vol.26 no.12 • December 2018
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DECEMBER 2018 • VOLUME 26 • ISSUE 12
PUBLISHER’S LETTER Another Year in the Books.......................................6
PHYSICIAN OFFICE LAB Urinalysis: The Forgotten Test....................................8
IDN OPPORTUNITIES
Manufacturer Reps to Watch
28 POST-ACUTE
Supply Chain Executive Profile
Lynn Cook, CEO, HealthTrust Supply Chain............. 12
CONSOLIDATED SERVICE CENTERS Health systems continue to rely on distribution....................................................... 18 Bigger IDNs, bigger likelihood of CSCs...... 20
IDN OPPORTUNITIES: HIDA INSIGHTS
PDPM: A ResidentCentered Plan New reimbursement method will compensate SNFs for caring for medically complex residents
Hospital Laboratories Take Steps to Cope with Staffing Shortages ........................ 22
STREAMLINING HEALTHCARE EXPO & BUSINESS EXCHANGE
50
A Meeting Place Streamlining Expo in Chicago facilitates 1,200 meetings....................................................... 24
repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2018 by Share Moving Media. All rights reserved. Subscriptions: $49.00 per year for individuals; issues are sent free of charge to dealer representatives. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address. POSTMASTER: Send address changes to Repertoire, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors. Periodicals Postage Paid at Lawrenceville, GA and at additional mailing offices.
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DECEMBER 2018 • VOLUME 26 • ISSUE 12
WINDSHIELD TIME
SUPPLIER DIVERSITY Supplier Diversity Symposium......................... 27
CHRONIC CARE MANAGEMENT The ‘C’ Words ‘Cancer’ and ‘chronic’ were rarely used in the same breath … until now........................... 62
Automotiverelated news 66
REP CORNER
HEALTHY REPS
Doc Wrong Way Gets it Right Ron Smith has a Bronze Star for valor, and a bunch of gold ones for 43 years in medical sales.......... 74
HIDA GOVERNMENT AFFAIRS UPDATE
Health news and notes
70
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Key Public Health Agencies Participate in Supply Chain Continuity Summit................. 80
QUICKBYTES Technology news............................................................. 81
INDUSTRY NEWS News........................................................................................... 82
You Keep Us Going Some things are essential to win the day. For us, it’s distributors like you who sustain and fuel our success. And we want to thank you. Thank you for providing the high-quality products critical to healthcare professionals’ needs. Because of you, B. Braun is a leading healthcare provider.
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Sales representatives in your area are ready to discuss how to further improve your customer experience.
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PUBLISHER’S LETTER
Another Year in the Books Can you believe it’s December? This month is stacked with some of my favorite mo-
ments. Celebrating my birthday (December 30) is a pretty good one, but having my first granddaughter Ivee Grace Adams born last December 30 certainly surpassed that. Now, all the birthday celebrations can be focused on her. I also love this month because the holidays bring us together with friends and family that we may only get to see once or twice a year. And, December is a great time to reset, reflect, and prepare for a new year of opportunities. As I look over the past 11 months of Repertoire cover stories, here are a few highlights: •W e started 2018 facing the PAMA challenge, while the beginning stages of MACRA were taking shape. Both initiatives caused reimbursement stress on providers. However, just like our industry always does, we fought through it and are still educating America’s care givers on healthier practices and better outcomes for patients. • In the spring, we inducted Paul Julian to the Medical Distribution Hall of Fame, while at the same time celebrated two new Excellence in Sales award winners – Dianna Hundl of Quidel and Mike McGoldrick of Henry Schein. • During the summer, we examined our new reality, “Point and Click” ordering, and what we found is that providers still value their relationship with the field sales rep. Reps continue to make all the difference in shaping our industry, year in and year out. • And, as we rounded the third quarter and started looking to the fourth, it was apparent we needed to address flu season. Based on the record year we had in 2017, everyone was determined to be prepared.
Scott Adams
All and all, it’s been a pretty typical year. We faced some major issues thanks to DC, had some amazing people recognized in the industry, dealt with changes to technology and the way customers are buying, and like always, started another selling season with flu. As I reflect on 2018 Repertoire’s 25th year in print, I want to thank you for reading the magazine. Thank you to the advertisers for their continued support of the channel. And thank all of you for what you do, day in day out, for the caregivers and patients of America. Merry Christmas and Happy Holidays, R. Scott Adams repertoire is published monthly by Share Moving Media 1735 N. Brown Rd., Suite 140, Lawrenceville, GA 30043 Phone: (800) 536-5312, FAX: (770) 709-5432; e-mail: info@sharemovingmedia; www.sharemovingmedia.com
editorial staff editor
Mark Thill lthill@sharemovingmedia.com managing editor
Graham Garrison ggarrison@sharemovingmedia.com editor-in-chief, Dail-eNews
Alan Cherry acherry@sharemovingmedia.com art director
Brent Cashman bcashman@sharemovingmedia.com
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vice president of sales
Jessica McKeever jmckeever@sharemovingmedia.com (800) 536.5312 x5271 director of business development
Alicia O’Donnell aodonnell@sharemovingmedia.com (800) 536.5312 x5261 sales executive
Lizette Anthonijs Lizette@sharemovingmedia.com (800) 536.5312 x5266
publisher
Scott Adams sadams@ sharemovingmedia.com (800) 536.5312 x5256 founder
Brian Taylor
Subscriptions
www.repertoiremag.com/ subscribe.asp or (800) 536-5312 x5259
2018 editorial board Richard Bigham: IMCO Eddie Dienes: McKesson Medical-Surgical
btaylor@ sharemovingmedia.com
Joan Eliasek: McKesson Medical-Surgical
circulation
Doug Harper: NDC Homecare
Ty Ford: Henry Schein
Laura Gantert
Mark Kline: NDC
lgantert@ sharemovingmedia.com
Bob Ortiz: Medline Keith Boivin: IMCO Home Care
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Blackshear, Joseph L., MD, “Appendage Obliteration to Reduce Stroke in Cardiac Surgical Patients With Atrial Fibrillation” <http://www.annalsthoracicsurgery.org/article/0003-4975(95)00887-X/pdf>, The Annals of Thoracic Surgery, 1996;61:755-759
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC101077/
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MC15639
PHYSICIAN OFFICE LAB
By Jim Poggi
Urinalysis: The Forgotten Test My tacky analogy of the month: urinalysis testing is a
lot like flossing. Everybody agrees it’s important, but not everybody is really doing it. Now that I have your attention, let’s examine the facts. You have cool customer promotions on a variety of national brand and private brand urinalysis systems with no capital investment required year-round, right? And you are placing a bunch of urinalysis systems every year, right? Yes, on both counts. But, is your urinalysis business growing along with the rate of new placements? I contend it’s not. Go check your sales reports. I’ll wait. Just as I thought. Lots of systems going out; not so much revenue coming back. Why? If you ask 100 primary care clinicians to tell you about the value of urinalysis, you will get a convincing story ready to make you buy a urinalysis analyzer: “Urinalysis testing is
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non-invasive, well proven, has powerful screening tests for diabetes, kidney disorders, urinary tract infection, liver disorders and dehydration. It should be used on every senior patient visit.” Everybody knows urinalysis is useful. But, if you took a minute and asked your key physician customers to tell you how many of their last 100 annual physical or diabetes follow up patients got a urinalysis and they gave you an honest answer, I am willing to bet the number would be small. Probably under 20. Admittedly, I am working with empirical observation, but no real data. But, here are my observations. In my annual physicals over the last five years, I have not had a single urinalysis. The only urine testing I had in the last five years was a mandatory drug screen for a consulting client. (BTW: I passed.)
In talking with other professionals in our business, I get the same acknowledgement. Their experiences are similar. And, when you go into the rest room of the average primary care practice, where are the urine cups we used to see? Where is the pass-through door to the sample handling area? I almost never see them anymore. When was the last time you had your physical and the nurse handed you a urine cup, told you to give a sample, put it on the counter and the doctor will see you in a few minutes?
Action items Ok, now that the whining is over, what do we do? I would target a modest number of my key customers and arrange a visit with my best urinalysis supplier and have a real discussion of how the practice uses urinalysis and how often. Probe for: •H ow often do you use urinalysis to initiate or modify a patient treatment plan? • I s it part of your annual physical protocol? • I s it part of your Medicare patient annual visit? • Are you using newer tests like albumin/creatinine ratio to follow up on your established diabetic patients? •D o you routinely encounter patients, particularly elderly, with urinary tract infections? How is the practice handling these patient situations? •D o they believe their urinalysis testing program is being implemented effectively when necessary for patient care? Some of your thoughtful physicians will experience a wake-up moment. And, chances are your urinalysis supplier is satisfied with the placement rate of systems and has resigned themselves to a low rate of test strip growth because “everybody is already performing urinalysis and it is a replacement market.” I believe urinalysis is presently under-utilized and subject to re-visit with thoughtful customer visits and discussion. Pointing out the obvious can increase the number of truly needed urinalysis tests performed by your customers every day. In the process, you will sell other ancillary supplies: urine cups, urine controls, paper towels, hand sanitizer. You might even sell a few drug testing cups, but the focus here is routine health screening, where I believe urinalysis is becoming a missing link. For the really bold, offer a free box of urine cups to the practice and put a dozen of them in the rest rooms and five stacked up in
every exam room as a reminder. You might even ask your urinalysis supplier to dust off those old urinalysis wall posters and let you pass a few around to your customers. Sometimes, the classics work. If you take the time to re-visit urinalysis with your key customers and how it is used for important patient screening and follow up purposes, I think you will be surprised at the results. The testing is so useful and so fundamental to good patient care, I am convinced that a timely reminder will get your highly engaged customers to increase their urinalysis testing and that they will thank you down the road. You can also take the time to review newer urinalysis tests to determine which ones might add useful diagnostic information. Albumin/creatinine ratio testing appears to be under-utilized. You can also make it
If you take the time to re-visit urinalysis with your key customers and how it is used for important patient screening and follow up purposes, I think you will be surprised at the results. easier and smooth work flow by reminding your customers that they can connect their urinalysis systems (check with the manufacturer first) to an LIS or EMR system and track patient results and make sure they do not miss any needed billings also. True, there is a cost to connect, but for proper work flow and to avoid missing patient healthcare data and billings, there are good reasons to connect the urinalysis data to LIS and EMR. They would make sure to connect a hematology system or chemistry system. Why not urinalysis? So, take my dare and select some key customers for deep discussions on how they use urinalysis. Granted some of them will chuckle and wonder if you “have lost a wheel.” But the thoughtful ones are likely to have a wakeup moment. How cool is that? And, as an added bonus, I believe you will see your urinalysis revenue grow. So, run the program, gather customer feedback and run your sales reports. Let me know the results. I’ll wait.
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IDN OPPORTUNITIES
Supply Chain
Executive Profile Lynn Cook CEO Richmond Consolidated Service Center HealthTrust Supply Chain Richmond, Virginia A native of “Wild, Wonderful West Virginia,” Lynn Cook graduated from the
medical technology program at West Liberty State College, and became a staff medical technologist at Wheeling Hospital. She also served as a medical technologist with a major reference laboratory before becoming director of clinical laboratory services for a consolidated laboratory serving multiple HCA Healthcare hospitals in Richmond, Virginia. In 1999, HCA made a commitment to consolidate revenue cycle, supply chain and other back-office functions. Given her working relationship with the revenue cycle team, Cook was asked to serve as project director for the revenue cycle project in Richmond. She became chief operating officer of the revenue cycle services team, then vice president of transitional operations, working with client facilities on revenue cycle. In May 2016, she was named CEO for HealthTrust Supply Chain for HCA Healthcare’s Capital Division. She and her husband, Paul, live in Richmond. They have three children.
About the Richmond Consolidated Service Center The Richmond Consolidated Service Center is one of 14 field-based supply chain operations that support primarily HCA operations and in some cases, non-HCA facilities. The CSC provides support in supply and pharmacy distribution and logistics, purchasing and accounts payable transactions, clinical value analysis, contracting, clinical pharmacy and central order entry pharmacy administration and support service coordination to 14 acute care facilities and one behavioral health facility in Virginia, Kentucky, New Hampshire and Indiana. The
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CSC provides transaction services, purchasing and accounts payable activities as well as financial reporting support for HCA facilities in four other divisions in Florida, Georgia and South Carolina. It also provides business continuity support along with sister centers in Dallas, Texas, and Nashville, Tennessee, in the event of weather or other situations necessitating backup support. Repertoire: Can you describe the most challenging and/or rewarding supply-chain-related project in which you have been involved in the past 12-18 months? Lynn Cook: That would be the comprehensive, collaborative and integrated response HealthTrust developed in response to drug, fluid and general supply shortages caused by
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IDN OPPORTUNITIES catastrophic weather events in Puerto Rico, Texas and Florida last year. Distribution, supply chain, facility operations, pharmacy, procurement, clinical resources, chief medical officers, nursing staff and physicians all contributed to ensure the continuity of care. Their efforts included monitoring of product supply levels, identifying substitutes, and creating new protocols. Daily inventory and communication protocols were established, allocation approval hierarchies were implemented, and swift physician and nursing education and adaptation plans contributed to the success. Some of the changes have been adopted as new standards of care and will support improved drug administration management. Repertoire: Please describe a project you look forward to working on in the next year. Cook: I am excited about the opportunities HealthTrust Supply Chain has to collaborate with our clinical and administrative teams in the support services areas, such as food and nutrition, linen, valet, environmental services, waste management, asset management, etc. Our supply chain organization is poised to assist and provide expertise to our hospitals, from analysis of best practices, to contracting, performance monitoring and patient satisfaction monitoring. Expansion into these areas can facilitate identification of options, provide standardization where applicable, and leverage economies of scale. I continue to be excited about the increasing integration of Supply Chain and clinical services. We are fortunate to have many clinicians on our team, including nurses, pharmacists, and surgical services specialists. These experts collaborate with vendors as well as the procurement, contracting and logistics teams to identify solutions and opportunities to our clinical teams. Additionally, they work side by side with the nurses, physicians, chief medical officers and facility finance officers to bring products of the highest quality to caregivers and ultimately, the patients we all serve.
I’ve had many wonderful mentors in my career and I am indebted to each of them for their unique blend of wisdom, candor and patience.
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Repertoire: How have you improved the way you approach your profession in the last five to 10 years? Did you have any help doing so, or was there any particular incident that was particularly significant? Cook: I’ve had many wonderful mentors in my career and I am indebted to each of them for their unique blend of wisdom, candor and patience. Hopefully I’ve woven lessons from them into my daily work. I also hope that I’ve made improvements by employing a stronger focus on empathy and compassion. Healthcare touches all of us. Navigating the system can be intimidating, particularly for those with little or no exposure to a facility and those who are in physical or emotional pain. Demonstrating sensitivity and awareness hopefully lessens the stress for our patients and their families. I also believe that advances in our ability to analyze and interpret financial and quality data improve the delivery of healthcare. Fostering a commitment to data integrity and to improving the analytical and interpretative skills of our clinical and non-clinical teams provides the foundation for supply chain to be a strategic asset to providers and generates opportunities for all healthcare professionals. Repertoire: In your opinion, what will be some of the challenges or opportunities facing the next generation of supply chain professionals? What should they be doing now to prepare to successfully meet those challenges and opportunities? Cook: I think our challenges fall into three main categories: 1) talent recruitment, 2) increased cost associated with medical device innovation and advancing individualized pharmaceutical therapies, and 3) continued potential supply chain disruption due to weather, regulation, etc. These same challenges should also be considered opportunities to secure and develop the best talent, provide better patient care and mitigate supply chain disruptions. Proactive steps that we can take include 1) enhancing our development programs, 2) maximizing commodity standardization opportunities to allow funding for advancing devices and pharmaceuticals, and 3) continued clinical integration to identify alternatives and manage disruptions. These steps are stated broadly and will require robust, detailed work, but that work will set a strong foundation for the future.
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CONSOLIDATED SERVICE CENTERS
Health systems continue to rely on distribution There may be a buzz around consolidated service cen-
ters. But according to the Health Industry Distributors Association, most health systems continue to depend on healthcare distributors to access products. HIDA surveyed 171 IDN executives in 2017 to learn how systems will approach supply chain strategy in the coming years. The results were published earlier this year in a HIDA Horizon Report. Among the findings: • 90 percent of systems surveyed use a prime vendor distributor to acquire med/surg supplies. • 7 3 percent said they obtain “all or most” med/surg supplies from distributors. • 7 6 percent purchase a “few or some” supplies direct from manufacturers. • 1 0 percent purchase “most or all” supplies direct. • 40 percent plan to increase their reliance on distribution. Many (71 percent) of surveyed health systems perform some internal distribution of med/surg supplies to care settings within their organizations, according to the
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HIDA report. The leading sites to which systems deliver med/surg supplies are: • Hospital (49 percent). • Laboratory (49 percent). • Physician office/clinic (49 percent). • Imaging center (46 percent). When asked if they will build a new supply chain facility in the next three years: • 7 percent said yes, they will build a consolidated service center. • 8 percent said yes, they will build a distribution center. • 28 percent said they are “not sure” about building a CSC. • 1 8 percent said they are “not sure” about building a DC. • 65 percent said they will not build a CSC. • 74 percent said they will not build a DC. For more information on the 2018 Horizon Report, “Health System Supply Chain Strategies,” contact HIDA at www.hida.org.
CONSOLIDATED SERVICE CENTERS
Bigger IDNs, bigger likelihood of CSCs Consolidated service centers are growing in number
and in size. So are the services they offer. But supply chain executives contemplating a CSC should proceed with caution. They’re not for everybody. Jamie C. Kowalski Consulting, LLC, and PerformanSC Supply Chain Ltd, released the 2018 edition of their research on CSCs, based on input from healthcare supply chain professionals that use a CSC model for their supply chain and other support services. It is the fourth such report published by Kowalski and PerformanSC since 2012. TECSYS Healthcare, a supply chain software company, sponsored the 2018 edition of the survey. In 2012, 24 CSCs were invited to complete the survey. For the 2018 survey, the invitees numbered 70. Much has changed since 2012, says Kowalski. Many older CSCs were developed by IDNs with fewer than eight (or so) facilities in a single metropolitan area, with the sites being close together. Today they are being developed for 30, 40, 70-plus hospitals, plus ambulatory surgery centers, long-term-care facilities and other primary care venues, which might cover a dozen or more states.
Preparing for growth IDNs that have operated CSCs for a number of years remain focused on continuous improvement in terms of financial performance and quality of service, says Kowalski. Many are
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preparing for growth, that is, adding new providers to their customer network as a result of IDN mergers and acquisitions. They are also adding more support services. The survey team counted more than 20 unique services offered by the country’s CSCs. “If IDN mergers and acquisitions continue the rapid pace they are on today, I believe there will be continued growth in CSCs,” says Kowalski. But supply chain executives should note that the time from start (strategy, feasibility study and design) to opening a CSC can be 20-30 months. Warehousing and distribution of supplies remain the foundation of most CSCs, says Kowalski. But many have decided to take advantage of relatively cheap (compared to hospital) real estate and add square footage for such activities as records storage, linen processing, and even office space. Pharmaceutical distribution is growing as CSCs learn the do’s and don’ts of licensing and other regulations, including IV mixing and unit dose packaging. Lab products, on the other hand, are frequently carved out for a lab specialty distributor, rather than handled by the CSCs, he adds. CSCs come in many shapes, colors and models, says Kowalski: • Some use a third-party-logistics provider to manage warehousing and distribution, others do it all by themselves.
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• Some rely on a med/surg distributor to handle certain products or act as a backup, while others are totally into self-distribution. • Some rely on their GPO for contract pricing for some percentage of the products they buy, while others prefer self-contracting. • Some – particularly, larger IDNs – may offer different centralized functions out of multiple buildings. “There’s no one ‘pure’ way of doing this,” he says. “Each IDN has to decide the best configuration of the model for themselves. But the core principles apply to all CSCs: consolidation, standardization (of products, suppliers), some degree of centralization, and integration. Plus they have to be run like a business.”
Stay away That said, an IDN should resist building a CSC if any of the following are true: •T he corporate culture of the IDN is risk-averse, or is incapable of driving product and process standardization. • S upply chain lacks a solid strategic plan. •T he IDN has failed to commission anyone with knowledge of the CSC model to conduct a thorough feasibility study.
• There is no compelling ROI or payback for the required investment. • The IDN simply lacks the talent to develop the right plan and execute it. What’s more, IDNs should probably resist the temptation to commercialize their CSC operation, that is, act as a “distributor” to facilities that are not part of the IDN. “It’s a matter of overhead,” says Kowalski. That includes salespeople and SKUs. “Most CSCs typically handle 7,000 to 15,000 SKUs. But a distributor can have 100,000 SKUs in the warehouse. Think about the cost of that inventory. It’s big.” Of course, the future will bring with it some wild cards, he says. For example, what impact will companies such as Amazon have on the supply chain and on CSCs? They could be a factor, though to this point they have demonstrated their expertise primarily at handling and delivering small packages, not pallet-loads of IV solutions. As healthcare CEOs, CFOs and others learn about the CSC model and see the success stories – which outnumber the failures – the risk-aversion factor will likely be reduced, says Kowalski. And as the industry gains more experience, the likelihood that a new CEO – that is, someone who was not involved in the original strategy – will close the CSC, will diminish. For more information on the survey, contact Jamie Kowalski at jamie.kowalski@jckcllc.com
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IDN OPPORTUNITIES: HIDA INSIGHTS
Hospital Laboratories Take Steps
to Cope with Staffing Shortages Provided by the Health Industry Distributors Association (HIDA)
Sixty-five percent of hospital laboratory administrators
Majority of labs expect volume increase
identify staffing as their top challenge, a seven percentage point increase from last year, according to the HIDA Provider Survey: Hospital Laboratories Scrutinize Operations. To address these challenges, lab administrators plan to take steps to both attract new personnel and to increase their facilities’ productivity. This provider survey looks at the particulars of these steps, and how they may affect distributors. Here are some of the key takeaways from this research:
The majority of hospital lab administrators (59 percent) anticipate greater volume in the next 12 months. Survey respondents attribute volume growth primarily to their ability to handle more testing in-house, although marketing efforts, population growth, and the construction of new facilities were also cited as important factors.
Labs plan to spend more on supplies Cost reduction remains strategic focus Though staffing is the issue most likely to keep lab administrators up at night, respondents identify cost reduction as their top priority for the next 12-18 months. Increasing the productivity of their existing staff comes in second, followed by recruiting new employees. One respondent commented that these moves are part of a broader strategy to cope with limited resources. In addition to cutting costs and boosting productivity, this individual remarked that they would be selective about the clients and patients they serve. One factor driving labs to focus on costs are new payment cuts, such as the ones under the Protecting Access to Medicare Act of 2014 (PAMA). Specific strategies for responding to these cuts include focusing on utilization management, restricting access to more expensive tests, increasing prices for private payers, and developing a leaner and more automated work environment.
Over the next fiscal year, 47 percent of respondents say they their medical supply budgets will increase by 1 to 5 percent. A similar percentage say their laboratory supply budgets will increase. Only 28 percent of respondents say their medical supply budgets will decrease, while 29 percent say their lab supply budgets will decrease.
Capital equipment budgets remain flat or decrease Half of respondents report their laboratory’s capital budget will remain flat over the next fiscal year, with 28 percent saying these budgets will decrease. Labs are primarily focused on replacing or updating existing capital equipment over the next year, with only 17 percent planning to invest in new types of capital equipment. As hospital labs look to control their expenses, distributor reps can play a key role by guiding them to solutions that will address their concerns. While this may require guiding customers to cheaper options, it could also include educating providers on new equipment that can free up lab staff ’s time.
For more information, and to see additional research reports in HIDA’s Provider Survey series, visit www.HIDA.org/ProviderSurveys. 22
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STREAMLINING HEALTHCARE EXPO & BUSINESS EXCHANGE
A Meeting Place Streamlining Expo in Chicago facilitates 1,200 meetings
The Health Industry Distributors Association reports
that its Streamlining Healthcare Expo & Business Exchange, held in Chicago this fall, provided “unprecedented collaboration opportunities” among healthcare supply chain trading partners. Some 900 participants from healthcare distributors, manufacturers, GPOs, and health systems took part in more than 1,200 meetings in two and a half days. At the event, Mark Hineser, owner of Eco Sound Medical Services, was installed as 2019 Chairman of the Board of Directors for HIDA. He was introduced by current Chairman Chris Kerski, Cardinal Health, and will begin his one-year term Jan. 1. To strengthen coordination between distributors, manufacturers, and federal agencies, HIDA brought together representatives from the Office of the Assistant Secretary for Preparedness and Response (ASPR/HHS), Food and Drug Administration (FDA), and Office of Public Health
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Preparedness and Response (PHPR/CDC). Attendees brainstormed ways to ensure product availability, particularly during emergencies and epidemics. During the “Making the Case for Quality Products” session, health system supply chain leaders talked with supplier executives about how they judge quality when it comes to medical products. Despite the growing focus on outcomes, supply chain leaders said their primary focus remains on costs and the measures that contribute to costs, such as patient length of stay. Participants in the second annual Independent Distributors Summit observed that keeping product information up-to-date in their systems and on their websites can be a full-time job. The prospect of investing in standards, technology, and infrastructure, on top of current product information management (PIM) needs, seems daunting for many, but can yield dividends, according to participants.
Pricing accuracy poll HIDA conducted a live audience poll at its Streamlining Healthcare Expo & Business Exchange in Chicago that addressed its initiative to improve pricing accuracy for trading partners. (Top two responses were included). Q: Which do you think is the biggest reason for chargeback denials upon first submission? • Customer eligibility/incorrect tier: 54 percent. • Customer identification: 30 percent.
Q: Approximately how much time does your organization need to load pricing from a new contract? •O ne week: 42 percent. •O ne month: 33 percent.
Q: On average, how much time do you personally spend each week resolving pricing discrepancies? • Minimal to three hours: 42 percent. • More than 8 hours: 22 percent.
Q: In the past three years, have overall contract administration / pricing accuracy efforts gotten better, worse, or unchanged? •U nchanged/No opinion: 65 percent. • Better: 28 percent.
Pricing accuracy HIDA released initial results from its 2018 Pricing Accuracy Survey. For the second straight year, eligibility was the No. 1 chargeback dispute issue. Findings include: •M ore than half of 2017 medical/surgical chargeback disputes were due to eligibility issues, including minimum order quantities not met, referenced contracts not yet implemented, customers and/ or products not covered on contract or not yet eligible, or distributors not covered on contract or authorized. •R oughly 65 to 85 percent of contract change notifications are communicated via Excel XLS or CSV file. Respondents reported year-over-year increases in EDI communications, however. • I n the absence of an industry standard, manufacturers
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STREAMLINING HEALTHCARE EXPO & BUSINESS EXCHANGE
and distributors transact with multiple customer identifiers. GPO ID is the most common identifier partners are able to send, followed by the provider internal customer ID. • More manufacturers (78 percent in 2017 vs. 70.6 percent in 2016) are aiming to meet HIDA’s 45-day notification standard to distributors for contract
The industry has yet to standardize who customers are (no single customer identification standard), but this remains a separate issue to classify what customers are, whether within contract language or in reference to tier eligibility. changes. The majority of notifications are still received in the 30-to-44-day range, but nearly 20 percent of notifications in 2017 were received with 45 days’ notice or more. • Distributor respondents reported that more than $13.9 billion in 2017 chargebacks were submitted to manufacturers. The reported initial denial percentages for these chargebacks ranged between
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3.2 percent (reported by distributors) and 5.0 percent (reported by manufacturers), but nearly half of all survey respondents don’t know or don’t measure these figures.
GPO panel The GPO Panel featured perspectives from Amy Campbell, senior vice president, Yankee Alliance; Bryce Hughes, senior vice president, Alliant Purchasing; and Micah Smith, associate vice president, Provista. Topics included: • Self-inflicted errors in contract administration. Customer eligibility and member rostering remain two practices that could be improved across the board. • Owned vs. affiliated designations within health systems and IDNs. Open and transparent communication between all parties and to IDNs can help customers understand what is and isn’t covered on their contracts. • Class-of-trade standards. Calls in the industry persist for standard definitions of provider customer types and locations. The industry has yet to standardize who customers are (no single customer identification standard), but this remains a separate issue to classify what customers are, whether within contract language or in reference to tier eligibility. HIDA’s next Streamlining Healthcare Expo & Business Exchange will take place in Chicago, Illinois, Sept. 23-26, 2019.
SUPPLIER DIVERSITY
Left to Right: Earl G. Reubel Award Winners with O&M Teammates, Dr. Danni Green, O&M Director; Dr. Sam Ross, CEO Baltimore (Bon Secours Mercy Health) - Large Corporation of the Year with Gloria Goins, CDO (Bon Secours Mercy Health); Tim Martin, Contracting Manager (CHRISTUS Health) - Civic Leader of the Year; Sam Kumar, CEO (MYCO Medical) - Diverse Enterprise of the Year with Michael Taylor, Sales (MYCO); Will Sapp, National Accounts (Medtronic) - HSDS Chairman’s Award for Excellence in Diversity & Inclusion; Geoff Marlatt, O&M SVP, Manufacturer Services
Supplier Diversity Symposium Owens & Minor hosted its 13th annual Healthcare
Supplier Diversity Symposium in Chicago this fall, to coincide with the Health Industry Distributors Association’s Streamlining Healthcare Expo & Business Exchange. Speakers, panelists, hospital and healthcare executives, along with diverse suppliers, participated in the Symposium to encourage industry players to be intentional about economic inclusion, according to Owens & Minor. Guest speakers included Daryl Mackin, founder and executive director of A Soldier’s Child Foundation; and Bill Strickland, community leader, author, and president and CEO of the non-profit Manchester Bidwell Corporation of Pittsburgh. Clarence Page of the Chicago Tribune and Dr. Fred McKinney, director of the People’s United Center for Innovation & Entrepreneurship, moderated panel discussions. As in past years, the Symposium recognized industry leaders for their commitment to diversity with the Earl G. Reubel Awards. The awards were established by Owens & Minor in 2012 and named in honor of Earl G. Reubel,
the late founder and CEO of Kerma Medical Products. The winners were chosen for excellence in three healthcare industry categories: civic leadership, large corporate leadership, and diversity enterprise. • The Earl G. Reubel Civic Leader of the Year Award was awarded to Timothy Martin, strategic sourcing manager for CHRISTUS Health in Dallas/Fort Worth, Texas. • The Earl G. Reubel Diverse Enterprise of the Year Award was presented to MYCO Medical of Apex, North Carolina, a certified diversity supplier of medical devices specializing in single-use disposable clinical preference items. • The Earl G. Reubel Large Corporation of the Year Award was presented to Bon Secours Mercy Health in Baltimore, a 100-bed facility licensed in the state of Maryland serving more than 17,000 residents in the Baltimore area. In addition, the inaugural Chairman’s Award for Excellence in Diversity and Inclusion was awarded to Medtronic.
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Manufacturer Reps to Watch Reponsive. Accessible. Knowledgeable. These are a few of the
traits that help make a manufacturer rep successful in their partnerships with distributor reps. Repertoire asked ten successul manufacturer reps their insights on several topics, including how they can add value to their accounts, the biggest change they anticipate in medical products sales â&#x20AC;&#x201C; and even ride days with distributor reps.
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Manufacturer Reps to Watch Amy Soto Ambulatory Care Specialist B. Braun Medical Pompano Beach, Florida Nine years in medical sales
Snapshot: • Born/raised: Born in Beaumont, Texas; raised in Birmingham, Alabama • Undergraduate degree: Degree from University of Alabama at Birmingham; two majors – medical industrial distribution and marketing. •F irst “real” job: I started my sales career early – when I was 15; I sold pageant, prom and wedding dresses at a local shop. •F avorite restaurant: I don’t think it would be possible for me to pick a favorite restaurant. I enjoy trying new foods and restaurants, so I’m always adding a new favorite place to my list. • Family info: My husband, Javier, and I live in Pompano Beach with our dog, Brooks. •H obbies/activities: Traveling, cooking, scuba diving, paddle boarding … pretty much anything active/outdoors.
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Repertoire: What are the most important things you do for your distributor reps to enhance their sales? Soto: I started my medical sales career as a distributor rep, so that has enabled me to have a better understanding of their side of the business. Distributor reps sell countless products and wear so many hats, so by being a resource and product expert for them and our customers, my goal is to help take something off of their plate.
Being responsive is key. Most of the time, distributor reps need answers for customers immediately, so always being responsive and accessible allows them to accomplish their tasks and move on to help the next customer. When I was a distributor rep, the most helpful thing a manufacturer rep could do was respond in a timely manner and be knowledgeable about their products. Repertoire: Name some ways distributor reps help you add value to their accounts and increase sales. Soto: Distributor reps have access to a significant number of accounts/customers, so utilizing them to meet new customers to grow our business together is such a benefit for me. Having an established trust with a new customer through the distributor allows me to advance the sale quicker and be a better resource and product expert for the customer. I don’t think it’s a distributor rep’s job to know specific/clinical details about my products, but if they walk into an account and see some competitive products and immediately think to contact me about an opportunity, then I know that they see me as a valuable resource. When they bring me an opportunity, it’s my job to be the expert of my product and portfolio, bring the customer value and savings, and increase distributor margins. Repertoire: What is the biggest change you anticipate in medical products sales in the next five years?
Soto: As more hospitals and IDNs are forced to transition to a valuebased payment model, ambulatory surgery options are becoming a necessity. The ambulatory surgery center (ASC) market growth is expected to continue to rise significantly over the next several years, which will bring about new opportunities and business in our outpatient market. At a time when everyone is focused on reducing costs, ASCs are able to accomplish that along with improving quality, patient outcomes, and customer service. Repertoire: Ride-days with distributor reps: What do you like? What don’t you like? Soto: What I like most is the focus the distributor rep has on my products and targets. For a ride-day to be effective for both parties, there must be a focused amount of pre-call planning completed. From my experiences, it seems to help my distributor reps more when I plan a few key accounts to target. It also helps when I’ve already established that trust and partnership with the rep, so they know they can trust me by bringing me into their accounts. Repertoire: Do you have a favorite ride-day story to share? Soto: I don’t have one specific story that stands out, but in general, if I am able to make the distributor’s day a little easier, show them that I respect their business and their customers, and grow our business together, then I consider that a win for all. By establishing and solidifying these trusted relationships, we can all benefit.
“ Most of the time, distributor reps need answers for customers immediately, so always being responsive and accessible allows them to accomplish their tasks and move on to help the next customer.”
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Manufacturer Reps to Watch Brady Bernhoft Territory Portfolio Manager Midmark Corporation Lodi, California Fifteen years in medical sales
Snapshot: • Born/raised: Born in Sacramento, California. Raised in Lodi, California. • Undergraduate degree: BA, Communication Studies, California State University, Sacramento •F irst “real” job: Sports marketing, California State University, Sacramento. (Fun fact: Was offered a sports marketing job with the Sacramento Kings basketball team ON THE SAME DAY he was offered a sales job with Midmark. Still grateful to have chosen the latter.) • Favorite restaurant: Love trying out new restaurants, but a big fan of steak houses, Italian and Mexican cuisines. • Family info: Married seven years to my beautiful wife, Kirsten. Three children (two girls, one boy): Addy is 5, Bennett is 4, and Sutton is 1. Can’t forget about Tucker, our Welsh Corgi. •H obbies/activities: Love to golf, travel, watch/play all sports, and spend quality time with my family.
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Repertoire: What are the most important things you do for your distributor reps to enhance their sales? Bernhoft: • Continuous education and insight regarding our changing healthcare system and strategic ways to teach our customers. • Helping to tailor our unique value proposition to our customers and finding ways to improve patient care and the patient experience while reducing cost. • Being the expert, displaying value and helping our distributors teach and tailor this message. Our daily goal is make healthcare a positive experience for all. By being genuine, passionate and adding educational insight to our customers, sales will increase.
Repertoire: Name some ways distributor reps help you add value to their accounts and increase sales. Bernhoft: Finding the right mobilizers inside our mutual accounts is key. By working together and tracking them down, we are able to help teach and tailor our commercial insight. Having the right conversations with key mobilizers to position our unique value and move forward with the sales process is crucial. Working together as a team to find these mobilizers will increase our sales and allow us the opportunity to improve patient care and the patient experience. Repertoire: What is the biggest change you anticipate in medical products sales in the next 5 years? Bernhoft: Our value-based healthcare system and importance of patient satisfaction scores are driving great change in healthcare. It’s not about a product; it’s about work flow, clinical design, process of conveyance, improving patient care, the patient experience, equal access to all, accessibility, technology, standardization and making the healthcare experience excellent for everyone. Healthcare systems are looking to develop strategic partnerships with companies who are aligned with these outcomes. Our ever-changing healthcare environment will continue to focus on clinical work flow/ design and favor companies heading in this shared direction. Repertoire: Ride-days with distributor reps: What do you like? What don’t you like?
Bernhoft: Being able to spend time with my friends is a privilege, and I am very grateful for the opportunity. Having the ability to spend one-onone time and discuss current healthcare insights, updated regulations, requirements, case studies, success stories and other educational info to help them succeed is a blessing. We share educational info with one another and help each other grow and become better consultants. Together we are able to track down key mobilizers and position ourselves for the next sale. Repertoire: Do you have a favorite ride-day story to share? Bernhoft: Ten years ago I spent a couple of days in Redding, California, with the legendary Don Hill with McKesson. Our Barrier Free Promotion had just kicked off, and Don wanted to sell more Barrier Free Chairs than anyone in the country during his final year before retirement. We met at the Red Lobster in Redding, ate way too much food and then put together a strategic game plan, tailored to his specific territory/accounts. Don Hill was the master of Sales 101 and made sure he lived and breathed every one of his trained sales techniques. Don believed in our Barrier Free story, was extremely passionate, didn’t prequalify anyone, educated himself on current regulations, was beyond prepared for every account, was dialed in with insight to educate his customers, and didn’t take no for answer. He set a record that year, and the record might still stand.
“ By being genuine, passionate and adding educational insight to our customers, sales will increase.” He sold close to 100 Barrier Free exam chairs, and none were for new clinics opening up a new site. One hundred percent were replacement exam chair sales, and no more than four each to one account. Plus, Don didn’t silo our exam chairs; he wanted to improve patient care and improve his customers’ entire exam room work flow process with our leading diagnostic EHR integration solutions and flexible cabinetry design layouts. Don became the clinical exam room expert that week and for the rest of his career. Don’s numbers during that promotion were legendary and still are to this day. The Legendary Don Hill Story will stay alive forever!
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Manufacturer Reps to Watch
Claire Bishop Territory Account Manager Quidel Corp. Washington, D.C. Eight years in medical sales
Snapshot: • Born/raised: Birmingham, Alabama • Undergraduate degree: Bachelor of business administration with a concentration in marketing and computer science, The University of Alabama. • First “real” job: Account manager for Pitney Bowes in Washington, D.C. • Favorite restaurant: Rose’s Luxury, a local favorite located walking distance to our house in Capitol Hill, serving new American cuisine. • Family info: My husband and I are both from the South and met in D.C. We have been married for three years and have a Pug named Archie (“Arch-Bishop”). • Hobbies/activities: Traveling, boating, college football (“Roll Tide”) and hosting friends and family for BBQs.
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Repertoire: What are the most important things you do for your distributor reps to enhance their sales? Bishop: I maintain trust, integrity and accountability with a positive attitude. Trust is established and maintained by being transparent, honest and following up when promised. Even in tough situations, having an open conversation goes a long way. I am here to listen. Introducing new ideas and industry best practices increases credibility in my partnership. Maintaining integrity, standing by the right decision, even when it is the hardest decision, is always a rule to live by. I am always looking for ways to increase their margin dollars without adding more work. Each distributor has their own style of account management, and it is up to me to learn their individual style and adapt accordingly. I am grateful for their support and keep a smile through challenging times.
Repertoire: Name some ways distributor reps help you add value to their accounts and increase sales. Bishop: The best distributor reps build and maintain the strongest relationships with their accounts. Being a trusted advisor for new business ventures leads them to new opportunities. They also maintain constant communication and follow-up. The best distributors are knowledgeable about when decisions are being made and which key stakeholders are involved in the decision-making process. They add tremendous value, helping the manufacturer reps navigate accounts and narrow down who they should be spending their time with. They are also aware of changes within accounts and how to adapt to them. I want my distributors to be their customers’ first call for new opportunities. I want to be my distributors’ first call to set up an appointment to close the business. Repertoire: What is the biggest change you anticipate in medical products sales in the next five years? Bishop: Consolidation and new performance measures for providers. Consolidation is often the result of new demands for value-based care vs. volume-based care. The shift has required healthcare organizations to re-shape their internal and external operations, combining best practices. In the last year I have seen many new partnerships and acquisitions designed around maximizing patient satisfaction and extending services to new patient populations. As a representative in our industry, it
is my responsibility to stay educated on how our solutions increase quality today and in the future. It is imperative to be the one my customers trust to introduce innovative solutions to add to their value-based offering. Repertoire: Ride-days with distributor reps: What do you like? What don’t you like? Bishop: A successful ride day includes accounts with new opportunities and existing business. Having a distributor rep with the ability to introduce you to multiple call points within one account allows you to benefit from learning what is truly important to each role. The ability to leverage information from multiple areas sets you apart from competitors and allows you to build credibility as a true partner to their organization. Understanding multi-level buying criteria will steer conversations toward value, making price less of a factor. Most important: A successful ride day is fun. It is a chance to learn from your peers and even to challenge each other with friendly competition and side goals you set together as a team. Repertoire: Do you have a favorite ride-day story to share? Bishop: My favorite ride day was a prime example of both manufacturer and distributor becoming one team to service our customers. I was new to working with the distribution team, and the rep I was working with had been experiencing challenges. The distributor and I met beforehand to discuss our strategy, address each concern and compromise on moving
“ I want my distributors to be their customers’ first call for new opportunities. I want to be my distributors’ first call to set up an appointment to close the business.”
forward. Through the distributor’s relationship with the account, we sat down with the decision-maker right away. From workflow to pricing to clinical studies, we both addressed different sides of the equation. We collaborated with another manufacturer rep to create bundled options and address unmet needs. The customer standardized our solution for the complete system. Each person played a pivotal role.
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Manufacturer Reps to Watch Conor Bradley Account Executive Medtech/Medcare (MTMC) West Hartford, Connecticut Eight years in medical sales
Snapshot: • Born/raised: West Hartford, Connecticut • Undergraduate: BA, History, Hobart College • First “real” job: Sales representative for Cintas •F avorite restaurant: I am spoiled, because we have a lot of great local restaurants, but I would have to say my favorite is Max’s Oyster Bar. I love seafood, especially oysters. • Family info: I live in West Hartford with my girlfriend, Megan, and our two dogs, Parker and Hayley. •H obbies/activities: I love to golf and try to play as much as I can. I played hockey in college and still get out and play once a week in a men’s
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league. I enjoy time with friends and family and try to spend as much time outdoors as possible. I’m on the board of the West Hartford Exchange Club, whose mission is to make
its community a better place to live through programs of service in Americanism, Community Service, Youth Activities and its national project, the Prevention of Child Abuse.
Repertoire: What are the most important things you do for your distributor reps to enhance their sales? Bradley: My distribution partners are vital to my success and because of that, I constantly need to stay in front of them to let them know of the newest technologies, promotions and contract positions, so that together we can bring value to their accounts. My goal is to find a way to bring value to my distribution partners every time I am in one of their accounts. Whether it is something as simple as staff training, or having higher-end conversations about EHR connectivity, HEDIS measurements or standardization, I strive to bring as much value as possible to my distribution partners and their accounts. Repertoire: Name some ways distributor reps help you add value to their accounts and increase sales. Bradley: I work with my distribution partners daily to get in front of their accounts’ key decision-makers to drive sales. Because I represent many different product categories, each account may have a different person as the correct call point. The decisionmaker may be someone in the supply chain, someone in value analysis, a clinical nurse, an office manager, someone in biomed, a lab director, or a physician. I constantly challenge my distributor partners to get me in front of the correct call point so that we can bring valued and strategic solutions to their accounts.
Repertoire: What is the biggest change you anticipate in medical products sales in the next 5 years? Bradley: Medical products sales has changed drastically since I started, and it will continue to evolve over the coming years. Changes have included health system consolidation and movement away from fee-for-service to valuebased reimbursement; and these kinds of changes will continue to present challenges for the medical sales rep. Successful medical sales reps must accept the changes and challenges that will inevitably come with the shift in how healthcare is delivered in their accounts. Even so, they must present solutions that meet the health system’s needs. Repertoire: Ride-days with distributor reps: What do you like? What don’t you like? Bradley: Ride-days are great and allow for one-on-one time with our distribution partners, but with the ever-evolving healthcare landscape and so many different call points, ride-days need to be structured and planned out to maximize efficiency. Understanding each rep’s business to proactively target accounts with a strategic mindset allows everyone involved to get the most out of it. Utilizing our distribution partners to set strategic appointments with the appropriate call points allows us (distributor and manufacturer) to deliver a solution that fits an account’s specific needs.
“ Whether it is something as simple as staff training, or having higher-end conversations about EHR connectivity,HEDIS measurements or standardization, I always strive to bring as much value as possible to my distribution partners and their accounts.”
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Manufacturer Reps to Watch Jenean Harris Manager Distribution Sales, Mid-Atlantic Sysmex America, Inc Mooresville, North Carolina Fourteen years in medical sales
Snapshot: • Born/raised: Born in Wilmington, North Carolina; raised an hour south, in Ash, North Carolina. • Undergraduate degree: BS in medical technology, UNC Wilmington • First “real” job: Customer service representative for the clinical lab, Presbyterian Hospital in Charlotte, North Carolina • Favorite restaurant: Epic Chophouse, downtown Mooresville. (American steak house.) • Family info: One child, my son, Justin, six years old. Currently in kindergarten at Woodland Heights Elementary School. • Hobbies/activities: In the past I played volleyball, tennis and golf. Now my time revolves around my son. He plays soccer, T-ball and basketball. Between his practices and games, there’s not much time left for Mom. Our family does enjoy Wake Forest sports. We have season tickets to the football games, and we attend basketball and soccer games when we can. GO DEACS!
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Repertoire: What are the most important things you do for your distributor reps to enhance their sales? Harris: In the past three years, I’ve learned what distribution reps really want is a happy customer. So the No. 1 thing I can do for them is take care of their customers in a timely manner. Sysmex is No. 1 in customer service. Our instruments are extremely reliable and in the POL market, where back-ups are not common, this is a must. Just like the reps I work with daily, we put the customer at the center of everything. I also try to provide them with tools – e.g., video demos – so they can work with a customer on a solution even if I am not available. By using video demos, the rep can provide a demo without waiting to coordinate with my schedule, which can be quite a daunting task!
“ The distribution reps are my eyes and ears in each site. They relay information to me so that I can continue to take care of the customer.”
Repertoire: Name some ways distributor reps help you add value to their accounts and increase sales. Harris: By being the face to the customer, having the relationship and understanding the customer’s business, the distribution rep provides the information needed to make sure I recommend the right solution. Once an instrument is installed, they provide feedback from their day-to-day interactions with the customer. I cover the entire Mid-Atlantic, so oftentimes I don’t actually meet the end user. But I don’t need to, because the distribution reps are my eyes and ears in each site. They relay information to me so that I can continue to take care of the customer. It’s truly teamwork!
Repertoire: What is the biggest change you anticipate in medical products sales in the next 5 years? Harris: With all the changes in reimbursement for lab testing, I see more affordable products coming from manufacturers. For example, Sysmex launched the CLIA-waived hematology instrument this year. Other companies are following suit. POC testing is key in patient care, so the more products we have that fit in the POLs, the better care the physicians can provide. Effective Jan. 1, 2018, PAMA is an attempt to bring the rates that Medicare pays for lab tests closer to the rates paid by private payers. Repertoire: Ride-days with distributor reps: What do you like? What don’t you like?
Harris: I will always say “yes” to working hand-and-hand with the distribution reps in my area. It is a great learning experience, because they are the experts on what is going on in the market and know all the latest and greatest products. So I love to pick their brains professionally, but I also love getting to know them on a personal level. I enjoy hearing about their families and what they do in their free time. The hardest part about being on the road with a rep is that I am cut off from other reps who may need something quickly. This can cause a little delay in response time. I’ve often said the best thing I can do for my reps is stay in my office so they can reach me if needed. It’s a catch 22!
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Manufacturer Reps to Watch Lindsey Knudten Senior Sales Representative Sekisui Diagnostics Laguna Niguel, California Nine years in medical sales
Snapshot: • Born/raised: San Francisco Bay Area in Danville • Undergraduate degree: San Diego State University; major in communication, minor in psychology • First “real” job: In 8th grade I applied for a worker’s permit, so I could get a “real job” at the age of 13. I worked at the local beauty supply store, which was walking distance from our house. Prior to Sekisui, I worked at Terumo Medical after graduating college. • Favorite restaurant: Depends on the day … but it would be between Alessa in Laguna Beach for Italian food, or Bandera in Corona Del Mar. • Family info: Married to my husband, Jeff, who has also been in the medical sales industry for over 12 years. Our favorite days are when we get to go on ride-days together! • Hobbies/activities: Yoga, cooking, recently trying out golf, annual trips to Maui, spending time with our families.
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Repertoire: What are the most important things you do for your distributor reps to enhance their sales? Knudten: In my opinion, the most important thing I can do for my distributor reps is to make their job easier. Growing up in a family that has been in the medical sales industry, I have seen firsthand the directions reps get pulled in on a daily basis. As a manufacturing partner, if I can provide solutions that make their customers happy, take something off their plate, and increase their margin, it is a win-win for all parties. To piggyback on this, I feel the most successful way to go about this is to have immediate response times. People want answers quick; I know I do. And if I’m not getting back to my reps and/or their accounts quickly, they can easily go elsewhere.
In addition to this, it’s very important that I have an understanding of my rep’s compensation model. By being familiar with this, I can help them see why selling my products will impact them positively from a financial standpoint, while gaining new business. Repertoire: Name some ways distributor reps help you add value to their accounts and increase sales. Knudten: Pre-call planning! When I am in front of my rep’s accounts, the prep work that goes into the meeting makes all the difference. Knowing their patient population, a good idea of the payer mix, why they’re considering in-house lab testing, what their concerns are and their biggest motivation for change allows us to have a successful meeting. By having these discussions prior to going in, the rep and I are on the same page and we have our story customized to the customer’s needs. That way we can ensure the customer has a full understanding of what we’re presenting and we’ve covered any areas of concern. Repertoire: What is the biggest change you anticipate in medical products sales in the next 5 years? Knudten: Being on the tail end of the millennial generation, I frequently have conversations about how things are changing and what this generation wants. It’s all about access to knowledge. Before I try or go anywhere new, I do online research and have my answer within minutes from my phone. When it comes to anything in the medical
industry, we question things and whether or not they are really necessary, what the best plan of care should be, who the best physician is – not just in our local area, but in the entire country. We can do research for days on end. All this being said, I think the direction we’ll see in the years to come is the increased importance of patient satisfaction and moving away from our current reimbursement model. It’s important that we’re tailoring our messaging to reflect this. Repertoire: Ride-days with distributor reps: What do you like? What don’t you like? Knudten: Going on ride-days with reps absolutely has some key benefits. First and foremost, ride-days allow us to build relationships. Although our time in front of a screen has increased dramatically in the last 20 years, face-to-face time with reps is the best way to enhance our relationships and for the reps to gain their trust in me. In addition to this, ride-days give the rep an opportunity to see how I present my product to the customer, overcome challenges and answer questions related to my products and how they’ll fit into their workflow and practice as a whole. This allows the rep to have confidence in the future when talking about my products when I’m not there. Repertoire: Do you have a favorite ride-day story to share? Knudten: Not exactly a ride day … but a distributor meeting was held in Reno, Nevada, and our team-building
“ Although our time in front of a screen has increased dramatically in the last 20 years, face-to-face time with reps is the best way to enhance our relationships and for the reps to gain their trust in me.”
activity was going skeet shooting. This was my first time doing anything like this, and it was a total blast that had just enough of a competitive edge to keep things fun! It was definitely unlike any other work event I attended and was excellent for teamwork and relationship building. I always appreciate when managers think out of the box for their regional meetings.
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Manufacturer Reps to Watch Shawna Osborn Non-Acute Account Business Manager Becton Dickinson San Antonio, Texas Seventeen years in medical sales
Snapshot: • Born/raised: Oklahoma (BOOMER SOONER!) • Undergraduate degree: The University of Oklahoma (kinesiology) • First “real” job: I worked for a medical publishing company that produces women’s health education materials in Arlington, Texas, called Customized Communications. The owner of this company was the first to recognize my talent in sales and to “give me a shot.” I credit him still, all these years later, for my success. I am very grateful for the opportunity that guided me to find my calling. • Family info: I have a domestic partner named Valerie. She and I live together in 42
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San Antonio with our two 9-pound Shih Tzus (Baker Mayfield and Pendley) (named after Sooner greats!). I have two wonderful children: my daughter, Hailey, is 22 and lives in Oklahoma, and my son, Seth, is 19 and lives in Oklahoma as well.
•H obbies/activities: I am an avid college football fan, or should I say, THE UNIVERSITY OF OKLAHOMA football fan! I don’t miss a game! I go to as many live as I can, and watch all the others on TV. I also love to travel and spend time with my family and friends.
Repertoire: What are the most important things you do for your distributor reps to enhance their sales? Osborn: WALK IN THEIR SHOES. I put myself in the distributor rep’s shoes. I take the time to understand their margins and needs from the sale. I treat their needs as I do my very own. I hear “You just get it!” all the time from my distribution reps. BE PRESENT. I am the expert on my instruments, and I work to make myself available to my reps as well as their accounts as much as possible. I always clarify next steps with the account in the sales process and keep the distribution rep up to date. FOLLOW THROUGH. I see my sales from start to finish and even after the sell. I attend implementations, trainings and start-ups of my instruments whenever possible, and continue to be a face in the account well after they are using a BD product. Repertoire: Name some ways distributor reps help you add value to their accounts and increase sales. Osborn: My distributor reps have the relationships with the accounts. They have the ability to get you in to speak with the decision-makers and help you understand the needs of the particular account. My distributor reps are more feet on the street and advocates for my products. Together we can cover so much more territory and reach so many more accounts. They are also references for me, not only to their accounts, but
to other manufacturer reps as well. Once I worked hard, proved myself and earned the trust of the rep, they let everyone know it! Repertoire: What is the biggest change you anticipate in medical products sales in the next five years? Osborn: I anticipate a shift in call points over the next 5 years. With new innovations in medical devices being brought into physician practices to help bring revenue in-house, and with the ever-declining reimbursement for services, I believe we will see a large increase in physician office sales. Repertoire: Ride-days with distributor reps: What do you like? What don’t you like? Osborn: I LOVE riding with my distributor reps. It is how I learn what his or her needs are so I can do my very best to meet those needs. It is also an opportunity to get into accounts and get to know them and develop trusted relationships. My distribution reps have become friends as well as mentors for me. Repertoire: Do you have a favorite ride-day story to share? Osborn: I guess I would have to say my favorite ride-along day came in the height of 2018 flu season. Our BD Veritor was in high demand due to most other companies being on back order during the epidemic. I rode with seven different distribution reps in a single day! We closed over 30 accounts that day!
“ Once I worked hard, proved myself and earned the trust of the [distributor] rep, they let everyone know it!”
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Manufacturer Reps to Watch Karina Phelan Senior Sales Manager, Southern California Masimo Corporation Santa Monica, California Fourteen years in medical sales
Snapshot: • Born/raised: Gardena, California • Undergraduate degree: BA, philosophy, University of San Diego • First “real” job: My father owned a sign business, and I would help him screen print and paint as well as install. Very hard work. He inspired the work ethic I have today. • Favorite restaurant: I love good food. I’ve traveled a lot, and it never surprises me that there is always good food to find no matter where you are. I went to a restaurant once called Trois Mec in Los Angeles. The chef is French. From the outside, the restaurant looks like a dingy pizza parlor with privacy stained glass windows, but once inside it’s a beautiful and romantic place, and the food experience was out of this world! • Family info: My husband, Brian, and I have been married for 11 years and have two amazing
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boys Dean (10), Jack (8), and our Siberian Husky, Mishka (6). Brian is a supportive and loving husband and father. He does double time when I am traveling for work. My kiddos are my Number 1 fans, as I am theirs, and they love basketball, surfing, skateboarding and mountain biking.
• Hobbies/activities: I love RVing – camping and hiking – with the whole family. I also enjoy reading about historical figures and events, as well as medical and science breakthroughs. But nothing beats snuggling with my kiddos and reading stories to them before bed.
Repertoire: What are the most important things you do for your distributor reps to enhance their sales? Phelan: The most important things I can offer my distributor reps and their customers are my knowledge and clinical understanding of Masimo technology and how it can improve patients’ lives and help clinicians better assess their patients; and to be professional in every aspect when meeting with my distributor reps’ customers. Repertoire: Name some ways distributor reps help you add value to their accounts and increase sales. Phelan: Distributor reps know their customers and their needs. By qualifying their customers for me – that is, telling me what exactly their customers’ needs are – they help me determine what products to demo and how to price accordingly with my distributor rep. Second, when a distributor rep discloses competitive products they have demoed their customer, I can be better prepared and offer a competitive price. In addition, it shows the customer that we are there to provide all necessary clinical information so they can make the best choice for their practice. Repertoire: What is the biggest change you anticipate in medical products sales in the next 5 years? Phelan: I already see big changes in the medical sales industry. Small physician offices are being integrated into large health systems. Physicians who want to stay independent of
health systems are looking for ways to stay financially afloat so they bring in point-of-care testing devices, not only to provide better patient care but to also bring in revenue. Further, with MACRA, physicians are being rewarded on a value-based model rather than on the volume of patients they see. Repertoire: Ride-days with distributor reps: What do you like? What don’t you like? Phelan: I enjoy ride days! It gives us a chance to catch up on our personal lives. When you’ve been in this business long enough, it’s hard not to become good friends. I love working with newer reps, especially those who are new to the medical industry, because I can help them navigate the waters and understand how manufacturer reps can help them open doors to new opportunities. Repertoire: Do you have a favorite ride-day story to share? Phelan: I and a rep were cold calling surgery centers. The rep did not have any business in this surgery center, since they were purchasing from a competitor. I was leading the call, so I introduced myself first and asked to see the nurse manager. Once inside the nurse manager’s office, I began asking her if they were monitoring their patients’ Endtidal CO2 after surgery. She began to tell me how they actually needed to get a new patient monitor, so I introduced my distributor rep and mentioned that the distributor had promotions on the device she was
“ I love working with newer reps, especially those who are new to the medical industry, because I can help them navigate the waters and understand how manufacturer reps can help them open doors to new opportunities.”
interested in. The manager liked our technology so much and the distributor rep’s eagerness to gain her business, that she opened up a new account on the spot and placed an order. This happens frequently when I cold call with distributor reps, and it just attests to Masimo’s superior products and technology.
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Manufacturer Reps to Watch Michael Piper Territory Manager MedPro Associates Silver Spring, Maryland Eight and a half years in medical sales
Snapshot: • Born/raised: Skaneateles, New York • Undergraduate degree: BA, English major, Loyola University Maryland • First “real” job: I was a sports/news writer for a small newspaper in Upstate New York for eight years. • Favorite restaurant: Outback Steakhouse. For my money, you can’t beat a BBQ combo platter. • Family info: My wife is Dawn, and I have three boys: Ryan (12), Colin (9) and Brendan (7). • Hobbies/activities: I love being outdoors and being active, so camping, hiking, jet skiing, snow-boarding.
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Repertoire: What are the most important things you do for your distributor reps to enhance their sales? Piper: The more you know about your products, the more of a resource you can be for your distributor rep and their customer. The basics – like product numbers, pricing, etc. – can help, but knowing how to position the products and how best for the customer to optimize those solutions can be helpful for both the end user and the rep. As a manufacturer rep firm, we can offer multiple product lines outside of the original opportunity within the call. Doesn’t happen all the time, but occasionally, one demo can lead to other opportunities at the same account.
“ The rep doesn’t need to know the finer points of every product, but a solid understanding of what makes the product/product line unique is a huge help in terms of qualifying the opportunity.”
Repertoire: Name some ways distributor reps help you add value to their accounts and increase sales. Piper: The biggest thing a distribution partner can do for a manufacturer rep is ask questions of his/her accounts. The distributor rep inherently has a more intimate relationship with the end-users, so their opinions and suggestions carry more weight, which makes for a more meaningful conversation. The other key is understanding what makes your product/ product line a potentially beneficial option for the customer. The rep doesn’t need to know the finer points of every product, but a solid understanding of what makes the product/product line unique is a huge help in terms of qualifying the opportunity.
Repertoire: What is the biggest change you anticipate in medical products sales in the next five years? Piper: It’s hard to say. It’s pretty clear that distribution is given more corporate direction on what the preferred products are to sell, and we are seeing that IDNs are making continued efforts to control the purchases in the outpatient offices. There are also other parties. I would think medical products will become part of a larger solution sale given the consolidation of end-users under larger IDN umbrellas, the increased direction given to distribution on what products to sell, and the entrance of entities like Amazon into the medical sales market. There will always be opportunities to sell individual
product lines, but I’d assume manufacturers will be fighting to align themselves with these larger entities at a corporate level. Repertoire: Ride-days with distributor reps: What do you like? What don’t you like? Piper: Traditional, open-ended ride days don’t happen as often. Ride-days are more effective when they are structured around a couple of qualified opportunities. Those discussions tend to be more fruitful, and the opportunity to build off those discussions and broaden the potential sale is easier when there is a concrete basis for the appointment itself.
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Manufacturer Reps to Watch Andrew Rose Senior Ambulatory Sales Representative Welch Allyn/Hill-Rom Rancho Santa Margarita (Orange County) California Thirteen years in medical sales
Snapshot: • Born/raised: Ukiah, California (Mendocino County) • Undergraduate degree: BA, liberal studies with a concentration in natural and biological sciences, CSU Sacramento • First “real” job: An event promotion company called EMP (Event Management and Promotions) out of Santa Monica. • Favorite restaurant: Javier’s on the Newport Coast. Best high-end Mexican cuisine you can find. Carnitas is to die for. • Family info: Married for 10 years to my beautiful wife, Rebecca. We have three children: stepson Aiden (14), daughter Aubrey (7), son Drew (4). We also have Benson, a very lively 12-year-old Jack Russell mix. • Hobbies/activities: Our main hobbies center around our kids, like most people’s do, I suppose. But our main passion is to get out of town and go up to our property in the mountains to swim and fish and have a great time with our whole family. I love football, basketball and tennis, and am in two football fantasy leagues, which usually ruins my Sundays for the entire fall season.
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Repertoire: What are the most important things you do for your distributor reps to enhance their sales? Rose: Some of the main things I do on a regular basis are: •T ry to ask open-ended questions about their goals in specific areas of patient care, which can lead to more and bigger opportunities than we originally thought. • Maintain deep knowledge of our product – which is key. My distributor reps often bring me in to answer the tough questions that they can’t handle. •T ruly partner with the rep who brought me in, and sell as if we are a true team at that point. I do everything I can to support the sale both pre- and post-. •M ake sure the customer knows that they can call me anytime, and that I will support them in any way I can.
Repertoire: Name some ways distributor reps help you add value to their accounts and increase sales. Rose: My distributor reps set me up as the “expert” when it comes to our product lines. They make the customer aware that I am an extension of them and that I am there to support them on their purchase. Many times I have been told that because of my professionalism and how supportive I was on a particular sale, customers needing another piece of equipment specifically ask if Welch Allyn makes it, so I can be their rep. Any time I hear that, I am very happy and feel I have done my job to the best of my ability. I have also earned the respect of many reps to the point where they don’t even need to be with me anymore and they know that I will do everything I can to maximize the sale. Repertoire: What is the biggest change you anticipate in medical products sales in the next five years? Rose: I definitely see challenges ahead on how clinics order and what they order: •W ith companies like Amazon making a bid to play in this market, competition for both the manufacturers and the distributors is only going to get more aggressive. •T elemedicine will continue to grow, and companies that want to grow along with the industry will need to innovate at an even faster pace to keep up with that everchanging landscape.
• Successful equipment companies in the future will need to offer patient solutions to not only hospitals and clinics, but to the patients themselves. Repertoire: Ride-days with distributor reps: What do you like? What don’t you like? Rose: Ride days are a tough one. Some reps don’t mind them, and other reps despise them. I am kind of neutral on them myself. If you have something exciting to talk about, and the distributor rep has set up interested clinics based on what you have to talk about, ride days can be very beneficial. If, however, you are simply along for the ride, with no prior heads-up given to the clinic, the day can be pretty brutal and a waste of time. The worst is when the rep finishes taking the order and then says, “Oh, here’s Andrew, and he wants to talk to you about some new stuff.” Repertoire: Do you have a favorite ride-day story to share? Rose: Many years ago, I was working with a rep and we were going around to all his accounts that were interested in getting new cardio equipment. We were driving near Universal City when all of a sudden he turned into the lot and we headed into the back lot area of the studio. The studio clinic needed new ECGs for all their physicals. Once we parked and started walking, I noticed recognizable faces, and without naming any names, I got to see quite a few celebrities close up on that day, which was kind of cool.
“ If you have something exciting to talk about, and the distributor rep has set up interested clinics based on what you have to talk about, ride days can be very beneficial.”
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POST-ACUTE CARE
PDPM: A ResidentCentered Plan New reimbursement method will compensate SNFs for caring for medically complex residents
Effective Oct. 1, 2019, your SNF customers will receive
Medicare reimbursement based on a new model of payment, called Patient Driven Payment Model, or PDPM. It’s designed to be budget-neutral and, in a global sense, it very well might be. But there will be winners and losers. The winners? Skilled nursing facilities that accurately assess the needs of the resident upon admission, and tailor their care accordingly.
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The losers? Facilities that cling to the old reimbursement method, which rewards SNFs that maximize the number of hours they spend providing physical therapy, occupational therapy or speech/language pathology therapy. In the new system, more therapy hours won’t add up to more reimbursement dollars. (That said, the level of therapy anticipated for each resident will continue be one factor in the new reimbursement scheme.)
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POST-ACUTE CARE SNFs that admit medically complex residents, that is, those who need higher levels of potentially expensive care (e.g., expensive drugs, ventilator care, care for residents with HIV/AIDS, etc.) will receive reimbursement that more closely reflects those higher costs. “It’s good for residents,” says Robin Hillier, RLH Consulting, Westerville, Ohio, and director of reimbursement and quality metrics for Welcome Nursing Home in Oberlin, Ohio. She spoke about PDPM at the annual Convention and Expo of the American Health Care Association and National Center for Assisted Living in San Diego. “The current Prospective Payment System (PPS) used by CMS to pay for Medicare stays in skilled nursing facilities had the unintended consequence of leading to a ‘one size fits all’ approach to providing skilled care. The new Patient Driven Payment Nate Ovenden Model focuses more on the unique characteristics of each individual beneficiary, rewarding SNFs for focusing on the holistic, individualized plan of care that will help the person meet their specific post-acute goals.” “PDPM is a residentcentered model,” says Nate Robin Hillier Ovenden, senior Medicare and managed care consultant, Good Samaritan Society, Sioux Falls, South Dakota, who also spoke at the recent AHCA/NCAL convention. “It will help us focus on the resident as an individual, instead of our current system, which relies on the amount of therapy minutes delivered.”
– classifies patients into one of 66 possible resource utilization groups, depending on the resident’s nursing care needs; amount of therapy provided; other services furnished, such as respiratory therapy and specialized feeding; the patient’s ability to perform activities of daily living; and certain medical conditions, such as pneumonia and depression. The current RUG-IV system includes payment for staff time spent on nontherapy ancillary (NTA) services, but not the cost, which can be high for SNF residents who require expensive drugs, a ventilator, tracheostomy care, wound care, IV medication, etc. (“Nontherapy
Existing method to fade out
And, whereas under RUG-IV, therapy minutes delivered is the primary determinant for reimbursement, under PDPM, therapy minutes will have no impact on reimbursement. SNF administrators and staff will enjoy another benefit from PDPM – less time spent completing assessments of their residents. RUG-IV calls for SNFs to perform five scheduled assessments of the resident, at Day 5 of the stay,
Until October 2019, Medicare will continue to pay SNFs a prospectively determined rate for each day of care. That daily rate has three components: nursing, therapy, and room and board. The nursing and therapy portions of the payment for each patient are adjusted for differences in casemix using a classification system called resource utilization groups, or RUGs. The current iteration – RUG-IV
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“ It will help us focus on the resident as an individual, instead of our current system, which relies on the amount of therapy minutes delivered.” – Nate Ovenden ancillary services” refers to any ancillaries a provider uses other than therapy services, such as drugs, supplies and equipment.)
The patient-driven approach Under PDPM, residents will be classified into one group for each of the five case-mix-adjusted components: • Physical therapy • Occupational therapy • Speech/language pathology • Nontherapy ancillary services • Nursing
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POST-ACUTE CARE Day 14, Day 30, Day 60 and Day 90. In addition, SNFs are expected to perform unscheduled assessments throughout the stay, depending on the needs of the resident. Under PDPM, however, SNFs need only perform one scheduled assessment – at Day 5 – and unscheduled assessments as needed. While PDPM will save SNFs time spent on assessments, it also will demand a higher degree of accuracy at that Day 5 assessment. “For many – if not most – Part A beneficiaries, reimbursement will be based solely on the information captured on the initial (5-day) assessment,” says Hillier. “Under certain circumstances, facilities will
“Accurate and complete coding on the initial assessment will be critical to a facility’s success.” – Robin Hillier
have the ability to complete an ‘Interim Payment Assessment’ to adjust the reimbursement rate if new conditions arise during the stay that would increase the payment rate. But accurate and complete coding on the initial assessment will be critical to a facility’s success. “In order to achieve complete and accurate initial assessments, facilities will need to evaluate their admissions processes to ensure they are considering all relevant clinical information.”
Simplicity CMS hopes that PDPM will simplify the payment system, says Ovenden. “We currently spend so much time
Nontherapy ancillary services Under the Patient-Driven Payment Model, SNFs will be reimbursed for their Medicare residents based – in part – on the nontherapy ancillary services needed. Medicare has assigned a cer-
tain number of “points” for 50 conditions. More points mean more reimbursement. The following 15 conditions receive the highest number of points.
Nontherapy ancillary service HIV/AIDS Parenteral IV feeding: level high Special treatments/programs: Intravenous medication post-admit code Special treatments/programs: Ventilator or respirator post-admit code Parenteral IV feeding: level low Lung transplant status Special treatments/programs: transfusion post-admit code Major organ transplant status, except lung Active diagnoses: multiple sclerosis code Opportunistic infections Active diagnoses: asthma, COPD, chronic lung disease code Bone/joint/muscle infections/necrosis - except aseptic necrosis of bone Chronic myeloid leukemia Wound infection code Active diagnoses: diabetes mellitus (DM) code Source: American Association of Nurse Assessment Coordination
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Points 8 7 5 4 3 3 2 2 2 2 2 2 2 2 2
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POST-ACUTE CARE meeting regulations and doing assessments that our nurses don’t have as much time to see residents face to face. With PDPM, we will get to know our residents on a more personal basis, and our MDS [Minimum Data Set] assessments will be more accurate. We will have the resources to focus on our clinical competency skills, and make sure we’re providing great care for our residents with comorbidities.”
In addition, by recognizing 50 nontherapy ancillary services for which SNFs can be reimbursed, the PDPM model will more accurately reflect the time, effort and cost of caring for clinically complex residents, rather than emphasizing therapy minutes, says Ovenden. That said, it would be a mistake to believe that PDPM will lead to a flood of new clinically complex residents in SNFs, he says. Those residents are already
The distributor’s role in PDPM Repertoire readers might be especially interested in the variable rate adjustment (or “tapering”) that applies to the nontherapy ancillary services (NTA) component of Medicare reimbursement under PDPM, says Robin Hillier, RLH Consulting, Westerville, Ohio, and director of reimbursement and quality metrics for Welcome Nursing Home in Oberlin, Ohio. “Nontherapy ancillary services” refers to any ancillaries a provider uses other than therapy services, such as drugs, supplies and equipment – but not labor. For the first three days of the stay, providers will receive 300 percent of the calculated NTA payment component. Starting on Day 4, this will drop to 100 percent. CMS has created a list of conditions or diagnoses that call for higher-cost supplies or equipment. Each is assigned a certain number of points (with more complex conditions earning more points). The more points, the greater the reimbursement. “[Repertoire] readers can play an important role in helping providers identify clinical conditions and needs that contribute to the NTAS scoring early in the stay, so they can be captured on that initial assessment,” she says. “This will give providers more money at the beginning of the stay, which can be used to pay for additional supplies and equipment needed as a result of those conditions. “It’s important that whatever is applicable to the resident gets captured right away.” Deborah Haywood, vice president of sales and strategic development for McKesson
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Medical-Surgical, says the industry is “very early into understanding the full financial impact that PDPM will have for our SNF providers. The NTA case mix provides additional resources to facilities for treating potentially vulnerable populations, such as ventilator, infection isolation, end-stage renal disease (ESRD), diabetes, wound infections, IV medication, bleeding disorders, behavioral issues, chronic neurological conditions, and bariatric care. The initial admission assessment will set the case-mix reimbursement level and will be important for manufacturers and distributors to support their SNFs in driving the best outcomes for the residents’ care.” Haywood notes that SNFs can gain a better understanding of the financial impact of PDPM from their current RUG data from CMS. “McKesson’s partner Pathway Health offers providers tools, such as the PDPM Financial Impact Analysis Tool, which can help them understand their current data, potential impact and clinical impact to their organization.” In addition, SNFs can use automated tools such as McKesson Quality One to focus on continuous performance improvement to quality care, performance outcomes and resident satisfaction, she says. “SNFs that adopt technology, drive training competencies on the new PDPM model and provide improved patient outcomes will be successful,” she says. “Those facilities that do not have some type of adoption will struggle with the new PDPM change.”
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POST-ACUTE CARE being cared for. But PDPM will reduce the incentive for some SNFs to pick and choose residents who may require many therapy minutes, but who do not present clinical complexities.
Making adjustments “Under PPS, providers are paid based on the amount of therapy they provide,” says Hillier. “If two beneficiaries receive the same level of therapy, the rate is the same – regardless of their overall medical complexity. Under PDPM, providers who treat people with greater clinical complexity will finally be compensated for that care.” All facilities have the ability to be successful under PDPM if they take the appropriate steps to prepare for it, says Hillier. Some will develop clinical programs that attract more medically complex patients, since reimbursement will be available to properly care for them, she says.
The first step for SNFs is to evaluate the need in their specific market for such programs, she says. They could start by identifying patients whom hospitals are having difficulty placing, given their medical complexity. Then they should focus on what they need to do to accommodate such residents. In some cases, that may mean making physical changes to the facility, or acquiring additional capital equipment, she says. Just as important, it may call for upgrading the clinical skills of the nursing staff. “You have to make your clinical team comfortable and confident that they have the ability to provide that type of care. “Providers and their suppliers should educate themselves about the new payment system and understand the new incentives contained within. I encourage strategic planning to identify opportunities to provide skilled care in a way that is more patient-centered and will achieve better outcomes with higher customer satisfaction.”
Therapy hours don’t add up
Study shows SNF patients near death receive more hours of therapy Nursing home residents are increasingly spending time in rehabilitation treatment during the last days of their lives, a University of Rochester study shows, according to an Oct. 9 Bloomberg report. The proportion of nursing home residents who received “ultrahigh intensity” rehabilitation increased by 65 percent between October 2012 and April 2016, “There’s a possibility according to research that nursing homes published in October. know a patient is Medicare defines “very high” therapy as almost approaching end of nine hours per week, life, but the financial and “ultrahigh” therapy pressures are so as more than 12 hours high that they use per week. Some resithese treatments dents were found to so they can be treated with the maximize revenue.” highest concentration – Helena Temkin-Greener of rehabilitation during their last week of life. The study analyzed data from 647 New Yorkbased nursing home facilities and 55,691 longstay decedent residents, with a specific focus on
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those who received very high to ultrahigh rehabilitation services – including physical, occupational and speech therapy –during the last 30 days of their life. “There’s a possibility that nursing homes know a patient is approaching end of life, but the financial pressures are so high that they use these treatments so they can maximize revenue,” Helena Temkin-Greener, the lead author of the study and a professor at the University of Rochester Medical Center Department of Public Health Sciences, was quoted as saying. Alternatively, “if it’s being driven by a failure to recognize that a resident is approaching end-of-life, then it calls for improving the skills of nursing home teams.” Medicare’s existing reimbursement method rewards SNFs that maximize the number of hours they spend providing physical therapy, occupational therapy or speech/language pathology therapy. A new payment system, called the Patient-Driven Payment Model, to become effective Oct. 1, 2019, more therapy hours won’t add up to more reimbursement dollars.
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F-Tag 880: New name, same message Insofar as blood glucose meters are concerned, eight words matter: Clean and disinfect after use on each resident. Chances are, your long-term care customers use one
blood glucose meter for multiple residents. That’s a good thing. After all, using one system – such as the ARKRAY Assure® Platinum or Assure Prism multi blood glucose monitoring systems – minimizes training requirements for nurses, improves accuracy, and allows for a more efficient use of staff time. But convenience and efficiency come with a responsibility: The meter must be cleaned and disinfected after use on each resident according to the manufacturer recommendations. It’s for the safety of your residents and your staff. And it’s the law.
F-Tag 880 As of Nov. 28, 2017, the Centers for Medicare & Medicaid Services implemented phase 2 of cleaning and disinfecting standards in the facility assessment code 483.70. It’s called F-Tag 880 (formerly referred to as F-Tag 441). F-Tag 880 is a guideline for infection control programs in Long-Term Care facilities. It is put in place to prevent, recognize and control the onset and spread of infection. F-Tag 880 is used for guidance by CMS regional offices and state survey agencies for [re-] certification and complaint investigations. F-Tag 880 applies to all resident care equipment and environmental services – including blood glucose
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meters. Surveyors may issue a citation if they observe incorrect or no cleaning and disinfecting of meters after a blood glucose test, as that would not follow CMS F-Tag 880.
Bloodborne pathogens Why is cleaning and disinfecting of blood glucose meters such a high priority? Blood glucose meters are at high risk of becoming It is contaminated with bloodrecommended borne pathogens, such as hepatitis B virus, (HBV), to use two hepatitis C virus (HCV) and wipes when human immunodeficiency cleaning and virus (HIV). Transmission disinfecting the of these viruses from resident to resident has been meter – one documented due to contamiwipe to clean nated blood glucose devices. and the second Cleaning and disinfecting of wipe to disinfect. meters after each use for individual resident care can prevent the transmission of these viruses through indirect contact, according to the Centers for Disease Control and Prevention.
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Clorox® Germicidal Wipes
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Dispatch® Hospital Cleaner Disinfectant Towels with Bleach
56392-7
Professional Disposables International, Inc. (PDI)
Super Sani-Cloth® Germicidal Disposable Wipe
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Metrex® Research
CaviWipes1™
46781-13
Clorox® Professional Products Company
Cleaning and disinfecting
should include addressing the cleaning and disinfection of blood glucose meters along with other equipment and It’s important that your customers understand that cleanenvironmental surfaces. It should include goals and prioring and disinfection are two distinct activities. ities, planning, strategy implementation, post-surveillance and more. Staff roles and responsibilities should be idenCleaning is needed to remove dirt, blood and other tified, and training should be documented. bodily fluids off the exterior of the meter before perThe program should also provide education on infecforming disinfection. It can be accomplished by wiping tion control and the proper use of products. More inforthe meter down with soap and water, or isopropyl alcohol. mation on establishing a comprehensive infection prevention and control program can be found in Disinfecting is necessary to preIt is important the CMS Infection Control Guidance Document. vent the transmission of bloodborne that your longpathogens. It is always recommended to follow the Instructions for Use for Need more information? term care the meter that is used at the facility. The Centers for Disease Controls provides reccustomers Disinfecting is accomplished with an ommended practices on preventing bloodborne establish a EPA-registered disinfectant deterpathogen transmission during blood glucose monprogram for gent or germicide that is approved itoring at www.cdc.gov/injectionsafety/blood-glufor healthcare settings or a solution infection control cose-monitoring.html of 1:10 concentration of sodium ARKRAY USA offers cleaning and disinfecand identify a hypochlorite, that is, bleach. A list of tion guidelines for blood glucose meters at http:// key individual effective EPA-registered disinfectants arkrayusa.com/diabetes-management/profesresponsible can be found at the following website: sional-care/support/cleaning-and-disinfecting. Or www.epa.gov/pesticide-registration/ contact our Technical Customer Service departfor the overall selected-epa-registered-disinfectants ment at 800-566-8558, option 1.
program.
Many wipes act as both a cleaner and disinfectant. Clean and disinfect using the manufacturers recommended process. If blood is visibly present on the meter, two wipes must be used – one wipe to clean and a second wipe to disinfect.
Set up a program It is important that your long-term care customers establish a program for infection control and identify a key individual responsible for the overall program. The program
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CHRONIC CARE MANAGEMENT
The ‘C’ Words ‘Cancer’ and ‘chronic’ were rarely used in the same breath … until now By David Thill
Editor’s note: Demographics are changing. Venues of care are changing. Reps’ call points and the products in their bags are changing too. In this issue, Repertoire continues its series of articles on chronic care management. Chronic diseases and conditions – such as heart disease, stroke, cancer, type 2 diabetes, chronic obstructive pulmonary disease, obesity and arthritis – are among the most common, costly and preventable of all health problems. As of 2012, about half of all adults – 117 million people – had one or more chronic health conditions. One in four adults had two or more chronic health conditions. Seven of the top 10 causes of death in 2014 were chronic diseases.
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Chronic disease isn’t just for old people. Conditions
like osteoporosis can hit much earlier than a person’s golden years, and for former cancer patients, the risk is often higher. What’s more, as cancer treatment advances, patients live longer, and their cancer conditions often become “chronic” themselves. This means caregivers – from primary care doctors to oncologists – must consider more factors now when administering treatment to former and current patients with cancer than they have in the past. It also means they have to coordinate their efforts more closely.
way by looking out for any adverse effects they may experience as a result of the treatment they received, which was often years before they arrived at the STAR Program. Patients aren’t typically screened for many chronic conditions until later in life. But this isn’t the case for patients with a history of cancer. If they received cancer treatment as a child, they may be more at risk depending on how they were treated. Before she meets her patients, Didwania tries to learn as much as she can about their previous treatment, so that she knows what to look for. For example, if a person received cranial radiation as a child, Didwania might monitor them for hypothyroidism. If they received steroids as part of a bone marrow transplant early in life, they’ll be at higher risk for osteoporosis in young adulthood.
‘You’re not just surviving; you’re surviving with a good quality of life.’ Doctors face a small challenge in reading test results for younger patients, says Didwania. Since those tests were often developed to screen older adults, she has to interpret results in light of the patient’s age. But the earlier she detects it, the better the outcomes. “I’m a big fan of talking about secondary prevention,” she says. “I can’t take away your past treatments, but I can try to find things before they become a problem.”
Cancer as a chronic disease Caring for survivors “My primary concern is secondary prevention,” says Aarati Didwania, an internist and director of the STAR Program at Chicago-based Northwestern Medicine. STAR – which stands for Survivors Taking Action & Responsibility – serves childhood cancer patients who are now adults, as they transition from cancer care to longterm follow-up care. Many of Didwania’s patients come to her hoping they’re finished with cancer treatment, she says. They may have been referred by their oncologist, but they’re not actively being treated for cancer. She wants to keep it that
“Even though we would like to believe that we cure [cancer] patients with a minimum of side effects, we are learning that cancer causes long-term morbidity,” says WuiJin Koh, an oncologist and chief medical officer at the National Comprehensive Cancer Network. The longer patients live, the more time they have to manifest morbidities potentially caused by their cancer therapies. This is partly why oncologists like Koh are particularly concerned about pediatric and young adult patients. Doctors also focus on quality of life in cancer survivors now more than they did decades ago, he says, referring to “quality-adjusted survival”: “You’re not just surviving; you’re surviving with a good quality of life.”
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CHRONIC CARE MANAGEMENT
‘ Even though we would like to believe that we cure cancer patients with a minimum of side effects, we are learning that cancer causes longterm morbidity.’ Part of this practice involves considering patient-reported outcomes – factors that weren’t measured as much in the past, like the person’s sexual function, Koh says. But cancer doesn’t just increase the risk of chronic disease. Sometimes, cancer itself is a chronic disease, or at least very similar to one. “In some cases, we may not be able to completely eliminate a cancer, but patients live longer and have functional lives,” says Koh. This is especially true as treatment technology advances. For example, breast and prostate cancer patients can undergo continuous therapy, and while their cancers aren’t necessarily “cured,” they can be managed, he says. “In that case, cancer as a chronic disease is maybe more similar to diabetes and other chronic diseases.”
The intersect Cancer care has traditionally been “somewhat of a silo,” Koh says: The patient gets treated by their oncologist, and other doctors don’t have much of a role in the process. But treatment now is so multifactorial that other providers need to be involved in the patient’s cancer care, he says.
“It used to be that when I saw a referral, I made sure the referring surgeon got a copy of my evaluation treatment plan,” says Koh. Now, he might send that report to the primary care physician, the cardiologist, the endocrinologist and any other specialist the patient might see. There’s an increased role in cancer treatment for primary care providers, he says. “I don’t think we’ve completely defined all the roles, but I think we’re beginning to evaluate how to educate primary care doctors and how to give them the tools to manage cancer patients.” He also sees a role for primary care doctors in palliative care – which he clarifies is different from end-of-life care. “I think [palliative care] has gotten this bad connotation,” he says, when really, it’s meant for pain control and maximization of function. He notes that starting palliative care with curative cancer treatment can improve patients’ cure rates. As all these techniques evolve, says Koh, “I think there will be a lot more communication” between primary care doctors and oncologists.
David Thill is a contributing editor to Repertoire.
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WINDSHIELD TIME Chances are you spend a lot of time in your car. Here’s something that might help you appreciate your home-away-from-home a little more.
Automotive-related news 2-second rule for distracted driving can mean life or death Distracted driving was linked to more than 9 percent of U.S. traffic deaths in 2016, according to the National Highway Traffic Safety Administration. And the odds of a car crash double when drivers take their eyes off the road for more than two seconds, an Auto Alliance spokesman tells The New York Times. With that risk in mind, car manufacturers, tech developers and government agencies are trying to figure out how to minimize distracted driving. Technology highlighted includes “head-up displays,” which project information like speed onto the windshield in front of the driver; software to sync drivers’ phones to
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built-in vehicle displays; and the ability to program cars – for example, by giving them a speed limit – a function that may be useful for parents of teenage drivers.
Own the night: 10 tips for driving after dark Nighttime driving can be dangerous, and human night vision is less than ideal for driving in the dark. Popular Mechanics published 10 tips to keep in mind for nighttime driving. Among them: • Aim your headlights correctly. • Avoid staring at oncoming headlights. • Use a newspaper, rather than your hand, to remove residue from the windshield.
Health Industry Representative Association
PRESIDENT
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President & CEO Willcare Associates, LLC
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SECRETARY
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John Patterson
Bailey Cobbs
Ben DeGuilio
Lamar Lester
President John Patterson Associates, Inc
Owner Cobbs & Associates
President DeGiulio Associates
President Pate & Lester, Inc.
Representative Directors: Dorothy Gosnell / President / Gosnell Medical Sales, Inc. Kaynae Agnew / CEO & President / Agnew Pacific Enterprises, LLC Chris Haynes / President / Haynes Medical Supplies Manufacturer Directors: Laing Heidt / National Sales Manager / Adroit Medical Systems Ray Baynard / President / Tex Care Medical Bob Warzecha / President / Two Rivers Enterprises, Inc.
www.hira.org
WINDSHIELD TIME • Clean your exterior mirrors and adjust them slightly downward. (This allows you to move your head out of the path of reflected headlights.) • Keep your eyes continually moving to reduce the effects of eye fatigue while driving.
‘Dutch Reach’ car door opening technique added to Britain’s road rules The U.K. is officially introducing the so-called Dutch Reach into its official Highway Code, the rulebook for drivers. Drivers perform the technique by opening their car door with the hand furthest from the handle. Uber began This is meant to force allowing them to look over their passengers to shoulder and check for tip their drivers in oncoming cyclists, hope2017, joining many fully decreasing incidences other rideshare of “dooring,” which can companies be deadly for cyclists. Nathat already tional statistics aren’t available for the U.S., but in allowed tipping. Illinois, for example, the Experts generally Department of Transrecommend portation reported 302 passengers tip dooring accidents in 2015. between 10 and “Car dooring” is a crimi20 percent of the nal offense in the U.K., fare, based on the punishable with a fine of quality of their ride. up to £1,000 (an estimated $1,300). The Dutch Reach has been used for decades in the Netherlands, but it only recently became known as the “Dutch Reach,” a term coined by a Cambridge, Massachusetts, physician in 2016. (He launched the site dutchreach.org.)
Goodyear’s new tire store will come to you Replacing your car’s tires may become easier if Goodyear’s new Roll stores are successful. The stores will pop up in “vibrant lifestyle centers,” allowing customers to drop their cars off after picking out their tires online, according to an article in Auto Week. Technicians will pick up the car from the store, install the tires and return the car, providing text or email updates during the process. And if customers don’t want to visit the store at all, they can schedule an appointment with a mobile installation van, which will visit the car at a scheduled location while
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the owner is at work. At press time, the first stores are scheduled to open in the Washington, D.C., suburbs.
Should you tip your Uber driver? If so, how much? Uber began allowing passengers to tip their drivers in 2017, joining many other rideshare companies that already allowed tipping. Experts generally recommend passengers tip between 10 and 20 percent of the fare, based on the quality of their ride. Tips can add substantially to drivers’ relatively skinny wages. But it doesn’t appear to have caught on among passengers. In a Ridestar.com survey of 2,625 rideshare drivers, 36 percent reported they didn’t earn any tips during the period covered by the survey. Among the drivers who did receive tips, the median tipping percentage was 7.19 percent.
Stats show teens are bad drivers; here’s how to help them be safe Car accidents are the leading cause of death among U.S. teens, according to the U.S. Centers for Disease Control and Prevention. Aside from lack of experience, distracted driving, speeding and not using seat belts are among other factors linked to many teen driving deaths in the U.S. But as Matt Schmitz writes for cars.com, parents can take some precautions to help their teen drivers stay safe, like talking about safety before they start driving; setting ground rules for seat belt use, phones and other risk factors; and setting a good example, “as your teen is more likely to do as you do, not as you say,” Schmitz writes.
Heads up, George Jetson: Terrafugia starts taking orders for its flying car U.S. car developer Terrafugia is taking preorders for the Transition, a two-seat aircraft that can switch between driving and flying in less than a minute. The company plans to release the “flying car” in 2019. Planned tech features include a gasoline-electric hybrid powertrain delivering a 400-mile range and top speed of 100 mph. Terrafugia considers the Transition a “street-legal airplane,” according to Digital Trends. The aircraft is meant for pilots to use to fly into small airports and drive to their final destinations, or, during unfavorable flying conditions, to land and then finish their trip on the highway. The Transition is one of several flying cars in development, but, as Digital Trends notes, “it remains to be seen whether any of these efforts will be successful in the long term.”
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HEALTHCARE MANUFACTURERS MANAGEMENT COUNCIL
HEALTHY REPS
Health news and notes Flu season is coming. If you live in a large city, it may stretch longer than elsewhere, study says If you live in a large city, flu season may last longer than it does elsewhere, and if you live in a small city, flu season may be shorter but with a more explosive spread, a new study shows. The study doesn’t indicate that a person’s risk of contracting influenza varies depending on community size, an October STAT News article explains. “Rather, it argues that in less populous places, flu needs the right atmospheric conditions to spread effectively.” Jacco Wallinga, an infectious disease expert in the Netherlands, tells STAT that these results indicate health agencies in small cities should work on surge capacity – the ability to handle many sick patients in a short amount of time – while agencies in larger cities should try to find ways to reduce transmission.
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Caffeine may increase pain tolerance Caffeine may increase a person’s pain tolerance, according to a study by researchers at the University of Alabama at Birmingham. The researchers asked 62 women and men, between 19 and 77 years old, to record their daily caffeine consumption over seven days. On the seventh day, participants reported to a laboratory where scientists measured their pain sensitivity to heat and pressure. Participants averaged 170 milligrams of caffeine a day – about the amount in two cups of coffee, according to The New York Times – but 15 percent of them consumed more than 400 milligrams a day. It appears that the more caffeine a person consumed, the greater their tolerance for pain, the Times article says. This research is reminiscent of other studies, including an Arkansas State University study that showed plant-based diets may be linked to lower pain sensitivity.
Do longer maternity leaves hurt women’s careers? Evidence indicates that the longer a new mother’s maternity leave, the less likely she is to be promoted, move into management or receive a pay raise after her leave ends, according to a September Harvard Business Review article. To find out why this is, Harvard researchers examined perceptions of working women’s agency – in other words, to what degree others consider them ambitious and careerfocused – in three complementary studies of Canadian employers and employees. In the first experiment, they found that employers perceived potential female job candidates whose resumes noted 12-month maternity leaves (common in corporate Canada) as less desirable for the job than candidates who reported one-month leaves. However, they found in the second study that when the job candidates brought a recommendation letter from a former supervisor, there was no perceived difference between candidates with longer and shorter leaves. And finally, they found that “keep-intouch” programs, which allow parents on leave to stay in contact with their workplaces, help improve employer perceptions of female applicants.
HPV causes more than 33,700 cancer cases annually in men and women, according to the CDC. Vaccines like Gardasil can prevent 90 percent of those cases – 31,200 – the agency’s website says.
HPV Vaccine Gardasil now approved for adults ages 27 to 45 The Food and Drug Administration has approved the use of Gardasil, a vaccine that protects against human papillomavirus (HPV), for women and men ages 27 to 45. Previously, the vaccine was only approved for people between the ages of 9 and 26, according to BuzzFeed. The Centers for Disease Control and Prevention website explains that HPV is a common sexually transmitted disease that most people get at some point in their life. The virus usually clears on its own but can lead to several types of cancer. HPV causes more than 33,700 cancer cases annually in men and women, according to the CDC. Vaccines like
Gardasil can prevent 90 percent of those cases – 31,200 – the agency’s website says. BuzzFeed notes that after Gardasil’s 2006 approval, it was recommended in the U.S. for girls and women ages 9 to 26, before being approved for men in that age group. “So there’s an entire generation of adults who missed out on Gardasil,” the article says. The expanded age range could help them.
Exercising healthy limb may fight atrophy in broken one If you have a broken arm, you may benefit from exercising your other arm, researchers at the University of Saskatchewan found. Muscle atrophy is a common side effect when wearing a cast for an extended length of time. But Jonathan Farthing, a U of S professor, writes in The Conversation that a study performed in his lab found that for college students who wore casts on their left wrist for four weeks, those who exercised their right arm aggressively during that time maintained strength and muscle volume in the immobilized wrist. One possible reason for this outcome is that the arm in the cast experiences small “mirror” contractions when the person exercises their opposite arm. Farthing acknowledges these findings require further research before standard rehabilitation practices can change. Nevertheless, he writes, “we can still recommend that if you ever experience a limb fracture, you might consider training your opposite limb.”
Being overweight or obese in your 20s and 30s could cut life expectancy by up to 10 years New research indicates that life expectancy decreases more the younger a person with overweight or obesity is. Researchers in Australia predicted the remaining life expectancy for people from their 20s to 60s, ranging from a healthy weight to severely obese. They found that while healthy men and women in their 20s could expect to live another 57 and 60 years, respectively, women in their 20s who are classified as severely obese lose an expected eight years, and men in the same group lose an expected 10. That number decreased the older participants were. For example, women in their 40s classified as obese experience a reduction of 4.1 years of life expectancy, and men lose 5.1, while women in their 60s lose 2.3 years and men 2.7. “We know that excess weight has an impact on your health, but to have excess weight as a young adult is really significant on life expectancy,” lead study author Thomas Lung told the Philippine Daily Inquirer.
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Sofia 2 Lyme FIA: CLIA-waived Results in minutes, not days. Diagnosing Lyme disease is hard. Symptoms are broad and generic, mimicking many other conditions. Patients feel horrible and want answers. It doesn’t help that current testing methods may take hours or days for results. Not anymore! Sofia 2 Lyme FIA uses a fingerstick whole blood sample to provide accurate, objective and automated results in as few as 3 minutes, getting doctor and patient on a path to treatment much sooner. Sofia 2 Lyme FIA is the only rapid, near-patient testing solution that provides IgM and IgG differentiated results in a single test. It has demonstrated accuracy on par with current testing methods — all with less than 1 minute hands-on-time. And as you’ve come to expect from Sofia 2, our Lyme assay functions in WALK AWAY and READ NOW modes, providing flexible workflow options based on your needs.
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Doc Wrong Way Gets it Right Ron Smith has a Bronze Star for valor, and a bunch of gold ones for 43 years in medical sales
He’s not quite Forrest Gump, but Ron Smith, territory
sales consultant for the Laboratory Products division of Cardinal Health, has led a pretty interesting life. Born in Manitoba, Canada, he was raised in Odessa, Texas. He graduated in 1966 from Permian High School, the school on which the book and movie “Friday Night Lights” was based. After high school, he served as a corpsman for the U.S. Marine Corps, and spent most of a year serving on the Demilitarized Zone in Vietnam in 1967-1968. He received a Bronze Star for Valor for his service, though he had to wait 26 years for it. Today, he relishes his work with Cardinal Health, his family life, and the occasional bow hunting.
Head start Smith had a head start on interesting. He was born in St. Boniface, Manitoba, just outside of Winnipeg. His dad, also named Ron, was born in Moose Jaw, Saskatchewan, and later joined the Royal Canadian Air Force. Ron Smith Ron Sr. was honorably discharged from the RCAF due to conditions he had acquired as a kid with rheumatic fever, and later became a radio personality in Winnipeg, hosting a show in which he interviewed a variety of people – some of them famous (e.g., Donna Reed, Audie Murphy). It was at the radio station where his father met his wife-to-be, Fran, from Regina, Saskatchewan. Fran played the voice of different characters on the station (among them, Wendy in “Peter Pan”) and did writing for the station as well.
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In 1952, when young Ron was five, the family moved to Odessa, where Ron Sr. was pursuing a job at that city’s new TV station, KOSA. The job didn’t pan out, so Ron Sr. started selling swimming pools, and then real estate. (Nevertheless, on Saturday nights in Odessa, he hosted “Uncle Ron’s Cabin,” a show of classical music and listener call-ins on KRIG Radio.) It was in Odessa that young Ron got his first taste for the lab. In 1954, when he was in first grade, he was diagnosed with rheumatic fever, and he spent a good part of that year in the hospital. He’d jump in a wheelchair and go to the laboratory. “Everybody got to know me,” he says. It wasn’t the science that drew him there so much as the frogs. They were used for pregnancy testing back then. (The lab would inject the frog with the woman’s urine, wait for a couple of days, then dissect the frog to see the effects – if any – of the hormone hCG, which is produced during pregnancy.)
Doc Wrong Way His interest in medicine – first stoked in the lab in Odessa – stayed with him. So, after graduation, he joined the Navy to receive training as a corpsman. After a year of training, he got the call to join the Marines – which had been his goal when he enlisted in the Navy. Each platoon had two corpsmen, on whom the men in the platoon relied heavily. “Here I was, 19 years old, with all that responsibility,” he recalls. “The Marines in my platoon would come to me with everything and anything.
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Item #14-204 Alere Cholestech LDX® System Starter Kit 5 boxes of Lipid Profile • GLU Cassettes (50 tests)
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corner I was their mom, dad, psychiatrist, you name it.” Despite the burdens, to this day he still misses the camaraderie he enjoyed back then. “The bond between corpsman and Marine is like no other in any branch of service.” His comrades in the 3rd Battalion, 4th Marines were intrigued that, while some young Americans were fleeing to Canada to escape serving in Vietnam, Canadian-born Smith had actually enlisted. For that reason, they called him “Doc Wrong Way.” Serving on Con Thien (the “Hill of Angels” in the Vietnamese language) and other positions around the Demilitarized Zone (between North Vietnam and South Vietnam) from July 1967 to August 1968 proved harrowing. “Over-
One month after Smith arrived in Vietnam in July 1967, two Marine engineers tripped a mine in a minefield not far from Smith’s position at Con Thien. Smith and another corpsman, Bob Wilson, went after them, only to find one of the Marines had died, and the second near death. “We patched him up and carried him out, and he was medevac’ed out.” The Marine died two days later, but Smith didn’t find out his fate – or his name – until 1993.
Bronze Star “I got a call from someone who was writing an article about Con Thien,” he recalls. It turns out the battalion chaplain (known by the troops as “Chappy”) read the story, got in
“The bond between corpsman and Marine is like no other in any branch of service.”
looking the DMZ, as we were, the North Vietnamese pounded us with artillery every day,” he says. The troops there referred to it as “spending time in the barrel” and “the meat grinder.” In fact, when the North Vietnamese Army and Viet Cong (supporters of the NVA in South Vietnam) launched what became known as the Tet Offensive on Jan. 31, 1968, “to us, there was relatively little difference between Tet and any other time,” he says. “We got hit numerous times while on patrols, operations and sweeps along the DMZ. We lost a lot of Marines and corpsmen as well.”
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touch with Smith and let him know that years before, he had recommended Smith and Wilson for the Bronze Star for their valor for venturing into that minefield. Nothing came of it then. But the producers of a newsmagazine show called “The Crusaders” learned about what happened in 1967, researched it, and identified the two Marines whom Smith and Wilson had tried to rescue. It was the producers of that show who brought all the families together in Washington for the awarding of the Bronze Star by Secretary of the Navy John Dalton. “Talk about emotional,” says Smith. In Washington, Smith not only learned the name of the young Marine whom he had helped medevac – Andy Latessa, from Fall River, Massachusetts – he also met
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corner Andy’s father (also named Andy) and mother. Some time later, he spent a week with the Latessas in Massachusetts. Smith and Andy Sr. stayed in touch until Latessa’s death in 2000. “His family called me and told me their dad had wanted me to serve as a pallbearer, so I flew to Fall River,” recalls Smith. And, as their dad had asked, the family gave Andy Jr.’s Marine Corps ring – which the elder Latessa had worn since his son’s death – to Smith. He wears it today.
“When the reps came to the lab, I could see their personalities were very much like mine. They liked to have fun, but they also liked to close deals.”
Ron Sr. hosted a radio show in Winnipeg.
Returning to the States, Smith married Debbie Garms and, with assistance from the GI Bill, he got an associates degree in medical technology from Odessa Junior College and a bachelor’s degree from UT Permian Basin in May 1976. To help finance his education and a growing family (the couple had a baby, Todd), he worked full-time in a hospital lab while attending school. There, he got to know the sales reps calling on the lab.
Itching to sell “When the reps came to the lab, I could see their personalities were very much like mine,” he says. “They
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liked to have fun, but they also liked to close deals.” As he drew close to graduating, Smith passed his resume on to his Scientific Products sales rep, and in June 1976, started his career there. (At the time, Scientific Products was owned by American Hospital Supply. In 1985, American was acquired by Baxter Travenol Laboratories. Then, in 1995, Baxter spun off much of what it had acquired into a company known as Allegiance Healthcare Corp. Three years later, Cardinal Health acquired Allegiance.) For six months, he worked in a warehouse and distribution center in Grand Prairie, Texas, where he learned everything from customer service to picking-and-packing lab supplies. “I was itching to get out into the world of sales,” he recalls. And he did, moving his family to Abilene, Texas, to work a territory in West Texas. Since then, life has been good, though not without sorrow. Todd died of cancer in 1994, and Debbie died in 2003. Later, Smith married a transcriptionist from one of his accounts – Janet White. The two have been happily married ever since. “I call her my ‘happy thought,’” he says. “When I think of her, I can fly.” After 43 years selling to the laboratory, Smith is still doing what he loves. “I learn something new every day, and I think that’s what I enjoy most about my job.” He describes his teammates in West Texas as “the most awesome people I know,” and says his customers are like family. In fact, one time, when he was late for an appointment, his customer called his wife to see if he was OK. Good customers, products and teammates are important, but representing a really great company is essential for success in sales, says Smith, adding that Cardinal Health is such a quality company. “It’s the gold standard.”
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HIDA GOVERNMENT AFFAIRS UPDATE
Key Public Health Agencies
Participate in Supply Chain Continuity Summit
At this year’s Streamlining Healthcare Expo & Business Exchange in Chicago, HIDA
By Linda Rouse O’Neill, Vice President, Government Affairs, HIDA
facilitated its first ever Healthcare Supply Chain Continuity Summit between meeting attendees and government representatives. You may recall that we hosted a Readiness Partner Workshop in 2017 to address product continuity issues related to emergency events, drawing upon the expertise of HIDA members and Strategic National Stockpile leaders. This new Summit was created to build off of the progress our industry has made over the past year, while involving more government stakeholders seeking collaboration opportunities. At the event, representatives from the Office of the Assistant Secretary for Preparedness and Response (ASPR/HHS), Food and Drug Administration (FDA), and the Strategic National Stockpile offered insights into the crucial roles partners can play during public health scenarios. Attendees discussed topics like shortages, disruptions, and the public/ private response to emergency events, and conducted roundtable exercises to identify areas where we can strengthen coordination between distribution and federal agencies.
Perhaps the biggest workshop takeaway was that industry leaders must sustain the close relationships we’ve built with these, and other, government agencies. Having proactive and transparent communications between public and private entities can help determine new and This legislation more efficient ways to inincludes numerous tegrate capabilities. While public health important on its own, programs and the urgency to improve federal initiatives continues to become evident when our country to improve experiences severe events, preparedness, including the two recent as well as all of hurricanes in Florence and HIDA’s advocacy Michael. priorities, and has Any organization inbeen passed volved in the production or delivery of lifesaving by the House. medical countermeasures should be aware of current and future processes and procedures, information-sharing capabilities, capacity or market availability, and potential vulnerabilities during public health emergencies. HIDA continues to lead
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the commercial charge on this effort as the collaboration with federal resources is an important one. These discussions are particularly timely as the Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPRA) is up for reauthorization in 2018. This legislation includes numerous public health programs and federal initiatives to improve preparedness, as well as all of HIDA’s advocacy priorities, and has been passed by the House. The Senate is next to act and is expected to pass the law before the end of this year. You can expect HIDA to bring its key preparedness advocacy messages to Capitol Hill throughout the year, as well as during our annual Washington Summit in the summer. We also anticipate having more to share this upcoming April at our Supply Chain Visibility Conference (April 17-18, Orlando, FL), and I’d be interested to hear what your organization is doing to advance response capabilities. If you or your teams would like to get more involved in HIDA’s efforts and collaborations with the federal government, please email me at Rouse@HIDA.org or our team at HIDAGovAffairs@HIDA.org. There is more work to be done around this issue and there’s no lack of opportunities to help our most important public partners.
QUICK BYTES Editor’s note: Technology is playing an increasing role in the day-to-day business of sales reps. In this department, Repertoire will profile the latest developments in software and gadgets that reps can use for work and play.
Technology news How to delete Facebook and Instagram from your life forever Facebook has been in a lot of hot water lately, including a data breach, reported in September, in which 30 million users’ information was compromised. This and similar incidents has led some people to decide to leave the social network. But “leaving” isn’t as simple as deleting your account. Brian X. Chen writes a detailed description in The New York Times of the process he took to delete his own Facebook account. Precautions he advises include ensuring you know which of your other social media and app accounts are linked to your Facebook account; downloading all your data (this includes your posts, and it’s a relatively simple step); and, once you’ve pressed “delete,” ensuring the 30-day grace period doesn’t tempt you to walk back your decision.
Does your phone need a smaller companion phone? “The only thing that can protect you from your gadgets is more gadgets,” reads the subhead on an October article in Vox. Writer Kaitlyn Tiffany describes several new products meant to put a barrier between ourselves and the screens that consume us. These products include: • “ IRL Glasses,” which can block light from LED and LCD screens, “and therefore put the wearer in a world free of (digital) billboards and (some) TVs,” Tiffany writes. Designer Ivan Cash told Wired that the glasses are based on the sunglasses from the 1988 John Carpenter sci-fi cult classic “They Live.” •A tiny Palm phone from Verizon. This device, which at press time was scheduled for a November release, is a small phone – you could wear it on a necklace – and it must be linked to another regular phone. The idea is that this very small screen will make apps and other features less fun to use, and therefore less tempting.
• If the tiny Palm isn’t an option (it costs $349.99), another option might be to monitor your app use on Apple’s Screen Time, which the company released with iOS 12 in September.
Why Arianna Huffington literally tucks her phone into bed every night – and why you should too And if you really need to disconnect from your phone at night, you can use one of Thrive Global’s phone beds, which founder Arianna Huffington introduced in 2017.
Motorola is partnering with iFixit to sell official DIY phone repair kits Phone manufacturers often make it very difficult for customers to replace broken parts on their smartphones. But now, Motorola is partnering with the tech company iFixit to offer users official phone repair kits. iFixit is known for tearing apart popular new devices within hours of their release so that users can see how they work on the inside, Greg Kumparak writes for TechCrunch. The company also sells replacement parts for items like iPods, but the Motorola partnership is the first time iFixit is using parts sourced straight from the original manufacturer. At press time, iFixit sells battery replacement kits (about $40) and screen replacement kits ($100-$200) for eight Motorola phones. As Kumparak notes, other manufacturers haven’t joined Motorola yet, but if the trend catches on, this could be an appealing option for smartphone users.
The 8 most unbreakable, indestructive smartphone cases Until Apple does jump onboard with iFixit, Alexander George at Popular Mechanics offers his pick of “The 8 most unbreakable, indestructive smartphone cases,” specifically for the iPhone XS. “We deliberately dropped each [case] from waist height onto hardwood floors and asphalt several times,” he writes. “All finalist cases protected the phone from a cracked screen.”
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Industry news Owens & Minor announces interim president and CEO Owens & Minor Inc (Richmond, VA) announced that Robert C. Sledd, a member of the company’s board of directors, was elected chairman and interim president and CEO. Sledd has been a director of Owens & Minor since 2007 and most recently served until his appointment as Interim President and CEO as a member of the Executive and Audit Committees and Chairman of the Compensation & Benefits Committee. Sledd succeeds P. Cody Phipps, who served as chairman, president, and CEO. The company also announced that the board has already formed a search committee to recruit a new CEO with the assistance of a leading executive search firm. The company also announced that Robert Snead will continue in the role of interim CFO.
Midmark breaks ground on new technology center Midmark Corp (Dayton, OH) has broken ground on a 107,000-square-foot expansion, including a technology center “that signals the next phase in the company’s evolution as a clinical environmental design company,” Midmark said. Located on the company’s Versailles, Ohio, campus, the state-of-the-art technology center will bring together Midmark engineers, designers and experts from across the company to develop new approaches, technologies, and proven solutions with the goal of enabling a better care experience for caregivers and patients. It will also become a research and development hub for additional collaboration with customers, industry leaders, and strategic partners. The technology center will be joined and supported by a new Midmark experience center that is designed for customers to help them make
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informed design and workflow decisions to improve clinical outcomes. Construction of the technology and experience centers is scheduled to be completed in the spring of 2020.
Flu season could cost employers $21B Influenza cost employers more than $21 billion in lost productivity during the 2017-18 flu season, according to an estimate from global outplacement and executive coaching firm Challenger, Gray & Christmas Inc. The company estimated the flu sickened 25 million workers last season. Based on this estimate, analysts calculated average wages lost due to missing four eight-hour shifts using data from the Bureau of Labor Statistics. They estimated flu caused $21.39 billion in losses for US employers. The company advised that employers, especially those with open offices and shared workspaces, should treat these spaces and other common areas as gyms treat exercise equipment. This includes daily cleanings of all surfaces with disinfectant. Employers should also keep soap and hand sanitizer in plentiful supply.
Walmart launches telehealth initiative with Doctor On Demand Walmart announced a new partnership with RB (Reckitt Benckiser Group plc) (England), a global consumer health and hygiene company. Together, the companies have collaborated on a telehealth initiative with Doctor On Demand, a virtual care provider. This fall, consumers who purchase Mucinex, Delsym, Airborne, or Digestive Advantage at any Walmart stores or Walmart.com will receive a limited time offer for a no-cost telehealth medical consultation with a Doctor On Demand physician. Additional details of the partnership were not disclosed.
SAVE up to $750 Right now your customers can SAVE big on Midmark exam room equipment, including the only chairs designed to help improve the accuracy of BP measurements. midmark.com/saveREPdec Š 2018 Midmark Corporation, Miamisburg, Ohio USA
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