REP-Feb.25

Healthy Hearts

A forecast of cardiovascular health 30 years from now did not paint a rosy picture. What can healthcare stakeholders do to create a better future for patients?

Healthy Hearts

A Message for the Industry

The holidays are behind us, and the fresh energy of a new year is here. January, with its challenges and opportunities, sets the tone for the months ahead. For medical distribution reps like you, the first month of the year can feel like a balancing act between shaking off the holiday lull and building momentum toward hitting your annual budget. But as we enter February, it’s time to shift gears and focus on keeping the pace strong as we work toward Q1 goals.

February is Heart Health Month, an important reminder of the vital role you play in supporting clinicians and their patients. Heart disease remains the leading cause of death in the United States, which makes your work essential. From ensuring cardiology clinics have the EKG machines and diagnostic tools they need, to providing the proper medications and exercise equipment for patient care plans, your contributions directly impact lives. Your ability to equip healthcare providers helps them deliver life-saving care for their patients – and that’s a responsibility we should all take pride in.

February is the month I get my annual physical, so as you help others prioritize their heart health, don’t forget your own. The demands of this job can be stressful, especially in the first quarter when so much is at stake. Take the time to care for your physical and mental well-being. Schedule that check-up, make time for regular exercise, and don’t underestimate the power of a balanced diet and a good night’s sleep. After all, a healthy and energized rep is a successful one.

The same principles apply to the accounts you serve. Whether you’re working with a small physician’s office or a large health system, ensure they’re fully prepared to meet their patients’ needs. From stocking essential cardiology supplies to providing educational resources about preventative care, your expertise makes all the difference. When you proactively address these needs, you set your accounts – and yourself – up for success.

Take a moment to reflect on your Q1 progress. Are you connecting with your accounts regularly? Are you identifying opportunities to help them grow? Are you taking advantage of all the tools we provide you here at Repertoire, from 2-minute drills to RepConnect. If adjustments are needed, now is the time to act. With a clear plan and focused effort, you can not only meet your goals but exceed them.

Let’s make February a month of momentum, health, and achievement. Together, we’ll finish Q1 strong and set the foundation for an exceptional year ahead. Stay focused, stay healthy, and let’s keep rolling toward success!

Dedicated to the Industry,

R. Scott Adams Publisher

editorial staff

editor Graham Garrison ggarrison@sharemovingmedia.com

editor-in-chief, Dail-eNews Jenna Hughes jhughes@sharemovingmedia.com

content creator Pete Mercer pmercer@sharemovingmedia.com

art director Brent Cashman bcashman@sharemovingmedia.com

circulation Laura Gantert lgantert@sharemovingmedia.com

sales executive Aili Casey acasey@sharemovingmedia.com (404) 625-9156

publisher Scott Adams sadams@sharemovingmedia.com (800) 536.5312 x5256

founder Brian Taylor btaylor@sharemovingmedia.com

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

Repertoire is published monthly by Share Moving Media 350 Town Center Ave, Ste 201 Suwanee, GA 30024-6914 Phone: (800) 536-5312, FAX: (770) 709-5432; e-mail: info@sharemovingmedia.com; www.sharemovingmedia.com

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PAMA: Dead End?

Where we are, how we got here and what’s next.

 PAMA has been around for 10 years now, but due to the many twists and turns since its initial implementation in 2018, I am providing Repertoire readers with an update. For some of you, it will be eye opening. For others, it represents a concise summarization of the bill and its impact on us and our customers. However, this year, I have some new insights and recommended actions to offer that I believe are in our customers’ best interests, irrespective of what eventually happens with PAMA.

By Jim Poggi, Principal, Tested Insights

PAMA, the Protecting Access to Medicare Act, originally became a law in 2014 and was initially implemented in 2018, with the intention of aligning the higher costs of lab tests being reimbursed under the Clinical Laboratory Fee Schedule (CLFS) for Medicare payments with the lower costs paid by private insurance companies.

As many of you may remember, the Office of the Inspector General published a report pointing out the gap in reimbursement between the CLFS and private insurance and recommending cuts to the CLFS over a six-year period, with 10% mandated for each of the first three years, and 15% in the next three years until such time as CLFS fee schedule payments were aligned with private insurance payments. The OIG claimed the gap between these payment schedules would amount to a saving of $2.5 billion over a 10-year period. However, in just the first year of cuts an impact of up to $370 million was estimated. Cumulative cuts over the first three years in CLFS are estimated at $4 billion by the American Clinical Laboratory Association (ACLA).

The magnitude of these cuts, and concerns about access to lab services (in rural areas in particular) if smaller labs went out of business or were acquired by the largest labs were voiced widely by the laboratory community. Additionally, the observation was made that while private payer data was supposed to be collected using a representative sample of labs being reimbursed by both Medicare and private insurance, the fact that the largest labs were grossly over-represented was widely acknowledged within the lab community. While the largest labs reporting data in

2018 performed fewer than 50% of all U.S. lab tests, their data represented 90% of the information used to determine the size of the gap between private pay and CMS under the CLFS.

For all these reasons, PAMA has been a cause of concern across the lab business with advocacy groups including the National Independent Laboratory Association (NILA) and the Association for Diagnostics and Laboratory Medicine (formerly AACC) issuing legislative appeals

legislative actions. First there was the Laboratory Access for Beneficiaries (LAB) Act during the COVID pandemic, passed in 2019. Then came Protecting Medicare and American Farmers from Sequester Cuts in 2021. As we enter 2025, once again PAMA fee cuts to the Clinical Lab Fee Schedule have been postponed by an extension of the Continuing Appropriations and extensions Act, 2025 which was also responsible for the delay in PAMA cuts in 2024. The Saving Access

You and your key lab manufacturers have an obligation to perform periodic audits of your customers’ current laboratories and offer your recommendations to management. Additionally, we need to remind our current customers and position the value of lab to prospective customers across ALL the three pillars of value for our lab products and services.

for postponement of PAMA due to the significant cuts in its initial implementation as well as the observation that data collected to show the differences between CLFS and private payers was highly skewed to the largest private labs and did not represent a true cross section of labs reimbursed under Medicare for lab tests. Ultimately, the Centers for Medicare and Medicaid Services (CMS) agreed to change the definition of reporting labs to create a more equitable representation of the marketplace. Most lab advocacy groups still believe the balance remains too skewed toward the largest labs.

Since 2020, PAMA has been put on hold by three successive

to Lab Services (SALSA) Act has been around 2022 and has been locked in committee since 2023. It provides needed changes in how lab reimbursement data is collected, which labs will collect it and the timing and extent of cuts to the CLFS. It addresses many of the shortcomings of the current PAMA legislation and is endorsed by virtually every lab advocacy organization. Unfortunately, both the 117th and 118th Congresses have failed to pass this bipartisan bill and have used work around solutions placing holds on PAMA rate cuts into broader legislation. Its future is unclear.

So, is there a stop, yield or dead-end sign ahead for PAMA?

Should we care? In this column, I am going to suggest a practical approach to protecting our current lab customers, assuring our new customers start off on the right foot, and assuring our reputation as lab consultants provides significant benefits to our lab customers.

Keep the big picture in view

What does this mean and how can we, as valued consultants to our lab customers, use this approach wisely? You and your key lab manufacturers have an obligation to perform periodic audits of your customers’ current laboratories and offer your recommendations to management. Additionally, we need to remind our current customers and position the value of lab to prospective customers across ALL the three pillars of value for our lab products and services.

Controlling future risk means being highly involved with each of your customers’ labs and their needs. Remember that “quality provides sustainability,” and act accordingly in your interactions with your customers and prospects.

Specific threats to be watchful of include:

Internally

` Poor performance against any of the three elements of value described below.

` Lack of enthusiasm, inspection issues, staff turnover, focus on revenue.

` Leases coming up for renewal without a solid business review to reinforce the three elements of value and clear direction on the right assays and right instrument platform.

Externally

` Likely to come from private insurance.

` I will be conducting research to verify this supposition and will report back later this year.

` Negative feedback from your customers’ peers about their lab solution

` Changes in your customer’s payer mix

Clinical value

Clinical value remains the greatest single reason to perform lab tests in any setting, but most particularly in the physician office and point of care. The most appropriate reason to perform any lab test is to provide data “to initiate or modify a patient treatment program.” This has been the defining reason I have proposed for lab testing at the point of care for a number of years and still assures that the clinician’s encounter with the patient is most productive. Whether the clinician is trying to establish an initial diagnosis, engaging in general or risk-based screening or follow up for a chronic condition, lab testing, in combination with vital signs monitoring, provides the most actionable data to base a diagnosis. The conventional wisdom is that 7 out of 10 medical decisions are based at least in part on laboratory data. Most clinicians would agree. Make sure you lead with the clinical story and develop your clinical value story along with your trusted lab manufacturer. Always seek agreement from your customer or prospect as you develop this narrative and ask questions about how they manage the leading causes of morbidity and mortality. Chances are, they will remind you of how often they rely on lipid tests, tumor

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markers, CBC, hemoglobin A1C, and organ panels. Taking the clinical high road and focusing on the leading causes of morbidity and mortality will set you apart as a thoughtful consultant who understands the daily challenges our customers face.

Workflow value

From the initial patient encounter to the request for lab tests, to performing them, counseling the patient and reporting results into EMR, the shortest time frame with the most direct path to having the data available wins every time. Delays in diagnosis prolong the road to treatment and risk the patient not returning for proper counseling and medication and lifestyle direction. In addition to the general workflow, assuring the most needed tests are available during the patient’s encounter, you need to take on the tough issues.

needed tests and being performed in the most economical fashion? If any of these answers is “no” your business is vulnerable from either customer dissatisfaction or your competition providing a more well-tailored solution. You need to take this element of value head on and be very objective in providing your recommendations. Is it uncomfortable providing a recommendation that differs from the previous one? Of course, but it is better to be open and objective than to learn your lack of transparency has led your customer to look elsewhere for solutions.

Economic value

PAMA certainly adds challenges here, even with reductions in CLFS rates postponed yet again. But, is PAMA the biggest economic risk? Probably not. Private insurance has led the way

Properly positioned, you should be viewed as proposing insightful data rather than being intrusive.

Is the lab well organized and run to be CLIA compliant? Are the lab personnel confident and competent? Are the right tests being done on the right instrument platform? Each lab solution must be customized to the customer’s needs, and you need to work collaboratively with the lab manufacturers providing your customers’ solutions to research, discover and recommend ANY needed changes. Do lab personnel need additional training? Are there obvious CLIA compliance challenges? Are the testing platforms compatible with the most urgently

to reductions in reimbursement for lab tests. Do you know the proportion of your customers’ patients covered on Medicare, Medicaid and private insurance? You should. We are not here to propose lab as an economic panacea, but knowing which insurance plans they offer can help you guide your customers to internal discussions about which tests to offer, and this discussion will have a direct impact on your guidance in which lab platforms make the most sense.

In addition to payer mix, staffing issues lead to more labs

closing than any other preventable reason I know of. Poorly trained or unhappy staff can lead to CLIA issues and proficiency testing failures. Dissatisfaction can also lead to turn over, which compromises test availability and costs time, and money as new staff are recruited and trained. Turnover also ultimately challenges the practice to reevaluate their need for a lab every time it comes up. Loss of a lab director or key technical resources could spell the end of lab testing at even your best, most loyal customers.

Make sure you help your customers’ management know your insight into overall lab performance, recommendations for improvement and any specific recommendations you and your leading lab manufacturers can offer. Properly positioned, you should be viewed as proposing insightful data rather than being intrusive. A respectful tone along with objective findings and recommendations by you and your lab manufacturer are in the best interests of all involved and should always be positioned as in the best interests of the practice and their patients.

In summary, is PAMA really the root issue and reason a lab may reduce or eliminate testing? Not by a long shot, but it is one of the issues that you, as a thoughtful and respected lab consultant, need to integrate into your overall lab solutions and customer counseling.

Know your customers’ needs, stay focused on the big picture, work closely with your key lab manufacturers and you will reap the rewards. Quality provides sustainability. Your consulting quality will create sustainability in your customers’ labs and patient care plans.

Right People, Right Roles

Transparency and empowerment are key to leading a high-performing sales team, says Owens & Minor’s Dean Huibregtse.

 Dean Huibregtse joined Owens & Minor in 2009, but his experience in driving commercial strategy for companies that support healthcare goes back more than 25 years. “My philosophy as a commercial leader is to listen to our customers’ needs first and foremost,” he said. “And to support that I start by ensuring we have the right people in the field, that they’re empowered to serve the customer, and that they’re aware that behind everything we do is a patient or caregiver depending on us to get them the supplies they need.”

Owens & Minor has worked diligently to get even closer to customers in part by more than doubling the organization’s number of sales regions in 2024 so they can better serve and connect with customers. “I’ve also been deeply involved in supporting our expanded investment and launching of key products that offer both choice and value, for example our new advanced wound care products and a full incontinence care line,” he said.

Huibregtse sees his role as twofold: developing and executing a strategy with key customers and industry input that ensures Owens & Minor’s products and services meet the evolving needs of the healthcare industry, and working closely with the operations, marketing and product management teams to align offerings and services with market demands to deliver customer value.

Open lines of communication

Enhancing customer focus and satisfaction starts with understanding each customer’s unique needs and challenges, Huibregtse said. “I believe in maintaining open lines of communication and regularly seeking feedback to ensure we are meeting customers’ expectations.”

As an organization, Owens & Minor is constantly investing in training and development for its sales and customer service teams. Continuous improvement through training is crucial, so teammates can provide knowledgeable and personalized service for customers.

Dean Huibregtse

Better Health Better Future

“We’re also focused on further leveraging data analytics to help us anticipate what our customers need, so that we can be even more proactive in helping to drive operational efficiencies,” Huibregtse said. “Our ultimate goal is always to identify ways that we can make the business of the healthcare supply chain easier for our customers, so they can focus on the humanity at the heart of care – the patient. For Owens & Minor teammates, that’s really what motivates us.”

learning (ML), to more fully optimize supply chain efficiency,” he continued. “Owens & Minor has found that it takes a combination of technology and human touch to achieve true optimization, and we’re excited about our current portfolio of technology solutions as well as the roadmap for future innovations that will help drive further efficiencies.

Lastly, there’s been a lot of discussion around the potential effect of tariffs on various medical supplies. It’s an issue

Another important leadership tenant is empowerment. Huibregtse strives to give his team the tools and autonomy they need to excel and make good decisions, while knowing that Huibregtse is there to support them as needed.

One major trend across the healthcare distribution landscape is the focus on supply resiliency. This is an area where Owens & Minor has been very thoughtful in terms of leveraging the strength of its product manufacturing capability, and strategically combining it with its vast network of suppliers to drive flexibility and resiliency across the supply chain, Huibregtse said. “In 2025, we’ll continue working collaboratively to solve the ever-changing gaps in product availability that consistently present challenges for every distributor in the industry.

“Another trend that we’re seeing evolve across the industry is the integration of advanced technology, such as artificial intelligence (AI) and machine

that Huibregtse said the entire industry will have to address. The tariffs that were enacted earlier this year will have a twoyear impact and will force the industry to focus on strategies to address this unbudgeted expense increase.

From the heart

Huibregtse believes he has the team and resources needed to meet those industry challenges head on. As a leader, Huibregtse focuses on transparency when engaging with his team. “I believe in being open and honest with my team, which fosters trust and collaboration.”

Another important leadership tenant is empowerment. Huibregtse strives to give his

team the tools and autonomy they need to excel and make good decisions, while knowing that Huibregtse is there to support them as needed.

“Lastly, I firmly believe that the path to best-in-class customer service is to put the highest performing teammates on the field,” he said. “If you get the right people in the right roles – on both sides of the table –that’s when the magic happens and the partnership is set up to help deliver amazing outcomes.”

Huibregtse learned a lot about leadership throughout his career and from many different individuals, but it was his son Bennett who taught him the heart lessons that he carries with him in both his personal and professional life. “Bennett struggled with significant health challenges throughout his life, but his strength and perseverance showed me the importance of meeting challenges head on, and the value in knowing that no matter the circumstance, with the right amount of focus and determination, anything is possible.”

Looking into the future, Huibregtse’s vision for the future of the Owens & Minor commercial team is to continue driving customer focus and operational execution that delivers value through their expanded products and services offerings. “Additionally, I envision a more personalized approach to our healthcare distribution, where we can tailor our solutions to meet the specific needs of each customer, ultimately improving patient care and outcomes,” he said. “The more we engage, evaluate and execute, the more we will drive change, together.”

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Forging Leaders of Iron Integrity

The not-so-secret ingredient needed for effective leadership.

By Pete Mercer

 The quality of leadership in organizations across all economic sectors is in a state of crisis. Effective leadership is a necessity for running a company, but it is not easy to find a candidate who can handle all the responsibilities that come with a leadership position. There are certain qualities that leaders need in order to be effective in their roles, whether they are operating as a business leader or a political one.

According to former navy admiral and author Mike Studeman, one of the most important qualities is integrity. People of integrity are honest (especially when it’s easier not to be) and abide by a strict moral code –essential for leadership positions.

In a recent interview with Repertoire Magazine, Studeman discussed his military career, the value of integrity, and the qualities of strong leadership. “Might of the Chain: Forging Leaders of Iron Integrity” covers almost four dozen leadership traits and why they are essential qualities for great leaders.

What leadership should look like

Studeman served his country for 35 years and retired as a two-star navy admiral in 2023. During his time in the navy, he served as a commander of the Office of Naval Intelligence, a theater intelligence commander for the entire Indo-Pacific command (about half the Earth), and the theater intelligence director for all of Latin America and Central America.

After retiring, Studeman began working as a national security fellow for MITRE, a federally funded research and development center that “helps government connect with private industry, think tanks, and academia trying to solve issues in defense, cybersecurity, healthcare and other areas.”

His book, “Might of the Chain: Forging Leaders of Iron Integrity ”, dives deep into what great leadership looks like and how the overall trust of leadership in the public and private sectors has sunk to a devastating all-time low.

He said, “I looked around and I saw so many examples of poor leadership in the country, and I could not keep my peace. We do leadership the right way in the military – if you’re not a good leader, you’re not going to get promoted and you’re not going to be given more responsibility. It’s a basic thing, like 101. And then you look around the United States and you see political leaders who are violating basic tenets of leadership.”

While conducting research for his book, Studeman found a number troubling statistics, including:

` Four out of five people think we have a leadership crisis in both political and corporate sides of America.

` Four of five people do not have trust in their leaders, regardless of organization.

` Two-thirds of people don’t see anyone they aspire to be in their organization.

` One-third of people don’t trust mass media.

His hope for this book is that readers will have a better understanding of what leadership should look like and inspire them to be more astute and discerning about who they want to represent them in their government and organizations.

Forging iron integrity

This idea of “forging leaders of iron integrity” is integral to Studeman’s philosophy on leadership. He based that phrase on the fact that we are all meant to be doing a lot of “self-forging” of ourselves, submitting ourselves to environments where a lot of sculpting will need to be done. Most people operate and learn the best while under pressure – “forging iron integrity” requires a mindset of continuous, never-ending improvement.

That integrity component is what separates strong, effective leaders from the rest of the pack. But what does integrity really mean? Studeman said, “Integrity

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has a lot of different meanings – one of them is to be honest, one is to have a moral underpinning. You operate from a moral base. Another definition, which is critical, is that integrity is about uniting, not dividing.”

Studeman argues that integrity allows strong leaders to pursue unity in a world that’s so divided on every little thing. It’s one of the moral pillars of leadership, “fundamentally related back to the golden rule of how you treat people.”

While most of us understand what integrity is, the real question is whether everyone is capable of living with integrity. With the amount of people in positions of leadership who are seemingly lacking in integrity and character, there’s certainly some sort of catch, right?

leadership can be boiled down to four distinct qualities:

` Character – Character is such an important trait that it should be at play in the beginning, middle, and end of your leadership journey. “If your character is right, nothing else matters,” Studeman

While most of us understand what integrity is, the real question is whether everyone is capable of living with integrity.

“I think it can be born and bred,” Studeman argued. “Everyone can have high integrity. It’s both something you might have in your genetic makeup and your upbringing, but it’s also something where you can hone it in a way that makes it better every day.”

Qualities of effective leadership

What qualities do you look for in leadership? This might look a little different for everyone, but there are certain qualities that distinguish leaders from everyone else. For Studeman, effective

said. “If your character is wrong, nothing else matters. Character is the genesis point of every way that you’re going to behave, and it is how people are going to attach themselves with you because they can trust you.”

` Authenticity – Authenticity is almost impossible to fake, and many people can spot inauthenticity from a mile away. “You don’t disown yourself to be someone else. You borrow devices, approaches, and techniques that you have seen other great leaders use, but you have to make it your own. This

is a true sign of someone who knows exactly who they are deep in their bones.”

` Self-discipline – Self-discipline is an essential ingredient for leadership; without it, it will be difficult to accomplish anything. “The best leaders are ones who remain voracious learners throughout their entire lives – they never settle or think that they’ve got anything perfected. They continue to listen to other people; they continue to open themselves up to evolve with the times and the circumstances they face.”

` Civility – There are few things simpler than just being kind to the people around you. Civility is a lost art, making it all the more necessary as a quality of leadership. “Just being fundamentally decent, kind, and respectful of other people is a basic thing. The idea that you have some common, basic frameworks for how human interactions occur is going to win you a certain amount of morale that will generate a willingness for people to really throw in and give their all to something.”

Integrity is an important quality for leadership, but it’s also bigger than that. Integrity is an essential quality for everyone –holding society to a higher standard might the best way to help bridge all of the division that we see today. Studeman said, “When people are not held accountable for their behavior and their actions and allowed to get away with what they are doing, then it normalizes poor behavior and begins to be a major form of erosion of all those things that we know to be right and true and good.”

Mike Studeman

New Fast Pass Law a Victory for the Medical Supply Chain

By Wyeth Ruthven, Director of Congressional and Public Relations, Health Industry Distributors Association.

 We did it. Fast Pass is now the law of the land. Just before the end of last year, Congress approved and President Biden signed into law the National Defense Authorization Act.

This is a bipartisan victory for the medical supply chain, and a testament to the hard work that HIDA members have dedicated the last three years to convincing our elected officials of the need to expedite critical medical cargo.

Why we need Fast Pass

Transportation is a healthcare issue. During the pandemic and the subsequent supply chain delays, healthcare distributors worked closely with ports and shippers to get critical medical products to patients and providers. But patients and providers still suffered from delays. A HIDA study of the medical supply chain found that during the West Coast port backlog of 2021-22, approximately 31,00046,000 containers of critical medical supplies were delayed an average of 29 days throughout the transportation system.

How Fast Pass got enacted

For three years, HIDA has advocated for legislation that would help to expedite the flow of critical medical cargo through American ports. Fast Pass was initially introduced by Representatives Mike Ezell (R-MS) and John Garamendi (D-CA) as H.R. 6140, the Facilitate Access to Swiftly Transport Goods during a Publicly Announced State of Emergency Situation (FAST PASS) Act. It was unanimously approved by voice vote in the House Transportation and Infrastructure Committee in March 2024, and then added as a bipartisan amendment to the House NDAA bill in June.

How the medical supply chain got it done

HIDA members were our strongest and best advocates for Fast Pass. Members of our Shipping & Logistics Working Group provided persuasive evidence of cargo delays and the impact they had on patients and providers. Key members of the HIDA Board of Directors met at critical moments with key staff on committees of jurisdiction. And dozens of HIDA members have had hundreds of meetings with Congressional staffers at HIDA Washington fly-ins for three consecutive years.

What the new law does

By Wyeth Ruthven, Director of Congressional and Public Relations, HIDA

The GAO study will cover the transportation of PPE through vessels and ports onto trucks or rail, and the role played by the Department of Transportation and other relevant federal agencies to expedite the transportation of PPE. The study will look at ways to improve the coordination among relevant federal agencies to expedite the transportation of PPE, and the impact (if any) that this might have on the transportation of other goods. The GAO study must be conducted within one year of enactment, and report back to Congress by the end of 2026.

What comes next?

It is now the job of everyone in the medical supply chain to help the GAO research their report, by telling the story of how we overcame multiple transportation obstacles to better serve our customers. We are eager to share best practices with the government that can be applied to supply chain bottlenecks in the future. If you would like to help us tell this story, please reach out to me at ruthven@hida.org.

Health Systems Gobble Up Urgent Care Locations

Providers seek to meet patients where they already are.

 As MedExpress Urgent Care locations faced closure in 2024, health systems across the landscape began to scoop them up.

The Morgantown, W.Va.based clinics have been part of UnitedHealth Group’s Optum since 2015 when they were purchased for $1.5 billion. But nurses were laid off at nearly 150 locations this past August as part of larger layoffs at Optum and health

systems like Pittsburgh-based UPMC jumped at the opportunity to take over some MedExpress Urgent Care centers in Pennsylvania, West Virginia and Virginia beginning this spring.

UPMC formed a joint venture with GoHealth Urgent Care to

become UPMC-GoHealth Urgent Care to run the centers. During the transition, MedExpress, UPMC Urgent Care and UPMC Express Care will operate under their current names.

The urgent care provider and operator GoHealth has

partnerships with 11 health systems and manages over 250 urgent care centers in 14 states, including one with ChristianaCare to operate five new urgent care clinics in Delaware previously managed by MedExpress.

GoHealth currently has partnerships with ChristianaCare, Hartford HealthCare, Henry Ford Health, Inova, Legacy, Memorial Hermann, Mercy, Northwell Health, Novant Health, Nuvance Health and UCSF Health.

Why urgent care?

Why are so many health systems acquiring urgent care clinics and partnering with urgent care operators?

The urgent care industry has seen rapid growth, driven by factors like increasing patient demand for convenient care, the rising costs of healthcare, and the need for services outside of regular office hours. Many urgent care centers also offer extended hours, making them a popular choice for patients seeking quick medical attention.

Some health systems see urgent care acquisitions as a way to expand their footprint in a certain geographical area, while all of them see it as a way to meet their patients where they already are.

For example, in 2024:

` HCA Healthcare purchased 41 Texas urgent care centers from FastMed.

` Baylor Scott & White also had 41 urgent care clinics across Texas join its network through a partnership with NextCare Urgent Care.

` Baptist Health purchased five urgent care centers, which maintained their care teams

with expanded access to Baptist Health specialists in Arkansas. ` Memorial Hermann Health System partnered with GoHealth Urgent Care to operate 10 existing urgent care centers in the Houston area.

` Ochsner Health acquired Diamondhead Urgent Care and has two locations to provide urgent care in Mississippi.

Winston-Salem, N.C.-based Novant is now taking that success in urgent care to South Carolina.

In 2024, it acquired a 200-provider urgent care group from Blue Cross and Blue Shield of South Carolina called UCI Medical Affiliates, which included Doctors Care and Progressive Physical Therapy. Doctors Care is South Carolina’s largest urgent

“ Expanding access to high-quality outpatient care is a key part of our strategy to transform healthcare in South Carolina.”

As of recent estimates, there are over 10,000 urgent care centers across the country.

Health insurers and hospitals have become focused on keeping people out of the emergency room since those visits are around ten times more expensive than visits to an urgent care center. And, like other health care options, urgent care centers make money by billing insurance companies for the cost of the visit, additional services or the patient pays out of pocket.

Urgent care in the Carolinas

GoHealth’s partnership with Novant Health in North Carolina spans 33 locations.

The two partnered in 2018 and their most recent location opened in December. All Novant Health-GoHealth Urgent Care locations are in the Charlotte metropolitan area, Asheville and the Triad region, providing the communities with a direct link to Novant’s network of high-quality healthcare services.

care network and employs 1,100 healthcare professionals.

A Novant spokesperson told Becker’s Healthcare that the acquisition allowed the health system to expand its reach in South Carolina and extend its safety and quality program to these South Carolina clinics. The purchase now makes Novant the largest urgent care provider in the state. It also complements Novant’s three South Carolina hospitals and associated physician clinics, as well as its Ridgeland clinic established in partnership with Ochsner called Ochsner and Novant Health 65 Plus – Okatie.

“Expanding access to highquality outpatient care is a key part of our strategy to transform healthcare in South Carolina,” said Carl Armato, president and CEO of Novant Health, in a statement. “The addition of our urgent care and physical therapy network enhances our ability to support patients across the state with their unexpected care needs and recovery from injuries.”

Healthy Hearts

A forecast of cardiovascular health 30 years from now did not paint a rosy picture. What can healthcare stakeholders do to create a better future for patients?

By Graham Garrison

As a medical student, Dhruv S. Kazi, M.D., M.Sc., M.S., FAHA was fascinated by the physiology of the cardiovascular system – the heart sounds, the cyclical nature, the electrical system of the heart. Halfway through his training, he felt a calling to better understand not only what heart disease does to the individual patient, but what it does to us as a society. It felt intuitive that the two were connected.

“They are,” said Dr. Kazi. “But it’s a different mindset when you try and understand what a disease does to society, both from a health perspective and an economic perspective.”

Dr. Kazi was a recent volunteer vice-chair of American Heart Association advisory writing groups tasked with forecasting what cardiovascular health could look like 30 years from now. The outlook is concerning if current trends continue.

Total costs related to cardiovascular disease (CVD) conditions are likely to triple by 2050, according to projections. At least 6 in 10 U.S. adults (61%) – more than 184 million people – are expected to have some type of CVD within the next 30 years, reflecting a disease prevalence that will have a $1.8 trillion price tag in direct and indirect costs.

What’s causing it?

The AHA’s forecasting exercise projects substantial increases in the burden of cardiovascular disease across all sections of society: young adults, middleaged adults, older adults, men and women across all racial and ethnic groups, across all categories of insurance coverage, and educational attainment.

Dr. Kazi said there are three drivers of the forecasted increases. First is the fact that the population is getting older. “As our population ages, heart disease increases as we get older. And so, as a population gets older, we see an increase in heart disease.”

The second driver is that the burden of some of these risk factors is going up, in particular hypertension, diabetes, and obesity. From 2020 (the most recent data available) to 2050, projected increases of CVD and risk factors contributing to it in the U.S. include:

` High blood pressure will increase from 51.2% to 61.0%, and since high blood pressure is a type of CVD, this means more than 184 million people will have a clinical diagnosis of CVD by 2050, compared to 128 million in 2020.

` Cardiovascular disease, including stroke, (but not including high

blood pressure) will increase from 11.3% to 15.0%, from 28 million to 45 million adults.

` Stroke prevalence will nearly double from 10 million to almost 20 million adults.

` Obesity will increase from 43.1% to 60.6%, impacting more than 180 million people.

` Diabetes will increase from 16.3% to 26.8%, impacting more than 80 million people.

` High blood pressure will be most prevalent in individuals 80 years and older; however, the number of people with hypertension will be highest – and rising – in younger and middleaged adults (20-64 years of age).

` People aged 20-64 years also will have the highest prevalence and highest growth for obesity, with more than 70 million young adults having a poor diet.

The third driver is that the U.S. population is getting more diverse. Some of the subpopulations and racial ethnic groups have a higher burden of disease than others. Among adults aged 20 and older, projections note:

` Black adults have the highest prevalence of hypertension, diabetes, and obesity, along with the highest projected

prevalence of inadequate sleep and poor diet.

` The total numbers of people with CVD will rise most among Hispanic adults with higher numbers also seen among Asian populations.

` Asian adults have the highest projected prevalence of inadequate physical activity.

` The aggregated group of American Indians/Alaskan Natives (AI/AN)/ multiracial adults will have the highest projected prevalence of smoking.

Heart disease has been the leading cause of death in the U.S. since the inception of the American Heart Association in 1924. Stroke is currently the fifth leading cause of death in the U.S. Together, they kill more people than all forms of cancers and chronic respiratory illnesses combined, with annual deaths from cardiovascular disease now approaching 1 million nationwide.

Among children, the projections found:

` Black children will have the highest prevalence of hypertension and diabetes.

` Hispanic children will have the highest prevalence of obesity and the greatest projected growth in hypertension, diabetes, and obesity.

` Asian children and Hispanic children had the highest prevalence of inadequate physical activity.

` AI/AN/multiracial children will have the highest prevalence of smoking.

` Black children and white children will have the highest prevalence of poor diet.

` The absolute increase in each risk factor will be greatest for Hispanic children, reflecting broader trends in population growth.

Past, present and future

Not all the projections were dire. There are several positive developments that forecasters found related to cardiovascular health.

For instance, more adults in the U.S. are embracing the healthy behaviors of the AHA’s Life’s Essential 8, as prevalence rates for most are expected to improve:

` Inadequate physical inactivity rates will improve from 33.5% to 24.2%.

` Cigarette smoking rates will drop nearly by half, from 15.8% to 8.4%.

` While more than 150 million people will have a poor diet, that is at least a slight improvement from 52.5% to 51.1%.

Indeed, as the AHA celebrated its centennial in 2024, the organization highlighted some “monumental” accomplishments in the fight against cardiovascular disease which includes all types of

heart and vascular disease. Supported by efforts led by the Association, death rates from heart disease have been cut in half in the past 100 years. Deaths from stroke have been cut by a third since the creation of the American Stroke Association in 1998.

Dr. Kazi said we have much to celebrate in terms of the success of science and population health over the past century. Yet, there have been some alarming trends over the past decade that must be addressed. In particular, blood pressure control has declined, while diabetes and obesity have started to rise significantly.

“This contrasts with a longterm decline in blood cholesterol, for instance, that we don’t fully understand,” he said. “A shift to lower saturated fats in our diet has played some role, but this predates any medical intervention. We’ve also made great progress on average on tobacco control. Far fewer Americans smoke today than smoked say 30 to 50 years ago.”

But that progress has been uneven. Some sections of society have made very dramatic progress compared with others. A classic example is tobacco control. It’s very easy for individuals in certain sections of society to not know anyone who smokes, yet, smoking is often clustered in individuals of lower socioeconomic level, lower educational attainment. It’s also rising in certain subpopulations like LGBTQ populations, which are being targeted by ads for products.

“So, I think there’s much to celebrate on average across the country,” said Dr. Kazi, “and yet a word of caution that the trends over the past decade are

alarming both overall and in certain subpopulations.”

Making changes

Through its research and advocacy, the AHA hopes this data and forecasting will help both individual clinicians, health systems and policy makers plan better for the health of the populations they serve.

cardiovascular risk, there are very effective therapies already available. For instance, effective low-cost therapies for blood pressure have existed for a long time, yet blood pressure control remains poor. Or for individuals with high levels of cholesterol, clinicians can encourage and educate them on ways to do better in nutrition and exercise.

Not every solution is going to involve a medication or an injection. Some solutions will require lifestyle changes or having a real conversation on how clinicians can help support patients to lose weight or manage diabetes better.

“We have been closely following trends in cardiovascular risk factors over time,” Dr. Kazi said. “Yet, when I looked at recent trends on obesity and diabetes, they were really alarming. It has led me to believe that there is no future of good cardiovascular health in the U.S. that does not go through systematic efforts to address obesity and diabetes. We need to have an honest conversation about what our strategy is to help individuals and society as a whole to beat obesity. Because this is not an individual failing. This is a systematic issue in the country, something fundamentally broken in our food system that leads to such high levels of obesity not seen in many other parts of the world.”

At the individual practitioner level, there needs to be heightened recognition that for many of the conditions that increase

While there has been a general erosion of society’s trust in sources of scientific and health information, whether it’s from the general media, politicians, policymakers, etc., trust in clinicians, physicians, and caregivers remains very high. “That’s bipartisan,” Dr. Kazi said. “So, particularly as we live in a world of political polarization, I think clinicians should take their roles seriously as purveyors of high-quality health and lifestyle information. What can we do to support our patients?”

Not every solution is going to involve a medication or an injection. Some solutions will require lifestyle changes or having a real conversation on how clinicians can help support patients to lose weight or manage diabetes better. Those changes for individuals might

mean restricting salt so their blood pressure gets under control or increased physical activity – or even something as basic as more sleep.

“We now have compelling data on what sleep does to heart disease risk,” Dr. Kazi said. “And I think the individual clinician can play a very vital role in communicating this information effectively to patients and families.”

There is a fundamental need to think about how we in the U.S. provide access to high quality preventative care early in life and sustained access to care, because some of these weight trends start early in adolescence. Obesity among children (2-19 years of age) is estimated to rise from 20.6% in 2020 to 33.0% in 2050, increasing from 15 million to 26 million children with obesity; highest increases will be seen among children 2 to 5 years of age and 12 to 19 years of age. The prevalence of inadequate physical activity and poor diet among children is projected to remain high at nearly 60% each, exceeding 45 million children by 2050.

“How do we shift our focus from these high-cost procedures that we’re doing late in life to a more robust primary care system where people can see their physicians, get their blood pressure in control well before they have their stroke or develop heart failure, get their weight under control well before they develop diabetes, for instance?” Dr. Kazi said. “That is going to require systematic strategies both within and outside the health system.”

Within the healthcare system, it includes better access to primary care, and affordable pharmacological interventions that are

Clinically, cardiovascular disease refers to a number of specific conditions, including coronary heart disease (including heart attack), heart failure, heart arrhythmias (including atrial fibrillation), vascular disease, congenital heart defects, stroke and hypertension (high blood pressure). However, while high blood pressure is considered a type of cardiovascular disease, it is also a major risk factor contributing to nearly all types of heart disease and stroke, so for the purposes of these analyses, high blood pressure was predicted separately from all CVD. The American Heart Association said this aligns with its Life’s Essential 8™ – key measures of health factors and health behaviors identified for improving and maintaining cardiovascular health.

effective like GLP-1 inhibitors. Outside the health system, it may involve subsidizing healthy foods, disincentivizing unhealthy foods like sugar-sweetened beverages and systematic strategies to reduce tobacco use.

On the healthcare system side, no conversation about the future of heart disease in the U.S. is complete without talking about weight loss drugs like Ozempic and Wegovy, Dr. Kazi said. The AHA recently published some data finding that one in two U.S. adults is eligible for these therapies based on the current indications, and their indications continue to grow over time. These weight loss drugs have the potential to improve the population’s health, but at the same time, they come with a very hefty price tag. Most people who start these drugs stop taking them at one or two years and lose most of the benefits.

“They’re effective, but they’re expensive, and they’re also not a magic bullet,” Dr. Kazi said. “They’re not going to work unless we also invest in other systematic changes to our food supply or

primary care system to make sure that patients can make sustainable lifestyle changes.”

Imperatives

Improving cardiovascular health in the U.S. will take both prevention and treatment. If we put all our eggs in the treatment basket and ignore prevention, then we’re not going to be able to make any sustained changes in society, Dr. Kazi said. At some point, it’s going to be too expensive to manage as the population gets older.

The forecasting paper found that as a proportion of the GDP, cardiovascular disease will almost double by 2050 (with inflation already taken into account). When you compare it with GDP, that’s a massive change between 2020 and 2050 if we don’t start addressing it now.

“What we’re trying to say is that there is a health imperative to make change,” Dr. Kazi said, “but also an economic imperative to turn this ship around, because we won’t be able to afford these kinds of expenses as a society if the trends continue.”

Life-Saving Action

Why an NFL star is teaming up with Zoll to educate the public on the importance of AEDs and swift action in cardiac emergencies.

During a highly televised NFL game, Damar Hamlin, a professional football player, experienced commotio cordis – a rare, life-threatening condition that occurs when a blow to the chest disrupts the heart’s rhythm and leads to sudden cardiac arrest. Viewers of the game witnessed Hamlin get tackled, stand up for a second or two, and then immediately collapse. At that moment, Hamlin was considered clinically deceased because he wasn’t breathing and didn’t have a pulse.

“Fans of both professional teams looked very scared, and everyone could tell that this was not a normal event. This type of medical issue happens occasionally in sports such as lacrosse, softball, or different events where a person can get hit in the chest. It is important to know that commotio cordis can happen to anybody,” said Jonathan Bowman, Senior Director of Alternate Care Markets at ZOLL, in a recent Repertoire podcast episode with Scott Adams. “There were no issues with his heart prior to this incident.”

Following the incident, communities across the nation began to realize just how crucial it is to have AEDs accessible in public

spaces, and to be prepared for sudden cardiac emergencies.

To boost the public’s confidence in working with AEDs, ZOLL has teamed up with Damar Hamlin to promote “Anything Can Happen. Anyone Can Help,” a national public awareness campaign aimed at debunking myths about AEDs and informing the public as to how everyday heroes can be empowered to act quickly in the event of cardiac emergency.

“Our campaign’s goal, with Hamlin’s help, and the many others who are also advocacy partners with us, is to make AEDs as familiar and accessible as fire extinguishers; positioning them as essential life-saving tools that

anyone can and should use in emergency,” said Bowman. “This includes informing the public with clear and easy to follow instructions on the life-saving process of using an AED.”

ZOLL tackles AED awareness

There are approximately 350,000 cardiac arrests that occur outside of the hospital in the U.S. each year, according to the CDC. The first three to five minutes of cardiac arrest is the most crucial time for a victim to have the highest chance of survival. For this reason, there is an urgent need for bystanders to feel confident and capable of using an AED to help save a life.

Hamlin’s story has had a nationwide impact, with the number of capital bills related to cardiac emergency response being passed or becoming active went from three in 2021 and 2022 to nine in 2023 and 36 in 2024. The HEARTS Act that was signed into law by the President, ensures that schools nationwide have cardiac emergency response plans in place, and that students and staff are trained in CPR, and campuses are equipped with an AED.

Bowman said, “This campaign has really helped people feel comfortable with taking action and getting involved, whether it’s in a real rescue or just getting out in their communities so that more folks can have access to AEDs.”

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The 2025 PWH® Leadership Summit is headed to Frisco, Texas!

Frisco is a hub of modern innovation and growth, that offers a vibrant and cutting-edge environment, making it the ideal location to inspire and empower industry leaders at this year’s leadership conference

All leaders are welcome! Open to women & men from all career levels – Aspiring Leaders to C-Suite Executives. Gain actionable takeaways through our PWH Leadership Insights (TED-style talks), empowering keynote speakers, engaging panel discussions, workshops & breakout sessions that cover a host of topics around pressing leadership issues

Agenda At-A-Glance

Monday, March 31

2:30 – 3:15 pm New Member / New Attendee Meet & Greet

3:30 – 4:45 pm Opening Keynote: Erin Diehl

4:45 – 6:00 pm Kickoff Reception

6:30 pm Dinner on Your Own – Dine Around The Star

Tuesday, April 1

7:30 am - 4:30 pm Registration & Information

8:00 – 10:45 am Welcome, Leadership Insights & Awards

11:00 am – 12:00 pm Leadership Workshops

12:00 – 1:00 pm Lunch

1:00 – 2:00 pm Leadership Workshops

2:00 – 4:00 pm Breakout Sessions

4:00 – 5:00 pm Quick Pass & Pour: Speed Networking

6:30 – 9:00 pm Networking Dinner

Wednesday, April 2

8:00 – 9:15 am Leadership Panel

9:30 – 11:00 am Closing Keynote: Manley Feinberg

11:00 am Closing Remarks

All times listed are Central Standard Time. Schedule subject to change.

Register today to attend the industry’s only conference completely dedicated to inclusive leadership development.

Registration now open at mypwh.org

ALL-STAR 2025 SPEAKER LINE-UP

Opening Keynote: The Empathetic Leader Leading Yourself & Others

Erin Diehl, Business Improv Edutainer, Failfluencer, and Professional Zoombie

Closing Keynote: Exponential Commitment™

Build Breakthrough Momentum inthe Storm of Chaos

Manley Feinberg, Keynote Speaker, Bestselling Author, & Expert Mountain Climber

WEN! KEYNOTE-LED WORKSHOPS DEEP DIVES INTO TOP CONTENT

Effective Communication: Learn to ‘Yes, And’ Your Way to Meaningful Interactions

Erin Diehl, Opening Keynote Speaker

Jenny Collopy

The Christ Hospital, VP, CMCO Leading by Example: Cultivating WellBeing with Empathy and Purpose

Jack Stephens NDC, Inc., President & CEO

John Pritchard

Moderator

Share Moving Media, President

Get On Belay : Build the Relationships

You Need to Reach Your Next Summit

Manley Feinberg, Closing Keynote Speaker

Leadership Insights: Respected Leaders Sharing Insights on Relevant Topics

Rachelle Ferrara ModivCare, SVP Leading with Resilience

Ashley Vertuno

HCA Florida JFK North Hospital, FACHE, CEO Leading through Generational Diversity: Building Connections That Inspire Growth

Leadership Panel: Ring of Honor

The Journal of Healthcare Contracting, Publisher

Matt Bourne

Midmark Corporation Cheif Commercal Officer

Lamont Robinson

Netflix, Director Supplier Diversity Building and Repairing Communities Through Supplier Diversity

This session will conclude with a panel discussion featuring our Insights thought leaders

Jennifer Treglia

J&J, VP, North America Deliver Operations MedTech Center Supply Chain

Andrea Harrison Owens & Minor SVP of Product & Solutions

Breakout Sessions: Improvin g Your Leadership Skills

What’s AI Got to Do with It? Tools and Strategies for Career Acceleration and Work-Life Integration

Amie Rafter Hbird Consulting, LLC, Founder

Get to the Point → and let AI help

Rachel Bailey Penwan Communication & Former PWH Board Member

Sarah Charai Cleveland Clinic

Executive Director Supply Chain Operations

Clinton Hazziez

Baylor Scott & White VP Supply Chain & Sourcing

Breakout 1: Cultivating Your Power Beyond “Executive Presence” and Titles

Nenuca Syquia

BOxD, CEO and Founder

Raising Your Professional Visibility and Voice

Jennifer McCluskey

Jennifer McCluskey Coaching, Founder

Breakout 2: Design the Magic: How to Systematically Build High Performing Teams

At the Center of Optimal Health

 As an organization, Pioneer Physicians Network believes that the center of healthcare should revolve around the patient and their primary care physician trying to quarterback that care.

Dr. Victoria DiGennaro, CEO and family physician at Pioneer Physicians Network, said that emphasis has allowed the clinical team to provide excellent patient outcomes.

“It has also allowed us to maintain a better quality of life and lower burnout for our physicians, which is a huge issue in medicine right now, and it has allowed us to remain independent,” she said. “We like to say we’re fiercely independent, which has been nice in the current landscape, especially with some of the major health systems that surround us.”

Currently, the organization has about 60 primary care physi-

cians (PCPs) with an additional 30 nurse practitioners (NPs) serving 22,000 patients within three counties in Ohio. Pioneer’s clinicians do everything for the patient. They are responsible for their total cost of care in terms of pharmacy, hospital spend, ER spend, surgeries, etc.

Pioneer has “countless” patient stories and successes of how they’re providing better care for patients in this model,

Dr. DiGennaro said. For instance, recently one patient came in for a routine bloodwork follow up. The patient was distraught and emotional during her visit. She kept talking about her computer. In traditional fee-for-service, the PCP would have 10 to 15 minutes to go through the visit and move on, but because Pioneer is doing comprehensive care, the PCP took a step back and talked to her. The clinician figured out she was having some kind of issue logging into her computer at home, and that was distressing her.

The PCP called the nurse care manager and asked her to go check on the patient at home. The nurse manager went out the same day as the office visit, and helped get the patient back into her computer. The nurse manager called the PCP back to indicate more was going on than a simple computer problem.

“So we brought the patient in, did testing, and it turned out she had early dementia,”

Dr. DiGennaro said. “We were able to diagnose her, get her on appropriate treatment, provide resources at home, and prevented a bad outcome. This is a patient who in the fee-for-service world would’ve just

been overlooked and literally could have crashed into care down the line because of her mental health issues. So much of the care happens outside of the exam room.”

Another benefit of Pioneer’s approach is that it has access to comprehensive data on specialists and uses it to determine the best place to send a patient. Pioneer uses that data to tier the specialists based on quality and cost.

“That helps our PCPs guide the patient to the right specialist,” Dr. DiGennaro said.

In another example, an elderly patient with several comorbidities came in for neck pain. When the PCP got the X-ray of her neck, it was determined she had broken her dens, which is the bone you break when you hang yourself. “Again, in a fee-for-service world, I would’ve just sent her to the ER, and she probably would’ve had expensive surgery and bad outcomes. But because I had the specialist data, I called up one of the tier one orthopedic spine doctors.” The orthopedic doctor saw her the next day and determined she was not a surgical candidate based on all her other comorbidities. Instead, she received a much less invasive approach to care through a neck brace, pain control medications, and physical therapy. “The woman lived another year very happily and comfortably, and didn’t have to go through a procedure that could have actually caused her passing,” Dr. DiGennaro said.

A team effort

The better Pioneer does clinically, the more they have been able to reinvest in the organization. They’ve experienced almost 40% PCP growth since the start of their partnership with agilon.

The clinical investments have extended beyond the PCPs. Pioneer utilizes nurses in several different ways. There are nurses that work within the central care teams and meet, call and do home visits with patients.

Pioneer also has embedded nurses in local emergency rooms. When a Pioneer patient comes to the emergency room, the nurses help coordinate care with the hospital. For instance, if the ER physician needs to talk to the PCP, the nurse will help with connecting the two clinicians. If a patient gets admitted to the hospital, Pioneer nurses follow that care and will help coordinate discharge services and other elements of care with the hospital team. “The goal is to help get the patient to the right level of care.”

Along with PCPs and nurses, Pioneer employs social workers and has access to pharmacy services. There are palliative care, renal care and heart failure programs within the communities that Pioneer serves. “All these different things combine to provide that total level of care to bring the patient in house to where they need to be.”

Taking a risk

In order to approach primary care differently, though, the Ohio-based primary care provider needed to take a different approach to how its physicians were reimbursed. Since 2018, Pioneer has been responsible for the total quality and cost of their patient population in Medicare and Medicare Advantage arrangements.

Pioneer’s principal partner in the full risk model is agilon, a company that provides technology, people, capital, process and access to a peer network of more than 3,000 PCPs who are delivering care to more than 700,000 patients. agilon’s platform helps independent physicians to improve care for Medicare members and participate in the benefits of improving health outcomes. “As the platform of physicians and members scales up and quality grows, so do the potential cost savings from improving care,” the company states on its website. agilon shares in the outcome with its physician groups in a long-term partnership model.

By partnering with agilon, physician practices make a joint commitment to transform health care delivery by shifting to a value-based Total Care Model for their Medicare patients that improves outcomes and lowers cost. Established in 2016, agilon has expertise in full-risk, value-based care for Medicare Advantage and Fee-for-Service innovation models. Currently, more than 30 physician groups and health systems are in long-term partnerships with agilon and have transitioned to full-risk for their Medicare patients through agilon’s technology-enabled platform.

Pioneer chose agilon for a couple reasons, Dr. DiGennaro said. First, it’s a true partnership model in that Pioneer is able

Victoria DiGennaro

to maintain its independence. Second, Pioneer clinicians were intrigued with the idea of being fully responsible for the care of its patients. “What’s interesting about the healthcare space is there’s so much waste in the system,” she said. “When you break it down, it’s something like 8% of that spend is primary care. Yet, if you invest in primary care, you can decrease the spend, admissions and morbidity/mortality that happen to patients outside down the road.”

debt and more potential earnings in specialty roles. “When students look at primary care versus some specialties, the compensation could be two, three, four times higher in those other specialties,” Campanella said. Linked to the workforce shortage is that the number of independent providers – traditionally made up of family doctors – also continues to shrink. The days of the small, one-to-two-person primary care family medicine practice are fading away. Health systems, retailers, insurers and even private

Judging by the fact that the number of primary care physicians continues to dwindle, stakeholders aren’t doing nearly enough. Fewer students in medical school are choosing primary care because of a combination of higher educational debt and more potential earnings in specialty roles.

Incentives must align

When it comes to primary care in the United States, healthcare stakeholders – including payers, providers, and the government –all seem to agree that there needs to be more access to it and more clinicians providing it.

“Obviously, everybody wants more primary care, but what are they really doing about it?” asks Thomas Campanella, a healthcare consultant and former Healthcare Executive in Residence at Baldwin Wallace University.

Judging by the fact that the number of primary care physicians continues to dwindle, stakeholders aren’t doing nearly enough. Fewer students in medical school are choosing primary care because of a combination of higher educational

equity organizations have gobbled up most of the market share over the last two decades.

For primary care to work well, clinicians need to spend time with patients, getting to know them, and trying to find ways to keep them healthy, not just going through the motions and handing them off to a specialist.

But the incentives need to align, and in a predominantly fee-forservice world, thus far they haven’t. Campanella said there are gains to be had in more realistic reimbursement models. Payers and providers can try something more risk and valued based, he said. In this approach, there is a little bit of upside and downside as it relates to providing the appropriate value, and/or some form of capitation, which is

providing the providers X number of dollars per member/per month to take care of the individual.

“A way those providers then would make money is keeping them healthy; in other words, you’ve got to change the paradigm from payment systems that focus on escalating healthcare costs – the more you do, the more you make –to payment systems where you are actually more financially successful if you can keep people healthy.”

That ideal is not as far off as one may think. Pioneer is a case in point. And in several states, other independent primary care practices are acquiring smaller, independent, primary care practices to compete with larger health systems and private equity organizations. Payers are keen to go into full risk with them via Medicare Advantage Plans because of the prospect of an independent primary care physician overseeing the patient’s care.

“Primary care is calling the shots on the health of the patient,” Campanella said. “They’re looking at the person from a holistic standpoint, and ultimately are in the best position to provide that care.”

Data has shown that independent primary care providers are much more focused on keeping patients healthy and not issuing referrals for specialists or tests that are unnecessary, Campanella said. The independent physicians direct care – when needed – to the best providers, no matter which organization they happen to be at. “That could be independent providers. That could be in different hospital systems. That could be outside the region, because they have that form of independence … It’s a win for the Medicare Advantage Plan, and it’s fuel to keep the independent practices going.”

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Investing ahead of the outcome

Dr. DiGennaro said there is a lack of knowledge when it comes to what value-based care can look like. “Traditionally, the fee-for-service world has been happening for so long that –especially for those in primary care – you’re just not aware of what else is out there.”

Regulatory challenges with Medicare in the last several years have added to the problem. Compound that with increased medical utilization, and it’s becoming very challenging to break out of the fee-for-service world.

requires all participating ACOs to have a robust plan describing how they will meet the needs of people with Traditional Medicare in underserved communities and make measurable changes to address health disparities. Additionally, the model uses an innovative payment approach to better support care delivery and coordination for people in underserved communities.

Patients in a REACH ACO get help navigating the health system and managing their conditions, according to CMS. They may have greater access to enhanced benefits, such as telehealth visits,

Patient and administrative task volumes are major contributors to the high burnout rate of physicians. Compound that with the projected 60,000 PCP shortage in the next 20 years, an aging population living longer and with more (complex) health issues, and the momentum is shifting in the wrong direction.

Along with its partnership with agilon, Pioneer participates in the ACO Realizing Equity, Access, and Community Health (ACO REACH) Model through the Centers for Medicare & Medicaid Services (CMS). This federal program provides novel tools and resources for health care providers to work together in an accountable care organization (ACO) to improve the quality of care for people with Traditional Medicare. REACH ACOs are comprised of different types of providers, including primary and specialty care physicians.

To help advance health equity, the ACO REACH Model

home care after leaving the hospital, and help with co-pays.

Begun in 2022, the program is set to expire in 2026.

Dr. DiGennaro has spent a lot of time advocating in Washington, D.C. and with different groups to promote value-based care. Specifically, she and her organization want to see the ACO REACH model or some form of full-risk model continue beyond 2026.

“We need that stability, because all of these things cost a lot of money and resources,” she said. “We have an entire care management system with nurses, social workers, and care managers. We have to invest ahead of the out-

come, and if we don’t have the stability knowing that the government is going to continue those programs, it becomes very challenging for smaller, independent groups to maintain that. We must continue to advocate so that we can continue this trend and get more people into the value-based care world.”

Avoiding burnout

For today’s primary care providers there’s much to do for patients. Often too much, when you consider the sheer volume of tasks and information required to provide and coordinate care –portal messages, telephone calls, reviewing labs, documents and specialist notes.

There aren’t enough hours in the day. Indeed, following national recommendation guidelines for preventive, chronic disease and acute care would take a primary care physician 26.7 hours per day to see an average number of patients, according to a recent study conducted by the University of Chicago, Johns Hopkins University, and Imperial College London. That breaks down to 14.1 hours/day for preventive care, 7.2 hours/day for chronic disease care, 2.2 hours/day for acute care, and 3.2 hours/day for documentation and inbox management, researchers noted. “Obviously the math doesn’t work,” said Dr. DiGennaro.

Patient and administrative task volumes are major contributors to the high burnout rate of physicians. Compound that with the projected 60,000 PCP shortage in the next 20 years, an aging population living longer and with more (complex) health issues, and the momentum is shifting in the wrong direction. “If we don’t do

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Reasons behind shifting ownership model

According to a recent analysis of physician practice arrangements by the American Medical Association (AMA), between 2012 and 2022 the share of physicians working in private practices fell by 13 percentage points from 60.1% to 46.7%. In contrast, the share of physicians working in hospitals as direct employees or contractors increased from 5.6% to 9.6% between 2012 and 2022. The share of physicians working in practices at least partially owned by a hospital or health system increased from 23.4% to 31.3% between 2012 and 2022. In 2022, 4.5% of physicians worked in a practice owned by a private equity group, similar to the percentage in 2020 when the AMA first added private equity to the analysis.

Four of five physicians indicated the need to better negotiate favorable payment rates with payers was a very important or important reason in the sale of their practice to a hospital or health system, AMA said. Next was the need to improve access to costly resources and the need to better manage payers’ regulatory and administrative requirements. Each was flagged by about 70% of physicians as a very important or important reason.

“The AMA analysis shows that the shift away from independent practices is emblematic of the fiscal uncertainty and economic stress many physicians face due to statutory payment cuts in Medicare, rising practice costs, and intrusive administrative burdens,” said AMA President Jesse M. Ehrenfeld, M.D., M.P.H. “Practice viability requires fiscal stability, and the AMA’s Recovery Plan for America’s Physicians is explicit in calling for reform to our Medicare payment system that has failed to keep up with the costs of running a medical practice.”

something, we’re on the precipice of major problems in our healthcare system going forward,” Dr. DiGennaro warned.

What to focus on

In a LinkedIn blog post on the topic of primary care models that work, Campanella wrote that “it would be short-sighted of payers (both governmental and non-governmental) to attempt to minimize capitated type payment levels to primary care physician practices… You cannot pay too much for primary care physicians to provide value-based care.”

Also, as more successful primary care physician models appear in communities, both federal and state regulators need to require the elimination of noncompete language in employment contracts, he wrote. “Non-competes stifle opportunities for physicians and penalize the patients and our communities.”

Value-based care could help by better aligning compensation for physicians and providing a path for people to remain in medicine, Dr. DiGennaro said. “I think that’s the kind of thing that we need to focus on, because if you think about a traditional PCP, they were seeing 30-plus patients a day running that hamster wheel to survive using fee for service. Whereas if you’re focused on value-based care, you might see half that, with longer appointments and more resources. So it provides you, as the PCP, with more help to take care of the patient and also provide the patient with better outcomes.”

For the patient, provider and payer, it’s a “win-win-win” all around.

Streamlining Care

Increasing specialization within the ASC care continuum.

By Pete Mercer

 Outpatient care is booming – in fact, more than 80% of surgeries are now performed in outpatient settings, outsourcing these procedures to ambulatory surgery centers. ASCs are highly regulated care facilities that provide outpatient surgery and preventive care for their patients, performing a more focused scope of procedures compared to hospitals and other healthcare facilities. These facilities are creating unique opportunities for physicians to provide high-quality care in a high-value market.

One of the more interesting opportunities for patient care at an ambulatory facility is that the procedures are increasingly becoming specialized. Specialization in an ambulatory setting is when patients receive a specific kind of medical care or surgery at an ASC. As ASCs have recently grown to become the dominant provider of specific surgical procedures in the U.S., many have diversified their services to offer a wider range of surgical specialties and other services, including pain management, diagnostic imaging, and gastroenterology services. ASCs continue to drive innovations that are transforming the world of outpatient surgery. In order to fully understand how the ambulatory care market is effectively streamlining patient care protocols, we need to look at why these facilities are trending towards specialization and what that specialization means for physicians and patients alike.

The influx

of specialization

Part of what makes specializing work in the ambulatory space is the autonomy granted to these facilities by simply not being a hospital. In a hospital setting, there are

so many different moving pieces that go into a patient stay that it becomes just about impossible to offer any level of specialized care.

Dr. Neal Badlani, an orthopedic surgeon who specializes in minimally invasive spine surgery, wrote in The Journal of Spine Surgery, “Compared to hospitals, ASCs have a much greater capacity to pick and choose what procedures they perform, who their patients are, and what processes both clinical and administrative are to be used in their centers. This autonomy results in, proportionately, far less overhead for the facility. Specifically, the lower overhead costs can be achieved by limiting the scope of procedures.”

This surge of ASC specialization is likely because physicians are pushing the drive to develop new ASCs. A report from the ASC Association says that by leveraging a focused model for specific procedures, ASCs can provide a more consistent and controlled environment that largely avoids the many challenges of delivering a multitude of different surgical and medical services.

Increased physician autonomy

Consistency in healthcare is critical. Physicians in an ASC environment have a significant amount of control over many components of the healthcare continuum; they can

build more convenient procedure schedules, assemble a team of specially trained and highly skilled staff, obtain high-quality equipment that best fits the specific sets of procedures they offer, and even design their facilities to fit the specific needs of their patients and the procedures they provide.

ASCs allow a level of autonomy that is hard to come by in the healthcare industry, making them more attractive to physicians who would otherwise have to operate within the parameters and boundaries of a hospital.

Part of the autonomy that piques the interest of so many physicians is because approximately 52% of all ASCs are operated in a physician ownership model. In this scenario, doctors own 100% of the equity in the ASC, are responsible for all management decisions, and make all decisions related to the quality of care.

“There are great benefits to physician ownership such as autonomy and control,” Badlani writes. “This usually leads to a clinical environment with a high quality of care for patients and convenience for physician owners. There is a flatter hierarchy which can lead to better access for patients to physician operators who have direct knowledge of the patient’s clinical situation and control over the care environment. Physician entrepreneurs often stimulate innovation and progress.”

In this ownership model, physicians can also partner with a management company to handle all the contracting and administration tasks that come with owning an ASC. These partnerships allow physicians to maintain their focus on the care of the patient and the quality of the procedures, without sacrificing too much control or their equity in the facility.

The impact of specialization

There are many benefits of increased specialization within the ASC space. From the patient’s perspective, it’s a significant time saver. Patients undergoing procedures in ASCs are often in and out of the facility within the same day, spending whatever recovery time is necessary from the comfort of their own home. The increased convenience, flexibility, and accessibility of an ASC makes it a compelling option for outpatient care.

Patients in an ASC setting also see significant cost-savings by opting for outpatient procedures. The ASC Association reported that a Medicare beneficiary “could pay as much as $496 in coinsurance for a cataract extraction procedure performed in a hospital outpatient department, whereas the same beneficiary’s copayment in the ASC would be only $195.”

Another added benefit to operating a specialized ASC is they are often associated with lower facility costs. By providing a focused set of procedures, these facilities can significantly reduce overhead costs. A study conducted by UnitedHealth Group showed that conducting more joint replacement surgeries in ASCs could result in 500,000 fewer hospitalizations and $3 billion in annual savings across the board.

The study found that hospitalacquired infections have been a significant challenge for patient safety, with up to 3% to 4% of hospital patients contracting infections – this also includes infections in patients following 1% to 2.5% of joint replacement surgeries. Because of this, up to 26,000 joint replacement patients each year face additional treatment and a longer stay in the hospital.

Procedures like joint replacement don’t necessarily require a hospital stay. Patients who get an outpatient hip or knee replacement are often discharged the same day, with no increased likelihood of infection or readmission compared to inpatient procedures. In fact, an outpatient procedure might even decrease the likelihood of infections – hospital-acquired infections are a huge risk and safety challenge.

Looking toward the future

As ASCs continue to branch out and specialize in more procedures, it gives the patient a larger menu of options to choose from. ASC Data found that the specialties with the highest growth rate in 2023 were cardiology, musculoskeletal, and orthopedics, while the specialties with the most potential for growth in 2025 are orthopedics, cardiovascular, and gastroenterology.

With the increase of specialization in the ambulatory care space, it will be interesting to see how this affects the rest of the care continuum. ASC Data predicts that private insurance will continue to shift towards ambulatory, which will completely reshape the hospital environment. Additionally, the consolidation of ASCs through mergers and acquisitions will continue to enhance efficiency for physicians and staff, while also enabling ASCs to negotiate better reimbursement rates with payors. Technology will also continue to evolve in the ambulatory space, allowing physicians to better streamline their workflow and patient care processes. Specialization will continue to advance across the board, allowing for more patients to tap into cost-effective, efficient, and high-quality outpatient care.

ASC News

AAHC earns CMS approval as national ASC accreditor

The Accreditation Association for Ambulatory Health Care announced that it has been awarded Centers for Medicare and Medicaid Services approval as a national accreditation organization for ambulatory surgery centers that request participation in the Medicare Deemed Status Accreditation program. This renewal underscores AAAHC's long-standing commitment to high-quality patient care and regulatory compliance in the ambulatory surgery field.

AAAHC has held Medicare Deemed Status for ASCs since 1996, demonstrating leadership in promoting safety and quality within the ambulatory health care community. This renewal confirms that AAAHC’s Medicare Deemed Status Accreditation Standards continue to meet or exceed CMS’s rigorous requirements for accreditation organizations, ensuring ASCs uphold federal Standards, patient safety, and quality care.

The AAAHC Medicare Deemed Status Accreditation program is supported by a team of surveyors with ambulatory care experience, providing a peer-driven review process tailored to the unique needs of ASCs. As part of its mission to promote continuous improvement, AAAHC offers accredited facilities a range of educational resources and tools that provide actionable guidance to support operational success.

CommonSpirit

‘focusing heavily’ on ambulatory

development

CommonSpirit Health added eight ambulatory care sites across six states in the first quarter of 2025 (three months ended Sept. 30), CFO Dan Morissette said on the system’s Dec. 2 investor call and Becker’s. The additions come after the system added 56 ambulatory sites in fiscal 2024, which ended June 30.

The system’s efforts to improve operating performance include volume growth, with an emphasis on expanding ambulatory services, improving network integrity, and capacity optimization for perioperative and imaging services, according to Becker’s.

Another part of that plan is labor cost management through the deployment of standard department staffing models, as well as reduced contract labor expenses.

$21M ASC to open in Iowa

A $21 million surgery center is coming to Ames, Iowa, as part of a partnership between Mary Greeley Medical Center and McFarland Clinic. Ames will be the only town in the region with an ASC. It will have 33 private rooms and a waiting room.

The 31,000-square-foot space will also feature six operating rooms and four endoscopy rooms. Currently, the facility sees two cases per week while it works toward Medicare accreditation.

Leaders anticipate earning accreditation in January, which will open up the ASC to see commercial providers like United Healthcare and Wellmark of Iowa.

When the ASC is fully operational in early 2025, it will provide ENT, gastroenterology, general surgery, gynecology, ophthalmology, orthopedics, podiatry and urology services.

Meet The Experts Shaping Healthcare At The

Meet The Experts Shaping Healthcare At The

•Navigate the evolving healthcare landscape with Dr. Alok Patel, medical contributor for ABC News.

•Navigate the evolving healthcare landscape with Dr. Alok Patel, medical contributor for ABC News.

•Gain a fresh perspective on the economy from economist Peter Ricchiuti, whose wit makes complex insights unforgettable.

•Gain a fresh perspective on the economy from economist Peter Ricchiuti, whose wit makes complex insights unforgettable.

•Elevate workplace performance and culture with Shola Richards, an expert in creating thriving, resilient teams.

•Elevate workplace performance and culture with Shola Richards, an expert in creating thriving, resilient teams.

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Plus, connect and network with senior leaders from all your key trading partners.

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Post-Acute Care Regulatory Compliance

Regulatory requirements are meant to improve patient care; however, many post-acute care providers struggle to meet them considering post-pandemic challenges.

By Jenna Hughes

 Long-term care (LTC) providers such as skilled nursing facilities, inpatient rehabilitation centers, and home health providers face the daily task of maintaining compliance with a growing number of healthcare regulatory requirements. Federal regulations on healthcare facilities have historically been implemented to ensure that patients receive high-quality access to care. However, the post-acute care sector is subject not only to federal compliance requirements but also state, local, and agency requirements. Increasingly, physicians are having to delay care or spend less time on patient care overall to focus on administrative tasks related to compliance.

Health systems, hospitals, and post-acute care providers must adhere to over 629 discrete regulatory requirements across nine domains, according to the American Hospital Association’s “Regulatory Overload Report,” published in 2018. This includes 341 hospital-related requirements and 288 post-acute care specific requirements, with the number of regulatory requirements having significantly increased for post-acute care providers since the pandemic.

The primary drivers of federal regulation include the Centers for Medicare & Medicaid Services (CMS), the Office of Inspector General (OIG), the Office for Civil Rights (OCR) and the Office of the National Coordinator for Health Information Technology (ONC), according to AHA. However, providers must also keep up with their specific state and local requirements simultaneously.

Impact on long-term patient care

Hospitals and post-acute care providers spend nearly $39 billion a year on administrative activities related to regulatory compliance annually. An average sized hospital spent nearly $7.6 million annually on administrative activities related to compliance in 2018, and the figure raises to $9 million for hospitals with post-acute care facilities. In 2018, regulatory burden cost more than $1,200 every time a patient was admitted to the hospital, according to the AHA.

Post-acute care facilities have their own specifically designated regulatory requirements that differ from general hospitals. One such requirement is the recently

proposed ‘Minimum Staffing Standards for Long-Term Care Facilities’ from CMS, which was updated in April 2024.

The minimum staffing requirement final rule aims to reduce the risk of residents receiving unsafe care by finalizing a total nurse staffing standard of 3.48 hours per resident day (HPRD), which must include at least 0.55 HPRD of direct registered nurse (RN) care and 2.45 HPRD of direct nurse aide care, according to CMS. Facilities may use any combination of nurse staff to meet the requirement (such as an RN, licensed practical nurse (LPN) and licensed vocational nurse (LVN), or nurse aide) to account for the additional 0.48 HPRD. Before the minimum staffing requirement, nursing homes were only required to have an RN on-site for eight hours per day.

and the potential for any nursing homes that don’t meet staffing requirements to not be able to legally operate and they must close entirely, according to NPR.

Impact on patient care

Patients, too, are significantly impacted by regulatory requirements, receiving less time with their caregivers, unnecessary hurdles to receiving care, long wait times to be discharged from the hospital to post-acute and hospice care, and a growing number of regulatory requirements leading to increasing healthcare costs.

Nearly 54% of nursing home providers are now having to limit new admissions due to staffing shortages, according to the American Health Care Association/National Center for Assisted Living (ACHA/NCAL). Nursing homes are down more than 240,000 employees since the start

Nursing homes are down more than 240,000 employees since the start of the pandemic, according to NPR and the Labor Department. Facilities across the country are facing numerous unfilled staff positions because of staff departures during the pandemic.

While the new rule aims to provide improved patient care, it has resulted in negative impacts for hundreds of already stretchedthin nursing facilities, many postacute care providers have said. For facilities that were already struggling to retain staff and care for a growing number of patients, the staffing requirement rule has led to higher healthcare costs

of the pandemic, according to NPR and the Labor Department. Facilities across the country are facing numerous unfilled staff positions because of staff departures during the pandemic.

Often, spending time focusing on complying with regulations means that already overwhelmed physicians are taken away from patient bedsides to focus on

administrative tasks. For many post-acute care facilities, this results in less time spent with patients and reduced care quality. Many post-acute patients have experienced long waits for care or inadequate care altogether, according to NPR.

An average-sized hospital dedicates almost 59 full-time equivalents (FTEs) to regulatory compliance, over one quarter of which are doctors and nurses, according to the AHA report. Physicians, nurses and healthcare staff make up more than onequarter of the full-time equivalents (FTEs) dedicated to regulatory compliance, which also takes clinicians away from patient care responsibilities. While an average size community hospital dedicates 59 FTEs overall, PAC regulations require an additional 8.1 FTEs.

The timing and pace of regulatory change can additionally make compliance very challenging

to keep up with for LTC providers. Regulations change often, which can result in the duplication of compliance efforts and substantial time away from patient care. According to the AHA, as new or updated regulations are issued, facilities must quickly mobilize clinical and nonclinical resources to understand the regulations and communicate new processes throughout a facility.

Complying with federal regulations

The post-acute care workforce continues to face significant regulatory burdens, exacerbated by post-pandemic staffing shortages. The industry is in critical need of practical considerations to improve patient care and safety in LTC facilities while meeting regulatory requirements.

The Nursing Facility Industry Compliance Program Guidance (ICPG) is a source of

compliance program guidance for nursing facilities from the U.S. Department of Health and Human Services (HHS) and the Office of Inspector General (OIG). In the Nursing Facility ICPG, OIG has paid special attention to four risk areas. Within each risk area, the OIG explains the relevance of the topic, cites the requirements of participation (RoP) or other applicable laws that relate, and provides recommendations for mitigating those risks.

The four risk areas are Quality of Care and Quality of Life, Medicare and Medicaid Billing Requirements, Federal AntiKickback Statute, and Other Risk Areas. The resource identifies methods that nursing facilities can use to reduce fraud, waste, substandard care, etc.

The purpose of the ICPG compliance guidelines is to help nursing facilities identify their risks and implement an effective compliance and quality program to reduce those risks. The guidelines are voluntary and non-binding, meaning they do not represent a regulatory requirement but instead are intended as a reference for building better compliance programs across the nation, according to the OIG. The guidelines are not one-size fits all and must be tailored to each postacute care facility’s unique needs.

The AHCA/NCAL recommends that long-term care facilities review the Nursing Facility ICPG with attention to risk areas that are relevant to their operations. AHCA is also working on additional educational training to support LTC facilities’ understanding and application of these guidelines.

US Access Board releases new standards for examination and procedure chairs

The Midmark 626 Barrier-Free® Examination Chair is the only chair to meet and exceed requirements

Exam room equipment can make a crucial difference. For clinics looking to improve patient access and caregiver safety, accessible healthcare environments are essential.

In September 2024, the US Access Board, which provides guidance for accessible design and standards for accessible medical diagnostic equipment (MDE), ruled that examination and procedure chairs should be compliant to a low seat height of 17 inches. However, the board says of the adjustableheight examination tables it reviewed, over 75% have a low height of 18-19 inches.

The new standards from the US Access Board were issued under the Americans with Disabilities Act (ADA). Some of the core requirements focus on the features that directly aid patients during the transfer onto and off of the exam equipment. For example, examination chairs must provide multiple height settings to help ensure an easy transfer for patients of all mobility levels as well as compliant transfer supports like the Midmark Patient Support Rails that are designed to provide patients with stability

while entering, exiting or repositioning on the exam chair.

According to August Boehnlein, associate marketing manager, Midmark Medical, these new standards place greater responsibility on the manufacturer as well as the distributors.

“Healthcare facilities rely on distributors and manufacturers for equipment guidance, so being knowledgeable about these new accessibility standards is essential,” he said. “Both manufacturers and distributors who understand these requirements are definitely better positioned to support clinics in selecting compliant equipment.”

Better patient care quality and inclusivity

For clinics, meeting these standards means enhancing patient care quality and inclusivity. Caregivers can improve the overall patient experience by investing in compliant equipment. They can also reduce the risk of injury during patient transfers and potentially avoid future legal liabilities, according to Boehnlein.

“The Department of Justice is enforcing the 2017 Access

Board Standards, requiring a 17-inch to 19-inch low transfer height range. However, the Department of Justice is considering adopting the 17-inch low seat height in the near future,” he said. “Clinics have a bit of a grace period but are encouraged to start updating their equipment as soon as possible. When purchasing, they should consider the life of their equipment and the changing regulatory landscape.”

Boehnlein encourages clinics to partner with informed manufacturers and distributors who understand these new standards.

Today, the Midmark 626 Barrier-Free ® Examination Chair is the only chair on the market that meets and exceeds the 2024 US Access Board low seat requirement. 1 It has a wide adjustability range from 15-and-a-half inches to 37 inches in height that allows for a comfortable and safe experience for patients and a more ergonomic height for caregivers.

“The design of the 626 is a prime example of how Midmark anticipates regulatory changes in the market and continues to focus on accessibility and safety needs of the patients,” Boehnlein said.

SOURCE: 1 US Access Board. (2024, July 25). Standards for accessible medical diagnostic equipment. Federal Register, 89(143), 47823-47839. https://www.federalregister.gov/documents/2024/07/25/2024-16266/standards-for-accessible-medical-diagnostic-equipment

Trigger Warning

Proper infection control practices by healthcare providers are critical to reduce the risk of sepsis.

 Any type of infection can lead to sepsis, a life-threating emergency related to the body’s extreme response to infection, according to the Centers for Disease Control (CDC). Without timely treatment, sepsis can quickly lead to tissue damage, organ failure, and death.

Each year, at least 1.7 million adults in America develop sepsis, according to the CDC. Bacterial infections cause most cases of sepsis; however, sepsis can also be the result of viral infections such as COVID-19 or influenza.

“Any infection, from the tiniest source (a bug bite, a hangnail, etc.) to the more severe (pneumonia, meningitis, and more), can trigger sepsis, which can lead to severe sepsis and septic shock,” said Thomas Heymann, Sepsis Alliance President and CEO.

“The infection can be bacterial, viral, fungal, or parasitic.”

Infants and the elderly have the highest risk of developing sepsis, as well as patients that are immunocompromised or have a chronic illness. Most cases of sepsis begin before a patient goes to the hospital, according to the CDC, and at least 350,000 adults in the U.S. who develop sepsis die during hospitalization or are discharged to hospice.

Recognizing sepsis

Sepsis Alliance works across the nation to save lives and reduce suffering from sepsis by providing healthcare professionals, lawmakers, and the public with education and support on sepsis.

Recognizing the warning signs of sepsis can get patients

to much-needed emergency care faster, according to Sepsis Alliance. Symptoms of sepsis, according to the CDC, include clammy or sweaty skin, confusion or disorientation, extreme pain or discomfort, fever, high heart rate or weak pulse, and shortness of breath.

“Sepsis Alliance uses the acronym ‘It’s About TIME™’ when referring to the symptoms of sepsis, which include T- Temperature higher than normal, I- infection, M- mental status decline, and E- extremely ill, shortness of breath,” said Heymann. “Sepsis is a medical emergency. It should be treated as

quickly and efficiently as possible as soon as it has been identified.”

Effective sepsis treatment in a healthcare setting includes the use of antibiotics, IV fluids, maintaining blood flow to organs, and other medications, according to Sepsis Alliance. Healthcare professionals will monitor a patient closely following a hospital admission for sepsis, carefully tracking vital signs and reassessing patient status.

Sepsis is an inflammatory response to infection, while septic shock is the most severe and life-threatening complication of sepsis. Patients with septic shock have very low blood pressure that

cannot be easily corrected, often leading to multiple organ failure.

A significant number of people that receive sepsis treatment may still die in spite of it. “If sepsis is discovered and treated before it becomes septic shock, the mortality rate ranges from roughly 10% to 15%, nationwide, with striking exceptions on either side of that range,” said Dr. Steven Simpson, the Board Chair of Sepsis Alliance. “Some hospitals have driven mortality below 5%, and some remain above 20%. Septic shock is similar. Overall septic shock mortality remains roughly 40%, nationwide, while truly excellent hospitals have their mortality rates down to the upper teens.”

Hospital lengths of stay for sepsis vary on how ill a patient is when treatment begins. For those who do survive a sepsis hospitalization, said Dr. Simpson, about “75% will be left with chronic physical, psychological, or cognitive impairment.”

“Treatment for sepsis includes rapid administration of antibiotics and fluids,” said Heymann. “The risk of death from sepsis increases by an average of up to 7.6% with every hour that passes before treatment begins, which is why it’s so important for the public and healthcare professionals to recognize its symptoms.”

Sepsis Prevention

There are steps that can be taken to prevent infections leading to sepsis, including infection prevention awareness, practicing good hygiene, and understanding the signs and symptoms of sepsis.

Prevention of infections includes addressing chronic conditions and getting recommended vaccinations to reduce the severity of certain infections; keeping hands

clean and wounds covered; and knowing the signs and symptoms of sepsis, according to the CDC.

“Sepsis Alliance stands behind the principle that ‘Infection prevention is sepsis prevention™!’,” said Heymann. “The only way to prevent sepsis is by preventing infections in the first place. That can be through vaccinations, good hygiene, proper care and treatment of wounds, hand washing, and antimicrobials as needed.”

“Most hospitals have plans in place to prevent hospital acquired infections to the extent that they can – to prevent sepsis,” said Dr. Simpson. “The best hospitals participate in continuous quality improvement to prevent infection in the patients they treat, and many of them participate in the CDC’s Nation Health Safety Network, reporting their rates of nosocomial (hospital acquired) infection and implementing strategies to drive them down.”

The future of sepsis prevention

The Centers for Medicare and Medicaid Services (CMS) designs Hospital Quality Initiatives (HQI) to assure delivery of quality health care for institutions. CMS defines sepsis for adults 18 years and older as having a source of infection plus two or more systemic inflammatory response syndrome criteria (SIRS), (based on temperature, respiratory rate, white blood cell count, etc.).

Infection control for admitted sepsis patients is crucially important to their recovery.

“CMS considers certain infections to be 100% preventable and provides financial incentives on both the positive side (no infections) and the negative side (too

many infections) to encourage hospitals to drive down infection rates,” said Dr. Simpson. “Such conditions include post-surgery, catheter-associated central line infections, catheter-associated urinary tract infections, ventilatorassociated pneumonia, and Clostridium difficile infections.”

Infection control within healthcare settings includes proper physician education, disease tracking, multi-professional expertise, and more. According to the CDC, the development of a multi-disciplinary hospital sepsis program is critical to improving outcomes for sepsis patients.

“What we do as healthcare providers is to be vigilant, know that infections can occur, and intervene appropriately when they do – before the infection has a chance to evolve into the organ dysfunction that defines sepsis,” said Dr. Simpson.

Sepsis Alliance believes in educating the public about the signs and symptoms of sepsis, so they know to seek emergency care quickly, as, according to Sepsis Alliance, mortality for sepsis increases by 4-9% for every hour that treatment is delayed.

The organization also educates healthcare professionals to better diagnose and treat sepsis and care for sepsis survivors; and works in government to pass legislation around sepsis, infection prevention, and antimicrobial resistance.

“Sepsis Alliance is striving toward a more sepsis-safe world,” said Heymann. “We will save lives and limbs with our awareness efforts. Sepsis is a complicated, multi-faceted condition, as is our plan of attack for creating a more sepsis-safe world.”

ACOs and National Healthcare Savings

Ochsner Accountable Care Network achieves top-ranking healthcare savings for Medicare.

By Jenna Hughes

 The Centers for Medicare and Medicaid Services (CMS) announced data from the 2023 Medicare Shared Savings Program (MSSP) for accountable care organizations (ACOs), with Ochsner Accountable Care Network (OACN) achieving top-ranking results for clinical performance and healthcare savings for the Medicare population.

The CMS Medicare Shared Savings Program aims to save Medicare money while simultaneously supporting high-quality healthcare access throughout the nation. The program yielded more than $2.1 billion in healthcare savings in 2023, according to CMS, which is the largest in the program’s history.

According to the 2023 MSSP report, OACN’s participating physicians and advanced practice providers lowered the expected cost of care by $30.9 million for the more than 58,000 Medicare beneficiaries in its care.

“OACN has successfully reduced the expected cost of care for Medicare beneficiaries in 2023 through a strategic combination of care coordination, technology, and preventive care,” said Eric Gallagher, CEO, Ochsner Health Network. “Key to this achievement is the seamless integration of care coordination across our network, which ensures that healthcare providers work collaboratively to manage patients’ health needs efficiently. This

reduces unnecessary procedures and hospital admissions, leading to significant cost savings.”

Despite serving a patient population with significant health disparities, OACN has made many improvements in ACO preventative care, such as increasing annual wellness visits by 37% from 2022, achieving among the top 9% of ACOs in hypertension control and screening for depression and follow-up plans, and nearly 87% of patients received appropriate breast cancer screenings.

ACOs and cost savings

Accountable Care Organizations are groups of doctors, hospitals, and other healthcare providers that collaborate to provide coordinated, high-quality care to people with Medicare, according to CMS. ACOs focus on delivering proper, whole-person care at the right time to avoid unnecessary services and medical errors that often lead to higher healthcare costs.

When ACOs succeed in the delivery of high-quality care at an affordable cost, they may be eligible to share in the savings they achieve for the Medicare Program. ACOs may also share in losses if they increase spending, according to CMS, driving lower health care costs for people with Medicare.

“Accountable Care Organizations (ACOs), like OACN, play a pivotal role in enhancing healthcare delivery while significantly reducing costs nationwide,” said Gallagher. “ACOs bring together groups of physicians, hospitals, and other care providers to ensure that patients, particularly those with Medicare, receive well-coordinated,

high-quality care. This collaboration minimizes redundancies and ensures seamless communication among healthcare providers, which leads to more efficient and effective patient care.”

CMS specifically strives to improve preventative care services through ACOs by advancing the integration of technology in healthcare, emphasizing valuebased care, streamlining processes, and enhancing communication between healthcare providers.

“Technology integration enables ACOs to perform more precise and effective care coordination, improving health outcomes while reducing costs,” said Gallagher. “Emphasizing valuebased care improves the health of beneficiaries and also contributes to cost savings, making healthcare more affordable and sustainable.”

Rural healthcare initiatives

Delivering quality healthcare to rural populations can be especially challenging due to regional lack of access to healthcare. Far distances within these communities from clinicians’ offices and hospitals and lack of infrastructure pose greater health risks to populations in rural regions. Technology advancements within healthcare have significantly helped ACOs bridge these types of care gaps and provide much-needed patient care in remote areas.

“Through the strategic use of technology, ACOs bridge geographical gaps, enabling healthcare providers to reach rural patients more effectively,” said Dr. Sidney “Beau” Raymond, Ochsner Health Network.

“Advanced data-sharing capabilities empower clinicians with the information they need to make

timely and informed healthcare decisions, which is crucial in areas where resources may be limited.

In addition to technology, collaboration between clinicians is also a key component to providing coordinated healthcare to rural populations.

“By working closely with local healthcare providers, ACOs ensure that care plans are tailored to meet the specific needs of rural communities,” said Dr. Raymond. “This collaboration fosters relationships built on trust and understanding, which are essential for effective healthcare delivery.”

who provide care to nearly 11 million people with Medicare.

CMS continues to support Shared Savings Program ACOs in increasing investment in primary care services. The 2023 CMS report specifically showed that out of 453 accountable care organizations nationwide, Ochsner Accountable Care Network ranks in the top 11% for quality.

“OACN is dedicated to continuing to develop healthcare plans that meet the unique needs of each community we serve. By closely collaborating with local clinicians, we ensure that our initiatives are

“ Through the strategic use of technology, ACOs bridge geographical gaps, enabling healthcare providers to reach rural patients more effectively.”

Attributed beneficiaries can also utilize the Connected Care programs through Ochsner, according to Dr. Raymond, which allow for remote patient management of chronic conditions such as hypertension and diabetes no matter where a patient lives.

Future of ACOs

From performance year (PY) 2022 to PY 2023, ACOs’ nationwide performance improved on many quality measures overall, according to CMS, including statistically significant improvement on data related to diabetes, blood pressure control, breast and colorectal cancer screening, and more.

The Shared Savings Program has now grown into one of the largest value-based payment programs in the country, with 480 Shared Savings Program ACOs, including more 608,000 clinicians

not only effective but also resonate with the specific health challenges of each region,” said Dr. Raymond “Through these goals, OACN aspires to lead the charge in innovative healthcare, fostering healthier communities and setting new standards in accountable care.”

The network’s clinical successes, according to a 2024 Ochsner press release, can be attributed to ensuring appropriate care coordination; increasing primary care visits; focusing on high-risk patient care coordination and support; and improving patient satisfaction.

“Looking ahead, OACN aims to deepen its focus on health equity by addressing disparities across diverse communities,” said Dr. Raymond. “By deploying tailored healthcare solutions, we strive to close the gap in healthcare access and outcomes for all patients.”

An Entrepreneurial Spirit in Supply Chain

Yes, healthcare, supply chain can generate income and revenue.

By R. Dana Barlow

Editor’s note: The following article originally appeared in the December 2024 issue of The Journal of Healthcare Contracting.

 Outside of the healthcare provider organization market segment, companies generally regard the supply chain with a modicum of respect for managing assets used in the manufacture and sale of products. This links the supply chain in most other market segments directly to the top-line revenue stream as well as to the bottom-line expense stream.

Supply chain within the healthcare provider organization market segment, however, typically fails to experience similar benefits and rapport.

Supply chain as a department and function may serve as specialists in strategic sourcing, product and service evaluation, contracting, purchasing, logistics, distribution and process facilitation – all of which typically fall on the expenditure side of the budget. But a growing number of entrepreneurial supply chain teams also are creating, developing, launching and sharing revenue-generating processes and products to promote and reinforce additional

value to their provider organization and to others. These teams not only work to control costs but also to generate income.

Some of these entrepreneurial provider-based supply chain teams have launched a bevy of revenue-generating enterprises to help their own operations and processes as well as those of affiliated facilities and provider customers. The menu can include running consolidated/shared service centers where they sell supply chain services such as contracting, distribution, inventory management, laundry and sterile processing to affiliate facilities; group purchasing services for bulk and cooperative buying; softwarebased products that facilitate ordering, tracking and tracing, management consulting and process facilitation; mechanical products for materials handling and stocking; or even investing in domestic manufacturing ventures for backorder- and stockoutsusceptible personal protective equipment (PPE), intravenous fluids and other relevant products.

Among this burgeoning group of supply chain-emerging income incubators, several shared

their experiences with the Journal of Healthcare Contracting, not only highlighting what they did and why, but also explaining what motivated them to do it, the entrepreneurial spirit necessary and how to sell supply chain-generated income ventures to a C-suite that may expect them to stay in their original lane to control costs.

MultiCare Health

The Tacoma, Washington-based integrated delivery network (IDN) foresees tremendous growth and opportunity in harnessing business intelligence and digital expansion, according to Jason Moulding, Chief Supply Chain Officer (CSCO).

“Our Supply Chain division has been heavily investing in business intelligence and insights for the past several years,” Moulding told JHC. “We embarked on our digital transformation journey back in late 2019 just before COVID-19 which was very fortunate, as we had a foundation to quickly build dashboards for inventory management when days on hand became an important ratio. Now our Supply Chain Resource Analytics team

has grown significantly and the amount of disparate data that we can collect and ‘paint a picture’ with has improved financial, clinical and operational efficiencies. This is an area of our supply chain that we’re going to continually invest in as I believe it’s our competitive advantage and value that we bring to our organization and our customers.”

WHAT THEY DID:

An internal supply chain team created a suite of software products to help clinicians and administrators more effectively and efficiently manage operations.

“One of the major functions within MultiCare’s Supply Chain Management is our Innovation and Application Development team,” said Matthew Palcich, system director, Resource Analytics. “Over the last couple of years, we have partnered internally with stakeholders and subject matter experts to develop multiple offerings leveraging a combination of reporting expertise and low-code application development.” Palcich listed some of the key areas of development as in:

` Procedural Analytics Intelligence – a dynamic and flexible data eco system leveraged to compare physician cost per case, reimbursement and quality metrics to drive improvement across the full spectrum of procedural areas.

` Substitute Item Database –integrated workflow, approval and data capture of substitute activity leveraged to enable speed to execution and data enrichment for operational teams.

` Savings /Initiative Tracker –Single source of truth for all savings initiatives and results that

Jason Moulding

Matthew Palcich

is linked to data sources, intuitive user experience for data entry, and transparent results for value-based reporting to senior leadership.

` Demand Planning Suite – a highly integrated application focused on identifying lead time variation, demand signals and inventory availability that is quick to stand up targeted initiative-based reporting for supply shortages and visibility to run daily operations and senior leadership.

Because these products were developed internally by a dedicated team rather than relying on third-party vendors, MultiCare Health enjoyed a number of benefits through their methodology, according to Naresh Thapa, assistant vice president, Supply Chain Strategy & Integration.

“This helped us quickly pivot to and align with our own organizational need and strategy around analytics,” Thapa indicated.

“Having a dedicated team allowed us to conduct internal assessments and gather feedback from our stakeholders. This also led us to identify areas where tailored solutions could drive significant improvements. Our in-house solutions have a greater return on investment compared to purchasing external ones.

Strategic foresight aided in recruiting team members, Thapa noted. “When you have a good strategy and vision of where you want to be, hiring the right talent becomes bit easier,” he said.

“We recruited individuals, both internally and externally, with the right mix of technical skills and having operational experience. The products that we developed have proven to be successful

within our organization. Once we got good traction internally, we started pitching these to our colleagues in the community. We are already engaged with other healthcare systems in implementing the products that we have devoted.”

MultiCare also launched Myriadd Supply Network as a businessto-business, nonprofit venture that offers aggregation for contracting and distribution, non-labor expense management and operations improvement consulting, led by Moulding as president.

“Myriadd plays a crucial role in driving revenue for our organization,” Thapa said. “The Myriadd Supply Network generates additional revenue through our aggregation group by collecting administrative fees and reducing supply expenses. Myriadd Strategies focuses on optimizing supply chain processes and integrating advanced analytics. This helps enhance efficiency, reduce costs, and improve operations, leading to significant savings.” Myriadd works with Vizient as its aggregation solutions and GPO partner in the venture.

MOTIVATION: At first, internal satisfaction and success drove

innovation, followed quickly by the desire to share expertise.

“We have been intentionally investing in our analytics division within Supply Chain,” Palcich said. “Our ambition to become the preferred vendor of choice for health systems significantly influenced our strategic decision to prioritize analytics and application development as core competencies. As we observed substantial internal improvements and cost efficiencies in the last three years, it became evident that other health systems could also benefit from the applications we developed and continue to make it better. Consequently, expanding our approach externally was a natural progression in our journey towards continuous improvement and optimization.”

Being a provider gave them a leg up, according to Thapa. “Our value proposition lies in our unique position as healthcare providers addressing healthcarerelated challenges,” he noted. “Our competitive advantage comes from our direct experience in solving these issues firsthand. My goal is to turn this division into a revenue center. Investing in innovative

Naresh Thapa

Doug Bowen

solutions can lead to long-term savings and efficiencies.”

MultiCare works with four other healthcare systems, according to Thapa, with the proceeds reinvested in the organization.

C-SUITE EXPOSURE: COVID-19 certainly elevated Supply Chain’s recognition within MultiCare, Thapa observed. “The importance of Supply Chain has been significantly recognized in the wake of the global pandemic. The focus has shifted from merely reducing supply costs to creating value across the entire system,” he said. “To enhance visibility at the C-suite level, it’s crucial to demonstrate ROI by highlighting strategic value. This involves identifying new revenue streams and future-proofing the organization by staying ahead of technological advancements and trends. While our work has traditionally centered on cost reduction, developing problemsolving tools that also generate revenue effectively lowers the Supply Chain’s cost to serve the organization, paving a new path for cost reduction.”

Banner Health

The Phoenix-based IDN sought to control its own destiny by setting up its own regional GPO, called Supply Chain Value Network, that it operates with its consolidated service center that has been active for two decades running, according to Doug Bowen, senior vice president, Supply Chain Services.

WHAT THEY DID: Banner developed and grew SCVN organically – first internally before expanding outward to affiliate providers.

“SCVN allows Banner to offer contracts and all supply chain service offerings to selected independent healthcare sites,” Bowen noted. “These partnerships create supply chain synergies to improve Supply Chain operations across all enterprises and throughout the continuum of care. Since 2017, SCVN has been a huge success and has created significant incremental value to the supply chain for both Banner and the other participants.”

MOTIVATION:

Bowen’s team viewed this as something atypical and different for supply chain. “We saw this as an opportunity to bring in revenue that would help us fund supply chain improvements, move us in the direction of being a revenue generating department, reduce the impact of inflation and create incremental value,” he said. “We have marketed the program mainly to those facilities that were already Banner affiliates through our national GPO where we can identify additional value through our SCVN contracts. In addition to that we have marketed to some organizations outside of Banner where we have relationships within that organization.”

C-SUITE EXPOSURE: Running the CSC for 20 years certainly helped. “For us it was an easy sell as we utilized our existing resources to work on the SCVN GPO contracts so there were no incremental costs – just new revenue in the form of incremental administrative fees,” Bowen said. “We have now added one resource to handle the management of the sales reports and administrative fee reconciliation.”

Cleveland Clinic

The Cleveland-based IDN concentrates on clinician, physician and surgeon involvement to the point that the philosophy remains ingrained, according to Steve Downey, Chief Supply Chain and Patient Support Services Officer, Supply Chain Services.

WHAT THEY DID: Supply Chain

formed an operational link between the professions and a joint venture offering supply chain services.

“Cleveland Clinic spent significant effort getting physician alignment with supply chain,” Downey said. “We developed our medical director model, created new ways to partner and drove best practices. [See “Physician/Surgeon-Supply Chain Relations Fueled by Circle of Trust,” September 2024 JHC] That then led us to form Excelerate, a joint venture with Ohio Health, Cleveland Clinic and Vizient, to serve as a clinically driven supply solution for health systems. It leverages the supply alignment and selection practices that Cleveland [Clinic] and other top hospitals have used to narrow their supply formulary in the hardest-to-manage category of physician-preferred items (PPI). There are now dozens of hospitals using the program saving millions in value. Suppliers appreciate the program because it drives compliance to their products when on formulary.”

Revenue generated by Excelerate is funneled back into the organization. “Funds from the program cover the costs of employees serving it, such as sourcing,” Downey assured. “There are clinicians supporting Excelerate, including from member hospitals.”

Downey cautioned against viewing what Excelerate offers as

a “canned” program that could be applied elsewhere because of the customized nature of its solutions for clients. “The strength isn’t a packaged program to implement, but our clinicians and supply chain teams helping member hospitals create whatever specific structure works for them, then partnering with them on supply decisions,” he clarified. “As the products are vetted by the clinical teams, those clinicians then become available to others to understand the decision criteria. Then the program helps leverage the purchasing at scale, across the collection of committed members.”

At press time in October, Michelle Clouse, executive director, Excelerate Clinical Partnerships, quantified their current membership reach at 229 hospitals and rising. “I believe the biggest value that we bring is understanding – as a provider ourselves – the benefits we realize throughout the organization by having a clinically aligned supply chain,” she told JHC. “Because we’ve been through it, we can talk with members about their journey and meet them where they are to support them along the way.”

MOTIVATION: In short, they saw a gap. “It was a real need, driving standardization for quality, operational and financial reasons,” Downey insisted. “The team then assessed the market and saw that no one was doing a clinicalaligned, health system-operated GPO model. It takes patience though; many programs take years to come to maturity.”

Downey acknowledged that many organizations already may have implemented their version of a clinically aligned supply chain. “But building it as a service for others, and then growing and leveraging that size and scale to a point where it generates value for the membership is the long part,” he added.

C-SUITE EXPOSURE: The

C-suite looked for results.

“The new solution should have enough revenue potential and be worth the time and effort required,” Downey noted. “Executives also look for ways to help fellow health systems, and having a solution that proved effective at yours and being able to help someone else with that program generates

collective value. The team also needs a track record of success –start small and build up the reputation of execution and ability.”

Bon Secours Mercy Health

Senior executives at the Cincinnati-based IDN recognized that the organization’s supply chain operation needed to progress to the next level, according to Dan Hurry, CSCO, Bon Secours Mercy Health, and president, Advantus Health Partners.

WHAT THEY DID: Hurry convinced the C-suite that in the name of simplicity the next step in the organization’s development was to extract its supply chain operation and spin it off.

“We took the supply chain entity within the ministry moved it into an independent organization, a company that we set up called Advantus Health Partners,” Hurry noted. Advantus offers a cornucopia of supply chain services, including clinical engineering and healthcare technology management in partnership with GE Healthcare, as well as dietary, environmental services and patient transport services to

Dan Hurry

Michelle Clouse

Steve Downey

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LEADERSHIP SKILLS

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HMMC is commited to help all members continue to develop their skills which will allow them to succeed.

“HMMC provides unique oppor tunities that allow me to strengthen my professional net work and industr y knowledge, while bringing valuable insights to assist in my day-to - day career ”

Bon Secours Mercy and other Advantus members. Against the backdrop of the pandemicrelated supply shortages and to support domestic production, they also invested in Emerge Manufacturing, a local firm that makes a variety of in-demand medical products.

Advantus works with more than 120 other acute care facilities and more than 1,000 non-acute care facilities outside of the Bon Secours Mercy network, according to Hurry.

model and capabilities in real time with real results. Advantus debuted in 2021.

“The reason we did it was really twofold. One, we wanted to [demonstrate] a continuous effort to optimize the supply chain model for the ministry while also offering to the marketplace the ability to bolt on to what we’re doing in the ministry for those who maybe could use some support. We also saw it as an opportunity to convert it into a revenue-generating entity

“Whether we like it or not in the healthcare industry, supply chain always seems to be considered a secondary or tertiary role. So, you need to prove that you’re different and you need to do it through credible results.”

MOTIVATION: The organization itself planted the seed as far back as 2016 because they “felt the need to find innovation within their supply chain model and wanted to go atrisk and find somebody that was a change agent, so they recruited me,” Hurry recalled. He shared a vision and strategy and achieved some incremental wins during the next several years that built credibility and generated trust with proven results even before Bon Secours merged with Mercy Health.

When the pandemic emerged in early 2020, Hurry admitted that he and his team faced some brief trepidation and hesitation about launching Advantus. “Some asked, ‘Should we wait?’ and I absolutely said, ‘No way,’” he recalled. Hurry felt the global crisis would demonstrate their

back to the ministry. So, it works hand-in-hand with generating continuous value for others while leveraging the expertise we have in place. The business model is rather simple.”

Hurry’s motivation for Advantus is the desire to keep supply chain simple by offering a menu of services. “How do we keep it easy? How do we make it most effective for others without complicating it?” he noted. “We do have some traditional things that are as simple as plugand-play with the agreements or contracts or partnerships we have in the marketplace. But the biggest thing that we bring forward that we believe is a differentiator is the services that we provide. We can be an available outsourced entity where we come in and run a supply chain for somebody, we could be the

leadership for a supply chain at an organization or we can even provide micromanagement solutions, whether it involves surgical navigation, which in short form is resources that we apply to the surgical suite (for the OR or cath lab) to help optimize a supply chain within that area or it involved clinical resource project managers that cover a broad array of clinical products.

“We’ll also interface with people in the C-suite all the way to those that might be at a dock to help support, throughput, opportunities, initiatives and everything in between, or we can just come in and help people assess where they are, maybe on their journey within their own supply chain optimization, and show where can we help them maybe either augment what they’re doing, accelerate what they’re doing or bring new insights that they may not have seen already,” he added.

C-SUITE EXPOSURE: Supply chain’s influence and success is built on results produced, according to Hurry. “Whether we like it or not in the healthcare industry, supply chain always seems to be considered a secondary or tertiary role,” he indicated. “So, you need to prove that you’re different and you need to do it through credible results. I’ve seen a lot of people just mimic others and say, ‘Well, they’re doing it over there.’ You need to figure out the solution within your own walls, the culture of your own organization, the politics that come within the walls of any organization, but diligence, perseverance and results are always going to win.”

IDN Insights News

AdventHealth launches new Acute Care-at Home Program

AdventHealth has agreed to collaborate with Biofourmis, a global technology-enabled care delivery company on a continuum-wide remote patient management (RPM) program in Central Florida to provide safe, whole-person care and a superior patient experience within their homes.

As part of the agreement, Biofourmis will help AdventHealth expand whole-person care into the home with the AdventHealth Hospital at Home program where the Biofourmis platform and remote clinical care team will support inpatient-level care for patients at home. Biofourmis’ enterprise platform enables complex, personalized, holistic care at home through market-leading capabilities such as continuous monitoring and FDAcleared AI algorithms, which will support AdventHealth in delivering and scaling its care at home strategy while ensuring an outstanding care experience. The program will launch at AdventHealth Winter Park.

AdventHealth is looking to standardize the patient experience by also offering post-acute RPM to keep patients engaged in their health with a seamless patient experience across hospital at home and after discharge remote patient management for continuity of care.

Capstone Health Alliance announces leadership changes

Capstone Health Alliance announced significant leadership changes aimed at driving growth and enhancing service for its Members. Tim Bugg, owner of Capstone, will continue in his role as CEO, while Yolandi Myers has been promoted to President & Chief Administrative Officer of Capstone Health Alliance. Additionally, Jeff Lawing will be joining the leadership team as Chief Customer Officer.

Capstone Health Alliance has established key partnerships with top-tier suppliers and healthcare providers, providing its Members with substantial cost savings and value through its core foundations of Aggregation, Education, Collaboration, and Communication.

Yolandi Myers joined Capstone in 2021 and has demonstrated remarkable capacity in driving strategic engagements and expanding Capstone’s reach, and fostering collaboration across industry partners. With two decades of operational experience in the healthcare GPO sector, Myers has led diverse cross functional teams and has established proven successful partnerships throughout the industry to deliver tailored solutions across the healthcare business spectrum.

Columbus Regional Health becomes Cleveland Clinic Connected Member

Columbus Regional Health will join the Cleveland Clinic Connected program, which provides members with access to this world-class healthcare institution’s wealth of knowledge to enhance patient experience and care, safety, and outcomes. The goal of the Cleveland Clinic Connected program is to build a global network of independent, like-minded, qualityfocused organizations that have a positive impact on patient care around the world. Columbus Regional Health is pleased to join the program as one of two initial members in the United States and the only Indiana health system to be a part of the Cleveland Clinic Connected program.

As a Cleveland Clinic Connected member, CRH will enhance the quality of their service lines, program and initiative work, improve patient care and experience, and support its workforce members, providers, and physicians. CRH clinicians will be able to access educational opportunities either at Cleveland Clinic or through distance learning, as well as best practices and protocols that are used at Cleveland Clinic locations worldwide.

Cervical Health Awareness

Why vaccination and regular screening are critical for prevention of cervical disease.

 Each year, more than 13,000 women are diagnosed with cervical cancer in the U.S., according to the American Cancer Society. Cervical cancer, however, is a largely preventable disease. Awareness of the disease and its causes are crucial for its prevention, and through routine screening and youth vaccination, it has the potential to be treated early.

The cervix is in the lower part of the uterus and plays a key role in reproductive health. Early cervical cancer usually doesn’t present any symptoms, which makes it hard to detect, according to the National Cancer Institute. Symptoms of cervical cancer often begin once the cancer has spread to other parts of the body. Early-onset symptoms of cervical cancer include abnormal vaginal bleeding, longer menstrual periods, bleeding between periods, pelvic pain, and more.

“Symptoms aren’t always a good way to gauge if someone may have cervical cancer, as the symptoms typically associated with the disease can also occur with other conditions and diseases,” said Fred Wyand, director of Communications of the American Sexual Health Association/National Cervical Cancer Coalition (NCCC). “Also, an early cervical cancer may not have any obvious signs or symptoms, which may show up only as the disease progresses.”

Advanced cervical cancer symptoms, according to the National Cancer Institute, include dull backache, pain in the abdomen, painful urination, and difficult and painful bowel movements and bleeding from the rectum. For disease prevention, it is encouraged by the National Cancer Institute that women (and individuals that have a cervix) follow up-to-date cervical cancer screening recommendations.

Screening for prevention

The goal of screening for cervical cancer is to find potential precancerous cervical cell changes early, when treatment can prevent cancer from spreading, according to the American Cancer Society. Cervical pre-cancers are diagnosed far more often than invasive cervical cancer.

Cervical cancer incidence rates decreased by more than half from the mid-1970s to the mid2000s, largely due to increased disease screening rates, and these rates have stabilized over the past decade, according to the American Cancer Society. In contrast, rates declined by nearly 11% each year from 2012-2019 for women

ages 20-24, most likely a reflection of the first signs of cancer prevention from Human Papilloma Virus (HPV) vaccination.

“Regular screening for cervical cancer with an HPV test and/ or a Pap test is highly effective when done regularly at appropriate intervals,” said Wyand. “This might involve a Pap test every three years or an HPV test either alone or as a co-test with a Pap every five years.”

Women ages 21 through 65 should receive regular cervical cancer screening, or a Pap smear, every three years during a routine gynecologist visit, according to the National Cancer Institute. A Pap smear looks for changes in the cervix that may, in rare cases, lead to cancer. Pap smears also monitor whether a person’s cells have changed in size or shape, and determines how quickly they are growing. If a test registers change, it is possible that it is caused by HPV.

Finding cervical changes early means receiving the care needed to make sure the abnormal cells don’t become a further health issue. For women ages 30 and over, an HPV test is also recommended in addition to a Pap smear, according to the National Cancer Institute. HPV tests can pick up on many of the high-risk types of HPV that are commonly found associated with cervical cancer.

“As our understanding of cervical cancer has increased, so has the technology used to screen for and detect the disease (and the underlying HPV infections that cause it),” said Wyand. “As technology and our knowledge base evolve, the need to screen annually decreased, and now, most

patients are generally checked every 3-5 years.”

It can, in fact, be harmful to screen too often. Over-screening can result in “needless referrals to biopsies for women who have HPV infections or even minor, early cell changes that are all likely to clear spontaneously,” said Wyand.

according to the Centers for Disease Control and Prevention (CDC). In most cases, the virus is harmless and has no obvious symptoms, but certain high-risk types of HPV may lead to cancer.

“There are over 100 different types of human papillomavirus, or HPV,” said Wyand. “Some types of HPV can cause genital warts,

There are approximately 37,300 cases of HPV-related cancers each year in the United States including 11,100 cases of cervical cancer, according to NCCC.

If Pap-test results do show cell changes, it is referred to as cervical dysplasia (aka precancerous cell changes, abnormal cell changes, etc.). Just because a woman has cervical dysplasia does not always mean that she will get cervical cancer. Instead, this means that a woman’s healthcare provider will closely monitor the cervix, possibly treating, to prevent further cell changes that could become cancerous over time if left unchecked.

“If an individual experiences any symptoms that are concerning, they should be sure to talk with a healthcare provider,” said Wyand. “HPV vaccination is recommended for all genders through age 26 for prevention of the disease. The vaccine is more effective when given at younger ages and can be administered as early as age nine.”

The impact of HPV

Most cases of cervical cancer are associated with certain types of HPV. About 79 million people are estimated to have an active HPV infection at any given time,

and other types can cause cancer, including cancer of the cervix, vulva, vagina, penis or anus, as well as cancer in the back of the throat. The “high-risk” HPV types are linked to the development of cancer. The “low-risk” types that cause genital warts are almost never found with cancers.”

There are approximately 37,300 cases of HPV-related cancers each year in the United States including 11,100 cases of cervical cancer, according to NCCC. The CDC estimates that 90% of these cancers could be prevented with vaccination.

While HPV can cause disease, most HPV infections do not cause symptoms that are noticeable, so most people will never know they have the virus.

“With advancements in technology, medical professionals now have the ability to detect high-risk HPV types including very specifically the two oncogenic types –HPV 16 and HPV 18 – that combined are responsible for about 70% of cervical cancers globally,” said Wyand.

Recognizing Eating Disorders

The month of February recognizes Eating Disorder Awareness, shedding light on the signs, symptoms, and prevention of eating disorders.

 There are many misconceptions about eating disorders, such as that disordered eating is a lifestyle choice. Eating disorders, however, are serious illnesses associated with severe disturbances in an individual’s eating behaviors and related thoughts and emotions, according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD). People with eating disorders often become so preoccupied with food and their body weight that their daily life is significantly impacted.

Eating disorders affect people of all genders, ages, races, religions, ethnicities, sexual orientations, body shapes and weights. An estimated 9% (28.8 million) of the U.S. population will have an eating disorder in their lifetime, according to ANAD. Twenty-two percent of children and adolescents show disordered eating nationwide, according to The National Eating Disorders Association (NEDA). Despite stereotypes that eating disorders more commonly occur in women, nearly one in three people struggling with an eating disorder is male, according to NEDA.

“Eating disorders impact everything from quality of life, mental health, physical health and can even cause death. Eating disorders have the highest mortality rate of any mental disorder,” said Dr. Maria Rago, Clinical psychologist and ANAD president. “Malnutrition can cause dehydration and electrolyte imbalance, which affects every system in the human body from the heart to the kidneys to the GI system to the brain.”

Types of eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder (BED), body dysmorphic disorder (BDD), avoidant/restrictive food intake disorder (ARFID), pica, rumination disorder, and other specified feeding or eating disorder (OSFED), each with its own distinct symptoms and potential health impacts.

Health impacts

Emotional and behavioral symptoms of eating disorders include an individual exhibiting a preoccupation with weight loss, food, calories, and dieting, refusing to eat certain foods (often eliminating whole food groups), making excessive excuses to avoid meals or situations involving food, and extreme concern with body size and shape, according to NEDA. Physical symptoms include noticeable fluctuations in weight (both up and down), stomach cramps, dizziness upon standing, sleep problems, fainting, and more.

Eating disorders can quickly become life-threating when untreated, leading to medical complications impacting organ systems throughout the body, according to NEDA. The earlier a person seeks treatment, the greater the likelihood they recover physically and emotionally. For this reason, it is important that a patient’s primary care doctor acknowledges and recognizes the signs, symptoms, and health impacts of eating disorders.

“There are many myths that abound around eating disorders, and many people have difficulty being diagnosed because of them,” said Dr. Rago. “If a patient is not underweight, a physician may not understand that they can be at risk for medical complications of an eating disorder. Starvation at any weight can cause dehydration and electrolyte imbalance. Higher weight patients may not be recognized as having an eating disorder. Physicians should diagnose eating disorders not only on weight but also on behaviors, including an overweight BMI in a person eating very low calories or extremely high exercise levels.”

Common health consequences of eating disorders include cardiovascular issues, such as reduced resting metabolic rate, a result of the body’s attempts to conserve energy after long periods of nutrient restriction; gastrointestinal system impacts such as slowed digestion, leading to nausea and vomiting, blood sugar fluctuations, bacterial infections, and stomach pain; and neurological and endocrine issues such as lowered thyroid and sex hormones, according to NEDA.

development of associated behaviors in certain individuals.

Eating disorder prevention includes reducing an individual’s risk factors, such as working with a care team to reframe thoughts away from body dissatisfaction and basing one’s self-esteem on weight and shape, as well as strengthening ‘protective or resilience factors,’ such as selfcompassion and appreciation for the body’s functionality. Prevention also includes identifying individuals at risk of disordered

“ If a patient is not underweight, a physician may not understand that they can be at risk for medical complications of an eating disorder.”

“Seventy percent of people with eating disorder also suffer from other mental disorders, especially mood disorders, anxiety, PTSD, and obsessive-compulsive disorder. Being compassionate and non-judgmental in clinical settings means a lot to people with eating disorders,” said Dr. Rago. “Psychiatrists, cardiologists, nephrologists and GI doctors are all very important components of caring for people with eating disorders.”

Prevention of eating disorders

Shame, stigma, socioeconomic inequality, and societal misconceptions about the illness may impede the identification and treatment of individuals with eating disorders. Prevention for eating disorders includes planned attempts to change factors that may promote the

eating, according to ANAD, such as children with a parent with an eating disorder, children who have been abused, etc.

“Young people especially have always been very vulnerable to eating disorders, likely because they are trying to find a way to be accepted by their peers,” said Dr. Rago. “They are also developing their identities which can be a confusing time. During the Covid-19 pandemic, we saw a rise in adolescent eating disorder cases, as young people were isolated and could not attend their normal activities.”

“ANAD’s wish is for people with eating disorders to get compassionate help across the weight spectrum,” said Dr. Rago. “We also continue to encourage physicians to help patients find short-term and long-term goals to contribute to their patient’s eating disorder recovery.”

A Competitive Edge

How Henry Schein’s internship program helped Tanner Ledford start strong in a field sales role.

 Last March, more than 160 college students from 80-plus schools convened on Kennesaw State University’s campus for the National Collegiate Sales Competition (NCSC). The NCSC provides a venue for dedicated collegiate sales students to improve their skills and pursue career opportunities with top professional sales organizations.

One of those NCSC competitors was Kennesaw State’s Tanner Ledford, who was nearing graduation. He went into the competition for the experience, resume building, and the chance to meet with leading sales organizations who were attending the career fair. That’s where he met the Henry Schein Medical team, who offered him a unique sales internship.

Hands-on experience

Traditional internships have a reputation among college students as being confined to entry level, inside roles that involve hours of cold calling but no faceto-face meetings with customers. “That wasn’t something that really attracted me too much,” Ledford said.

But Henry Schein Medical offered an opportunity, for something different – an outside sales position with real world, hands-on experience. 2024 was the first field sales internship program for the Company’s medical business. “They gave me the opportunity to actually go out into the field, meet clients face-to-face, and manage my own book of business,” Ledford said. “The idea of being trusted

with my own accounts and having the autonomy to organize my own schedule and prioritize my own tasks was incredibly appealing to me.”

Ledford graduated from Kennesaw State University this past summer with a degree in marketing and a minor in statistical analysis. He immediately jumped into the internship with Henry Schein Medical under the guidance of Jim Dodgen, regional manager. After two weeks of company training, Dodgen began pairing Ledford with several field sales consultants. “I wanted Tanner to see all aspects of the business,” Dodgen said.

By shadowing the reps, Ledford could see first-hand how they managed their time and book of business. The reps showed Ledford their day-to-day routines, how they approached clients and how they conveyed Henry Schein’s value. He observed the support system utilized within the sales team and the resources used during customer visits or prep time. Some of the reps that Ledford shadowed had 20-30 years of experience in the field, but another rep – Justin Nixon – had one year of experience. “I learned a lot from Justin,” Ledford said. “He was able to relate to me a lot more because he was still new to the role, still learning himself.”

Tanner Ledford

Jim Dodgen

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Sometimes, the internship felt like drinking from a fire hose, especially in an industry as complex as health care. But Ledford said being able to learn from the field sales consultants before working on his own proved invaluable. Eventually, he was left to manage his time between customer visits and administrative work. “The biggest challenge reps have is learning how to manage the limited amount of time you have in the day,” Ledford said. “If you can learn how to manage your time successfully and effectively, it is the first step to being successful in a sales role. So being able to shadow Team Schein Members and learn how they do it and what’s worked for them for so long helped me learn how to stay organized and prioritize my tasks.”

Henry Schein’s culture exceeded Ledford’s expectations. “Every company, when they’re trying to hire you, they’re going to talk about how great their culture is; sometimes it’s true, and sometimes it’s not. But Henry Schein truly exceeded my expectations for culture at the company. They really want their sales team to have the support and the resources for long-term career growth. Seeing the size of Henry Schein’s tenured staff was a big indicator of how much the company values its people and how much the people value their company. That’s always going to be super attractive to someone looking for a full-time career.”

The perfect fit

Selling with Henry Schein Medical requires a lot of different skill sets; organizational

skills, time management, and data analytics, to name a few. Dodgen said that Ledford displayed those skill sets during the internship. “Tanner did a great job,” said Dodgen. “He’s one of the first interns I believe that actually received a customer buy list, which is our biggest win in the field – who they’re buying from, what they’re paying and what they’re buying – so that we can do a data analysis and hopefully present them with a solution to have them come over to Henry Schein. Tanner picked that up on his fifth or sixth week in the field while cold calling. He did a great job of learning the various systems.”

Although Dodgen did not have an opening in his territory when Ledford completed his internship, he knew Claire Porter, a regional manager in Nashville, did. He called her to recommend Ledford for the position. With his internship experience and understanding of

Henry Schein Medical’s systems and value proposition, Ledford got the job and is now a fulltime field sales consultant in the Nashville area.

Coming out of college and moving four hours away to a new city where you don’t know anybody and you’re starting a new role could have been intimidating for Ledford, but he said the internship helped him feel ready. “I was excited and packed my bags early,” he said. “I knew that I had what it takes to be successful in the role because I’d been doing it for 10 weeks previously. I had no doubt in my mind that this is where I wanted to work, so much so that I put off interviews with other companies even before I got the job here in Nashville because this is the one I wanted to have. The company is great, the culture is great, and the job itself is great, and so there was no hesitation on my end moving to a new city and starting this role.”

(Left to right) Justin Nixon, Tanner Ledford and Jim Dodgen.

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Industry News

Midmark announces new continuing education course

Midmark Corp. announced its new continuing medical education course, “Better BP Measurement for Improved Patient Outcomes.”

Hypertension affects many Americans and is known as the “silent killer,” because symptoms are not always present. Therefore, patients and their healthcare providers must work together to screen for hypertension at annual physical examinations with accurate and consistent blood pressure (BP) measurements.

In an effort to improve BP measurement at the point of care, the Midmark clinical education team has partnered with Pfiedler Education, a division of the Association of periOperative Registered Nurses (AORN), to offer training with continuing education units (CEUs). The on-demand, digital module course focuses on hypertension, the importance of accurate and standardized BP measurement with proper patient positioning, and best practice integration of BP measurement in the clinical setting.

This continuing education course is intended for a registered nurse, an EKG technician or other Allied healthcare professionals with responsibility for obtaining BP measurements. The National Center for Competency Testing (NCCT) has approved this program for 2.0 contact hours.

After completing this continuing education activity, the participant should be able to:

` Identify best practice methods for patient positioning to

improve blood pressure measurement at the point of care.

` Explain the health risks involved when hypertension is uncontrolled.

` Describe the importance of accurate BP measurement as it pertains to the diagnosis and treatment of hypertension.

Interested healthcare personnel can sign up on Pfiedler’s site to take the on-demand module or visit midmark.com for more information.

CME Corp. finalizes acquisition of Storage Systems Unlimited CME Corp. announced the acquisition of Storage Systems Unlimited,

a leading specialty storage solutions distributor based in Franklin, TN. The acquisition unites two leading organizations, expanding their product range and services to offer healthcare customers a more comprehensive and integrated solution. Storage Systems Unlimited is a company specializing in storage solutions for healthcare facilities. They offer a range of high-quality storage products, including carts, shelving, cabinets, and infection prevention solutions. Their services include project management, space planning and design, and installation. With partnerships with top manufacturers, they streamline procurement, ensuring clients receive optimal storage solutions that meet budget, space, and operational needs.

Travel Preferences Survey: The results are in!

Sales reps are seasoned travelers, which gives them a unique perspective on the various travel brands that are available. In the last issue of The Med/Surg Leadership Hub , we asked you about your travel preferences. The results of the survey are below. Thank you for your participation!

What hotel chain has the best rewards program?

` 73.33% – Marriott Bonvoy

` 26.67% – Hilton Honors

What is your favorite rental car agency?

` 53 % – Enterprise

` 33% – Hertz

` 6% – Alamo

` 6% – Avis

What is the best airline?

` 60% – Delta

` 26% – United

` 6% – American

` 6% – Southwest

Favorite mode of transportation?

` 73% – Uber

` 26% – Lyft

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