongoing labor headwinds
As the patient population ages, labor shortages persist and those that are best able to deploy their staff to meet their needs most effectively are ahead of the curve. Some are leveraging data and using methods like workforce optimization and others are determining how to use the staff they have to cover demand through predictive analytics.
“That has really borne a lot of fruit for organizations doing that,” Swanson said. “Those that generally build up their internal flow pools and resources of nurses and other staff that can effectively move across units or even across states in very large systems tend to outperform organizations that don’t have that in place.”
Some health systems are partnering with local nursing schools and even high schools, according to Swanson, to build up their workforce pipelines. That can stretch from being affiliated with some schools to helping sponsor some educational programs in those schools.
“But there’s still wage pressure across all spectrums of skill level,” he said. “Organizations
are competing against Amazon fulfillment centers and other companies in the community for lower paid staff. We see it a lot in physician offices with front office staff but there’s also some wage challenges with physicians, so it affects everyone.”
Two-thirds still operating at margins below zero, merger volume rising
Those wage pressures affect all health systems and 40% of hospitals in Kaufman Hall’s National Hospital Flash Report are still operating at margins below zero. Can they remain independent? That’s the question they’re asking themselves.
“The challenges hospitals faced during the pandemic were
pretty universal,” Swanson said. “But the recovery has been very uneven. The expanding divide between the top and bottom performers is interesting and it’s leading to growing hospital mergers.”
Larger health systems are seeking to acquire and partner with smaller ones as there were 31 announced hospital mergers in the first half of 2024 and 65 announced deals in 2023. That was up from 53 in 2022, according to Kaufman Hall. Smaller health systems that are struggling financially are also pursuing mergers before their status worsens.
“While we’ve seen years of increasing performance post pandemic, those median levels of performance are still below that of pre pandemic levels,” Swanson
“We’re returning to normal patterns and acuity of patients, which is good. But as patients continue to seek more care in ambulatory settings, the acuity of the patients coming into the hospital is going to continue to rise. So, the sicker acute patients will be cared for in those hospital settings and that requires a greater utilization of goods and supplies, including drugs, that are more expensive.”
noted. “The concentration of growth is really in the top onethird of hospitals.”
The volume grew significantly in the third quarter of 2024 with 27 announced transactions. Eleven of the transactions involved Steward hospitals and one of those 11 –Health Care Systems of America’s assumption of operations at eight hospitals in Florida, Louisiana and Texas – was among the four mega merger transactions announced in the third quarter. The others were:
` Florida-based Orlando Health’s announced acquisition of Alabama-based Brookwood Baptist Health from Tenet.
` Prime Healthcare’s planned acquisition of eight Ascensionowned hospitals in Illinois.
` The intended combination of South Dakota-based Sanford Health and Wisconsin-based Marshfield Clinic Health System.
According to Kaufman Hall’s M&A Quarterly Report: Q3 2024, the various transactions involving Steward Health Care facilities illustrate the current state of the market, while other announced transactions represent continuing themes of portfolio realignment and expansion into new markets.
The quarterly report states notwithstanding the financial difficulties facing all Steward facilities in the wake of the parent company’s bankruptcy, attractive assets are finding buyers in established, regional not-for-profit health systems that see opportunities for expansion and growth.
As finances begin to stabilize at least for some hospitals, health systems are finally seeing a clearer path forward four years after the Covid-19 pandemic.
STAND OUT
Healthcare is in crisis. Prices are soaring. Resources are being stretched and quality patient care cannot be compromised.
Partnering with Mölnlycke is a step toward better outcomes for you, your customers, and their bottom line.
QuidelOrtho receives FDA clearance for its Vitros® Syphilis Assay
With syphilis rates surging in the U.S., the need for comprehensive and accessible testing solutions is greater than ever.
Syphilis rates have surged recently, according to the Centers for Disease Control and Prevention (CDC), contributing to the sexually transmitted infection (STI) epidemic that has shown no signs of slowing in the U.S. Chlamydia, gonorrhea and syphilis reached over 2.5 million reported cases in 2021 with syphilis rates increasing nearly 32% for combined stages of the infection from 2020 to 2021. Cases of congenital syphilis rose by 32% during that time and resulted in 220 stillbirths and infant deaths.
With over 176,000 new cases of syphilis reported annually, a 36% increase in the prevalence of primary and secondary syphilis since 2021, the need for comprehensive and accessible testing solutions has never been greater. Syphilis is an STI caused by the bacterium Treponema pallidum (TP), which has a four-phase life cycle. Early detection and treatment of syphilis infections are important to prevent damage to the nervous system and to prevent spreading the bacteria to others. However, disruptions in STI-related prevention and care activities related to the U.S. response to the COVID-19 pandemic had a pronounced impact on trends in STI surveillance data.
The CDC says the nation must deepen its commitment to turn the STI epidemic around and prioritize both the increased involvement of multisectoral programs and groups and the creation of innovative prevention approaches and promising new tools. This includes making
STI testing and treatment more accessible, including through the development and approval of point-of-care rapid tests and selftests, and by expanding ownership for STI testing and treatment to more organizations and settings.
QuidelOrtho’s Vitros syphilis assay strengthens its position in infectious disease testing
QuidelOrtho Corp.’s infectious disease test portfolio spans the
healthcare continuum from pointof-care settings to high-throughput laboratories and is critical in addressing the growing syphilis epidemic in the U.S. It recently received U.S. Food and Drug Administration (FDA) 510(k) clearance for its Vitros syphilis assay as part of its menu, strengthening its position as a leader in infectious disease testing. Using the automated V itros systems, this assay is intended for the qualitative determination of total (IgG and IgM) antibodies
to TP-specific antigens in human serum and plasma using the automated Vitros 3600 Immunodiagnostic System, and the Vitros 5600 and XT 7600 systems. The presence of antibodies to TP-specific antigens, in conjunction with non-treponemal laboratory tests and clinical findings may aid in the diagnosis of syphilis infection.
“With an increased national incidence of syphilis and other STIs, having a quick and easy way to test in various healthcare settings is essential,” said Dr. Lily Li, senior director, medical scientific and clinical affairs, QuidelOrtho.
The 2024 CDC guidelines equally recommend two diagnostic testing algorithms, both of which include using a treponemal and non-treponemal assay. Benefits of a CDC reverse testing algorithm include:
` Yielding a higher sensitivity for primary syphilis.
` Offering better detection of latent and tertiary infections.
` Reducing risk of false negative results due to prozone reactions. ` TP assays typically having higher specificity than rapid plasma regain (RPR) tests, which reduces unnecessary confirmatory testing.
Recommended syphilis screening for high-risk groups
The U.S. Preventive Services Task Force (USPSTF) recommends syphilis screening for high-risk groups including men who have sex with men/persons engaging in high-risk sexual behavior, commercial sex workers/persons exchanging sex for drugs, adults in correctional facilities, persons diagnosed with other STIs and pregnant women.
Women giving birth in the U.S. are now three times more likely to have syphilis than they were in 2016, according to the CDC. The sharp rise coincides with a spike in congenital syphilis or when a baby becomes infected before birth. Syphilis in infants can be severe, disabling and sometimes threaten their lives. More than 10,000 women who gave birth in 2022 had syphilis or about one maternal syphilis case for every 357 births.
The vast majority of congenital syphilis cases in the U.S. might have been
Timely, accurate results when they matter the most QuidelOrtho’s Vitros syphilis assay provides the performance expected with Vitros assays. The time to first result is 34 minutes, providing timely, accurate outcomes when they matter the most to help clinicians deliver the trust their patients need in them. Vitros syphilis assay performance highlights include:
` Low sample volume needed.
` High sensitivity/specificity.
` Reducing valuable tech hands-on time.
` Performing comparably to leading competitive assays in seroconversion study.
The time to first result is 34 minutes, providing timely, accurate outcomes when they matter the most to help clinicians deliver the trust their patients need in them.
prevented with better testing and treatment because, for pregnant women who are in the early stages of a syphilis infection that is left untreated, there’s a high likelihood that the infectious agent will pass through the placenta to the fetus. But timely treatment at least 30 days before delivery cuts the risk of infection passing from the mother to the baby by close to 100%.
The CDC recommends rebuilding, sustaining and expanding local public health services, especially efforts to offer STI testing and treatment programs that respond to the needs of those most affected.
QuidelOrtho is a world leader in invitro diagnostics, developing and manufacturing intelligent solutions that transform data into understanding and action. It offers expertise in immunoassay and molecular testing, clinical chemistry and transfusion medicine, bringing fast, accurate and reliable diagnostics from home to hospital and lab to clinic, allowing patients, clinicians and health officials to spot trends sooner, respond quicker and chart the course ahead with accuracy and confidence.
It continues to partner with customers across the healthcare continuum and around the globe to power a healthier future for all.
When the Numbers Tell the Story
What’s in store for the global healthcare supply chain in 2025?
 In his work as Chief Consulting Officer and Co-founder of Access Strategy Partners Inc., John Strong does a lot of industry number crunching to look for the key headwinds and tailwinds that affect the U.S. healthcare supply chain. As such, there’s no question in Strong’s mind that inflation has played the part of disruptor in the marketplace.
Over the last couple of years, inflation has driven the cost of med/ surg supplies and drugs up approximately 21% to 22%. The good news is those percentages are coming down. The bad news is that any increases now are on top of those previous ones.
People are desperate to save wherever they can on supply purchases, said Strong. Unfortunately, this has led to a longstanding focus that’s now being magnified by buyers on price. For smaller purchases, such as commonly used items that are disposables, there’s not a lot of value analysis going on because the payoff is assumed to be small. “But this is where a lot of the price creep has occurred in my opinion,” he said. “These smaller purchases largely get ignored. They’re sometimes contracted by the GPOs. And even with the best intentions of the GPOs, there have been substantial price increases. And so, inflation has hurt everybody, including hospitals with their purchases.”
In the following article, Strong provided Repertoire Magazine with several other observations – and forecasts – of the global healthcare supply chain as 2025 nears.
Is onshoring a viable strategy?
During and after the pandemic, the government put more than $1 billion into creating onshoring opportunities for products like nitrile gloves and disposable masks. Many entrepreneurs also invested in these efforts.
The support from providers, it seemed, was there. In a recent
Premier survey of 102 hospitals, 90% of respondents indicated that domestic manufacturing is a key element of shoring up the supply of goods.
But Strong said over the last year he’s observed a trend toward hospitals going back to overseas sources in China and Southeast Asia for these disposable products. “It’s led to about 70% of these domestic companies going out of business,” he said. “It’s also led to frustration from those still in operation today and who have built out an infrastructure to manufacture and distribute these types of products. Are we being penny-wise but pound foolish? We can save two cents a mask by buying it from China versus the U.S. market, but right now there are a huge number of supply chain risks out there in the world.”
Indeed, if the last several years have taught us anything, the next round of supply disruptions could be just around the corner. The U.S. imports around 30% of its demand for disposable medical supplies and equipment. Potential global disruptors and other threats include:
` The recent port strike that threatened food, medical supplies, auto parts and more.
` The recent Canadian rail workers’ strike that affected North American freight.
` Continued Red Sea shipping troubles with commercial ships being attacked by the Houthis and other groups.
` The ongoing war in Ukraine.
` Trade war with China.
` The growing hostilities in the Middle East.
Strong said the U.S. healthcare supply chain should consider some of the real economic costs that are incurred when shortages occur:
` Reduction of revenue. The Premier survey indicated that about $350,000 in lost revenue was incurred by mid-sized health systems – defined as five hospitals or 650 beds.
` Safety stock. The survey indicated that shortages can perpetually tie up $1 million of excess inventory.
` Delivery costs. Shortages inflate care delivery costs by $3.5 million from disruptions in care plans and the costs associated with mitigating shortages.
` The constant disruption and staffing requirements to source substitutes, both in the purchasing department and pharmacy. Some sources have estimated
Endotracheal Tube Holders
Hold-n-Place® Foley Catheter Holders IV-ARMOR®
ArmBoards
that shortages are costing the average 200-bed hospital about 1 FTE in lost time just looking for product.
“There is this never-ending list of bad things happening in the supply chain as far as logistics go,” Strong said. “If I were back in a hospital again running the supply chain, instead of saving a penny or two on certain commonly used items, I might be looking for more domestic sources of supply that can guarantee delivery in good times and bad, even if domestic sourcing costs a bit more. You can actually do the math and figure it out.
the respondents did have some modification or cancellation of surgeries due to supply shortages.
“All of that adds to the cost of doing business for the hospital,” Strong said. “It’s inconvenient for the patient and the staff, and it is very problematic. So, I think you’re seeing JIT backing off a little bit. People are keeping larger stores of supplies so that they prevent those kinds of bad things from happening in their hospital.”
Getting a better handle on expenses
Right now, supply chain leaders are trying to do more in terms of big cost items. Hospitals are
“After close to 20 years of almost nothing happening in treating arrhythmias, we’re now seeing a move toward new technology called pulse-field ablation or PFA that is changing the arrhythmia catheter market. In Europe these catheters are being sold at about double the price of older technology, but patient outcomes can be significantly better.“
However, not all old habits have been hard to break. Strong said there’s been some movement away from Just-in-Time (JIT) delivery, and many larger health systems are adding additional inventory for certain products to ensure that they have a source of supply in the future. In a survey last year of healthcare providers, Premier asked respondents how many times they had to change, cancel or modify a surgical schedule because of a shortage of supplies. More than half of
generally doing a much better job today with service contracts than they did five years ago. Part of that is due to technology that now exists to help manage service contracts, but it also comes down to better control by the hospitals of who can sign service contracts and those types of things, Strong said. “And I’m not talking just services on capital equipment, I’m talking about services for whole departments such as the dietary services or food service department, as well as perhaps its
biomedical engineering, housekeeping, or other areas.”
Medical device market watch
One of the hottest markets right now, if you’re looking at it from the supply side or from the med/surg manufacturer side, is organ transplantation, Strong said. “There are three or four companies coming out with new solutions to organ transplantation, and their stocks have performed very well. They preserve organs for much longer than just being packed on ice and put in a camping cooler and taking them across the country on an airplane. These are systems that preserve organs and they arrive in much better shape.”
Over the next five years, as these technologies emerge further, Strong believes we’ll see an increase in viable transplant organs for heart, liver, kidney, etc.
Another device market to watch is cardiovascular. “After close to 20 years of almost nothing happening in treating arrhythmias, we’re now seeing a move toward new technology called pulse-field ablation or PFA that is changing the arrhythmia catheter market. In Europe these catheters are being sold at about double the price of older technology, but patient outcomes can be significantly better. “You’re going to see even bigger improvements in those cardiovascular areas over the next five years as well.”
Looking ahead to 2025
Continued disruption in the supply chain will remain a key trend to monitor in 2025, Strong said. “We’re going to see more movement by manufacturers
away from China, perhaps to other areas in Southeast Asia, or perhaps to North America, particularly Mexico.”
When it comes to value analysis, Strong said there’s going to be a closer look at new products that provide genuine innovation. “But the question then becomes at a certain price point, is the innovation such that we can afford it within our current cost reimbursement for patients?”
The third area for industry stakeholders to keep an eye on is the federal government’s continued involvement in trying to solve the drug shortages in this country. “There have been a number of articles both in The Wall Street Journal and The New York Times now about pharmacy benefit
Value props
managers (PBM) and some of their management of costs for patients seem a bit questionable. In some cases, you may be paying more because the PBMs product selection benefits them more than the benefits to the patient, according to recent federal studies.
“Having said that, I believe the government is going to continue to look at other middlemen,” Strong continued. “They’ve already talked about PBMs, they’ve also talked about looking at the actions of group purchasing organizations and perhaps others. So, I think that’s going to continue to percolate, particularly if Lina Khan stays as the Federal Trade Commissioner in the new administration, whoever is elected.”
To be successful in today’s and tomorrow’s marketplace, healthcare manufacturers must be able to do a good job of distilling their value proposition for the products that they’re trying to sell to their customers. And oftentimes, Strong believes, perhaps rightly, hospital buyers expect suppliers to be able to quantify in meaningful terms what that value proposition is.
Strong said there are several key elements. “First, what problem are you solving with this particular new product?” he said. “How does it benefit the clinicians and the healthcare provider itself in terms of value, cost, time, and those types of things? Does it impact reimbursement? And how does this impact the patients? Is it better for patient care? Does it reduce patients’ stay in the hospital? Does it reduce infections or length of stay, for example?”
All of those things have to be considered. If a manufacturer or distributor can document and quantify what those things are for their customers, they’ve got a much better shot of success in today’s market than simply dealing a sales pitch that doesn’t really have a measure of quantification and qualification attached to it.
Strong believes AI could be the next dot com boom and bust.
“There are things that artificial intelligence can do, particularly in the supply chain, but it still takes well-thought-out human strategies,” he said. “It still takes wellintentioned hard-working people. And artificial intelligence can’t solve all the problems we have within the supply chain today. It can be a help. I use artificial intelligence myself. I like using it, and it’s very quick and efficient, but there are also times when artificial intelligence hallucinates, and a total reliance on artificial intelligence in the healthcare system, whether it’s in supply chain or diagnosing patients or anything else, can lead to problems if there isn’t human intervention and management of them.”
“Because if it does end up going into the value analysis committee, they’re going to ask all those questions anyway,” said Strong. “So, you might as well have it in your bag in a very succinct form that you can take out and make your case based on facts, and don’t overwhelm the potential value analysis committee champion of your product with too much information. The 300-page VAC packs don’t cut it because no one has time to read them.”
Defending Healthcare from Cyberattacks: Strategies, Resources, and Legislation
 The rising number of cybersecurity breaches in healthcare, coupled with the critical role that healthcare distributors and manufacturers play in safeguarding patient data, underscores the urgency for enhanced cybersecurity measures. This isn’t a new phenomenon. According to the HHS Office of Civil Rights, which monitors the privacy rights of patients, the number of healthcare cybersecurity breaches affecting 500 or more individuals rose by 107% from 2018 to 2022.
At HIDA’s annual Preparedness Summit, representatives of the medical supply chain heard from Commander T.J. Christl, Director of the ASPR Office of Critical Infrastructure Protection; and Jay Gazlay, Deputy Associate Director of Vulnerability Management for the Cybersecurity & Infrastructure Security Agency (CISA) within the Department of Homeland Security. These federal officials emphasized that healthcare distributors and manufacturers must invest now in cybersecurity preparedness and response.
These federal leaders in cybersecurity communicated three important lessons to business leaders at the Preparedness Summit: ` Cyber risk is business risk: Cybersecurity must be a top C-suite priority. For a healthcare distributor, a company’s senior leadership should understand that cyber risk is business risk, which impacts the ability to care for patients.
` Not if but when: Business leaders should approach cyberattacks as a certainty. It is not a matter of if cyber-criminals will attack your company, it is a matter of when. Every company should participate in a tabletop exercise that assumes the organization will be subjected to a ransomware attack, so that response plans for such a scenario are in place in advance.
` Use federal resources to be cyber-ready: Christl and Gazlay encouraged companies to take advantage of the federal government’s large suite of free resources and
services. CISA can provide companies with vulnerability assessments for things like phishing and remote penetration attacks. These assessments are available to both public and private organizations at no cost, although service availability is limited. ASPR provides a Healthcare and Public Health (HPH) Sector Cybersecurity Framework Implementation Guide, as well as consensus-based best practices to strengthen the sector.
Meanwhile on Capitol Hill, HIDA is monitoring the following cybersecurity legislation
that would impact the medical supply chain.
By Linda Rouse O’Neill; Senior Vice President for Supply Chain Policy, Health Industry Distributors Association
` Health Infrastructure Security and Accountability Act (Warner/Wyden): This bill would require the Department of Health and Human Services (HHS) to develop and enforce a set of tough minimum cybersecurity standards for healthcare providers, health plans, clearinghouses and business associates. It would also remove the existing cap on fines under the Health Insurance Portability and Accountability Act for healthcare corporations that ignore cybersecurity standards.
` Healthcare Cybersecurity Act (Crow/Fitzpatrick): This legislation proposes the appointment of a special liaison to HHS within CISA to increase communication and collaboration during cybersecurity incidents. It also directs CISA and HHS to make cyberthreat defense resources available to nonfederal entities.
Companies within the medical supply chain must proactively adapt to evolving cybersecurity standards and collaborate with federal agencies to mitigate risk and protect the healthcare ecosystem. HIDA continues to utilize public-private partnerships that enable healthcare distributors to leverage federal resources to protect patients and providers from cyberattacks.
Health News
OhioHealth to offer breast cancer patients the opportunity to avoid unnecessary surgery
OhioHealth now offers breast cancer patients access to a groundbreaking surgical technique, which could spare them an invasive axillary procedure, according to the health system.
It is called ‘delayed’ sentinel lymph node biopsy, and is only possible to perform with Magtrace®, the world’s first non-radioactive, dual-tracer breast cancer staging technology. The technique gives physicians the opportunity to delay the surgery often used to assess the spread of breast cancer until they know it is needed, and spare surgery altogether for those who do not.
The lymph node biopsy that Magtrace ® offers is performed by injecting Magtrace ® into the breast at the time of mastectomy to remove the DCIS. The tracer, made from iron oxide particles, then migrates to the underarm, where it will remain for as long as the surgeon needs, marking the nodes most likely to contain cancer if it has spread.
The DCIS is then analyzed by pathology for any presence of an invasive component. If it is found to be invasive, the lymph nodes will still be marked with the Magtrace® meaning the patient can be scheduled to return for underarm surgery to confirm if the cancer requires upstaging. However, for roughly 80% of patients’ pathology will show that no further surgery is needed.
Peripheral artery disease: Leg pain, leg cramps, lingering foot wounds among symptoms
Leg pain and leg cramps aren’t always an orthopedic issue: Both can be signs of peripheral artery disease, or PAD, a serious bloodflow issue with implications for the heart. In peripheral artery disease, narrowed arteries reduce blood flow to the affected limbs. They do not get enough blood flow to keep up with the demand. It is important to manage PAD as early as possible. In the worst cases, PAD can progress to open sores that do not heal, causing tissue death and limb loss.
Common symptoms include leg pain or cramps while walking and small sores on the feet that do not heal, according to Mayo Clinic’s Dr. Young Erben. Your first inclination might be to think of these as small things to ignore, but it is best to bring up these symptoms with your healthcare team.
Treatment depends on where someone is on the spectrum. Early on the spectrum, treatment typically includes:
` Addressing risk factors for peripheral artery disease such as high blood pressure, high cholesterol, diabetes, obesity and smoking.
` Screening for additional bloodflow problems, such as coronary artery disease, may be needed.
` Developing a walking program – typically involving time on a treadmill – that the patient can pursue at home or with a physical therapist or trainer.
Researchers discover new bacterium that causes gut immunodeficiency
Cleveland Clinic researchers have discovered a new bacterium that weakens the immune system in the gut, potentially contributing to certain inflammatory and infectious gut diseases. The team identified the bacterium, Tomasiella immunophila ( T. immunophila), which plays a key role in breaking down a crucial immune component of the gut’s multifaceted protective immune barrier. Identifying this bacterium is the first step to developing new treatments for a variety of inflammatory and infectious gut diseases. These conditions, including inflammatory bowel disease, Crohn’s and ulcerative colitis, are associated with decreased levels of secretory immunoglobulin A (SIgA), an antibody that protects mucosal surfaces.
The 2025 PWH® Leadership Summit is headed to Frisco, Texas!
Frisco is a hub of modern innovation and growth, that offers a vibrant and cutting-edge environment, making it the ideal location to inspire and empower industry leaders at this year’s leadership conference.
All leaders are welcome! Open to women & men from all career levels – Aspiring Leaders to C-Suite Executives. Gain actionable takeaways through our PWH Leadership Insights (TED-style talks), empowering keynote speakers, engaging panel discussions, workshops & breakout sessions that cover a host of topics around pressing leadership issues
This dynamic keynote inspires participants to step up in a new way to overcome resistance and reach higher than ever by cultivating Exponential Commitment™ in themselves and those around them. Participants will learn essential Vertical Lessons for deepening their commitment, building momentum, and achieving breakthroughs in even the most challenging circumstances.
Leaders will take away:
• Actionable insights on what it takes to gain clarity and see through the chaos every day
• 3 steps to build and rebuild momentum, even when they get knocked off route
• A daily process to keep them focused and fully committed to their key initiatives
Manley’s 11 years of leadership influence contributed to a workplace culture that landed Build-A-Bear Workshop on the FORTUNE 100 Best Companies to Work For® List four years in a row. Manley served two terms as the president of the St. Louis chapter of the National Speakers Association. On a personal note, Manley likes to sleep on the side of mountains. Who doesn’t? Even more shocking is that his wife has been encouraging that for more than three decades, and his two kids still kiss him on the cheek in front of their friends.
Register today to attend the industry’s only conference completely dedicated to inclusive leadership development.
Registration now open at mypwh.org
Industry News
CME Corp. recognized as a top workplace for a fourth year in a row CME Corp. has been recognized by the Providence Journal, in conjunction with USA Today, as one of Rhode Island’s Top Workplaces of 2024. Says CME Corp. President, KC Meleski, “I am incredibly proud and honored that we have been named one of the top workplaces in Rhode Island for a fourth year in a row. This recognition is a testament to the continued dedication and hard work of our entire team to create a positive, supportive environment where everyone can thrive.”
This recognition is solely based on feedback gathered from employees through a confidential survey conducted by Energage LLC, a leading company in employee engagement technology. The survey assesses various aspects of the employee experience, including feeling respected and supported, opportunities for growth, and a sense of empowerment, among other key themes.
DETECTO receives NTEP certifications on medical scales
DETECTO has received NTEP (National Type Evaluation Program) approval administered by the National Conference on Weights & Measures for most of the company’s major medical scales. This verifies from a regulated governing body that DETECTO scales are manufactured to the highest accuracy and quality possible for medical scales
used to treat patients. Using an NTEP-certified medical scale can significantly reduce the risk of preventable dosage-related medical errors that heavily impact the U.S. healthcare industry every year. DETECTO is the only medical scale manufacturer with U.S. compliant scales held to NTEP weights and measures standards, according to a release. This NTEP accreditation means DETECTO scales have been subjected to 100,000 weighing cycles and maintained strict accuracy in a variety of testing temperatures. For more information and to see the full selection of NTEP certified medical scales, please visit detecto.com/product/landingpage/ntep-medical-scales
Cardinal Health announces two strategic additions to its portfolio
Cardinal Health announced that it has entered into definitive agreements to acquire two companies that accelerate Cardinal Health’s strategic growth areas and that will enhance patient care. The company also provided confirmation of its capital deployment plans. Cardinal Health will acquire a majority stake in GI Alliance (GIA), the country’s leading gastroenterology (GI) management services organization (MSO), from a combination of GIA physician owners and funds managed by affiliates of Apollo. Cardinal Health will purchase its majority stake for approximately $2.8 billion in cash, which will represent 71% ownership. GIA
will operate as a platform within Cardinal Health’s Pharmaceutical and Specialty Solutions segment.
Cardinal Health will also acquire the Advanced Diabetes Supply Group (ADSG), one of the country’s leading diabetic medical supplies providers, for approximately $1.1 billion in cash. ADSG will merge with Cardinal Health’s at-Home Solutions business.
“Today is an exciting day at Cardinal Health as we announce two strategic and financially compelling transactions that build upon our progress in Specialty and accelerate growth in our at-Home Solutions business,” said Jason Hollar, Chief Executive Officer, Cardinal Health. “Over the past two years, we have improved operating performance and financial flexibility by executing on our focused growth strategy. These transactions enhance Cardinal Health’s ability to deliver a greater value proposition for providers and patients, while representing the next step in our ongoing focus to drive sustainable shareholder value creation.”
PJ Valentini joins The IDN Directory as Director of Business Development
The IDN Directory welcomes industry veteran PJ Valentini as the new Director of Business Development. Valentini, based out of Nashville, TN, will lead the sales efforts for the IDN Directory going forward. PJ joins the IDN Directory from a successful sales career at Health Connect Partners. The IDN Directory provides
insights into the supply chain for the largest health systems in the country, giving national account executives a quick, accurate view of what is going on with their customers- right now. PJ Valentini can be contacted via email at pjvalentini@IDNDirectory.com.
U.S. Ambulatory Surgery Center market is booming worldwide 2024-2031
A recent report titled “U.S. Ambulatory Surgery Center Market” Trends, Share, Size, Growth, Opportunity and Forecast 20242031, by Coherent Market Insights, offers a comprehensive analysis of the industry, which comprises insights on the market analysis. The report also includes competitor and regional analysis, and contemporary advancements in the market.
The report additionally features a comprehensive table of contents, figures, tables, and charts, as well as an analysis of the data. The U.S. Ambulatory Surgery Center market has been expanding significantly in recent years, driven by various key factors like increased demand for its products, expanding customer base, and technological advancements. The report provides a comprehensive analysis of the U.S. Ambulatory Surgery Center market, including market size, trends, drivers and constraints, competitive aspects, and prospects for future growth.
Michael Cusack named President of BD Urology and Critical Care
BD announced that Michael Cusack has been named worldwide president of the BD Urology and Critical Care (UCC) business unit, effective November 1. In this role, Cusack will be responsible
for driving the global strategic, operational, quality and commercial excellence of the UCC business unit globally. He will report to Richard Byrd, executive vice president & president of the BD Interventional Segment.
Cusack joins BD UCC from BD Medication Management Solutions (MMS), where he has served as vice president and general manager of the MMS U.S. Region since October 2020. In this role Mike helped grow the business, increase customer retention and played a key role in leading the commercial integration for four acquisitions, including Parata Systems, Medbank, MedKeeper and RapidRx. He joined BD in 2016 as the vice president and general manager for BD Diagnostic Solutions in the U.S. and in 2019, was appointed vice president and general manager for BD’s Surgical business, where he focused on driving product development and exploring M&A opportunities to expand the company’s expertise and market leadership or presence.
MedPro Associates partners with Champion Manufacturing to expand reach of Champion Select Collection
MedPro has announced a strategic partnership with Champion Manufacturing. This collaboration will enable MedPro to provide comprehensive national sales coverage for the Champion Select Collection, a prominent line of healthcare seating solutions, across the acute, non-acute, and government markets.
Champion manufacturing is a leading manufacturer of highquality healthcare seating solutions
designed to meet the unique needs of patients and caregivers. Their chairs are renowned for their durability, comfort and versatility, making them an ideal choice for a wide range of healthcare settings. The Champion Select Collection offers a variety of customization options, including heated seats, built-in massage, and swing arms, to optimize patient care and comfort.
“We are excited to partner with MedPro Associates to expand the reach of our Champion Select Collection,” said Tom O’Neill, CEO of Champion Manufacturing. “MedPro’s extensive network and deep understanding of the healthcare market will help us bring our innovative seating solutions to a wider audience. We believe this partnership will be instrumental in improving patient care and satisfaction.”
“MedPro is thrilled to partner with Champion to represent their Select Collection of medical seating solutions. They have everything we look for in a partner; top of the line innovative products, strong brand equity and awareness across medical markets, and most importantly, great people,” adds MedPro CEO, Bill Sparks.
MedPro’s national sales force will leverage their expertise and relationships to introduce the Champion Select Collection to healthcare providers across the country. By combining Champion’s industry-leading products with MedPro’s sales and marketing capabilities, this partnership will offer healthcare facilities a comprehensive solution to meet their seating needs.
For more information and to view the Enterprise Map visit: mproassociates.com.
From the Baseball Diamond to the Boardroom
 Every organization needs healthy teams. A healthy team will be more productive, more efficient, and more willing to go the extra mile to get results for your organization. It’s a huge investment to build healthy and effective teams, but it’s well worth the effort.
In a recent episode of The Cure... With Scotty and Sully, hosts Scott Adams and Brian Sullivan spoke to Joel Goldberg, host of the pre- and post-game shows for the Kansas City Royals for Fox Sports, about the importance of building trust within your teams and the power of curiosity.
Establishing trust on your team
Trust is the foundation of any effective team. With trust, you can build a relationship and a reputation –for better or worse. Goldberg said, “One of the key pieces to building trust with someone is checking to make sure that we are making their lives easier. Are our personal friends, business acquaintances, employees, or team members eager to answer the phone when they see you calling? Or do they want to hide?”
A unique thing about trust is that it’s not something that you can establish and set aside. Trust needs to be cultivated and maintained. Building trust is a
daily job, and every decision you make can impact the level of trust that other people have for you.
That’s the hopeful part – if trust is broken, it can be restored. It will take a lot of work, but that’s what makes trust such a valuable piece of the puzzle.
The power of curiosity
Every sales rep has the opportunity to build relationships with their customers, which can help to get you better insights into the problems they need solved. How do sales reps get these insights? By listening. Average and below average sales reps will spend too much time talking about the solution and not enough time listening to the problem.
It all comes down to working on your communication skills. Goldberg said, “You need to listen and be curious. I’m amazed at the stories that I stumble into by just being curious and asking questions.” By asking questions, you can work towards a greater understanding of what the customer needs and how your organization can help them. Additionally, when you ask the right questions, your customers will feel like you are taking the time to truly hear and understand what they are working with.
There’s a fine line between chasing your curiosity and flying by the seat of your pants. You can’t come into these conversations and expect good results when you are not prepared. “The key here is that you need to be prepared,” Goldberg said. “I think that you can follow your own curiosity best when you are prepared, but you need to be flexible with where the conversation could go.”
SUBSCRIBE to The Cure on YouTube by scanning the code below
Joel Goldberg
According to the US Access Board 1, “Currently, on the market there is one examination chair which reaches a low transfer height below 17 inches, the Midmark 626 Barrier-Free ® examination chair...”
For clinics looking to improve both patient access and caregiver safety, this chair represents a crucial advancement.
01 Seat Height: 15 ½"- 37"
02 Transfer Surface: 28” wide and 19 ½" deep
03 Base Clearance: 23 ½"
04 Transfer Supports compliant to the new standards
