REP Dec 21 by BOC design Inc

vol.29 no.12 • December 2021

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Long COVID: The Pandemic’s Sequel Patients with Long COVID may share symptoms and receive similar treatment, but the disease remains an enigma.

Virtualize Thyself. The pand e mic has pre se nt e d us w it h unpre c e d e nt e d c halle nge s re quiring d ist rib ut o r and manufacturer reps to pivot from traditional selling techniques to virtual interactions. Our experienced sales and service teams are committed to continue as your trusted virtual selling partner and help ensure your success by providing the diagnostic products still critical to you and your customers. Until we can work together in the field again, SEKISUI Diagnostics will be here for you in any other way possible. Because we understand, every result matters.

POINT-OF-CARE READER

RAPID DIAGNOSTICS

IMMUNOASSAY SYSTEM

SEKISUI DIAGNOSTICS IS YOUR PARTNER IN HEALTHCARE 800-332-1042 / sekisuidiagnostics.com © 2021 SEKISUI Diagnostics, LLC. All rights reserved. Acucy® and OSOM® are registered trademarks of SEKISUI Diagnostics, LLC. is a trademark of SEKISUI Diagnostics, LLC. FastPack ® is a registered trademark of Qualigen Inc.

DECEMBER 2021 • VOLUME 29 • ISSUE 12

PUBLISHER’S LETTER Positive Momentum........................ 2

PHYSICIAN OFFICE LAB Leading Causes of Death The trends impacting changes in the leading causes of death, and how they relate to newer diagnostic and treatment modalities........................... 4

DISTRIBUTION Rooted in Independents IMCO celebrates 40 years at its 2021 Annual Conference and Trade Show......... 6

Long COVID: The Pandemic’s Sequel

TRENDS Inventory Reserved for Respiratory Season Cardinal Health’s Respiratory Testing Reserved Inventory Program is designed to help customers make preparations for respiratory season..........14

Patients with Long COVID may share symptoms and receive similar treatment, but the disease remains an enigma.

WINDSHIELD TIME

IDN OPPORTUNITIES Data Integration Success Novant Health’s process-driven approach and integration leads its supply chain team solutions through the pandemic and into the future...................................18

TRENDS Senior-Based Primary Care It could be time to scale up.....................38

SMART SELLING Anchors Away...................................50

Automotive-related news........51

MARKETING MINUTE Topics Every Healthcare Sales Training Program Should Include..................................52

TRENDS Necessity: The Mother of Innovation COVID-19 proved the point...................54

LEADERSHIP Deepening Relationships Randy Chittum: How Leadership Can Strengthen Relationships with Customers......................................58

HEALTHY REPS Health news and notes...............60

INDUSTRY NEWS Healthcare Supply Backlogs – A Timeline............................................63

Subscribe/renew @ www.repertoiremag.com : click subscribe repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2021 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 2021

PUBLISHER’S LETTER

Positive Momentum I went back and read my December 2020 Publisher’s Letter just to remember how much

we all wanted 2020 to be over with. The funny thing is, I didn’t mention it in the column. Instead, I highlighted the positives of the year and the fact that we all came through it for better or worse. So, for this issue, I’m going to take a page from R. Scott Adams of 2020 and stay with the positives by sharing some stats you helped us achieve on behalf of the manufacturers that keep our lights on: Stats

2020

2021

Repertoire Website Sessions up

235%

250%

Page views up to 150,000

150,000

340,000

Bounce rate down

18%

12%

2-Minute Drill module views up

50%

47%

Repertoire subscriptions

Grew

Scott Adams

After coming off a record year in content consumption, we somehow found a way to increase it year over year. This isn’t in anyway to brag on Repertoire – it’s to brag on you, the Repertoire reader. You continued to keep tapping into our content. As we look back on 2021, it was a better year than 2020 in so many ways: ʯ Bama won another one ʯ We avoided lockdowns ʯ We had live meetings ʯ We made face to face sales calls ʯ We came out of the PPE backorder situation ʯ Vaccines for COVID were delivered ʯ Normal life started to return ʯ The Braves won the World Series

Those are just a few things that come to mind for me. As you slow down for the holidays, my challenge to you is three-fold. 1. Take a minute to thank your manufacturers and your customers 2. Stop and thank yourself for the work you have done these last 24 months 3. Write down the positive things you recognize from 2021 We live in a great country, and we work in a wonderful industry. From all of us at Repertoire, Thank You to our advertisers and readers. We love you!!!! Merry Christmas, 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.com; www.sharemovingmedia.com

editorial staff editor

Mark Thill

mthill@sharemovingmedia.com

sales executive

Subscriptions

Amy Cochran

www.repertoiremag.com/subscribe or (800) 536-5312 x5259

acochran@sharemovingmedia.com (800) 536.5312 x5279

managing editor

2021 editorial board

ggarrison@sharemovingmedia.com

publisher

Richard Bigham: Atlantic Medical Solutions

editor-in-chief, Dail-eNews

Scott Adams

Eddie Dienes: McKesson Medical-Surgical

acherry@sharemovingmedia.com

sadams@sharemovingmedia.com (800) 536.5312 x5256

Joan Eliasek: McKesson Medical-Surgical

Graham Garrison Alan Cherry art director

bcashman@sharemovingmedia.com

founder

Mark Kline: NDC

circulation

Brian Taylor

Bob Ortiz: Medline

lgantert@sharemovingmedia.com

btaylor@sharemovingmedia.com

Keith Boivin: IMCO Home Care

Laura Gantert

Ty Ford: Henry Schein Doug Harper: NDC Homecare

Brent Cashman

December 2021

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PHYSICIAN OFFICE LAB

Leading Causes of Death The trends impacting changes in the leading causes of death, and how they relate to newer diagnostic and treatment modalities. Despite the fact that new diagnostic testing and treatment modalities have continued to ad-

By Jim Poggi

vance in recent years, the ranking of the 10 leading causes of death in the United States has remained pretty consistent. However, their trends have not due to changes in health habits and treatment improvements addressing specific conditions. The top 10 in order remain: heart disease, cancer, unintentional injuries, chronic lower respiratory diseases (COPD, emphysema), stroke, Alzheimer disease, diabetes, influenza and pneumonia, kidney disease and suicide. In this column, I will discuss the trends impacting changes in the leading causes of death, how they relate to newer diagnostic and treatment modalities, and speculate a bit on how I see the future.

with Troponin I, and high sensitivity Troponin I promises better outcomes still for acute injury and, more recently, for identification of obstructive coronary artery disease and confirmation of congestive heart failure. On the chronic heart disease front, BNP and lipid testing in combination with evaluation of other risk factors including prediabetes using hemoglobin A1c provide earlier alerts of the need to make lifestyle changes, including a reduction in weight, improved diet and increase in exercise to reduce risk factors for heart attack and also stroke.

Where are the wins? What changed the outlook for morbidity and mortality? From a big picture perspective, what has changed since 1980 to influence the decline in death rates for many of the leading causes of death? Diagnostic imaging, including MRI and CT scans, have made a big difference for heart disease (diagnosis of ischemia and arterial blockage in particular). Newer scanning techniques have also impacted cancer, with low dose CT scans available for Medicare beneficiaries 4

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annually who have a history of smoking. Commercial health insurance coverage is also available. Colonoscopies have also had a dramatic effect on the diagnosis of colorectal cancer, with earlier diagnosis leading to far better outcomes. As a result, lung cancer deaths have seen a steady decline in recent years. On the lab side of things, changes have been fundamental. For heart disease, acute cardiac injury is rapidly and accurately diagnosed

pressure medications as well as stent and coronary artery bypass graft availability. A level of cardiac functionality can now be restored following an initial heart attack, based on rapid diagnosis and intervention. The statistics show we are clearly winning here. Cancer diagnosis and treatment has also undergone revolutionary changes, from imaging (low dose CT and colonoscopy) to improved diagnostic tests, including novel molecular assays which can predict risk levels and even provide guidance for therapy. Multianalyte assays with algorithms have grown in number and acceptance and are influencing treatment decisions for breast, colorectal, prostate and other cancers daily. There are even predisposition assays intended to predict whether a patient’s genotype could lead to development of cancer later in life. Big changes in diagnosis are upon us. On the treatment side of things, so much has changed! Novel immunotherapy agents are showing promise. We are gaining a clearer understanding of the metabolic changes that take place as cells become cancerous and we are learning how some cancer cells can evade detection by the immune system. As a result, we are developing a cascade of treatment options for recurring cancer to facilitate better outcomes. CAR-T technologies are being employed to create a stronger immune response and help the body heal itself naturally. Stroke death rates have also dropped noticeably in the recent past. Recent studies show a reduction in stroke incidence of 11.3% from 1990 to 2017. Perhaps more importantly there has been a 34% reduction in stroke mortality considered to be largely attributable to

better management of risk factors by patients and better interventional and treatment techniques. As the U.S. population continues to age, while the incidence of stroke and reductions in mortality are seen, the total number of patients experiencing a stroke is increasing. This is largely a factor of changing demographics.

found by following this link: Health, United States 2019 (cdc.gov).

What’s on the horizon? Newer continuous glucose monitoring solutions are leading to better control of diabetes, increased patient convenience and better dietary compliance. At the same time, wearable

The results for heart disease and cancer especially have been impressive, and continue to get better, with even newer technologies on the horizon. Since 1980, overall death rates have declined by 50%, which is a clear tribute to advances in medical care. Where is further progress needed? With all this progress, there are several of the leading causes of death that have not seen notable reductions in incidence. Diabetes and kidney disease death rates are relatively unchanged. Diabetes death rates are largely the same from 1950 forward, and kidney disease death rates have actually increased since 1980 when mortality rates were first reported. Alzheimer disease rates have risen by more than 60% since 2000. Similarly, both suicide and homicide death rates have increased slightly over the reporting period, perhaps suggesting that behavioral health advancements are still on the horizon. Unintentional injuries have shown the largest amount of variation over the years, but remain the third leading cause of death, primarily attributed to males between mid teen years and mid 20s. The full data set showing the changes in morbidity and mortality is provided by the CDC and can be

technology couples the results for these glucose values and so much more data. Several companies are working to create solutions that combine vital signs data (pulse rate, respiration, etc.) with sensor data (glucose, ketones, respiratory measurements, etc.) and evaluating data from the individual patient to predict weight loss and monitor progress with dietary or other patient treatment programs. At a very high level, they also use population data to predict outcomes and recommend “best practices” for weight control and other behavioral changes. I see a continuing expansion of applications in behavioral health as a key future trend to reduce morbidity and mortality. Harnessed properly, they should be able to impact diabetes death rates that have remained stubbornly resistant to better lab tests and a general increase in our understanding of the metabolic patterns related to the development of diabetes. Exciting times are ahead. www.repertoiremag.com

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December 2021

DISTRIBUTION

Rooted in Independents IMCO celebrates 40 years at its 2021 Annual Conference and Trade Show

Bill McLaughlin, president and CEO opening speech.

With a theme of “Rooted in Inde-

pendents,” IMCO held its 2021 Annual Conference and Trade Show this September at the Hilton Beachfront in Daytona Beach, Florida. “Our members’ roots as independent distributors keep them grounded, connected with their customers, and strong in the industry,” said Bill McLaughlin, president and CEO. “This is what makes independent distributors unique and a key part of their customers’ business, especially during uncertain times we have all faced 6

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over the last 18+ months. IMCO is honored and humbled to be an extension of our members, helping them in many facets of their business to adapt, change, and manage anything that comes their way.” IMCO was excited to celebrate its 40th anniversary at the show with so many of its members and partners in attendance. IMCO brought on 10 new member distributors and 14 new vendor partners this past year. IMCO’s exclusive SEL (Sales Emphasis Line) preferred vendor program continues to be a success,

with the 18 participating vendor partners. “Additional support and new programs have been added to help differentiate IMCO members in the marketplace with our SEL vendors,” said McLaughlin. “We now have a robust eCommerce platform and social marketing multi-level offering to advance our members’ reach and capabilities in this growing segment of the market.” IMCO’s member-only website has been completely overhauled and updated. IMCO has upgraded the functionality, the look, and made it

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DISTRIBUTION even more user friendly. It is now 100% mobile-friendly for sales teams to use anywhere. In addition, IMCO added a new GPO support program that provides hands-on personalized service for the Vizient family of companies. This service offering also brings IMCO-approved distributors new med/surg GPO end user registrations, contract access, manufacturer tier verification and/or activation along with a robust portfolio of business resources that helps the distributor reduce its operational costs.

IMCO’s key initiative for 2022 is to continue adding new distributor members as the demand for services continues to grow amongst independent distributors. IMCO also continues to strategically add new vendors/ product lines to broaden its portfolio to provide new and advanced products that focus on the patient, McLaughlin said. “As telemedicine continues to grow due to COVID, we are adding opportunities around telemedicine devices and connectivity,” he said.

“We have put a renewed emphasis on all our partnerships because one of the biggest things learned from the last 18+ months is how crucial these are. As the market continues to change and adjust with COVID’s far-reaching impacts, communication and collaboration remain more important than ever before.” With remote workers remaining a part of the new office landscape, online sales training and education remains very important to IMCO members. IMCO continues to host its Pathway to Profit series every other Wednesday to educate members on a featured vendor and their products, informing and teaching them how to sell the unique benefits of their products. With points of care shifting, Home Care continues to become a larger part of healthcare. McLaughlin said IMCO is continuing to grow and build its IMCO Home Care (IHC) GPO to provide the best products and prices for its IHC Members.

Immediate and impactful takeaways Convention show floor.

IMCO team in costume at the 40th anniversary party.

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The educational sessions this year were designed to provide immediate and impactful takeaways that members could apply in their own businesses. In addition, IMCO increased the number of member roundtable networking sessions. Keynote speaker Troy Hazard discussed “Future Proofing your Business” based on his experience and knowledge over the last 18 months in multiple industries. Hazard spoke with many IMCO members and vendors before the show to better understand what they have been challenged with over the last 18 months and what they learned during the process.

Vanguard Intl Greg Sword best booth winner.

Sempermed vendor of the year.

Pocket Nurse costume winners.

New member D&&H medical and new supplier InSpec Solutions with Bill and Ashleigh.

Everyone enjoyed the Monday night event.

The Sunday breakouts began with Gunter Wessels, Ph.D., of Liquid Smarts on “Accelerating Market Adoption” – driving relevance in the market today. The Owners’ Roundtable session, led by Mike Marks of Indian River Consulting and Bill McLaughlin of IMCO, was a lively and interactive session with numerous member owners sharing their insights from the last 18 months where COVID has and continues to create issues. On Monday, IMCO kicked off the speakers with 6 TED Talk-type sessions with industry experts:

Bill and Ashleigh McLaughlin.

ʯ Gunter Wessels, Ph.D. Liquid Smarts – Be Relevant ʯ Jan Lehman, CTC Productivity – Outside the Box Time Management ʯ Scott Adams, Share Moving Media – Future of Medical Distribution ʯ Mike Marks, Indian River Consulting – Understanding the Forces of Change ʯ Kevin Manley, IMCO – Develop an Engaging B2B Digital Marketing Strategy ʯ Eric Papp, Agape Leadership – Sales Time System

These 10-minute sessions set the stage for the longer breakout sessions later that morning. Eric Papp of Agape Leadership brought down the house with his lively and entertaining session on “Laser Focused Selling”. Mike Marks of Indian River Consulting Group presented to a packed room about “Understanding the Forces of Change and How They Impact your Future Choices” in his unique and very informative way. Jan Lehman of CTC Productivity provided an enlightening session on how to “Eliminate Time Wasters and Increase Productivity”. The day ended with Linda Rouse-O’Neil of www.repertoiremag.com

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December 2021

DISTRIBUTION HIDA providing an in-depth governmental and regulatory update on programs currently affecting our healthcare system. During the tradeshow, product showcases, featuring IMCO SEL and EPIC vendors, provided an additional opportunity for these important vendor partners. where they provided product information and selling strategies to be utilized by attendees when addressing customer issues. Also during the convention, Bob Miller of Gericare Medical Supply from Monroeville, Alabama, was added to the IMCO Board of Directors. He brings his years of experience from both the vendor side early in his career as well as his wealth of knowledge on the distribution side.

A lot to celebrate Monday evening everyone enjoyed the meal and activities out on the hotel patio and lawn as members and vendors competed in a variety of tailgate-type games. The beach was steps away, and many enjoyed conversations while listening to the waves come right up to the sea wall. Tuesday evening was the 40th anniversary celebration and ’80s extravaganza. “It was an honor to recognize our long-time members,” said McLaughlin. “This shows not only the strength of our group, but the power of true partnership.” Indeed, many members and vendors have been partners for 10, 20, and even 30 plus years. Individuals as well as teams of members and vendors showed up dressed in their favorite 80s attire.

The best costume award went to the team at Pocket Nurse. The night was capped off with a drawing for two $3,000 travel vouchers. The member winner was Larry Wenthe of Shared Service Systems, and the vendor winner was of Zach Querci of Busse Hospital Disposables. Overall, the convention was an incredible hit. “Members and vendors alike were fired up to be at an in-person meeting again and were all ready for a great meeting, and they got it!” said McLaughlin. “Based on the surveys and feedback so far, the show was one of the best-ever! Thank you again to all our vendor partners and sponsors for supporting this incredible show that is dedicated to all our independent distributor members for 40 years and counting!”

Award-winners IMCO’s Equipment Performance Incentive Contest EPIC) is a year-long equipment selling contest in which members sell 10 key vendor lines of products and earn points based on sales orders and vendor interactions through the year. The top 10 point-earners were recognized at the convention and over $25,000 in travel vouchers were awarded.

The top 10 EPIC Sales Performers from 2020 are:

ʯ 10th ʯ 9th ʯ 8th ʯ 7th ʯ 6th ʯ 5th ʯ 4th ʯ 3rd ʯ 2nd ʯ 1st

Marie Rabin Ricky Bustamante David Ellis Kristina Pacheco Kevin Giles David Gordon Sanjay Shah Lawrence Franchetti Angi Muse Victor Amat

CARA Medical American Medical Supplies & Equipment Atlantic Medical Solutions Canada Medical Supplies Shared Service Systems Unimed USA AMSCO One Beat Medical Booth Medical American Medical Supplies & Equipment

Participating vendors experienced a 20% increase in total sales over the prior year! Congratulations to all our EPIC winners. The best booth award went to Vanguard International as Greg Sword captured the show theme with an ’80s nostalgia focused booth that featured a relaxed living room type feel with numerous ’80s devices and pictures depicting a decade of past booths. Sempermed USA was announced as IMCO’s 2020 Vendor of the Year. They were voted by IMCO members as the top vendor partner in 2020 for their proven quality products, customer support, outstanding communication, and overall support of IMCO and its members.

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SPONSORED

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Game Changer: Cepheid’s Xpert® Xpress CoV-2/Flu/RSV plus test Same-day PCR test is vital for independent clinic testing for multiple respiratory illnesses When COVID-19 hit Columbus, Georgia, and the surrounding area in early 2020, Acute Care Emergence was one of only two places in the community testing for it. Terri Jordan, CEO, PA-C of Acute Care Emergence, said the

independent clinic hasn’t had to close since the beginning of the pandemic.

“We were testing over 300 people a day,” Jordan said. “We weren’t set up for that, but we did it because we knew there weren’t other options for them.” Now the independent clinic has swabbed close to an estimated 70,000 people. Its duty has included testing the general population, companies in Georgia and Alabama, and soldiers at nearby Fort Benning. Cepheid’s Xpert ® Xpress CoV-2/ Flu/RSV plus – a PCR test – has been a game changer for Acute Care Emergence. It detects and differentiates between three distinct respiratory illnesses with four targets.1 That’s extremely important in this heightened respiratory season as people return to larger gatherings and other respiratory illnesses like flu and RSV emerge along with COVID-19. Cepheid’s 4-plex plus same-day testing allows same-day treatment for these respiratory illnesses.1 “Having a combination test like Cepheid’s 4-plex plus is incredible,” Jordan proclaimed. “We’ve been the leader in the community on testing for COVID-19 and we’ve had people come from five to six hours away to be tested and treated. We want our testing to be accurate. Cepheid’s Xpert ® Xpress CoV-2/Flu/RSV plus gives us the ability to confirm, on 1

the same day, whether someone has COVID-19, flu, or RSV.” Jordan explained that the Delta variant led to a higher percentage of false negatives in antigen testing, but having access to Cepheid’s Xpert ® Xpress CoV-2/Flu/RSV plus PCR test allowed for stronger confirmation and early treatment. “And those who have come from far away to be tested don’t have to come back,” she said. “We can also begin the correct treatment. For example, I had an elderly patient come in really sick and I thought she would have COVID-19. But she came back positive for RSV. So that changed the game.” Swabbing upwards of 70,000 people has taught the staff at Acute Care Emergence a little bit of everything about diagnostic testing and the accuracy between antigen and PCR testing. “PCR testing is the gold standard,” Jordan said. “For example, our flu and

COVID-19 combination antigen tests would give us positive for flu, which I thought was odd. A mother and daughter came in pretty sick, and I thought they would have COVID-19, but one came back positive for COVID-19 and Flu A and the other one came back positive for Flu B on the antigen. That was odd. So, I ran the Cepheid 4-plex plus PCR and neither had flu, but both had COVID-19.” Acute Care Emergence has been successful keeping patients out of the hospital during the pandemic. Jordan credited running Cepheid’s Xpert ® Xpress CoV-2/Flu/RSV plus in helping to confirm diagnoses. “That way, we don’t send them back into the community to possibly infect others,” she said. “And if we can treat patients within the first three or four days of their symptoms, we can almost guarantee they’ll recover and not be admitted to the hospital.”

Xpert® Xpress CoV-2/Flu/RSV plus Package Insert 302-6991, Rev. A. September 2021.

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December 2021

Introducing Xpert® Xpress CoV-2/Flu/RSV plus*

The Actionable, Rapid Respiratory Test Designed to Meet the Challenge of the Ongoing Pandemic Xpert Xpress CoV-2/Flu/RSV plus features a new, 3-gene design to provide broader coverage for SARS-CoV-2 variants and to ensure patients receive appropriate treatment in a timely manner. Choose the gold standard of PCR detection with Cepheid’s newest test.

This test has not been FDA cleared or approved; this test has been authorized by FDA under an EUA for use by authorized laboratories; this test has been authorized only for the simultaneous qualitative detection and differentiation of nucleic acids from SARS-CoV-2, influenza A, influenza B, and respiratory syncytial virus (RSV), and not for any other viruses or pathogens; and this test is only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostic tests for detection and/or diagnosis of COVID-19 under Section 564(b)(1) of the Act, 21 U.S.C. § 360bbb-3(b)(1), unless the authorization is terminated or revoked sooner.

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TRENDS

Inventory Reserved for Respiratory Season Cardinal Health’s Respiratory Testing Reserved Inventory Program is designed to help customers make preparations for respiratory season Respiratory season is always unpredictable, says Tekita Mckinney, MT (ASCP) M.Ed., infectious disease and PCR

laboratory manager at LeBonheur Children’s Hospital in Memphis. “The laboratory is tasked with keeping up with testing volume that fluctuates from week to week. The upcoming 2021-2022 respiratory season is even more unpredictable. Not knowing when or if we will have spikes in COVID viral infections along with the usual flu and RSV viral infections at any given time makes being prepared for the increased testing even more important.”

The hospital is an early adopter of Cardinal Health Laboratory Products’ recently introduced Respiratory Testing Reserved Inventory Program. “We developed the program to help customers be prepared for the upcoming season,” says Chris Huber, director, point-of-care and infectious disease product marketing at Cardinal Health. Always difficult, assessing demand for respiratory testing is especially complicated this season, given the sustaining pandemic and the low prevalence of flu in the 2020-2021 season. “Typical purchase patterns include a stock-up in lateAugust and September by customers as they build inventory 14

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in the event of an early season,” he says. “In this new program, we are asking customers to think differently and take a longer time horizon into consideration in their preparation for respiratory testing inventory needs. “To assist customers in this transition, we applied advanced analytics to help guide their decision-making, and we helped manage the purchase of dated materials. While we recognize that this shift in mindset will take time, based on the early adoption of the program, we’ve seen customers of all sizes engage in the program.” Huber explains the process. “Once product arrives from the manufacturer, that product is held in reserve

specifically for customers, in the exact amount requested. As product quantities decrease, we will work collaboratively with customers on necessary repeat orders, based on their individual needs.” The program has also enabled select diagnostic manufacturers to plan their manufacturing more effectively for crucial respiratory tests, he says. Customers are required to commit to purchasing the balance of the inventory secured on their behalf. “Even in an allocated situation, the inventory remains theirs and theirs alone,” says Huber. “Once reserved from the manufacturer on their behalf, it puts the customer in the driver’s seat to know exactly how much respiratory inventory they will have dedicated to them despite the severity of the season or manufacturer allocations and/ or backorders.”

“While there is always the need for redundant testing platforms, we believe that maximizing the utility of an analyzer drives clinical workflow and supply chain efficiencies.”

For Health Systems For The Supply Chain

– Chris Huber, director, point-of-care and infectious disease product marketing, Cardinal Health

The program incorporates a tool that aggregates historical demand at IDN levels, which allows customers to see historical utilization trends both at a facility and network level, says Huber. This historical utilization provides a roadmap on prior usage, and customers can then determine at what percent of historical usage they would like to reserve. The tool also helps identify assay menu gaps at the facility level. “While there is always the need for redundant testing platforms, we believe that maximizing the utility of an analyzer drives clinical workflow and supply chain efficiencies.” Says Mckinney, “The advanced analytics data has helped our lab predict future usage over the next few months. Using the snapshot of our ordering history in an easy-to-read format makes the process simple. In addition, having access to multiple years of data is helpful. With 2020 being such an odd year, having access to historical data from 2019 helped us predict possible flu and RSV usage for this respiratory season. The advanced analytics will help my lab save time gathering data manually.

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IDN OPPORTUNITIES

Data Integration Success Novant Health’s process-driven approach and integration leads its supply chain team solutions through the pandemic and into the future. By Daniel Beaird

Supply chain costs can account

for nearly one-third of total operating expenses for health systems. Clarity within those supply chains is a must and the COVID-19 pandemic highlighted that in new ways. Lack of data visibility and transparency left patients and frontline workers vulnerable as healthcare supply chains were thrown into the spotlight.

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Kim Haynes

As many health systems sought ways to improve their data analytics and integration, Winston-Salem, N.C.-based Novant Health was already prepared. It had implemented a methodical, process-driven supply chain approach seven years ago to its clinical decisions. One that incorporates clinicians, manufacturers and suppliers. Novant Health’s clean data within its supply chain provides the necessary transparency and trust to its healthcare partners. “It’s foundational to our relationships with physicians, clinicians, manufacturers and suppliers,” said Mike Bianchin, vice president of supply chain operations and distribution logistics for Novant Health. “Good data on the front end lessens the clean-ups and fire drills on the back end. We’re a collaborative partner with our vendors and clinical leaders, and we must be able to give them information that helps make informed and fact-based decisions.”

focus on having the correct product on hand – and enough of it – for our clinical teams,” said Kim Haynes, senior director of supply chain finance, procurement and analytics for Novant Health. “Our foundation helped us handle it as best we could. It provided us confidence in understanding what was really happening.” Hourly changes, including which PPE should be used and how much of it should be used, were controlled through Novant Health’s data integration.

A foundation built to meet the pandemic

“It allowed us to work quickly with third-party vendors that wanted to help during the pandemic,” Haynes said. “Our data was clean, and we had dedicated sourcing managers with knowledge of products that could be worked into our enterprises during the pandemic.” The supply chain team partnered with respiratory leadership to input data on all new fit-tested N95 masks for team members within the health system. A database was quickly built of team members who

“Good data equals efficiency and speed.” – Martha Bergstedt, vice president of sourcing and contract/vendor management for Novant Health.

Mike Bianchin

Martha Bergstedt

This data-accommodated supply chain laid the foundation for Novant Health’s response to the pandemic. Accurate data prevented wasted time and abetted the 15-hospital health system in changing tasks quickly. “Good data equals efficiency and speed,” said Martha Bergstedt, vice president of sourcing and contract/vendor management for Novant Health. “We weren’t worried about misinformed data and that allowed us to

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December 2021

IDN OPPORTUNITIES were fit tested to different brands of N95 masks and who chose a primary brand and a backup brand from seven distinct options. “We didn’t get to the point of mass switching N95 masks, but we were building toward it based on our data inputs and our system approach,” Bianchin said. “We kept locations stocked based on individual clinical needs.”

level across all service lines. The sourcing teams use data daily to identify opportunities at the system, market, facility, service line, procedure level and physician level, according to Bergstedt. “We’ve built numerous Microsoft Power BI dashboards to incorporate data into a live interactive dashboard for supply chain team members and non-supply team

“ We weren’t worried about misinformed data and that allowed us to focus on having the correct product on hand – and enough of it – for our clinical teams. Our foundation helped us handle it as best we could. It provided us confidence in understanding what was really happening.” – Kim Haynes, senior director of supply chain finance, procurement and analytics for Novant Health

Data is a regular topic of discussion Data is always a part of the weekly conversation between the supply chain team, clinical leadership and vendors. “Working backwards on data issues is much harder than keeping it in mind from the start,” Bianchin said. Whether it’s supply or implant cost per case or spend metric levels being met for rebate purposes, data builds trust that Novant Health’s supply chain team is focusing on the right things to better serve its patients and bring value to the health system. Novant Health’s supply chain dashboards track cost to the physician 20

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members and they can access data as needed,” Haynes said. “It also supports executive and department level meetings, presenting opportunities through data management.” Product contracts are associated with sourcing categories and tied to transactional level items like spend, savings and utilization. Novant Health’s categorization management system captures its spend based on how it sources its contracts for medical and surgical supplies. “Spend data is enriched with clinical outcome and revenue information, making it easier to make decisions,” Bergstedt said. It allows

spend to be seen in real time and automates data for monthly calculations of savings tied to specific item codes. “We can quickly analyze how we are performing, and report monthly realized savings,” Haynes said. “It’s a robust savings reporting, validation and tracking process.” Novant Health’s data and processes allow the supply chain team to tell the story of what’s happening in its system, including expanding on the purchased services side where it has leveraged third parties like Modulini, a provider of clinical and financial insight to hospitals. “Our transactional data isn’t currently connected to our contracts for purchased services like our product data,” Bergstedt said. “But it’s an area of improvement and advancement for us and the goal is to move our processes to purchased services too.” “On the purchased services side, we’ve developed dashboards of total spend by vendor and by a facility/ cost center perspective,” Haynes added. “We’re moving to a single point of entry for all requisitions and that will help us tie in spend at the time of requisition to specific contracts and also enable OCR to collect data on those invoices.”

AI and machine learning on the system level Novant Health is also branching into artificial intelligence (AI) and machine learning through some RPA and machine learning potential use cases. “AI is being used at the system level to help identify patterns and trends for better informed decision making,” Haynes explained. “It will be a significant part of our supply chain strategic plan for many years to come as the value it presents to efficiencies gained is evident.”

Bianchin added that a cleaner process will come as AI evolves in healthcare. “Inventory accuracy will improve, and we’ll be able to look ahead several weeks on surgery schedules and match the demand to the schedule,” he said. “Predictive ordering that’s based on patient type and patient volume will also progress.” Bergstedt concluded that while Novant Health’s supply chain isn’t doing it yet, it’s the best path forward to harvest and optimize the immense amount of data being produced. “In the future, it will ensure our teams are able to minimize their time spent on low value activities,” she said.

Clinicians desire data integration Supply chain shortages impact patient care, particularly in the operating room (OR). A survey of more than 300 clinicians from Cardinal Health reported that almost threequarters of those clinicians have experienced not having a product needed for a procedure. Manual supply chain management processes emerged as a challenge as over 80% of those clinicians said they still rely on manual inventory management for some parts of the supply chain. Clinicians answered that some advantages to automating the OR supply chain were decreasing costs, automating and advancing accurate documentation of case costs, improving charge capture, enhancing data for analytics and ordering, advancing clinical workflow, giving clinicians more time to focus on patients, reducing expired and recalled products, and improving patient outcomes. Employing the power of data analytics is the top supply chain outcome for provider organizations.

Business processes and the standardization of those processes are also highly ranked outcomes, according to a Global Healthcare Exchange survey. Data visibility and data management help reduce operational costs and improve service levels through optimizing processes like procurement, forecasting demand and managing inventory. It also helps the contract life cycle as it gets handed off to each team from negotiation to final price to tracking of metrics.

processes can be supported and utilized,” she said. “The people component is key,” Bergstedt said. “The best decisions are made with data, people and processes. Have all the voices at the table being heard and engaged. That gets us to a better outcome and gets supply chain buy-in and alignment.” Diversity in roles, backgrounds and perspectives at Novant Health helps for well-rounded decisions and minimizes the unintended consequences to decisions.

“ Good data on the front end lessens the clean-ups and fire drills on the back end. We’re a collaborative partner with our vendors and clinical leaders, and we must be able to give them information that helps make informed and fact-based decisions.” – Mike Bianchin, vice president of supply chain operations and distribution logistics for Novant Health

People and processes “We have dedicated teams within our supply chain that handle each function of the contract life cycle,” Bianchin said. “It’s built into our supply chain process and within our health system culture. We are constantly seeking the best terms for quality, outcomes and cost.” Haynes added that multiple viewpoints and thought leaders across Novant Health’s supply chain team is the driver to their success. “It brings different approaches to the table for discussion to vet how our

“Our team – in partnership with supply chain analytics – creates, reviews and takes concrete actions throughout the life of our key agreements and categories,” Bergstedt emphasized. “Targets are set, monitored and shared with supply chain leaders, physicians and clinicians.” Novant Health’s data integration success has resulted in significant contributions to cost savings, improved patient value, physician engagement and understanding of the need for continuous cost reduction. Its data, people and processes drive the approach to clinical immersion. www.repertoiremag.com

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of patients and all who serve them at the heart of what we do. From invention and patent applications to prototype development and design – from supply chain to branding, marketing and sales, we offer our innovation partners a full range of capabilities.

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approach. Working in partnership with leaders in the field of innovation, medicine, and universities – we’re creating a deeper understanding of healthcare professionals’ objectives and underlying processes to identify needs and foster successful innovation. “We’re leveraging our 30 years of product expertise and manufacturing processes to develop exciting patent-protected solutions to current pain points in the market,” said Michael Bielski, Director of Innovation for Dukal.

Capseus bone dust collector Dukal launched its first innovative surgical solution in September 2019,

Trusted partnerships A strength of Dukal has always been our ability to act as a trusted partner and advisor for our channel partners. Dukal’s industry-leading knowledge of quality and regulatory compliance requirements continue to differentiate us as the complexity of our product solutions increase. Dukal continues to look at our supply chain and innovation opportunities to ensure that we stand ready to provide our customers with the absolute highest level of service and care.

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Long COVID: The Pandemic’s Sequel Patients with Long COVID may share symptoms and receive similar treatment, but the disease remains an enigma. For more than a decade after the 1918 influenza pandemic, “a mysterious Parkinson-like syndrome with

sleep disturbance, hypomimia, and a high mortality rate developed in thousands of people across the globe,” write the authors of a recent editorial in the Annals of Internal Medicine. In 1920 the U.S. Surgeon General declared that the syndrome, popularly termed “encephalitis lethargica,” was caused by influenza. However, opinions varied, and even today, questions remain regarding its cause, transmission and treatment. And here we are, a hundred years later, short on answers to another ill-defined post-pandemic illness, which some call “Long COVID.” www.repertoiremag.com

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December 2021

Long COVID: The Pandemic’s Sequel

An enigma It wasn’t until October 2021 that the World Health Organization published a clinical case definition: “Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually three months from the onset of COVID-19 with symptoms that last for at least two months and cannot be explained by an alternative diagnosis.” Common symptoms include fatigue, shortness of breath, cognitive dysfunction, and other symptoms that affect everyday functioning. Complicating matters, some presentations of Long COVID resemble those of other post-viral syndromes, such as chronic fatigue syndrome, dysautonomia (e.g., postural orthostatic tachycardia syndrome [POTS]), or mast cell activation syndrome (MCAS). The CDC reports that some of these conditions have been reported in patients who recovered from severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), two other life-threatening illnesses resulting from coronavirus infections.

‘So many of our patients were told by a medical professional they have psychosomatic illness, PTSD, depression, or that they’re just ‘tired’ from the pandemic in general.’ Given the difficulty defining Long COVID, it’s not surprising that statistics about its incidence vary widely. The World Health Organization, for example, believes that approximately 10% to 20% of COVID-19 patients experience lingering symptoms for weeks to months following acute SARS-CoV-2 infection. The authors in the Annals editorial note that studies of SARS-CoV-2 infections indicate that up to 61% of patients have experienced symptoms that persist for months, occurring in hospitalized and nonhospitalized adults, adolescents and children. “However, the absence of well-defined control groups or reliance on serologic 26

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testing or self-reporting will limit improving our current understanding,” they write. “Even if only 10% of patients experience persistent symptoms after COVID-19, the number afflicted will easily be tens of millions.” Meanwhile, a report in the Journal of the American College of Cardiology estimates that 33% to 98% of patients who have recovered from initial COVID-19 illness experience long-term manifestation of PASC, or post-acute sequelae of COVID-19 – a more formal name for Long COVID. The most-often reported symptoms are fatigue (28.3%-98%), headache (91.2%), dyspnea (13.5%-88%), cough (10%-13%), chest pain (5%-42.7%), anxiety/ depression (14.6%-23%), and olfactory/gustatory deficits (13.1%-67.5%). Less frequent symptoms include palpitations/tachycardia (11.2%), concentration or memory deficits (23%), tinnitus or earache (3.6%), and sensory neuropathy (2.0%). Most symptoms are more frequently reported by women and older individuals.

Hard to believe “Long COVID is a brewing public health crisis, yet there is no consistent system for how to manage people affected in the UK,” writes Professor Brendan Delaney from Imperial College London. “[W]hen patients go to their GP they often find themselves being bounced back and forth with different referrals and no clear answers.” Some providers fail to take complaints from their patients seriously. It’s a pattern set with other postinfectious disorders, such as mononucleosis and Lyme disease. “Frustration frequently arises in these often marginalized patients with symptoms that some clinicians dismiss as only nonphysiologic or related to mental health,” according to Delaney. “On another angle, some alternative practitioners offer false hope with antibiotic treatments, using Lyme disease as a stand-in for chronic, medically unexplained symptoms without a basis in demonstrable infection. Moreover, desperate patients seek information through social media and take non-evidence-based treatments for chronic Lyme disease, partly due to modern mainstream medicine’s lack of effective approaches.” CDC suggests that healthcare professionals choose a conservative diagnostic approach in the first four to 12 weeks following SARS-CoV-2 infection. Laboratory and imaging studies can often be normal or nondiagnostic in patients experiencing post-COVID conditions, and symptoms may improve or resolve during the first few months after acute infection in some patients.

Long COVID: The Pandemic’s Sequel

“However, workup and testing should not be delayed when there are signs and symptoms of urgent and potentially life-threatening clinical conditions (e.g., pulmonary embolism, myocardial infarction, pericarditis with effusion, stroke, renal failure). Symptoms that persist beyond three months should prompt further evaluation. “Overall, it is important for healthcare professionals to listen to and validate patients’ experiences, recognizing that diagnostic testing results may be within normal ranges even for patients whose symptoms and conditions negatively impact their quality of life, functioning (e.g., with activities of daily living), and ability to return to school or work.” According to the CDC, holistic support for the patient throughout their illness course can be beneficial. Many post-COVID conditions can be improved through already established symptom management approaches (e.g., breathing exercises to improve symptoms of dyspnea). A comprehensive rehabilitation plan may be helpful for some patients and might include physical and occupational therapy, speech and language therapy, vocational therapy, as well as neurologic rehabilitation for cognitive symptoms. 28

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Gradual return to exercise as tolerated could be helpful for most patients. Optimizing management of underlying medical conditions might include lifestyle counseling such as nutrition, sleep and stress reduction.

‘The neurocognitive effects of COVID-19, namely mental ‘fogginess’ and fatigue, are the most difficult problems to treat.’ Long COVID clinics Some health systems have created clinics specifically for people with Long COVID. Norton Children’s in Louisville, Kentucky, for example, launched its Long COVID clinic in October

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Long COVID: The Pandemic’s Sequel

2020. “As infectious disease doctors, we’re always looking for up-to-date information about evolving diseases, as most infectious diseases do evolve,” infectious disease specialist Daniel Blatt, M.D., told Repertoire. “Long COVID was an emerging syndrome for a new disease. There wasn’t a lot of information out there, and we wanted to set up an all-encompassing clinic for people experiencing it. It isn’t only a resource for families and pediatricians, but also an exercise in learning about the disease and gathering data so we can help clinics all over the country. “We provide a medical home for these patients, with the time and expertise in infectious disease to not only track their progress, but make sure we deal with compounding developments if necessary,” he says. The clinic has a sophisticated data-gathering system, which allows clinicians to track even subtle changes over time, and if necessary, refer the child to a specialist. “That’s the medical perspective. From the patient point of view, we offer a lot of reassurance and time, and someone to just listen to them. Most kids get better.” WMCHealth in Valhalla, New York, launched its Post-COVID-19 Recovery Program in October 2020. The major symptoms with which patients present include fatigue, mental “fogginess” and shortness of breath, according to Carol Karmen, M.D. and Garry Rogg, M.D., internal medicine specialists with

Westchester Medical Center and the clinical leaders of the program. “These symptoms can be moderate to severe and very persistent. We have patients presenting now who have been sick since the start of the pandemic in the spring of 2020.

‘When patients go to their GP they often find themselves being bounced back and forth with different referrals and no clear answers.’ Given Westchester Medical Center’s wide variety of clinical specialties, “we are having success treating many of the symptoms,” they say. That said, “the neurocognitive effects of COVID-19, namely mental ‘fogginess’ and fatigue, are the most difficult problems to treat.” Common diagnostic tests may turn up normal, “but after caring for so many patients with these symptoms, sometimes over many, many months, we are certain these

Smell retraining therapy Smell retraining therapy (SRT) is a treatment for loss of smell, also referred to as hyposmia or anosmia. It is believed to work as a combination of the unique ability for smell nerves to regrow while encouraging improved brain connectivity. Most studies on SRT have been done on patients with post-viral smell loss (i.e., following a cold or upper respiratory infection). Research findings on SRT for COVID-19-related smell loss are not yet available.

The process of SRT involves the repeated presentation of different smells through the nose to stimulate the olfactory system and establish memory of that smell. It is best to start with at least four different scents, especially smells you remember. The most recommended fragrances are rose (floral), lemon (fruity), cloves (spicy), and eucalyptus (resinous). Many people use essential oils, which can be purchased online or from local

Source: American Academy of Otolaryngology–Head and Neck Surgery

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health food, aromatherapy or craft stores. Take sniffs of each scent for 10 to 20 seconds at least once or twice a day. While sniffing, it is important to be focused on the task. Try to concentrate on your memory of that smell. After each scent, take a few breaths and then move on to the next fragrance. It is recommended that you do this for at least 12 weeks, but you can do it longer, alternating the scents if you like.

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Long COVID: The Pandemic’s Sequel

symptoms are real. Program patients have shared stories telling how other physicians dismissed them. Because of this, they are so grateful WMCHealth established this program at Westchester Medical Center.” The University of Texas Medical Branch in Galveston launched its Post-COVID Recovery Clinic in July 2020, says Tammy McCrumb, RN, clinic manager. “Our original mission was to support post-hospitalized patients, some of whom were going home oxygendependent and with limited physical mobility and overall status. Gradually, we shifted to treating more patients who had not been hospitalized. Now we have a combination of both.”

‘Overall, it is important for healthcare professionals to listen to and validate patients’ experiences.’ The hospital has a robust pulmonary rehabilitation program and is a COPD Center of Excellence, says McCrumb. “We treat [Long COVID] patients with chronic shortness of breath similarly as we do patients with COPD.” Most undergo pulmonary function testing and a comprehensive assessment of mobility, nutrition, sleep and mental health. Oxygen-dependent patients with complex medical histories receive one-on-one rehabilitation, while others receive group therapy and exercises to perform at home. Patients reporting dizziness or palpitations are often treated with an initial Holter monitor and are referred to cardiology for further evaluation if necessary. “Early on, we referred many patients to neuropsychology, because we didn’t understand brain fog,” says McCrumb. “Now we evaluate all our patients using the Pittsburgh Sleep Quality Index, and we’re finding that some have undiagnosed sleep apnea and probably had it prior to COVID.” Patients with Long COVID may share symptoms and receive similar treatment, but the disease remains an enigma. “Some of our elderly patients who were very 32

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sick recover amazingly well after a couple of sessions of pulmonary rehab,” says McCrumb. “On the other hand, some younger patients – even those who weren’t hospitalized – may struggle for months to recover. Everyone recovers differently.”

The physician practice Physicians in solo or small-group practices should refer patients with dyspnea or fatigue to a regional pulmonary rehabilitation program, if one is available, advises McCrumb. Lacking such a program, however, they can point to online resources for breathing exercises for the home. “Above all, encourage your patients to increase their activity level. Encourage them to take two laps around the neighborhood instead of one. The more they increase their endurance, the quicker their recovery tends to be, even if it is little by little each day.” Says Dr. Blatt, “If the private practitioner can tap into a local health system with infectious disease or multidisciplinary support, I would recommend doing that. We have the time to help these patients, and we’re available. Not every infectious disease practice focuses on Long COVID, but a primary care physician can always refer to the proper specialist based on the patient’s presentation.” The independent practitioner can reassure patients that almost universally, patients with Long COVID get better, he says. “But in order to keep those patients safe during the process and to decrease the duration of the disease, refer for a specialist intervention when necessary.” Drs. Karmen and Rogg at the WMCHealth’s PostCOVID-19 Recovery Program encourage physicians to keep in mind that the symptoms patients with Long COVID are complaining of are, in fact, real. “So many of our patients were told by a medical professional they have psychosomatic illness, PTSD, depression, or that they’re just ‘tired’ from the pandemic in general. After seeing close to 400 patients since we started this program, we are sure these symptoms are real, and we are doing everything we can do to help.” Knowledge of post-COVID conditions is likely to change rapidly with ongoing research, says the CDC. Healthcare professionals and patients should continue to check for updates on evolving guidance for post-COVID conditions.

Long COVID and the lab

Before ordering laboratory testing for post-COVID conditions, the healthcare professional should be clear about the goals of testing, advises the Centers for Disease Control and Prevention. Laboratory testing should be guided by the patient history, physical examination and clinical findings. A basic panel of laboratory tests should be considered for patients with ongoing symptoms (including testing for non-COVID conditions that may be contributing to illness). Expanded testing should be considered if symptoms persist for 12 weeks or longer.

Basic diagnostic lab testing

ʯ Blood count, electrolytes, and renal function. ʯ Complete blood count with possible iron studies to follow, basic metabolic panel, urinalysis.

ʯ Liver function. ʯ Liver function tests or complete metabolic panel. ʯ Inflammatory markers. ʯ C-reactive protein, erythrocyte sedimentation rate, ferritin.

ʯ Thyroid function. ʯ TSH and free T4. ʯ Vitamin deficiencies.

More specialized testing Specialized diagnostic tests for Long COVID should be ordered in the context of suggestive findings on history and physical examination. They include testing for: ʯ Rheumatological conditions. ʯ Antinuclear antibody, rheumatoid factor, anti-cyclic citrullinated peptide, anti-cardiolipin, and creatine phosphokinase. ʯ Coagulation disorders. ʯ D-dimer, fibrinogen. ʯ Myocardial injury. ʯ Troponin. ʯ Differentiate symptoms of cardiac versus pulmonary origin. ʯ B-type natriuretic peptide.

Source: U.S. Centers for Disease Control and Prevention

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Healthy Skin is the First Line of Defense in Healthcare

Hand hygiene is a critical aspect of patient safety1 and a task that is performed more than almost any other activity in healthcare settings. In fact, frontline healthcare workers (HCW) may have the opportunity clean their

hands up to 100 times per shift, however not all of those opportunities are realized and skin irritation is often cited as the reason why.2 To maintain healthy skin and ensure proper hand hygiene compliance, it is essential that HCW take care of their hands.

The skin is the largest organ of the human body and is essential to providing a first line of defense from pathogens. HCW hands are one of the most important tools they have and can be negatively affected by dry or damaged skin. Lack of awareness of the true causes of skin damage is a significant contributing factor to improper hand hygiene. It is important for HCW to understand the 34

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behaviors that actually lead to skin damage and the steps they can take for prevention. The first key step for HCW is knowing when to use soap and water. A soap and water handwash should be used: ʯ When hands are visibly dirty or contaminated ʯ If hands are soiled with blood or other body fluids

ʯ Before eating and after using the restroom ʯ After caring for patients with C. diff if facility policy requires it Second, both national and international hand hygiene guidelines recommend using an alcohol-based hand rub (ABHR) as the preferred method of cleaning hands in healthcare

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settings.3 The reason for this is that well-formulated ABHR products have superior efficacy over soap and water (even antimicrobial soaps) and offer other benefits, such as convenience and speed of use. Additionally, overexposure to hand washing with soap and water removes oils and lipids naturally present in the skin and disrupts the natural skin barrier. This can start the cycle of skin damage. Once the skin’s natural barrier has been disrupted it allows channels of exposure to nerves and tissues in the deeper layer of the skin. HCW then apply ABHR and get an immediate stinging sensation which is only a sign of skin damage that has already occurred. The stinging sensation often drives HCW to return to the use of soap and water as their primary means for hand hygiene, not knowing this is the source of the problem. The skin damage progresses with the continued overuse of soap and water making it extremely difficult for a HCW return to ABHR as their primary hand hygiene practice. Skin irritation is often cited as a barrier to hand hygiene compliance.4 Therefore it is important for HCWs to be on the lookout for skin damage. Early warning signs of skin damage include dryness, tightness, flaking or itching of the knuckles, back of hands, and between fingers. To help prevent the cycle of skin damage it is essential for HCW to minimize handwashing with soap and water, except as required. Using

lukewarm or cooler water (never hot) when washing hands, rinsing well and gently patting hands dry with a paper towel is another best practice. HCW should also be careful not to don gloves when hands are still wet. This can trap moisture underneath the gloves and irritate the skin.

healthcare facility is switching from one hand hygiene product to another it is important to ensure lotion is used to support skin health during the transition period, or when hands feel dry for any reason. HCW can continue to take care of their skin when they are

Early warning signs of skin damage include dryness, tightness, flaking or itching of the knuckles, back of hands, and between fingers. To help prevent the cycle of skin damage it is essential for HCW to minimize handwashing with soap and water, except as required. Lotion is also essential for maintaining skin health. HCWs should use a facility-approved lotion frequently during their shift. Ideally this would be after every soap and water use, but at a minimum, applied twice per shift. HCW should never bring lotions from home into the clinical environment without approval. Non-approved lotions may not be compatible with other hand hygiene products, sterile gloves or may have levels of fragrance that are not appropriate. Incorporating lotion into HCW routine is a good practice all of the time and especially during cold, dry weather or changes in climate. If a

not working, too. Wearing gloves in cold, dry weather, using a mild soap at home, and applying lotion as frequently as possible are all elements to keeping skin healthy. Thicker lotions and creams have a higher oil content and can be very beneficial outside of work when more greasiness can be tolerated. Look for a thicker lotion or cream that is fragrance-free for use at home. Applying this type of a lotion or cream on hands before going to sleep allows it to remain on the skin for an extend period of time and is another beneficial step that HCW can take to help keep hands healthy.

enters for Disease Control and Prevention. Guideline for hand hygiene in health-care settings: recommendations of the healthcare infection C control practices advisory committee and the HICPAC/SHEA/ APIC/IDSA hand hygiene task force. MMWR 2002;51:RR-16. 2 The Joint Commission. Measuring hand hygiene adherence: overcoming the challenges. 2009. Available from: http://www.jointcommission.org/ assets/1/18/hh_monograph.pdf. Accessed February 7, 2019. 3 World Health Organization. WHO guidelines on hand hygiene in health care. First global patient safety challenge: clean care is safer care. http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf. Published 2009. Accessed February 7, 2019 4 The Joint Commission. Measuring hand hygiene adherence: overcoming the challenges. 2009. 1

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Family doctors have traditionally taken the lead in

managing care for senior patients. After years in practice, their patients tend to grow older along with their doctor. Together, doctor and patients learn how to navigate the complexities of caring for seniors, with their comorbidities, challenging living conditions, immobility, frailty and even dementia. But today, as baby boomers enter old age, a number of companies with regional and national aspirations are increasingly tapping into this market.

Regardless of who is delivering the care, future providers of geriatric medicine will most likely operate in a capitated, or value-based environment instead of fee-for-service. And Repertoire readers will be challenged to help them deliver compassionate, patient-centered care in a cost-effective – and profitable – way. “Geriatricians have deeply studied the diseases that affect older adults and how they manifest and react differently to treatment as we age,” says Scott Weingarten, M.D., chief innovation officer for SCAN Health Plan, a not-forprofit, Medicare Advantage health maintenance organization based in Long Beach, California. “They understand how, as patients age, their needs expand beyond just treatment for physical health, into mental and social limitations, and they work collaboratively in teams to solve these many issues.”

of each diagnostic test, procedure, and medication.”

A growing demand The statistics point to the difficulties – and the opportunities – facing primary care for seniors today. The increase in the number of older adults in the United States is unprecedented, according to the Centers for Disease Control and Prevention. In 2016, 49 million U.S. adults were 65 or older, representing 15% of the population. That number is expected to reach 71 million by 2030 and 98 million by 2060 – when older adults will make up nearly 25% of the population. Age brings a higher risk of chronic diseases such as dementia, heart disease, type 2 diabetes, arthritis and cancer. In 2019, healthcare and long-term care costs associated with Alzheimer’s and other dementias were $290 billion, making them some of the costliest conditions to society.

‘As human beings, we like to congregate with others. That’s why some of our centers are more like senior centers, serving meals and offering interaction with others.’ Specialists in seniors-based medicine also have learned to balance treatment for disease with patient quality of life and function, and they weigh the pros and cons of intervention, he adds. “Geriatricians are trained to avoid care that may lead to unnecessary procedures and medications in elderly patients, and they are focused on the tradeoffs between the harms and benefits

There’s another problem. The demand for geriatricians is expected to continue to climb, but their numbers will not keep pace. By 2025, demand is expected to outstrip supply by five times (i.e., an estimated 33,200 geriatricians will be needed, but only 6,230 are projected to be practicing), according to the Health Resources & Services Administration. www.repertoiremag.com

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TRENDS The family physician “Even if I hadn’t started out taking care of older patients, my younger patients have aged with me,” says Donnie Batie, M.D., a family physician and board-certified geriatrician in Baton Rouge, Louisiana. Batie started his family medicine practice in Baton Rouge 40 years ago. He was drawn to caring for the elderly when he was still young, following a six-month stint after residency. In his own practice, he found that his younger patients brought with them their parents and grandparents for care. As they did so, he became more engaged in geriatric medicine. When the exam for certification in geriatric medicine was first offered in the early 1990s, he wasted no time becoming board-certified.

care for them,” he says. “It’s next to impossible to care for an 80-year-old person with multiple chronic conditions in a 15-minute office visit.” Value-based care, as opposed to fee-for-service, is probably the best way to make such care viable in the future, says Batie, who participates in an accountable care organization for Medicare patients.

Big players At the other end of the spectrum from the solo practitioner, a growing number of public and private companies are zeroing in on senior-based care. In 2021 alone: ʯ Humana announced a new brand – CenterWell – to describe its services, including senior-focused primary

‘It’s next to impossible to care for an 80-year-old person with multiple chronic conditions in a 15-minute office visit.’

ʯ Miami-based CareMax – a provider of value-based care to seniors – signed an agreement with national health benefits firm Anthem to build medical centers in Indiana, Texas, Kentucky, Wisconsin, Georgia, Connecticut, Virginia and other locations. ʯ Jacksonville, Florida-based GuideWell made a “multiyear strategic investment” in its PopHealthCare subsidiary, which provides home-based primary care services to vulnerable seniors and adults. ʯ Miami-based Cano Health, a primary care provider for seniors, acquired University Health Care and its affiliates for $600 million, adding about 24,000 Medicare Advantage members to its rolls. ʯ In September, San Franciscobased One Medical acquired Medicare provider Iora Health for $2.1 billion.

Time well spent Family practitioners are well-suited to care for seniors, he says, given their lifelong relationships with patients and families. “Family practitioners recognize that death is as much a part of the practice as delivering babies,” he adds. “We are comfortable with palliative and hospice care, nursing home care and team-based care.” There’s another thing about caring for seniors. “At age 50, a person may take two medications, but after 10 years, another two or three might have been added. So we are trained to look at our patients’ bag [of medications] and eliminating as many as possible” to avoid harmful drug interactions. “We’ve always had complex patients, but haven’t been paid adequately to 40

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care facilities that had previously operated as two entities, Partners in Primary Care and Family Physicians Group. (Humana’s Conviva Care Centers subsidiary, which operates seniorfocused primary care centers in Texas and Florida, was not affected by the rebranding.) Humana expects to have close to 200 CenterWell and Conviva clinics by the end of 2021 or early 2022, with further expansion planned. ʯ SCAN Health Plan made plans to launch its geriatric primary care program in Los Angeles County in March 2022.

Large companies hold some advantages over private practitioners, including more powerful technology solutions. For CareMax, for example, it’s CareOptimize, a software platform that aggregates a patient’s medical records from all inpatient and outpatient visits, as well as payer information, to form a single, longitudinal view of each patient, says Ben Quirk, chief strategy officer. That data is parsed and can be accessed at the point of care for use in determining care management plans and resource use. Quirk has led initiatives in capitated, shared-risk and full-risk models for more than 15 years, and is continuing to do so at CareMax, whose physicians are rewarded based on health outcomes instead of volume,

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TRENDS he says. “They can take a different approach to care. It’s difficult for a primary care physician to see a mixed panel of patients. They have the same 15-minute slot for an 18-yearold with sniffles as for a 65-year-old [with comorbidities].” Patient panels at CareMax are smaller than those in traditional primary care practices, he adds. But physicians are responsible for their patients 24 hours a day, seven days a week. “It’s not enough to offer advice when the patient is in the exam room. Our physicians are always available and accessible.” Patients have their physician’s cellphone numbers. CareMax is accelerating the speed and geographies in which it plans to open medical centers for seniors – at least 15 in 2022, approximately 25 in 2023 and approximately 35 in 2024. In July 2021, the company signed an agreement with an affiliate of The Related Companies in which Related will advise CareMax on opening new medical centers nationwide, including but not limited to centers that are within and close to affordable housing communities owned by Related. (A global real estate firm, Related was founded in 1972 primarily as an affordable housing developer, owner and manager.)

Brick and mortar? Given their more limited mobility, some seniors may be better served by home-based care than in-office visits. But that’s difficult in a fee-forservice environment. “You have to consider transportation,” says Batie. “Whereas you can see maybe five or six patients doing morning home visits, you can see twice or three times as many in the office.” That said, he believes that, given the proliferation of home-based diagnostic tools, more home-based care may 42

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be possible, even for patients with chronic conditions, such as congestive heart failure, diabetes and peripheral vascular disease. “Some elderly people have mobility restrictions, incontinence, transportation challenges and other reasons, and may find it challenging to visit a clinic,” says Weingarten. “In many cases, it may be better for care to revolve around the needs of the elderly patient rather than the needs of the clinic or healthcare organization.” Says Quirk, “Our model is to envelop patients however they want to access care. As human beings, we like to congregate with others. That’s why some of our centers are more like senior centers, serving meals and offering interaction with others. But we think the home is equally important. As different conditions develop or mental faculties decline, we need to go to the patient in their home, particularly within 24 hours after discharge from the hospital.” Humana spokesperson Cary Willis says the company sees both bricks-and-mortar and in-home care as important parts of an integrated system of senior-focused care. In March 2021, Humana completed its acquisition of Kindred at Home (KAH), which it says is the nation’s largest home health and hospice provider. That said, its bricks-and-mortar clinics are designed to meet the special needs of seniors, he says. They offer motorized exam chairs, familyfriendly exam rooms, wide hallways, large windows that allow natural light, and, in many cases, on-site pharmacies and labs, and community centers, where seniors can socialize, learn new skills and exercise.

What’s next? The opportunities to serve seniors are expanding. But the question

remains, how motivated will young doctors be to do so? “Young people like to take care of young people,” says Dr. Batie. “When doctors come out of residency, they tend to focus on a younger population. But as they get older, they find themselves taking care of older patients. Today, some are focusing on long-term practice, that is, caring for patients in longterm-care and independent-living facilities, which need doctors for their residents. Those opportunities are growing.” Regardless of venue, it’s likely that senior-based care will increasingly be reimbursed on a capitated or value-based basis, not fee-for-service. The approach promises more individualized care that is also more preventive, says Willis. And it works best when paired with Medicare Advantage plans, which cover most of the patients of CenterWell and Conviva, and which combine Medicare parts A (primarily inpatient care), B (outpatient care) and, in many cases, D (prescription coverage). “This pairing allows deep alignment on what matters most to patients – commitment to personalization and partnership in the management of the very complex challenges these patients face.” It also promotes more cost-effective care, he adds. Medicare Advantage plans’ coordinated care approach has been shown to keep seniors healthier. Plan members with multiple chronic conditions experienced 23% fewer inpatient hospital stays and 33% fewer emergency room visits than those in fee-for-service Medicare. In addition, research shows that healthcare spending is 25% lower for Medicare Advantage enrollees than for enrollees in fee-for-service Medicare in the same county.

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MEDTRONIC

Efficiencies driving expansion in ASCs reinforced by pandemic behavior Changes in patient attitudes solidifies ASCs in healthcare delivery

The market for ambulatory surgery centers (ASCs) is steadily expanding.

It’s projected to grow with a compound annual growth rate (CAGR) of 7.5% from 2019 to 2029.1 Heightened public health awareness has significantly boosted the outpatient tally for ASCs, and the demand for minimally invasive surgeries that lead to early discharge and quick recovery for patients has driven ASC expansion through these efficiencies. Additionally, the COVID-19 pandemic reinforced the importance of ASCs. Patients had restricted admittance to hospitals during the onset of the pandemic to mitigate the spread of COVID-19 and many procedures were referred to ASCs, opening opportunities for wider acknowledgement as an elemental part of healthcare delivery. “Patient behavior was another dynamic accelerated by COVID-19,” said Mike LaCasse, Vice President, U.S. Specialty Channels for Medtronic. “Some patients are realizing that ASCs provide a fast and convenient clinical service in a safe environment closer to home.” Surgical technological advancements and patient affordable reimbursement programs are other driving forces behind ASC growth. “ASCs offer a lower cost to serve while delivering the same clinical outcomes,” LaCasse said. “ASCs are a vehicle to achieve year over

year savings as payers and providers search for ways to reduce cost.” Increased ASC momentum in cardiology and other procedures is being seen in specific states like Arizona, Florida, New Jersey and Tennessee, according to LaCasse, ASCs are seeking cost effective solutions without comprising the standard of care. “Suppliers need to better understand this business model and adjust their commercial model,” LaCasse explained. “This includes offering operational services and solutions that help the ASC owner run their business more effectively and efficiently, including maximizing space and caseload and assisting in capital financing and planning.” Physicians are the primary decision-maker or have direct influence on the decision at more than 70% of ASCs for medical devices or equipment, compared to less than 45% of hospitals.2 “It’s the physician equity owner’s capital and financing funding the business in many cases,” LaCasse said. Price sensitivity and financial flexibility are the key drivers in product choices in some cases. But in others, product preference still tips the scales. “The motivations may be different, but they all share the need for speed,” LaCasse said. “Decisions are made fast.” The ability to react quickly and have a sense of urgency is the mindset

suppliers need to be successful in ASCs. “Unlike hospitals, there are very few committees, and the product trials are short,” LaCasse emphasized. Medtronic can bring in on site resources and clinical speakers, host virtual events or direct perspective patients to tailored websites all based on the patient condition and associated Medtronic therapy. “These options are all geared toward patient education and removing barriers to care,” LaCasse said. “Our programs are well-developed and being used with patients considering bariatric surgery.” These Medtronic programs go beyond unique and outcomes-driven therapies to also include customer solutions. Medtronic is “engineering the extraordinary” through its ASC strategy, resources and solutions, creating a model that meets the future of ASCs. “We are already partnering with distributors to gain scale,” LaCasse explained. “ASCs cannot be regularly serviced by an in-person traditional sales rep due to the pure number of ASC facilities. So, we have incentive programs in place tied to specific products and geographies in the United States where we rely on distributor reps to co-sell our products. They have the administrative relationships, and we support the clinical requirements of those relationships.” To learn more, go to: Medtronic.com/asc.

esearch And Markets: Ambulatory surgery centers (ASCs) market size, market share, application analysis, regional outlook, growth trends, key R players, competitive strategies and forecasts, 2019 to 2029 2 Bain & Company: Ambulatory surgery center growth accelerates: Is medtech ready? 1

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SPONSORED

QUIDEL

Drugs of Abuse and the Physician Office Lab With drug abuse and misuse on the rise, physician offices need fast and accurate testing The COVID-19 pandemic has had some profoundly negative effects on the health of Americans. Perhaps

one surprising negative has been the substantial rise in drug usage. According to the National Center for Drug Abuse Statistics there are currently 31.9 million illegal drug users, and 53 million people that have used illegal drugs or misused prescription drugs within the last year among Americans aged 12 years and older. In addition, CDC data found that more than 93,000 people died of a drug overdose in the U.S. in 2020 – a nearly 30% increase from 2019. These pandemic-induced statistics, coupled with state regulations requiring physicians prescribing opioids to routinely test to ensure patient compliance, underscore the need for fast and reliable drug screening. Are your POL customers properly equipped to handle an increase in demand for drug screening? Currently, some physician office labs may rely on an in-house visuallyread test. These can be difficult to read and interpret and require manual recording of results which can lead to input errors, especially if they are running multiple tests. Others may be sending their testing to large reference labs which can be costly and require a long turnaround time for results.

The Quidel Triage TOX Solution Quidel’s Triage TOX Drug Screen, 94600 is a rapid urine drug screen run 44

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on the Triage Meter, for the simultaneous detection of drug and/or metabolites of up to 9 different drug classes. The Triage MeterPro is a portable fluorescence instrument that provides laboratory quality results on at point-of-care and offers connectivity to a majority of laboratory information system platforms available. Qualitative results are stored in the meter memory and can be displayed or printed. The Test Select® feature allows for increased flexibility in reporting only results that are medically necessary and customers are able to run tests by batching to significantly increase throughput. In addition to toxicology testing, the Triage platform provides a variety of testing options including the Cardiac panel (Troponin, Myoglobin, and CK-MB), D-Dimer, and BNP, allowing your customers to consolidate testing on one instrument saving valuable bench space.

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MEDPRO

MedPro brings OraSure’s OTC COVID-19 test, InteliSwab™, to non-acute markets and beyond OraSure Technologies, a leading innovator in diagnostic technologies, has partnered with MedPro, a national independent sales organization representing leading medical manufacturers, to bring OraSure’s innovative over-the-counter (OTC) COVID-19 rapid antigen test, InteliSwab, to market.

The strategic partnership leverages MedPro’s experienced nationwide sales team and OraSure’s expertise in infectious disease and molecular sample collection to expand COVID19 testing to markets outside of healthcare, giving people the power to test anytime, anywhere.

with the universal need for testing in mind. OraSure created the InteliSwab as a solution for use in markets beyond the traditional acute care or physician office setting. Designed with both accuracy and ease of use in mind, the result is a user-friendly test that is simple, quick, and non-invasive. The test also boasts impressive accuracy. In a clinical study conducted earlier in 2021, InteliSwab results were compared to highly sensitive molecular FDA Authorized SARS-CoV-2 assays to determine test performance. InteliSwab correctly identified 84% of the positive samples with both low

InteliSwab requires only three key steps**: Swab, Swirl, and See. Users swab their nostrils with the gentle swab, swirl the swab in the tube, and can see their test results in minutes. A Solution for Everyone InteliSwab is a lateral flow in vitro diagnostic antigen test for the detection of COVID-19. As an antigen test, it is designed to detect active infection in individuals, regardless of if they’re showing symptoms. InteliSwab was designed and developed by OraSure, a leading innovator in diagnostic testing for infectious disease,

levels and high levels of virus. Additionally, InteliSwab correctly identified 98% of negative samples**.

Smart Science Made Simple The gentle swab is designed to take samples from only the lower part of the nostril, making it ideal for use with patients in the home health care setting and beyond. The swab is unique

in that it’s built into the test device, which means less room for error and a feeling of confidence when running. In fact, 98% of users found InteliSwab easy to use*. InteliSwab requires only three key steps**: Swab, Swirl, and See. Users swab their nostrils with the gentle swab, swirl the swab in the tube, and can see their test results in minutes. There are no confusing steps, no batteries needed and no mailing samples to a lab. The simplicity and ease-of-use of InteliSwab make the test accessible not only for home health and long-term care providers, but for use across industries beyond healthcare, such as business office settings, schools, sports events, and more. Three versions of this innovative test are available to suit different needs: ʯ InteliSwab™ COVID-19 Rapid Test ʯ InteliSwab™ COVID-19 Rapid Test Rx ʯ InteliSwab™ COVID-19 Rapid Test Pro The test has received Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration (FDA) and is available OTC for nonprescription home use with self-collected nasal swabs. Visit www.InteliSwab.com to learn more.

* Per a usability study (see pg. 13) https://inteliswab.com/wp-content/uploads/2021/06/05a-EUA210378_OraSure.OTC_.IFU_.-06-04-2021.pdf **Please refer to the instructions for use for more information.

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MTI

How ADA Compliant Equipment Promotes Patient and Caregiver Safety Nursing has never been a particularly easy profession, even without a pandemic to further complicate matters.

A recent McKinsey survey found that 22% of nurses providing direct patient care indicated they may leave their current position within the next year. Without the proper Americans with Disabilities Act (ADA) compliant equipment, nurses and caregivers face greater threats of on-the-job injury and exhaustion in a time where healthcare workers are already stretched to their limits.

According to Ray Gagne EET, CFE, NADEP, “Nursing is the profession most associated with workrelated musculoskeletal disorders and back injuries. Anywhere from 35 to 80 percent of nurses sustain back injuries during their career from lifting patients, and these injuries are the single largest cause of lost workdays among nurses.”

to purchase new equipment, the nursing staff should be consulted on whether ADA compliant exam or procedure chairs would reduce the likelihood of injuries. For disabled patients, ADA compliance is a bigger issue. Often, individuals with disabilities do not have accessibility to medical and dental diagnostic equipment. In

As healthcare systems prepare to purchase new equipment, the nursing staff should be consulted on whether ADA compliant exam or procedure chairs would reduce the likelihood of injuries. The nursing profession has always had issues with injuries and burnout. There have been numerous reports, in publications like Fit2Work and MMWR, that illustrate that healthcare workers are seven times more likely to experience musculoskeletal disorders than other private sector employees. Patient movement and transfers are the most significant contributor to these injuries. Doctors and dentists don’t experience the same injuries because it isn’t their job to transfer patients. As healthcare systems prepare 48

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these cases, nurses have to physically transfer disabled patients, increasing the likelihood of injury to the patient and the nurse. Most exam chairs and procedure tables do not have a low enough surface to accommodate transfers from a wheelchair, as well as transfer supports or handrails to enable patients to transfer themselves.

Establishing regulations With a reputation for innovation in medical and dental equipment since 1999, MTI was invited in 2010 to

consult the Federal Access Board that wrote the current ADA regulations. Jeff Baker, CEO of MTI, and many other staff members listened to the voices of nurses and disabled patients to understand what needed to be done. With a newfound appreciation for the challenges that caregivers and disabled patients were facing, MTI worked to establish new regulations to improve equipment compliance and ensure that patients are never in a compromising or unsafe position. MTI established regulations for M301 tables in the lying down position, mostly seen in OB/ GYN and general practitioners offices, and M302 chairs in the seated position, most often used in podiatry, dermatology, otolaryngology, ophthalmology, and oral and plastic surgery. MTI also pushed for a lower entry height of 17 to 19 inches to accommodate patients transferring from a chair. Transfer surfaces need to be a certain size and dimension, and the device needs to have a sturdy transfer support rail next to the transfer surface. Indeed, MTI is an industry leader in designing better equipment for healthcare systems, not only for nurses and caregivers, but also for the disabled patients they treat on a daily basis.

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SMART SELLING

Anchors Away By Elizabeth Hilla, HIDA senior vice president Salespeople by nature are optimists.

It’s a helpful personality trait in the business – it can get you through the good times and the bad. Optimists believe that things will work out for the best, regardless of how a situation might look at this moment. As a salesperson, you want to deliver the goods or services to create value for your customers. But what if you can’t deliver those supplies in the way that you want, in the timeframe you want because some things are just out of your control? Take the shipping challenges facing the nation right now. If you’re a “glass half full” kind of person, you may say: “Well, at least there are only 61 ships laden with thousands of boxes of PPE and other critical medical supplies waiting to get into the Port of Los Angeles. Last week there were 70!” But at the end of the day, while there may be some improvement, that’s still a really big problem that isn’t going to be solved overnight. It’s a problem that you’ve got to figure out how to communicate with candor. Throughout discussions during HIDA educational sessions, workgroups, and committees, we hear that one of the biggest solutions to meeting challenges head-on is being transparent. When challenges are afoot, or in our current shipping situation, afloat, your customers deserve to know. One of the key takeaways during a panel discussion of C-suite executives at HIDA’s Streamlining Healthcare Conference was that trusted, highly transparent relationships between trading partners lead to a stronger, 50

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more resilient supply chain. Straight talk forges those bonds. The successful sales reps are trusted partners who give their customers what they want in today’s rapidly changing pandemic environment – absolutely accurate info. If you’re not sure that shipment is going to be there by Friday, don’t say it’s going to be there by Friday. By Elizabeth Today, successful sales reps are those who are candid Hilla, SVP, HIDA about telling a customer that the product they want is on back order and may not be available for a long time. Over the long haul, the customer is going to remain loyal and trust the salesperson who gives it to them straight. And who knows, because you’re an optimist, the product will get here eventually or maybe there’s an alternative to it that’s available now. Maybe your team will just have to use a different port to get the goods where they need to go. And maybe next week there will only be 50 ships sitting off the Port of Los Angeles.

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 Toyota: It’s electric Toyota announced in October that it will invest approximately $3.4 billion in automotive batteries in the United States through 2030. Specifically, the investment is for developing and localizing automotive battery production, including those for battery electric vehicles, and is part of the global total of approx. $13.5 billion set aside for investment in battery development and production announced recently by Toyota Motor Corporation.

in 2025, the project includes an investment of approximately $1.29 billion until 2031, which includes funds that will be used to develop land and build facilities, resulting in the creation of 1,750 new American jobs. “Toyota’s commitment to electrification is about achieving long-term sustainability for the environment, American jobs and consumers,” said Ted Ogawa, chief executive officer, Toyota Motor North America. “This investment will help usher in more

to further develop and expand its local supply chain and production knowledge related to Lithium-ion automotive batteries. The venture will first focus on producing batteries for hybrid electric vehicles. Additionally, the move is expected to help further the company’s goals to create a net positive impact on the planet and society, including advancing its efforts towards carbon neutrality in a sustainable and practical way. Further details of the project, including details on a site, production capacity, business structure, etc. will be shared at a future time.

Something new in a Range Rover

Toyota-Electrified-Lineup-2021.

To drive battery production localization, Toyota Motor North America also announced that it will establish a new company and build an automotive battery plant together with Toyota Tsusho in the U.S. Aiming to start production

affordable electrified vehicles for U.S. consumers, significantly reduce carbon emissions, and importantly, create even more American jobs tied to the future of mobility.” Part of the new company’s activities will include helping Toyota

The first new Range Rover in 10 years comes with an evolved look, and packs a host of innovations, according to Car and Driver. Those start with the model’s first ever three-row version, “which at long last puts it on equal footing with competitors such as the MercedesBenz GLS-class, the BMW X7, the Cadillac Escalade, and the Lincoln Navigator.” The seven-seat Range Rover uses the long-wheelbase body style and is expected to be especially popular in the U.S. market, where, Land Rover tells Car and Driver, one in four existing customers have requested such a vehicle. The 2022 Range Rover SE, Autobiography, and First Edition are available for order now, with deliveries next spring. www.repertoiremag.com

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MARKETING MINUTE

Topics Every Healthcare Sales Training Program Should Include Healthcare sales is far more complex than most other

fields of sales. Due to the additional obstacles involved, it also requires additional training. Unfortunately, 26% of healthcare sales representatives say their training has been insufficient. On average, investing in well-trained and successful sales representatives costs $1,459 per trainee. However, that cost is worth the investment. Healthcare companies that make that investment see their revenue increase by 95%. Most comprehensive sales training programs last ten weeks. To make the most of that money and time, here are some topics you should cover in your healthcare sales training program to maximize your return on investment.

A good sales representative cuts down on touches by maximizing each interaction to answer the buyer’s questions, address their concerns, and solve their pain points. Healthcare sales training programs are different from regular sales training programs because of the unique courses specific to the medical industry. However, sales training programs can lay the groundwork for healthcare sales.

How to Sell 101 The first course to any effective medical sales training program is learning the basics of sales. An excellent foundational sales course will include: ʯ Understanding customers and their needs ʯ Generating and contacting leads ʯ Learning your products ʯ Creating achievable goals ʯ Using tools and apps to simplify the process 52

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These topics teach a sales representative the entire process of making a sale, from finding potential buyers to selling the product. It also teaches finalizing a sale and filing the necessary paperwork. On average, a person interacts or sees a product seven times before buying the item. These are called touches. A good sales representative cuts down on touches by maximizing each interaction to answer the buyer’s questions, address their concerns, and solve their pain points.

Business Basics Sales representatives tend to focus on meeting their quotas. However, businesses-minded sales reps consider their whole company. This more comprehensive view influences their entire sales technique. Business knowledge sets sales leaders apart from regular sales reps. Knowing how businesses function also helps reps solve potential issues. For example, a sales rep may see a dip in customers in terms of lost commission. In contrast, someone with business savvy could identify more significant business problems behind the lower customer numbers. Someone who understands businesses also understands that making a sale isn’t the end goal. If a sales rep focuses on selling a product as the primary target, they will do whatever is necessary to make a deal. However, if you want to build a strong business, your end goal is creating a positive experience and lasting customers through meaningful interactions and strong sales tactics.

Invest in Healthcare Sales Training Programs for Your Reps Healthcare sales is a rewarding field, as you have the chance to be part of saving people’s lives by offering the best supplies and equipment to medical facilities and healthcare providers. However, becoming a leader in healthcare sales will not happen overnight. If you want to succeed in your healthcare sales, take a comprehensive healthcare training course that offers these five topics. To read the full article, visit: 5 Topics Every Healthcare Sales Training Program Should Include - Share Moving Media

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EVENTS

Necessity: The Mother of Innovation COVID-19 proved the point

Along with its challenges, the pandemic has forced providers to get creative in the ways they deliver care.

Smart suppliers have helped them. Speakers at the recent 2021 IMDA/HIRA Conference in Chicago spoke about innovations in processes and products that have emerged from COVID-19. IMDA is the Independent Medical Specialty Dealers Association, and HIRA is the Health Industry Representatives Association.

Speaking about financial management: Todd Nelson, chief partnership executive, Healthcare Financial Management Association Forced to postpone many elective procedures because of the pandemic, hospitals and health systems had to figure out how to provide care to those who needed it while maintaining revenues, said Nelson. Many turned to telehealth, and others explored mergers and acquisitions, repurposing old facilities and reducing their building footprints. Next up? Navigating the risks and rewards of capitation instead of fee-for-service reimbursement. 54

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Because of the pandemic, financial managers tuned in to the fact that supply chain management is far more than the purchase price of products and equipment. It also involves considering the country of origin of critical products, warehousing and distribution, and the potential benefits of buying from reliable local suppliers. When considering the cost-effectiveness of a medical product or piece of equipment, financial managers think in terms of spending time and money appropriately to achieve the best possible outcome in terms of patient health and safety, said Nelson. It’s more about mission than margin.

Speaking about supply chain management: Ian O’Malley, director of strategic sourcing, UChicago Medicine The pandemic forced supply chain professionals to consider the impact of national and global events on their operations, including hurricanes, wildfires, Brexit, trade wars, congestion at U.S. ports and trucker shortages in the U.S., said O’Malley. In fact, COVID actually has led to a more resilient supply chain, including: ʯ Improved demand planning and inventory management techniques. ʯ Development of techniques to safely reprocess critical PPE. ʯ Quickly identifying and qualifying new, unfamiliar suppliers. ʯ Potentially investing in U.S. manufacturers of medical products. ʯ Improved global sourcing capabilities. Suppliers should be proactive in providing customers with the information they need to keep their organizations up and running, including units of measure, pricing agreements, even the size of packaging, said O’Malley. With over 1,200 stocking locations, UChicago Medicine needs to know!

Speaking about value analysis: Gloria Graham, Northeast region director, Association of Healthcare Value Analysis Professionals With COVID-19 came backorders, outages, turn-on-adime conversions, said Graham. Given the preoccupation with PPE, value analysis professionals had little time to evaluate anything else. At the same time, though, the pandemic brought the clinical and value analysis teams closer than ever. And that could bode well for specialty dealers. “We saw a tremendous increase in the visibility of value analysis throughout the organization,” she said. “We were on a good pace before COVID, but now we’re on speed dial with many clinicians. They are recognizing the work we do behind the scenes, and they’re asking, ‘What can we do to help?’” For suppliers: ʯ Technology works! Zoom and Microsoft Teams may present a learning curve to some reps, but reps with new, innovative products should take heart: Value analysis professionals find it easier to get clinicians to participate in a Teams call than to gather them for an in-person product evaluation.

ʯ Don’t wait for your customer to place a PO to let them know about backorders, particularly given the frequency of product outages during the pandemic.

Speaking about ambulatory surgery centers: Chad Giese, associate principal, Sg2 Medical professionals, consumers and health systems have been busy shifting care from inpatient hospitals to outpatient clinics and surgery centers, said Giese. Specialties include orthopedics, gastroenterology and ophthalmology. Today, payers are pressing the issue, refusing to reimburse providers for procedures traditionally performed in high-acuity sites. Medicare has been active in encouraging the shift, though recently, CMS has taken its foot off the pedal and taken on a more measured approach. To stay competitive, hospitals must adapt. Suppliers can help by: ʯ Learning their hospital customers’ strategies for delivering outpatient care. ʯ Determining how they can help their customers build an outpatient program, not just by helping them manage costs (although that’s important), but providing direction on how to grow the program. ʯ Exploring consumer-centric approaches to marketing new technologies.

Speaking about innovation in product development: John Croushorn, M.D., developer of the Abdominal Aortic and Junctional Tourniquet-Stabilized (AAJT-S) Innovation enters the medical market in many ways. In the case of the AAJT-S, it was the frequency with which Dr. Croushorn – while serving in Iraq and Afghanistan – saw soldiers die because traditional tourniquets couldn’t stanch the flow of blood in pelvic injuries or limb dismemberments. The military immediately recognized the value of the device, now it is up to specialty dealers to introduce it to the civilian market, including EMS and the emergency department. A final note about innovation: It isn’t limited to inventors. “I truly believe everyone is an innovator,” Croushorn told conference attendees. People make improvements in the way things are done every day. “When you do, share it with others.” www.repertoiremag.com

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December 2021

EVENTS

Sales: It’s a process Intuition? Indispensable. But without a consistent process to back it up, sales may suffer. Speaking at this fall’s IMDA/HIRA Annual Conference in Chicago, Dawson Cochran, managing partner with global sales training firm ValueSelling Associates, suggested medical specialty dealers and reps implement a three-part process for sales: 1. Research. 2. Questioning. 3. ROI.

Research By failing to conduct proper research before a call, reps have only themselves to offer their customers – their opinions, their products, their perspectives. They can pitch hard, but, as in baseball, people tend to duck when they see a strong pitch coming toward their head, Cochran said. Reps need to take time to research their customers. Search the Internet for clues as to what the customer’s goals are, and how they are performing against them. Public data can shed light on issues they are facing with infection prevention, patient falls or mortality, or operating margins. “If research shows they have a problem that you can help them solve, address it,” she said. If the customer is reluctant to bring it up during the call, probing questions on the rep’s part can help. And if the customer doesn’t have a problem you can help them solve, find another prospect to whom you can bring value, she advised. To drive home the point, she quoted Albert Einstein, who said, “Strive not to be a success, but rather, to be of value.” She offered a training tip to sales managers: At the next sales meeting, give your reps 20 minutes to conduct Internet research on one of their customers. Instruct them to identify the biggest problem they can help that customer solve, and how they would address it with the customer.

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Questioning What salesperson hasn’t been told to listen to the customer before making a pitch? It’s true, the best way to get customers talking is by asking questions – but don’t start with, “What keeps you up at night?” advised Cochran. “It shows you haven’t done your research.” Begin with an open question, based on your research and understanding of the customer’s goals, then use probing questions to learn about difficulties they face in achieving those goals. After the customer shares their thoughts, repeat back what you believe you heard them say. If you got it right, that’s great. “And if you got it wrong, they’ll probably appreciate that you want to get it right,” she said. Above all, reps should speak with their own voice. “Authenticity is

important. The more real you are, the more your customers can trust you.”

ROI When you talk ROI with your customer, you’re talking about value, said Cochran. It’s not just about price (i.e., money spent), but also about the potential impact of your products and services on their revenues. Can your product or service help the customer recruit medical talent or succeed in a value-based purchasing program? Can it help them address financial or quality problems they may be facing? Just as important, can your product or service help your customer achieve a personal goal of theirs? If so, you’ve probably gained a champion in the organization.

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LEADERSHIP

Deepening Relationships Randy Chittum: How Leadership Can Strengthen Relationships with Customers By Pete Mercer

With all the complexities that the healthcare supply chain has faced in the last year, it’s easy to overlook the

impact it had on your relationships with your customers. Sure, it was harder, if not impossible, to meet in person. Regular customers may not have been purchasing as much as they usually would.

Dr. Randy Chittum, Principal of Still Leading, recently spoke at Share Moving Media’s Healthcare Supply Chain and Distribution Summit, leading an interactive group discussion on how supply chain leadership can focus on initiatives that will deepen relationships with customers and provide better service throughout the supply chain. Still Leading specializes in coaching and organizational development for executive leaders, teams, and entire organizations, keeping the goal of mindfulness as a core principle for creating excellence in leadership. Chittum works with executives and managers worldwide in the areas of emotional intelligence, succession planning and leading change. He spent almost a year developing and strengthening a nursing strategy with Prisma. In an attempt to understand how supply chain leadership can deepen relationships with their customers, Chittum led a conversation in three major parts: the present conditions for our healthcare customers, the future conditions of our healthcare customers, and how to lead with empathy. Chittum said, “With complexity, things like ‘best practices’ lose their value.”

What is true now of our healthcare customers? Dr. Chittum started the group discussion focusing on what we know 58

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Dr. Randy Chittum

is true about our healthcare customers to better understand what they are facing right now. It’s critical for supply chain leaders to understand how healthcare is being shaped by the current situation. ʯ Resource scarcity Resource scarcity has been a persistent issue since early 2020. As toilet paper and hand sanitizer started to disappear from stocked shelves, so did medical supplies and PPE materials for healthcare workers. This scarcity is hitting industries across the spectrum, and healthcare is feeling it with a shortage of masks, gloves, gowns, oxygen, beds, and ventilators.

ʯ Labor shortages With work conditions the way

they are, healthcare workers are becoming more difficult to find these days. Because of the challenges that the nurses, doctors, and primary care physicians are facing on a daily basis, it’s becoming harder to staff healthcare systems. Plenty of organizations are offering a higher salary than usual, stretching and breaking the limits of healthcare budgets everywhere.

ʯ Increased fatigue/ lowered morale Part of what leads to labor shortages are an increase in fatigue and a decrease in employee morale. Healthcare workers are more stretched than ever before, leading to burnout and a drop in morale. “Healthcare workers are a significant risk of physical and mental health challenges,” Chittum said. “Due to the nature of their job, nurses are at an even greater risk than doctors.”

ʯ Where do we go next? There’s plenty of talk about “agility,” “pivoting,” and “flexibility,” but how do we pivot in a time like this? And to what do we pivot to? Chittum said,

“Leaders are ill prepared for the world that we are living in.” There’s no amount of training that will prepare anyone to make the decisions that leaders are having to make right now.

What will be true three years from now? As important as it is to understand what’s happening now, it’s also critical to forecast what the future might look like. Getting a better understanding of what the future could bring will help suppliers and healthcare systems to prepare for a better and more efficient future. Chittum said, “Trust, convenience, and visibility will be service outputs from the seller to the buyer.” ʯ Fewer healthcare workers What will happen to all the future nursing students when they can see the state of healthcare right now? It’s not exactly an inviting profession, even with a higher paycheck. Going forward, we will likely see fewer healthcare workers.

ʯ Consolidation will continue As the supply chain becomes gradually more stressed, consolidation will force the smaller players out to give room for the bigger companies. While those who support consolidation cite benefits like better quality of care and improved clinical integration, but it can also lead to higher costs and an increase in organizational complexity.

ʯ Government may have a bigger hand With the current state of the United States supply chain, it would not be surprising to

see the government become more involved in the process. Whether it’s imposing more regulations regarding the stockpile or developing strategies for a more resilient supply chain, the government will likely step in to prevent another massive disruption.

ʯ More production in United States Perhaps the most positive future outcome is that we could see more production move to the United States. While it’s certainly cheaper to build manufacturing plants in a different part of the world, it would ensure more stability for domestic healthcare systems.

tactic as well. An empathetic leader will gain the trust of their employees, helping to increase productivity, efficiency, and improve employee morale. A lot of your employees are seeing firsthand the struggles that their clients are facing, which is not an easy thing to watch. They have worked to build relationships with healthcare workers and may not see any hope for the future of the healthcare supply chain. As the leader, it’s your responsibility to address those concerns and help to find an achievable solution. Chittum said, “The job of leadership is to confront the current reality and still inspire hope.” Using an empathetic approach will also help sales reps connect oneon-one to their customers. Chittum said, “It’s not the job of the sales rep

Part of what leads to labor shortages are an increase in fatigue and a decrease in employee morale. Healthcare workers are more stretched than ever before, leading to burnout and a drop in morale. Leading with empathy One of the most critical things that leadership in any industry can do right now is to lead with empathy. Empathy is the key to unlocking someone else’s experience, getting a better understanding of what they are experiencing and how they are experiencing it. This is a vital tool for business leaders, as it gives you a window into the lives of your customer base. For healthcare systems, empathy will help you understand their frustration and desperation right now. Empathetic leadership isn’t just a great tool for your customers, but it’s also a highly effective management

to fix the problems of the healthcare worker, but you need to be aware of what they are facing.” Even if they can’t fix the overall problems facing healthcare workers, they can work to better understand how they can help to meet the needs of their clients. More than ever, it’s up to leadership to pave the way forward for the healthcare supply chain. The next generations of supply chain leaders are depending on us to make the right decisions for the industry, which will greatly impact the future of the healthcare supply chain. Empathy will allow you to connect with your customers and encourage your employees. www.repertoiremag.com

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December 2021

HEALTHY REPS

Health news and notes Amazon to roll out Alexa for use in healthcare systems, senior living communities Amazon announced two new solutions for senior living and healthcare providers to integrate Alexa into their properties. Part of Alexa Smart Properties, the solutions were designed specifically for the needs of senior living communities and healthcare facilities.

Several large health systems including Boston Children’s Hospital (Boston, MA), Cedars-Sinai (Los Angeles, CA), BayCare (Tampa, FL), and Houston Methodist (Houston, TX) will deploy the new Alexa capability to select properties, according to the news release. Hospitals can provide information customized to their facility, like notifications about schedule changes or cafeteria menus, and skill experiences like games, podcasts, and more. Hospitals and senior living communities can also build and enable HIPAA-eligible skills, like medication tracking, to connect care 60

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providers with residents and patients in an environment designed to protect their health information. The company says that Alexa Smart Properties simplifies deploying and managing Alexa-enabled devices at scale, in order to help properties “offer customized Alexa experiences for residents and patients, and increase care team productivity and operational efficiency.”

Through the Amazon Echo device in patient rooms, administrators can offer access to tens of thousands of Alexa skills, and tailor resident experiences by customizing community information like activity schedules and meal menus. Care team members can communicate with residents using Alexa communication features, which enable them to make announcements, voice and video calls, or send direct audio messages to other Alexa-enabled devices throughout the property. The company says that no personal information is shared with Alexa to use the device, and voice

recordings are not saved. And that Amazon implements administrative, technical, and physical safeguards for protected health information received as part of HIPAA-eligible skill interactions. Alexa Smart Properties will support senior living and healthcare solutions in the U.S. starting in November.

Some workers want COVID-19 recovery accepted as evidence of immunity Some workers opposed to vaccine mandates on the job are pointing to the same reason for their objection: They already had COVID-19. The Labor Department on Sept. 9 recommended that private companies mandate vaccines for all employees or require them to submit to regular COVID-19 tests. Tens of thousands of U.S. workers across industries from healthcare to education to airlines and the military face dismissal if they fail to get vaccinated in coming months. However, some employees are asking that immunity from prior COVID-19 infection be recognized alongside vaccination as sufficient protection against the virus, the Wall Street Journal reports. Attorneys general of 24 states wrote in a letter to President Biden that more than 120 million Americans previously infected with COVID-19 had a degree of immunity that the attorneys general say should excuse those people from vaccine mandates. Research comparing immune responses in people who have recovered from COVID-19 to those who have been vaccinated has been mixed.

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Built to protect While babies are building up their immune systems to the world around them, Health o meter®’s pediatric scale takes extra measures to protect them and the user from harmful bacteria. The tray, body, handles, and keypad are antimicrobial, meaning that the scale is built to disrupt and prevent the growth of microorganisms. The removable tray has an innovative, patent-pending mounting system that eliminates breakage and makes it easier to remove, clean, and reinstall. Complete with a built-in measuring tape that allows users to measure weight and height simultaneously, the 2210KL-AM neonatal scale is designed for easy operation. Additionally, this scale is built with motionsensing technology to compensate for babies’ small movements. This feature allows for fast

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December 2021

NEW PRODUCT OF 2021

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Metrex CaviWipes 2.0 Metrex’s CaviWipes 2.0, with its new generation of active ingredients, elevates the tried-and-true original CaviWipes to next-level cleaning and disinfection. CaviWipes 2.0, a one-step, broad-spectrum disinfectant wipe, helps reduce the risk of cross-contamination in healthcare facilities quickly and efficiently – all while addressing common challenges of material compatibility. Built off the chemistry of the legacy product, CaviWipes, CaviWipes 2.0 is effective against 42 pathogens, including commonly found multi-drug resistant organisms, as well as: ʯ SARS-CoV-2 ʯ Norovirus ʯ Candida Auris ʯ Mycobacterium bovis (TB) ʯ Methicillin-Resistant Staphylococcus aureus (MRSA) ʯ Human Immunodeficiency Virus Type 1 (HIV-1)

One-Step Cleaning CaviWipes 2.0 creates synergy between a quaternary ammonium compound with low alcohol to achieve highly effective surface disinfection while maintaining material integrity and resulting in a one-step infection-prevention solution. This powerful combination means that the CaviWipes 2.0 is effective against pathogens in the presence of a 5% blood soil condition, eliminating the need for a pre-cleaning1 step (when soil is not visible), which would require an additional wipe.

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NEWS

Healthcare Supply Backlogs – A Timeline By Alan Cherry At the outset of the pandemic, the

sudden spike in demand caused massive shortages for personal protective equipment such as masks, gowns, and gloves. Manufacturers were able to ramp up supply and alleviate those shortages in most places by the end of the year. In early 2021, providers began encountering shortages for needles, as a large portion of the general supply was needed for impending vaccine distribution. Earlier this spring, a steep downward trend in COVID cases worldwide had many starting to grow concerned about the bullwhip effect created by the lag between demand and fulfillment. Then, a second wave of COVID spurred by the Delta variant added more fuel to the fire of shortages in supply chain industries around the world. By summer of this year, the distribution section of supply chain became the emergent problem. Cargo

Global demand skyrockets for PPE and other supplies related to the treatment of COVID-19

2020

September In mid-September, the port of Long Beach, California moved to 24/7 operations in order to clear the growing shipping logjam. By the end of the month, medical supply shortages began to crop up all over the country for a host of critical items needed at medical facilities – from exam tables and heart defibrillators to crutches and IV poles, and more. Unlike earlier in the pandemic, the new shortages were generally for supplies that had nothing to do with treating COVID.

Top Glove – the world’s largest latex glove maker – is barred by the U.S. over allegations about the company’s unethical labor practices. The ban was lifted the next month.

2021

July

Massive increases Early 2021 in remote-working Needle shortages drive up demand for manifest, as a large computer chips and portion of the general quickly exhaust the supply was needed for available supply global vaccination efforts

Meanwhile, shortages of raw materials, including plastics, metals, glass, and electronics, hampered production for manufacturers. In the case of exam tables, tight supplies of electronic controllers, metal, and even the foam padding used to build them were hampering producers’ ability to meet product demand. Estimated wait times for some products grew from 3-6 weeks to 5-6 months. Even wait times for critical items like heart defibrillators – which had formerly taken only two weeks to deliver – jumped up to as long as three months or more.

began stacking up in ports as a dearth of truck drivers, among other factors, meant that containers could not be moved away from ports and taken to their final destination quickly enough. This led to a huge backlog of ships waiting for days or weeks in order to offload cargo.

October From the beginning, the global supply crunch for computer chips – fueled by soaring demand for electronics amid the increase in remote working – had disrupted car production and pushed up the prices of laptops and printers.

Shortages breakout across the country for a wide range of products and devices used in healthcare – from toilet seats to hospital beds to defibrillators and more. Most of those shortages are for supplies that have nothing to do with treating COVID-19.

Glove-maker Supermax Corp is banned by the U.S., likely leading to near-term shortages of gloves

Shortages of raw materials, including plastics, metals, glass, and electronics, hamper production for manufacturers

Shipping logjams reach ports on the East Coast

Mid September The Port of Long Beach, California moves to 24/7 operations in order to clear the growing shipping logjam.

Late September

Early October

Mid October

Computer chip and semiconductor shortages continue to increase, putting providers on high alert for lengthy delays for imaging equipment, among other critical electronics.

Providers begin asking local communities for donations of crutches and other gently used medical supplies amid a growing aluminum shortage

Late October

November

Port backlogs continue to increase Trucking industry announces huge need for drivers, and new policies at ports

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December 2021

NEWS Hospital supply chain teams had been on “high alert” for shortages of thousands of items containing semiconductors for six months. By October, medical device makers were also feeling the crunch. In a Deloitte survey of medical technology companies, every single respondent reported supply issues. Hospitals were also experiencing long order delays because of the semiconductor shortage for new CT scanners, defibrillators, ultrasound machines, and telemetry monitors. PPE shortages had become less dire thanks to manufacturers ramping up supply. However, in late October, the U.S. federal government banned

glove imports from one of the largest suppliers, Malaysian glove maker Supermax Corp, over alleged forced labor practices at the company. Supermax’s bigger Malaysian rival, Top Glove – the world’s largest latex glove maker – had been barred in July by the U.S. over similar allegations. That ban was lifted in September after the company resolved the labor issues. As retailers began importing stock for the holiday crunch, ports on both coasts became even more congested. The backup caused the Ports of Los Angeles, the second busiest port in the U.S., to also move to 24/7 operations to help ease the ongoing supply chain logjams.

Even with both ports operating around the clock, tens of thousands of containers were stuck floating in limbo. Dozens of ships were lined up waiting to offload, with waiting times stretching to three weeks. By the beginning of November, a growing shortage of aluminum had providers around the country asking their local communities to donate crutches and other “gently medical supplies.” The aluminum shortage could become a much bigger problem in the near future, since the end of the year is typically the busiest time for orthopedic surgeries as people squeeze in the surgeries prior the end of the year.

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REP Dec 21

Articles inside

A Timeline

Health news and notes

and into the future

IMCO celebrates 40 years at its 2021 Annual Conference and Trade Show

and treatment modalities

Should Include

Automotive-related news

Anchors Away

with Customers

COVID-19 proved the point