REP-Jan.25

Making the Grade

What steps can healthcare stakeholders take to elevate primary care in the United States?

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Making the Grade

What steps can healthcare stakeholders take to elevate primary care in the United States?

think about stress matters. One physiologist has the hack to make stress work for you in 2025.

` TRENDS

Addressing Physician Well-Being

The Physicians Foundation survey examined the current state of physician morale. 42 A Safety Net for the U.S Healthcare System

` INFECTION PREVENTION 54 Your 2024 Infection Prevention Wrap-up

A look at where we were before moving ahead in infection prevention sales.

` IDN INSIGHTS

57 Patient Access to Care in All Forms

Being

How Community Health Centers are shaping the future of healthcare. `

Leading trends on the rise of ASCs in the U.S. healthcare industry.

in Former Walmart Health Locations

Health systems see opportunities to meet their patients where they already are.

` POST-ACUTE CARE

50 Facing the Post-Acute Staffing Crisis

Many post-acute care facilities have struggled to recruit and retain qualified staff post-pandemic, highlighting a need for solutions that improve patient care.

Increased chronic disease, aging populations and behavioral health awareness will accelerate inpatient and outpatient volumes.

60 IDN News ` HEALTH NEWS 62 Thyroid Health and Stress

Highlighting the importance of thyroid health and stress’ effect on thyroid health for Thyroid Awareness Month.

` EXECUTIVE INTERVIEW

64 The Road Ahead

What steps has the med/surg industry taken since the pandemic to handle today’s – and tomorrow’s –supply chain disruptions? ` HIDA 66 What’s New In Washington: Advocacy In 2025

NEWS 67 Industry News

Excited About What’s to Come

As we step into 2025, I’m filled with optimism and excitement about the opportunities that lie ahead in our industry. The healthcare market in the United States continues to demonstrate remarkable resilience and growth, presenting us with new avenues to make a meaningful impact on our customers and their patients.

Last year, the U.S. healthcare segment grew by approximately 4.5%, with non-acute care and outpatient services seeing even greater expansion. Ambulatory surgery centers and urgent care facilities continue to thrive, while demand for telehealth and digital solutions surges forward. These shifts are reshaping the landscape, opening the door for innovative distribution solutions and deeper partnerships with providers.

For medical distribution reps like you, these trends are not just numbers – they are opportunities. Your role is more important than ever as physicians and healthcare facilities rely on your expertise to navigate complex supply chain needs and ensure they have the tools to deliver quality care.

As you look ahead to the next 12 months, I encourage you to set clear, ambitious goals for yourself. Personal goals act as a compass, keeping you focused and aligned with the targets your team and organization aim to achieve. Whether it’s expanding your product knowledge, building stronger relationships with clients, or exceeding your sales forecast, take the time to map out your vision for success in 2025.

Remember, hitting your forecast isn’t just about numbers – it’s about the lives you’re impacting. Each product you deliver, each solution you provide, ultimately supports better outcomes for patients. It’s a rewarding responsibility and one that underscores the vital role you play in the healthcare ecosystem.

As you take on the challenges of a new year, lean on the insights and resources available through Repertoire . Our mission remains the same: to support you with the knowledge, tools, and inspiration needed to thrive in this dynamic industry.

I’m excited about what’s to come, both for the industry and each of you personally. With determination, innovation, and a relentless commitment to excellence, 2025 has the potential to be your most successful year yet. Let’s seize the momentum, rise to the challenges, and celebrate the wins – together.

Here’s to a prosperous and impactful year ahead.

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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Taking Your Customer’s Temperature

How to get an accurate idea of how your customers see the value you provide.

 Customer business reviews are intended to help us and the customer understand the dynamics of our business and relationship at every meaningful level.

From a quantitative perspective, we need to understand several key metrics. What is the customer’s purchase trend? What are their high unit and dollar volume purchases? Are there product gaps? Is the proportion of private label product purchases at a level to help customers get the best value for their dollar? Are they buying private label from my competition and why? How do their purchase patterns compare to other similar customers?

By Jim Poggi, Principal, Tested Insights

Qualitatively, we need to assess and understand their view of us. Are we trusted as their top tier distributor? Are we a gap filler for them when their lead distributor has product supply issues? Are we considered a consultative resource? Are we viewed as a trusted resource by each key decision maker or simply a transactional convenience? Have we developed a coach with the customer to help guide and inform us?

We would all like every customer to consider us as their most valuable distributor and most trusted resource for their product needs and a consultant when they face strategic issues about their lab business, significant capital purchases and even alignment with GPO organizations. Many large distributors “heat map” their customers and their business patterns. While this data is useful at a high level, every well-established distributor account manager needs to understand their customers intimately, from what they buy to why they buy and to the extent that they invest trust in us as a consultative resource.

I propose that if you believe every one of your current customers gives you an “A+” against every metric, then you need to look for a few new customers. Every account manager I know has a mix of relationships. Within that mix some relationships are growing, others are steady, and unfortunately, some need improvement. The message behind this month’s column is simple: take a good, objective look at your business approach and relationships, at least with your key customers, and ask what you could be doing better.

Every customer represents a mutual investment in time, product selection, spend volume and most importantly in trust. By objectively asking yourself how you can improve, you are engaging in an investment that will pay dividends down the road. Let’s explore a few ideas that pertain not just to your lab business but also to your overall customer business.

Setting the stage for success

A respected colleague once offered me one of his keys to success and why he was so highly valued by his customers. This individual had an enviable level of customer trust and respect, a highly productive territory and was also considered an outstanding leader by management of our company. I was not alone in trying to learn more from him and how I could become more successful.

By using this process, he felt empowered to ask them more meaningful and probing questions about their practice, what they needed from a distributor and to observe where he felt valued and welcomed and where he did not. While simple, it was an idea I had never tried. But, once I gave it a try, the results were impressive. Customers felt more at ease sharing areas where I fell short, were clear on where I was considered a good consultant and also told me which departments and personnel felt like I was ignoring them during my visits. This level of candor can be humbling, but it gives you the information you need to improve. We all expect our financial results to improve each year, but to what extent do we tie the needed revenue improvement to improvements in how we interact

We all expect our financial results to improve each year, but to what extent do we tie the needed revenue improvement to improvements in how we interact with our customers and how we invest in them?

He agreed to coach me. He told me he treated every key customer as if they were “new” once a year. I asked what that meant and how he approached it. He let me know he selected certain customers for the “new” customer process each year. Before the next business review, he shared his desired approach with the customer and asked his selected customers to interview him as if they were deciding whether to do business with him for the first time.

with our customers and how we invest in them? Over time I have learned “to get more, give more.” It works.

Analysis leads to questions which lead to insight

Review your customer’s quantitative metrics before your next business review and be prepared to ask the hard questions while receiving blunt and truthful feedback. Is business slipping away? Are your private label products properly positioned and penetrated? Are

they buying around you, or from you? Are their rapid order guides up to date with the right products on them? Is their lab business stable and well managed? Is the practice you are analyzing an example of a well penetrated customer, or do you have spend gaps?

In addition to business review templates, most largescale distributors also offer their account managers information to compare their customers to similar ones from practice size, ownership type, specialties, and other factors. Before your next customer business review,

Qualitatively, you need to be able to assess the extent to which your customers both respect and trust you. These two pillars have often been described as the gateway to excellence in customer relationships.

you should have a very clear view of how your customer ranks on these metrics, whether their business is growing and, most importantly, the data you want to review with them and insightful questions you need to ask. As you consider your customers’ questions, avoid the temptation to focus on positive issues only and steer away from difficult topics. You cannot effectively manage your customer and their expectations without thoughtfully asking the difficult questions. Did you get your fair share of their vaccine spend? How about lab respiratory products? Have they purchased new capital equipment without asking you for your product options and a proposal? Are they moving toward more private label product?

If your relationship is strong and you properly position your questions, you should be able to have open dialogue and understand their needs and motivations well enough to improve your approach to the customer. You also need to welcome open, honest feedback and accept the information they offer to you in the spirit of partnership.

Qualitatively, you need to be able to assess the extent to which your customers both respect and trust you. These two pillars have often been described as the gateway to excellence in customer relationships.

Understanding how you rate here can be even more important than which products you offer. Are you perceived to be engaging in “fly by” customer visits? Focusing on friends? Avoiding concrete follow up or suggesting “I will get back to you on that”? Are there

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any departments that seem to be avoiding you? Are any of your key suppliers underperforming in terms of customer support? Do you answer calls and emails promptly and offer clear, concrete, actionable solutions?

The customer may not mention it directly, but believe me, if you get poor marks for follow up or response quality, your business will be in trouble.

Here’s an easy test for every lab salesperson: did you see new capital equipment you did not know about? Has the customer switched high lab spend items without your knowledge? Are they using new consultants you have not introduced them to? Have your recent requests for meetings been postponed or canceled?

If any of your key customers have made any of these changes, it’s time to have an open, honest discussion. You may not like what you hear, but it is better to be able to address it before you find your lab business shrinking and your customer relationship damaged beyond repair.

Getting a separate viewpoint

Over time, I have learned that I am not always completely objective by nature. I personally tend to make judgments, positive or otherwise, and act upon them until I see reasons to change my attitude and behavior. I am willing to bet some of you are at least somewhat like I am.

How can you avoid this trap? Bring fresh eyes to your next business review. Whether it’s your manager, a trusted colleague or a key supplier with a meaningful amount of your customer’s spend, it is useful

Coming out of the meeting, you should know:

` More about WHO the decision makers are.

` How they make decisions.

` What their strategic priorities are.

` How you fit into their purchasing and support plans.

` Areas of their business they are looking to improve.

` Areas of the business where they expect you and/or your company to improve.

` Planned capital expenses.

Bring fresh eyes to your next business review. Whether it’s your manager, a trusted colleague or a key supplier with a meaningful amount of your customer’s spend, it is useful to involve them in the process and to debrief openly after the meeting. You may be surprised by what you learn.

to involve them in the process and to debrief openly after the meeting. You may be surprised by what you learn. If you invite a key supplier to the meeting, it is also their opportunity to evaluate how their products and support are perceived by the customer and to reset their relationship as well if needed.

Using what you learned to improve

If you and your customer had the open, honest meeting you looked forward to and you received clear feedback, it’s up to you to make the changes needed to rebuild your relationship, or to acknowledge it is on the right track and continue with the approach that is working for your customer and you.

` Any (especially lab) equipment they are not satisfied with or which they want to replace.

` Who trusts you and who you need to work more closely with to gain their trust.

A smart account manager will send a summary of issues and proposed resolution with CLEAR actions, timing and responsibility for actions soon after the meeting. Ask for their input and agreement with the actions. Then set a plan in place and monitor it.

If you have assessed the situation properly, created a proper action item list and have committed to improvements, you will be on your way to delivering a more satisfied customer, a better business and have learned some valuable skills you can use every day. To get more, give more.

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Leading with Heart

Being a specialty distributor has allowed Lynn Medical’s Chris Fagnani to cultivate strong relationships with manufacturers, clients and the industry at large.

By Pete Mercer

 Lynn Medical is a family-owned, nationwide distributor of medical-surgical products, specializing in diagnostic cardiology and imaging. Lynn Medical strives to offer their clients innovative solutions that are tailored to their needs in a fast-paced and dynamic healthcare environment.

Repertoire Magazine recently spoke to Chris Fagnani, owner of Lynn Medical, about her career in medical device sales and distribution, how to bring value to your customers, and the challenges of taking over a family business.

Joining Lynn Medical

Fagnani joined Lynn Medical in 2003 after working at Johnson & Johnson for 16 years in senior sales management and marketing. She and her husband, Brian Fagnani, invested in Lynn Medical as Brian’s father was retiring. Brian’s father, Louis Fagnani, started the company in 1966 to introduce emerging products into an industry that was experiencing a rapid introduction in technology in the cardiology and imaging marketplace.

Coming from a company with the size and influence of Johnson & Johnson ended up being an incredible opportunity for Fagnani to apply the skills that she learned on the job to work with her husband and run her own business. Every day brings new diverse challenges and opportunities – one day might require a more strategic approach and the next day might require an operational or tactical approach.

She said, “Operating a business is very different from working for a large company, it’s a double edged sword. You have all the latitude, but also all the risk – I’m grateful for the experience. In the beginning, my husband and I enjoyed building on the foundation his father left for us. We have always stayed true to the foundation of Lynn Medical as a specialty distributor dedicated to servicing cardiology and imaging facilities, while always leaning into how emerging technology fits into our future growth.”

Lynn Medical was founded with the mission of introducing emerging technology into cardiology and

imaging facilities, bringing innovative solutions to an industry that needed it. Fagnani attributes much of the success of Lynn Medical to the many years of strong relationships with customers and manufacturers, saying, “To us, that speaks volumes about the results of what we strive to do day in and day out – provide solutions and exceptional service.”

Those relationships and that level of customer service are at the heart of the mission and values of Fagnani and her team at Lynn Medical. She said, “We want to become a valued resource and partner to our customers. We believe this is achievable because we specialize, meaning we partner with fewer manufacturers. This allows us to cultivate deeper relationships with our manufacturers and have the ability to become product specialists due to our niche focus. We look to develop a foundation of common interests to help us better align our vision and goals with both our manufacturer partners and customer”

On the horizon

The team at Lynn Medical is constantly trying to keep track of any changing trends in the healthcare supply chain. Fagnani

Chris Fagnani

and her team understand the value they can provide by helping their customers understand the “why” behind the big issues. Taking a future-focused approach is what has allowed Lynn Medical to operate in this space for almost 60 years.

“With our consultative approach, we present our customers with the knowledge we have about the healthcare supply chain, allowing them to make the best decisions for their facilities. We are always looking for technological enhancements to the devices we represent – looking ahead is just as important as excelling in the tactical execution now. We want to be the first to know what is changing and how that will benefit our customers.”

Anyone working in the healthcare industry is familiar with having to navigate a myriad of challenges at every touchpoint. Fagnani said Lynn Medical works to understand the biggest pain points for each facility to better tailor their solutions and recommendations to address those areas. Everyone throughout the healthcare industry is having to do more with less – less manpower, less reimbursements, etc.

For Fagnani, it’s important to be authentic with their customer base. She said, “We need to really care. If we can better understand our customers to develop and present a solution that meets their needs, we win the business.”

Working with HIDA

In 2020, Fagnani served as Chair of the Board for the Health Industry Distributors Association (HIDA). While any opportunity to serve an organization like HIDA would be an interesting

A major milestone

Family owned and operated since 1966, Lynn Medical has dedicated itself to addressing the needs of a rapidly changing healthcare system by distributing top quality products that improve patient management and reduce healthcare costs.

In late 2024, Lynn Medical celebrated its 58th anniversary. “For nearly six decades, we’ve been proud to serve the healthcare industry by providing best-in-class service through medical supplies, specialty equipment, and solutions to healthcare professionals nationwide,” the company said in an announcement. “Our success is built on the foundation of excellence, innovation, collaboration, integrity, and community. We owe this achievement to our amazing team, our dedicated partners, and our loyal customers who have supported us throughout the years.”

and challenging venture even in normal times, serving during the COVID-19 pandemic offered Fagnani a unique perspective on the role that HIDA plays in the healthcare continuum.

“A public-private sector partnership is critical to assure preparedness for future healthcare crises,” she said. “I am grateful that I got to see first-hand how HIDA is trusted and respected by regulatory agencies in Washington D.C. I watched as they asked HIDA how to draft recommendations on how to move forward to assure the healthcare systems were able to get the critically needed supplies where they needed to be during the pandemic.”

During her time as Chair of the Board at HIDA, HIDA championed the language to develop The Medical Supplies for Pandemics Act of 2020, which was introduced in a standalone piece of legislation passed by Congress. This bill would direct the strategic national stockpile to work with medical product distributors

to manage a domestic reserve of critical products and to work with manufacturers to diversify productions. The HIDA bill was ultimately incorporated into the Prevent Pandemics Act and enacted on December 29, 2022.

In July 2020, she testified before the House Small Business Committee on supply chain resiliency to share the success stories of small businesses during the COVID-19 response and flag the importance of the HIDA championed legislation. She shared specific recommendations for the future to help small business navigate the complex regulatory environment during a public health emergency such as creating a streamlined information source for small business.

“I am always proud to be part of an industry that pulls together for the best interest of the entire healthcare industry. HIDA members work together on many issues that will improve the supply chain, medical facilities, and patient care, which is the ultimate goal.”

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All Hands On Deck

CME hosts ninth annual National Sales Meeting in Newport, Rhode Island.

Courtesy of CME

 It was All Hands On Deck as account managers, manufacturing partners, equipment planning partners, and industry experts gathered together for three days of networking, relationship building, learning, and discussions around emerging healthcare industry trends.

Set against the backdrop of historic Newport, Rhode Island and warm sunny days bordering on perfect, CME’s National Sales Meeting radiated energy and vitality. From the first moment of the event the momentum took off and continued, kicking off the healthcare equipment training forums led by leading healthcare manufacturers with the expectancy of “what’s new.” In addition to showcasing strategic products,

the sales training sessions offered valuable insights into how the products help healthcare facilities meet and exceed patient expectations for care and improve workflow efficiency.

And just as everyone was thinking WOW, David DiLoreto of Sg2, a Vizient company, stepped to center stage with a presentation focused on key industry trends, how these trends are impacting healthcare systems,

and what that means for the supplier/provider relationship as the trends evolve. Attendees were left feeling they had just acquired the playbook for conversations down the road.

Infused with the energy of future opportunities and the thrill of a challenge, CME celebrated connecting in person with manufacturing partners, some who have been with us for the better part of 40 years, and networking

with new vendor and equipment planning partners who share the same passion to help raise the bar of excellence in healthcare

We are honored to have hosted so many of our strategic manufacturing partners and equipment planners from Introba, IMEG, and Chesapeake Healthcare Planning. Collectively, these teams met with CME sales teams in over 400 meetings to exchange information, share innovative solutions to challenges facing our industry, and celebrate the successes built on the flexibility that helps shape relationships within the supply chain.

This year’s National Sales Meeting was the manifestation of all that CME embraces – Collaboration, Flexibility, Innovation, Passion, and Respect. Thank you to our teams, manufacturing partners, and planning partners – you helped make 2024 a year to remember.

Here’s to bringing All Hands On Deck to deliver exceptional customer experiences in 2025!

Lost in Translation?

Communicating value to non-clinical buyers.

By Brian Sullivan

 Imagine this: You’re in the middle of a pitch with a non-clinical buyer – let’s say a hospital administrator – and you’re explaining your product. You’re dropping phrases like “angioplastyready catheterization” or “end-to-end biocompatible coatings” like they’re part of everyday conversation. You pause for a reaction, and what do you get? A polite nod, maybe even a squint, but no sign they’re catching what you’re throwing.

Welcome to the world of selling medical products to nonclinical buyers – a world where you’re essentially translating hieroglyphics without a Rosetta Stone. If you’ve ever wondered why some buyers just don’t “get it,” the problem might not be them – it might be your message. Don’t worry, though. This is fixable, and mastering this skill will not only boost your close rates but also make you look like a

genius who can bridge the clinical and business worlds.

Let’s break this down.

STEP 1 Remember, You’re Talking to Humans, Not Machines

It’s easy to forget that not everyone speaks “medspeak.” While clinicians might geek out over your product’s clinical trials and triple-blinded studies, non-clinical

buyers are wired differently. They care about bottom lines, efficiency, and patient outcomes – but in plain English. For them, a phrase like “adaptive photon sensitivity” might as well be a line from a sci-fi movie.

Translation tip: Instead of saying, “Our device utilizes a high-frequency impedance algorithm,” try, “This device reduces errors and speeds up patient diagnosis.”

Boom. Simpler, clearer, and far more appealing to someone who’s thinking about budgets, not textbooks.

STEP 2 Paint a Picture, Don’t Build a Puzzle

Ever try explaining your product and watch someone’s eyes glaze over like they’re stuck in a Sudoku puzzle? Yeah, that’s the moment you’ve lost them. Non-clinical buyers don’t need every single detail of your product’s inner workings – they need to understand the why and how it helps. Use stories and examples to bring your product to life. Instead of overwhelming them with specs, tell them how a similar client solved a real-world problem. Think of it as selling the solution, not the science experiment.

Example: Instead of saying, “This product improves aseptic technique by 28%,” say, “This solution prevents contamination, ensuring fewer infections and shorter hospital stays for patients.”

STEP 3 Swap the Jargon for Value

Here’s the hard truth: using jargon doesn’t make you sound smarter – it just makes you harder to understand. The more accessible your language, the more confident your buyer will feel about saying “yes.” Jargon creates distance; clarity builds trust.

Jargon Detox Example:

` Before: “Our equipment leverages bioactive polymers for antimicrobial efficacy.”

` After: “Our equipment stops germs, keeping patients safer.”

Pro tip: If you’re not sure whether your pitch is clear, try it out on someone outside the industry. If they look confused, it’s time to simplify.

STEP 4 Tailor the Message to the Buyer

Every buyer sees the world through their own lens. For non-clinical buyers, that lens often revolves around financials, operations, and risk management. So, while your product’s revolutionary mechanism might be impressive, what they care about is how it impacts their day-to-day.

For example:

` To a CFO: Focus on ROI. “This product reduces readmissions, saving your hospital $300,000 a year.”

` To an Operations Manager: Highlight efficiency. “You can sterilize twice as many instruments in half the time.”

` To a Patient Experience Coordinator: Emphasize outcomes. “Patients recover faster and leave better reviews.”

It’s not about dumbing things down – it’s about meeting people where they are.

STEP 5 Read the Room (and the Zoom)

Selling is as much about reading body language as it is about delivering your message. If you see someone furrowing their brow, leaning back, or – heaven forbid – checking their watch, it’s time to pivot. Ask

questions like, “Does that make sense?” or “Would you like me to go into more detail on this point?” This gives them a chance to guide the conversation and keeps you from drowning them in irrelevant details.

STEP 6 Confidence + Clarity = Credibility

Here’s the kicker: simplifying your message doesn’t make you look unprepared – it makes you look like a pro. Buyers trust salespeople who can distill complex ideas into actionable insights. It shows you know your product inside and out, and you understand what matters to them.

Remember, when a buyer can clearly see the value, they’re far more likely to sign on the dotted line.

The Big Takeaway

Selling medical products to nonclinical buyers isn’t about translating every feature into layman’s terms – it’s about connecting the dots between what your product does and what your buyer values. When you ditch the jargon, focus on outcomes, and tailor your message, you transform from a “salesperson” into a trusted advisor.

So, the next time you’re pitching to a non-clinical audience, don’t overcomplicate it. Speak their language, make it simple, and watch as your clarity becomes your superpower. And hey, if you ever slip back into “clinical mode,” just remember: nobody ever bought a product because they were impressed by big words. Now go out there and simplify your way to success. You’ve got this!

Brian Sullivan, CSP, is the author of “20 Days to the Top” and a leading voice in the field of sales training and development. He believes in the potential of every salesperson to achieve their best and continually challenges sales professionals to reach new heights. Visit him at www.preciseselling.com.

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Gaining Buy-In

Implementing change requires effective change agents.

By Patrick T. Malone

 Why do the results of even good plans and strategies sometimes fall short of our expectations in the execution? Because we make the mistake of focusing solely on strategy and planning. This is thinking about change, not “implementing” change. The implementation can be far more difficult than the planning. The reason: people. People have different reactions and points of view, different interests, and needs. People decide whether to help, hinder or ignore any change initiative. People – your customers and prospects – hold the key to your success as a distribution rep.

Successful change agents all possess a vital ability. They understand the importance of gaining support for any change initiative and they can obtain people’s “willing buy-in” to change. They recognize their customer/prospect’s emotional as well as logical reactions and can reason with any point of view. Only then are they able to link their customer/prospect’s best efforts to the execution of sound recommendations.

Buy-in is a powerful thing. It takes the customer out of analysis or skepticism and causes commitment – the emotional resolve to act and see a task through to completion. Without that resolve, change initiatives i.e., your recommendations, are doomed from the start. With it, you get people on board (leadership) and working in coordination (teamwork) on an on-going, daily, product-byproduct basis.

“But people resist change.” I cannot tell you how many times I have heard this excuse as an explanation for the lack of success. And it is just that –an excuse. Consider yourself. I’ll bet you are wearing something different today than you wore yesterday. I’ll bet you will eat something different today than you ate yesterday. And so, it goes with everyday being slightly different than the previous day.

So, if we don’t resist change, why is it so hard getting our customer’s buy-in to a change a product or service?

There are five possible generic barriers that effective reps must manage before they attempt to gain buy-in to any change:

1. Apathy.

2. Too much work to implement your recommendation.

3. Too much risk that your recommendation may not work as well.

4. Opposition to your recommendation.

5. Skepticism about your recommendation.

Each of these barriers has an emotional component and a logical component. Effective change agents know you MUST acknowledge the emotional component first before you can begin to reason with the logic. So, let’s look at how that might play out for each barrier if we were advocating our customer consider a new product.

Apathy

“Why bother, it won’t make any difference?” (Said with low energy, little or no eye contact and a sense of other priorities)

Acknowledge the emotion first, or in this case the lack of emotion.

“Sounds like this product conversion is not a priority at this moment in time…”

You have proven you have not only heard them, but you are taking their point of view seriously. There is little you can do if it is real apathy. If it isn’t, then acknowledge it as if it will elicit a different response – one that is manageable.

Now you can transition to the logical side.

“…so, it makes sense to deal with those issues that are a priority. What might those be?”

Too much work

“It’s hard enough to train our staff on the products we’ve used forever. Bringing in a new one will further complicate our lives.” (said with a complaining or even a whining tone)

Acknowledge the emotion first.

“Effective communication is a universal problem, and we don’t want to add to your workload…”

You have just proved that your customer has your 100%

attention, and you are taking their complaint seriously. And you have opened the door to a logical solution such as –

“…so, let’s look at the inhouse training program that is customized for you and your staff.”

Too much risk

“I have a risk of using a product I am not as familiar with.”

Acknowledge the emotion first.

“It is reasonable to measure the risks involved in making a switch…”

Or it may require some in depth probing using NIQCL (Need/Problem, Importance, Quantify, Consequence, Look/listen).

Quite frankly, you cannot deal with the logical component until you know and fully understand the problem(s) causing the opposition.

Skepticism

“You are going to have to justify your recommendation before I consider implementing it.”

Just because yesterday’s NO was due to price, or quality, or prior experience doesn’t mean today’s NO is for the same reason.

You might not see a risk, but you have acknowledged your customer’s right to that emotion at this moment in the conversation. That respect opens your customer to options to mitigate or eliminate the perceived risks, i.e.

“…so, let’s look at the ways these risks have been mitigated by other practices that are similar to yours.”

Opposition

“Absolutely not”

When you get a hard stop do not assume you know the reason behind it. Just because yesterday’s NO was due to price, or quality, or prior experience doesn’t mean today’s NO is for the same reason. Remember to acknowledge the emotion first.

“Got it. Let’s stop here…”

Time for some probing that could be a simple as “…sounds like there is a problem. Can you help me understand it?”

Skepticism can be a challenge if you have not done your homework. You need to know the competitive advantage your recommendation provides as well as be able to translate that into a benefit your customer will have by acting on your recommendation. But acknowledge the emotion first.

“Skepticism at this point is perfectly understandable…”

And then transition to the logical component.

“…so let me show you the reasons I believe the switch is justified and the benefits you will gain as a result of that decision.”

Adapt these generic barriers to the specific points of resistance you encounter in your territory and then sharpen your skills at acknowledging the emotion before transitioning to a logical discussion that justifies your recommendation. In that process you too will be an effective change agent and a remarkably successful distributor rep.

Are You Coachable?

How a coach can help you create and execute a vision for your life and career.

By Pete Mercer

 Leadership development is a critical process for growth – the best leaders are shaped by their experiences and surroundings. That tension between your experience and surroundings is where the best development happens, but it helps to have someone walking you through how to utilize these developments.

That’s where a coach comes in. An effective coach can help you to work through your skillset and prioritize your personal and professional goals. The coach is usually an individual who has experience developing leaders and has the ability to see the untapped potential in everyone they work with.

Repertoire Magazine recently spoke to Aaron Keyes, an executive coach at Novus Global, about how coaching can empower people to become better leaders and better define their vision for what’s possible. Novus Global is a coaching firm based in California that works with Fortune 500 companies, professional athletes, world renowned artists and multimillionaire business leaders.

Empowering leaders, closing the gap

Keyes has been coaching leaders for 17 years, spending the last two years coaching in a full-time role. After 15 years of coaching leaders, creatives, songwriters, and pastors in a ministry setting, Keyes has pivoted his career to working one-on-one with leaders through Novus Global.

capable of. What’s the potential? What’s possible?”

Novus uses three major tenets in their coaching framework: everyone is capable of more than they think, your teams are capable of exponentially more than you think, and most people have the tendency to get in their own way, without a little assistance. Within those tenets, Novus then focuses on three core areas in executive coaching: vision, mindset, and strategy.

In the first couple of coaching calls, Keyes will get to know his clients and develop an idea of

“A coach can help you to see what it’s like to be on the other side of you.”

While professional development certainly plays a role in his coaching sessions with his clients, Keyes is much more interested in helping the people he works with to tap into their potential. He said, “We’re not asking people how you win or how you be the best – we’re asking what you are

what they are looking for. Simply put, he’s looking to better understand what they really want.

He said, “It’s amazing how many people will work very hard, get to the end of the road, and realize they didn’t even want it – they were just on autopilot. Usually, people’s visions are just

way too small. They’re playing it safe. What a lot of our coaching is doing is helping people identify the gap between where they are and what they want.”

From there, he works to adjust the mindset of each client. According to Keyes, “mindsets are the things that we realize along the way.” As the vision and gap are defined, problems with implementation start to come up. These problems are likely also affecting them in plenty of other areas as well, creating blind spots to what might be simple solutions. “A coach can help you to see what it’s like to be on the other side of you,” Keyes said.

Once the mindset shift takes place, Keyes works on building a strategy to help close that gap. This stage is all about finding the best way to move forward. For Keyes and his team, they are working to encourage people to chase what they most desire. The future is coming anyway, why not make it one that you want? His clients will set goals for where they want to be and what they want to do in the next 12 months, but it usually doesn’t even take that long to see progress.

He said, “Often in four months, they’ve already exceeded their 12-month goal. They haven’t had someone pushing them like a coach can.”

Leading from where you are

One of the most powerful things about leadership is that you don’t necessarily need to have a title to be effective. Sure, there are plenty of ways to implement change and influence those around you from the c-suite or director levels of an organization,

Aaron Keyes

but it’s not about the position you hold at your company.

“Authority is not a prerequisite for leadership, but a byproduct of leadership,” Keyes said. “Even someone who’s just a volunteer on their team that is actively showing integrity, making big commitments, keeping their word, and demonstrating character and competency, will begin to influence their surroundings.”

It’s all about ownership –if you can only affect 1% of what’s going on in your organization (or even your personal circumstances), it’s important to own 100% of that 1% as much as you can. No matter what position you hold at your company, you deserve to feel empowered and equipped to fulfill those responsibilities and excel at your job.

Many organizations want to inspire their sales teams to drive creativity and efficiency within the organization. From Keyes’ perspective, this approach might be misguided.

“People are driven. I don’t think it’s a lack of inspiration – I think it’s a lack of empowerment. One thing that doesn’t work is just ‘inspiring’ people. I’ve been to plenty of sales meetings where we’re just celebrating the top 10 people this month, and we’ll do it again next month. ‘Go get them team, you can do it!’ You might not be able to do it. You might need some tools. Everyone has their own strengths and weaknesses.”

Embracing feedback

One of the main components of the coaching relationship is getting feedback. It doesn’t work

if it’s not honest, but just because it’s honest doesn’t mean it’s pleasant to hear. Very few of us like getting feedback, but it’s what this whole idea of coaching hinges on.

It’s an incredibly vulnerable spot to be in, especially when you’re in the middle of getting feedback. Keyes said, “I’m not there to be kind, I’m there to give them what no one else is giving them.”

The key here is to keep an open mind to whatever feedback your coach is bringing to your attention. The reason you’ve hired this person is to bring to your attention those areas that

might need work and polishing. It requires a lot of trust that your coach is working to ensure that you can become better. Leave your ego at the door. There’s no progress without discomfort – it’s all a part of the process.

“Hypersensitivity to criticism is only going to hinder you – it’s not going to help you at all. We’ll walk with people through these discoveries, and they choose if they want to change. You can be hyper-defensive and easily offended if you want, but is that going to get you where you want to go? It seems to me that it hasn’t yet.”

What to look for in a coach

For Keyes, there are several components that make up an effective and proactive coach. Here are some of the qualities you should look for:

` Consistency – For anything to improve, you need consistency. With coaching, this means consistent meetings to establish a rhythm. Getting into a rhythm allows you to establish a regular cadence of feedback as you continue to develop as a leader. Keyes has regular meetings with his clients two to three times a month, giving them the time they need to implement his insights and discuss what worked and what didn’t.

` Authority – In this sense, authority means an ability to deliver insights and feedback with significant impact. When you’re looking for a coach, you don’t need someone who’s going to walk on eggshells and protect your emotions – you need someone who will tell you the truth. “A coach doesn’t tell you what to do, they help you see what you are doing that you don’t know you are doing. Authority matters, and it’s hard to fake.

` Investment – Keyes argued that at the end of the day, investing in coaching is an investment in your future. There needs to be stakes for coaching to be effective. He said, “People need to put themselves on the hook. They need to put some skin in the game so that they show up ready to get every drop of value out of that call.”

Run Toward the Roar

How you think about stress matters. One physiologist has the hack to make stress work for you in 2025.

 Rebecca Heiss, PhD, believes there is a scientific answer to why we often self-sabotage our hopes, dreams and health. Our brains have been hardwired for it.

Robert Sapolsky, a famous stress physiologist, said that a person’s stress response is built for three minutes of screaming terror across the savanna, after which it’s over because the tiger ate them, or because they outran the tiger. But either way, it’s over. “It’s not our stress itself that’s the problem,” said Dr. Heiss. “It’s how we handle it.”

Our stress response was built for life-and-death situations, but humans are very special in that they’re the only animals that can create their own stress from their thoughts. A zebra’s cortisol drops the second it has outrun a predator, and then it’s right back to grazing. But humans are often left replaying stressful events, such as a near accident while driving or a

bad conversation with one’s boss. “We actually facilitate more stress that way,” Dr. Heiss said. For instance, a 2013 study examined how stress affects our health and our mortality rate. Looking at 20,000 Americans across eight years, researchers found that the people who had the highest level of stress, but who believed that stress was

healthy or good for them, had the lowest mortality rate of the study – even lower than the people who had very little stress.

However, the people with the highest level of stress, who also believed that stress was bad for them, had the highest mortality rate.

“One of the biggest things I tell people is the stress mindset is more important than the amount of stress you have,” Dr. Heiss said. “How you think about stress matters.”

Dr. Heiss is a stress physiologist, author and keynote speaker. She bases her work around the foundational concept that stress isn’t going anywhere, and we shouldn’t kid ourselves that we can get rid of it. “We’ve spent way too much time and effort trying to get rid of stress through activities like meditation and yoga, through medication, etc.,” she said. “Listen, all those things are good. There’s plenty of research that backs up how meditation and medication can help, but the more we push and fight against stress, the more we’re spending energy enhancing our stress.”

Dr. Heiss has conducted thousands of hours of research on people with high levels of stress. She has discovered that about 73% of them end up getting more anxious and fearful just trying to get rid of their stress. “That tells me we’re focused on the wrong problem,” she said. “We must recognize that stress is always going to come into our lives, but we can recognize it and transform it. Stress is just energy. The second law of thermodynamics is you can’t get rid of energy, you can’t destroy it, but you can transform it. So, we can use our stress to help us rather than fight against it.”

What stress can point us toward

We don’t recognize it in the moment, but our stress is actually pointing us toward something. It’s a barometer for how much that item or event is meaningful and purposeful in our lives, Dr. Heiss said. When we reframe stress as an indication that we care about something, we can use it to push us forward rather than hold us back.

Dr. Heiss recommends you do three things when you feel a stress response activate. The first step is to ask the question: Is it a tiger? Is this an actual life-and-death situation?

“Well, 99.999% of the time, it’s not actually going to kill you,” she said. “If it is a life-and-death situation, then your response is doing exactly what it’s supposed to do. But now that we’ve made it conscious, now that we’ve made it cognitive, we can realize this isn’t a tiger.”

The second step is the transfer. “This is not where we tell ourselves to calm down, because that doesn’t actually help,” Dr. Heiss said. “It just makes you more anxious. So rather than trying to get rid of that stress energy, this

is the time to transform it, and that transformation piece is about recognizing how we can use that energy differently.”

The stress response has a very similar hormonal profile to excitement. The trick of the transfer is recognizing that this stress response can be enhancing.

“We’re going to get curious about it,” Dr. Heiss said. “How does my heart pounding right now help me? Well, it’s pumping my blood faster, bringing nutrients to parts of my body that are going to be useful in thinking better and allowing me to move to take the action that I need to take. This curiosity piece allows us to transform that energy.”

Curiosity and fear cannot coexist. There’s no brain mechanism for it, Dr. Heiss said. “You’ve never had a tiger charging you and asked, ‘I wonder how fast it’s coming?’ So, if we can get curious in that moment, and ask how can this help? How can I use this? Where can I go with this? Now we’ve taken ourselves out of fear. We begin to transform that energy.”

The third step is building a trajectory. Where can we point our stress? “Often what I tell people is that the trajectory needs to involve something bigger than yourself. How does this create meaning and purpose for others? How is this bigger than just what I’m doing? And that trajectory can become really, really powerful.”

Sales reps and stress

Dr. Heiss has worked with many sales teams on reframing their response to day-to-day professional stressors. Indeed, sales involves a lot of rejection. To stay

Rebecca Heiss, PhD

motivated, reps must recognize there is a standard stress response in simple acts such as picking up the phone to call a customer who might reject them.

It’s easy sometimes to take the path of inaction. We know the negative cost of our actions – we might fail, screw up, and look bad. “What we fail to measure, and what our brains are bad at measuring is the cost of our inaction,” Dr. Heiss said. “Well, what happens if I don’t go all in?”

Sales reps are usually people that have very high intrinsic motivation, Dr. Heiss said. That night, they’re going to ask, why didn’t I do that? Why didn’t I try? Why didn’t I pick up the phone one more time?

“I call these the silent sirens of regret,” Dr. Heiss said. “They’re going to cause you more stress than if you took the smallest action forward, especially in sales.”

Even the smallest of steps can build what’s often called

“What’s the easiest thing that you can sell, or a step in the sales process you can follow through with now? Do it. Now you’ve won. Good, go to the next, then the next, and the next.”

the Winner’s Effect. To better understand what this looks like, Dr. Heiss said to imagine two stags fighting in the wild. One wins, one loses. Hormonally, the stag that wins has lower cortisol, higher testosterone, and higher dopamine, while the stag that loses has the exact opposite profile. The winning stag becomes sensitized to winning and hormonally ready to win more. Its brain has produced more receptors for those winning molecules, and so the next time the stag is more likely to win.

In sports, this is like having the hot hand in basketball. “In sales, it is when you close a deal, you’re more likely to close the next one,” she said.

So how do reps set this up? By creating situations that they absolutely will win, Dr. Heiss said. “What’s the easiest thing that you can sell, or a step in the sales process you can follow through with now? Do it. Now you’ve won. Good, go to the next, then the next, and the next,” she said. “You’re creating a habit of winning through small actions forward. That’s the trajectory.”

Once you get the cycle going, you can connect it to something bigger. “You sold a chip – what does that enable? What’s the bigger meaning behind it?”

Dr. Heiss said to ask ourselves. “Well, without this chip, this person couldn’t help this patient, or your daughter doesn’t get to go to the best school. You’re selling so your community can recover. You’re selling so that your company gives back X number of dollars. It’s a different setup when we begin to harness stress to help not just ourselves, but the greater community.”

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Focusing on the right things

There are a lot of reasons why people are more stressed than ever before. One is we’re focused on the wrong things, Dr. Heiss said. “We’re focused on trying to get rid of stress in our lives, but it’s impossible to control the stressors that come into our lives. You don’t get to control when your partner gets sick or when you get a diagnosis. You don’t have control over that.”

What you do have control over is the story you tell yourself about stress and how you can use it to your advantage in important situations. For example, Olympic athletes aren’t breaking world records in low pressure places like

When you are serving others, you’re creating. You’re using those molecules of oxytocin. You realize you are not alone in your stress. You’re not isolated. There are other people that have it worse than you, and you can give something to them, and that gives back to you.

practice, Dr. Heiss said. They’re breaking records at the Olympics when the pressure is at its highest. “I think everybody can adopt that, if we put in the reps,” she said. “If we recognize this isn’t a tiger, we can transfer this energy, and use it to our advantage, then we start to get this springboard effect where

The reframing timeline

How long does it take to reframe your stress response? It will be different for everyone, Dr. Heiss said. “Our brains are live wired. We’re different right now than we were 30 seconds before.”

Dr. Heiss put in a year’s worth of hard work reframing her stress response after a difficult season in life. “That year was really about figuring out where I wanted to run toward – run toward the roar. So often we run away from the things that are scary,” she said. “But when we realign our stress response to say, ‘OK, even if this doesn’t work out, I’m not going to die as a result,’ then we can start to run toward meaning and purpose. That feels really scary, because it is, so it took me a year to get there. But it’s going to be different for everyone.”

stress becomes something that we can bounce off of and use rather than have to fight against.”

Dr. Heiss said there was a recent study that looked at 90 different stress interventions in companies. Researchers found that every single one of them didn’t work, or even made stress worse, except one thing – community service.

“This is key,” she said. “When you are serving others, you’re creating. You’re using those molecules of oxytocin. You realize you are not alone in your stress. You’re not isolated. There are other people that have it worse than you, and you can give something to them, and that gives back to you. It’s a little bit contradictory in people’s heads that when they are most stressed that they need to reach out and help others. But we see it all the time in natural disasters or events like 9/11. People really come together as a community, and that’s a major stress relieving activity.”

My story is your story, and your story is my story, and so we bear the burden together, Dr. Heiss said. Going through discomfort together actually makes people closer. And that’s something worth running toward. “When you reframe that discomfort as we’re doing this big thing together, that’s how you can use stress to help.”

With complete ownership of every step, BD delivers excellence from end-to-end. We are committed to providing a sustainable supply of needles and syringes with safe and reliable performance your clinicians and patients can trust.

Making the Grade

What steps can healthcare stakeholders take to elevate primary care in the United States?

Yalda Jabbarpour, MD is a firm believer that primary care is not only essential to the health and well-being of every patient in the U.S., but it’s the backbone of the entire healthcare system.

“Everyone in their lifetime will see a primary care clinician,” she said. Indeed, good primary care is essential for population and individual health, said Dr. Jabbarpour, a family physician and director of the Robert Graham Center for Policy Studies.

From a population perspective, studies have shown that good primary care leads to higher life expectancy, lower healthcare costs, and better health equity. “I think that has been proven repeatedly in the literature, and it is the only medical specialty to have those three findings,” she said. “Primary care is absolutely essential to the health of the population.

“On an individual level,” she continued, “if you talk to anyone who has a good relationship with a long-term primary care doctor, they will tell you that it is absolutely invaluable in terms of their health and wellness, just having that person who knows them, knows their history, that they

can turn to for questions or they can turn to when it’s a scary diagnosis and they need help navigating that.”

For individuals who don’t have a primary care doctor because they can’t get access to one, it is challenging to navigate the healthcare system and get timely care when they need it. Often their health ends up spiraling. They may frequent the ER or get in to see specialists too late when their diagnoses could have been prevented with treatment from a primary care physician.

Lack of investment

Despite this evidence, the investment in primary care in the U.S. compared to other

countries remains low. The U.S. spends about 5 cents on the healthcare dollar on primary care. That lack of financial backing is causing problems for primary care providers, as well as negatively affecting the U.S. patient population, Dr. Jabbarpour said.

First, the lack of financial backing for primary care services means primary care practices are often overworked and under-resourced. There is a likelihood of higher turnover in those practices at the physician, nurse and front desk level – all because of burnout.

The trickle-down effect hurts patient satisfaction. Patients are upset because they often can’t get in to even see a primary care physician. It can lead to poorer outcomes too.

These issues all tie back to a lack of investment, Dr. Jabbarpour said. “If you look at other countries with better health outcomes, they are spending at least double to triple what we’re spending on primary care.”

Creating the scorecard

To better understand the current realities of primary care in

Medicaid and commercial insurer investment in primary care has decreased since 2012, and Medicare investment remains low. Since 2019, primary care investment has steadily declined for all payers; this decline is most pronounced in the Medicare population.

Trainees see this burnout. When they go into primary practice environments and observe the heavy workloads of primary care team members, they may think twice about getting into the field. “They’re seeing overworked and under-financed teams, so trainees are not choosing to go into primary care for that reason,” Dr. Jabbarpour said.

Even though there have been calls to increase the primary care physician workforce over the last decade to address the increase in chronic disease, mental health burdens and overall rise in sicker patients in the U.S. healthcare system, the number of physicians has actually gone down, Dr. Jabbarpour said.

the U.S. and map out models for improvement, in 2022, the Milbank Memorial Fund and The Physicians Foundation announced a partnership with the Robert Graham Center to develop an annual “Health of U.S. Primary Care Scorecard” to measure the implementation of high-quality primary care and inform national and state policy. The scorecard is grounded in the recommendations of the 2021 National Academies of Sciences, Engineering, and Medicine (NASEM) report, Implementing High Quality Primary Care: Rebuilding the Foundations of Healthcare . Its aim is to provide accountability for the nation’s progress in high-quality primary

care implementation across five dimensions: payment reform, access, workforce development, information technology, and accountability.

The inaugural scorecard in 2023 found a systemic underinvestment in primary care, shrinking workforce, increasing gaps in access to care, too few physicians being trained in community settings, and little to no federal funding for primary care research. The results of the 2024 scorecard revealed many of the same issues. The scorecard authors (including Dr. Jabbarpour) identified five reasons why primary care in the United States is inaccessible for so many Americans:

Reason No. 1: The primary care workforce is not growing fast enough to meet population needs.

` The number of primary care physicians (PCPs) per capita has declined over time from a high of 68.4 PCPs per 100,000 people in 2012 to 67.2 PCPs per 100,000 people in 2021.

` While the rate of total clinicians in primary care, inclusive of nurse practitioners (NPs) and physician assistants (PAs), has grown over the past several years, it is still insufficient to meet the demands of overall population growth, a rapidly aging population with higher levels of chronic disease, and workforce losses during the pandemic. Compared to Canada, which boasts a primary care physician-only density of 133 per 100,000 people, the U.S. primary care total clinician (physician, NP, and PA) density was only 105 per 100,000 people in 2021.

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Reason No. 2: The number of trainees who enter and stay on the professional pathway to primary care practice is too low, and too few primary care residents have community-based training.

` In 2021, 37% of all physicians in training (residents) began training in primary care, yet only 21% of all physicians were practicing primary care three to five years after residency.

` In 2020, only 15% of primary care residents spent a majority of their time training in community-based settings where a majority of the U.S. population receives their care. Fewer than 5% of primary care residents spent a majority of their training with the most underserved communities in the United States.

` The number of medical residents per person in primary care has risen at a slower pace than all other specialties, increasing by only 21% compared to 26% in other specialties.

Reason No. 3: The U.S. continues to underinvest in primary care.

` The investment in primary care as a share of total health care spending has dropped from 5.4% in 2012 to 4.7% in 2021.

` Medicaid and commercial insurer investment in primary care has decreased since 2012, and Medicare investment remains low. Since 2019, primary care investment has steadily declined for all payers; this decline is most pronounced in the Medicare population.

Reason No. 4: Technology has become a burden to primary care.

` Data limited to family physicians demonstrate that health care technologies do not serve primary care

physicians adequately; more than 40% of family physicians report unfavorable scores in electronic heath record (EHR) usability, and over 25% report overall dissatisfaction with their EHR.

Reason No. 5: Primary care research to identify, implement, and track novel care delivery and payment solutions is lacking.

` Since 2017, only around 0.3% of federal research funding (administered through the National Institutes of Health and the Agency for Healthcare Quality and Research, for example) per year has been invested in primary care research, limiting new information on primary care systems, payment and delivery models, and quality.

that high-quality primary care is implemented in the United States.

How the U.S. compares globally

Another recent study by the Commonwealth Fund looked at how the U.S. health system ranked globally, and had less than flattering news. The study concluded that the U.S. health system ranked last among 10 nations on key health equity, access to care, and outcome measures. Despite spending the most of any nation in the study, the United States has the worst-performing health care system overall.

Key findings from the report include:

` Health Outcomes: People in the U.S. have the shortest lives and the most avoidable deaths. The U.S. ranks last on five of six health

“There should be more financial rewards for providing good quality care. Hopefully both public and private payers will see the value in increasing the payments going to primary care practices so that there can be innovation in the primary care practice.”

` Lack of adequate data about the primary care infrastructure hinders this Scorecard’s capacity to fully track progress on the NASEM report objectives: (1) Pay for primary care teams to care for people, not doctors to deliver services; (2) Ensure that highquality primary care is available to every individual and family in every community; (3) Train primary care teams where people live and work; (4) Design information technology that serves the patient, family, and the interprofessional care team; (5) Ensure

outcome measures. Australia, Switzerland, and New Zealand perform the best in this domain.

` Access to Care: Americans face the most barriers to getting and affording health care. The U.S. is the only high-income nation in the study that does not provide universal health coverage, Commonwealth study authors said. Despite major coverage gains made under the Affordable Care Act, 25 million Americans remain uninsured, and nearly a quarter cannot afford care when they need it. In addition, U.S.

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patients are more likely to report they don’t have a regular doctor or place of care compared to residents of other countries.

` Equity: The U.S. and New Zealand rank lowest on health equity, with many lower-income people reporting they cannot afford the care they need compared to higher-income counterparts and more people reporting unfair treatment and discrimination when seeking care.

` Administrative Efficiency: Physicians and patients in the U.S. experience among the greatest burdens when it comes to payment and billing. The complexity of the U.S. health system, with its mix of public and private insurers and thousands of health plans, forces providers and patients to navigate a labyrinth of cost-sharing

Taking Action

requirements, paperwork, and insurance disputes. This complexity causes the U.S. to rank secondto last in this domain, only slightly higher than Switzerland.

New ways of thinking

Building stronger primary care in the United States will take a concerted, collaborative effort among academic institutions, the government, public and private payors, and the vendors and technology companies.

At the payer level, everything starts with Medicare and the physician fee schedule, Dr. Jabbarpour said. If the government can move away from a majority fee-for-service schedule of payment and towards a payment model that values primary care, then commercial payers might be more inclined to follow suit.

The Commonwealth study researchers suggested the following policy actions need to take place in order to improve health outcomes and the U.S. healthcare system overall:

` Make health care more affordable and more accessible by extending health care coverage to the remaining uninsured and reforming insurance coverage to meet minimal standards of adequacy, including limits on patients’ out-of-pocket expenses.

` Invest in the long-neglected primary care system by improving compensation and supporting training for primary care providers.

` Improve health equity by eliminating disparities in the health and health care delivery that low-income individuals, Black, Latino, and Indigenous people, women, and people who live in rural areas receive. These populations often face discrimination and receive lower-quality care.

` Address the uncontrolled consolidation of health care systems and resources in local markets, which drives prices higher and makes insurance less affordable.

` To safeguard the well-being of all Americans, invest in interventions outside the health care system to address the social drivers of health, including poverty, homelessness, hunger, gun violence, and substance use.

“There should be more financial rewards for providing good quality care,” she said. “Hopefully both public and private payers will see the value in increasing the payments going to primary care practices so that there can be innovation in the primary care practice.”

There currently aren’t enough doctors, nurse practitioners and PAs in primary care to meet the need. Replenishing the workforce won’t happen overnight. Until then, healthcare providers must find innovative ways to distribute the work within the team.

“With the advent of technology and AI, you can imagine how if you have upfront payments to practices to support technology, so much of the administrative or busywork that is given to clinicians could be taken away and given to AI so that clinicians could spend their time actually taking care of patients face-to-face,” Dr. Jabbarpour said. “There’s a lot of innovation that can happen. Team-based care is important, but all these things take upfront payments. Right now, primary care practices are too cash-strapped to be able to do any of these innovative things or try new models.”

For its part, the Centers for Medicare & Medicaid Services Innovation has put forth several models that could help foster growth in primary care in the United States.

For instance, in June 2023, the Centers for Medicare & Medicaid Services (CMS) announced a new voluntary primary care model – the Making Care Primary (MCP) Model – that will be tested in eight states. The goal of the 10.5-year model is to improve care management and care coordination, equip primary

care clinicians with tools to form partnerships with health care specialists, and leverage community-based connections to address patients’ health needs as well as their health-related social needs (HRSNs) such as housing and nutrition. CMS is working with State Medicaid Agencies in eight states – Colorado, North Carolina, New Jersey, New Mexico, New York, Minnesota, Massachusetts and Washington – to engage in full care transformation across payers, with plans to engage private payers in the coming months.

MCP provides primary care clinicians with enhanced model payments, tools, and support to improve the health outcomes of their patients, CMS states on its website. It provides additional resources and data to help primary care clinicians better coordinate care with specialists. It also supports better care integration, meaning that clinicians can more seamlessly address physical and behavioral health needs and tap into community networks to reduce health disparities.

CMS said the MCP care delivery approach communicates its vision for care delivery through three domains:

` Care Management: Participants will build their care management and chronic condition self-management support services, placing an emphasis on managing chronic diseases such as diabetes and hypertension, and reducing unnecessary emergency department (ED) use and total cost of care.

` Care Integration: In alignment with CMS’ Specialty Integration Strategy, participants will strengthen their connections with specialty care clinicians

“Patients are increasingly diagnosed with multiple chronic conditions, which only intensifies the importance of accessible, affordable, high-quality primary care teams that can help anchor their overall health care.”

while using evidence-based behavioral health screening and evaluation to improve patient care and coordination.

` Community Connection: Participants will identify and address health-related social needs (HRSNs) and connect patients to community supports and services.

“Primary care clinicians are the first line of defense for prevention, screening, management of chronic conditions, and overall wellness,” CMS said. “Patients are increasingly diagnosed with multiple chronic conditions, which only intensifies the importance of accessible, affordable, high-quality primary care teams that can help anchor their overall health care. However, care coordination is increasingly challenging as patients see a greater number of specialists more frequently.

Through MCP, the Center for Medicare and Medicaid Innovation (the Innovation Center) increases the investment in primary care so patients can access more seamless, high-quality, whole-person care.”

Another model, the Primary Care First Model Option, is a voluntary alternative five-year payment model that rewards value and quality by offering an innovative payment structure to support the delivery of advanced primary care. In response to input from primary care clinician stakeholders,

Primary Care First is based on the principles underlying the existing Comprehensive Primary Care Plus (CPC+) model design: prioritizing the clinician-patient relationship; enhancing care for patients with complex chronic needs and focusing financial incentives on improved health outcomes.

There are approximately 2,100 practices participating in Primary Care First across both cohorts, and 17 payer partners. The Primary Care First model is designed to help primary care practices better support their patients in managing their health – especially patients with complex, chronic health conditions – and enables primary care doctors to offer a broader range of health care services that meet the needs of their patients. For example, practices may offer around-the-clock access to a clinician and support for healthrelated social needs.

While it remains to be seen whether these models will lead to improvements and longterm changes in the way the U.S. approaches primary care, Dr. Jabbarpour is encouraged that CMS and state agencies recognize the problem and are creating measures to address the issues.

“These programs are examples of what we’ve been asking for,” she said, “and hopefully these will pan out and be a good path forward.”

Addressing Physician Well-Being

The Physicians Foundation survey examined the current state of physician morale.

By Jenna Hughes

 Many physicians in the healthcare industry have long attested to well-being as a significant workplace challenge.

A recent survey by the Physicians Foundation all but confirms it. According to the data, well-being has remained critically low post-pandemic among physicians across the nation. The report, titled “2024 Survey of America’s Current and Future Physicians,” unveils an urgent need to improve physician mental health and integrate physician perspectives in healthcare decision-making.

Physicians keep the healthcare industry afloat, providing positive patient health outcomes and saving lives, and it is increasingly important for health systems to look out for their staff’s wellbeing to retain a strong workforce among rising industry challenges.

Facing burnout

Six in 10 physicians and residents and seven in 10 medical students reported experiencing burnout “often.” Additionally, more than half of physicians know of another physician who has considered, attempted, or died by suicide.

“While physicians’ emotional outlook shows some signs of potential improvement, the overall state of well-being for current and future physicians

remains low,” said Dr. Gary Price, president of The Physicians Foundation. “We consistently hear that the top factors negatively impacting physician well-being and driving burnout are administrative burdens and loss of physician autonomy.”

Physician well-being has been trending downward since the beginning of the pandemic. Physician-related well-being needs have become an urgent focus across the industry, requiring healthcare leaders to bear in mind physician perspectives when making workplace decisions.

Burnout is a leading cause of workplace challenges in healthcare, and the tragic outcomes affecting the mental health of physicians. Many physicians are still afraid of speaking up to seek mental health help. According to The Physicians Foundation report, more than four in 10 (44%) residents and half of medical students were either afraid or knew another colleague who was fearful of seeking mental health care, based on questions asked in medical licensure/ credentialling/insurance applications. Additionally, medical students (49%) are more likely than

residents (33%) and physicians (18%) to seek medical attention for mental health issues.

“While we are seeing a shift with medical students being more likely to discuss mental health with peers and classmates and go on to seek care, there are still stigma and structural barriers that prevent current and future physicians from seeking mental health care, and this must change across the industry,” said Dr. Price.

A number of residents (18%), students (22%), and (12%) physicians revealed they know of a colleague or peer who has considered suicide in the past 12 months.

Generational shifts, however, have resulted in these groups to be much more likely than before to have had a conversation about seeking mental health support. According to the report, 60% of students agree that well-being is an important topic of conversation in their classes.

In recognition of National Physician Suicide Awareness Day (NPSA Day), The Physicians Foundation and The Dr. Lorna Breen Heroes’ Foundation have started to call for systemic change through Vital Signs: The Campaign to Prevent Physician Suicide , according to The Physicians Foundation, aimed at improving the wellbeing of current and future physicians.

Impact of healthcare consolidation

Healthcare consolidation, or the process of merging or acquiring hospitals and physician practices into large conglomerates, is a significant contributing factor to the current rates of high physician burnout. At least three in 10 physicians who have experienced a merger or acquisition

have reported negative effects in job satisfaction (50%), quality of patient care (36%), independent medical judgement by physicians (35%), and healthcare costs for patients (30%).

“Consolidation is dramatically changing the healthcare landscape and practice environment,” said Dr. Price. “Current and future physicians agree that these changes are not good for physicians, patients, and the future of healthcare. Even before the pandemic, physician wellbeing was in jeopardy; now, the rapid pace of healthcare consolidation is further deteriorating the practice environment.”

Healthcare consolidation inevitably impacts the patient as well as physicians, and according to the report, seven in 10 physicians and medical students believe that consolidation is negatively impacting patient access to affordable and quality care.

“A first step should be for physicians to be part of the decisionmaking process when it comes to healthcare consolidation,” said Dr. Price. “Furthermore, we need to increase education and awareness for physicians who are considering a healthcare consolidation scenario to ensure policies are included that preserve physician autonomy and keep patient care as a central focus for the practice.”

Safeguards for consolidation identified by physicians, residents and medical students include high rates of agreement with 90% in favor of preserving physician autonomy, 87% in favor of maintaining patient standards, 86% in favor of increasing transparency and disclosure, and 84% in favor of assessing the long-term impact of healthcare consolidation.

Prioritizing well-being

Current and future physicians undoubtedly need well-being solutions that are prioritized by healthcare leaders. These solutions should consider the actual needs of physicians and aim to improve physician well-being while simultaneously retaining more physicians in the industry now and into the future.

In The Physicians Foundation report, 79% of physicians and 87% of residents indicate that the reduction of administrative burdens would prove helpful. Furthermore, 71% of residents and 59% of students found that the change or removal of medical licensure questions that stigmatize accessing behavioral healthcare to be helpful.

“Physician’s viewpoints on workplace issues will be critically important to ensure that our healthcare system works as it should for everyone, especially those who work within it,” said Dr. Price.

There have been signs of positive improvement for physician mental health, which offers hope for future healthcare industry initiatives that prioritize wellbeing. Significantly fewer physicians, nearly four in ten, or 38%, have reported withdrawing from family, friends, or co-workers, compared to 42% in 2023 and 46% in 2022.

“Physicians are the cornerstone of healthcare, and they must be able to prioritize their own health to provide the quality of care that people deserve,” said Dr. Price. “We need our country’s physicians to be able to care for themselves so that they can continue to care for the rest of us.”

A Safety Net for the U.S Healthcare System

How Community Health Centers are shaping the future of healthcare.

 Primary care access has become an important focus for healthcare providers, as it allows for the early detection of disease, provides patients with preventative healthcare, and increases care coordination for people across the nation.

Community Health Centers, also referred to as Federally Qualified Health Centers (FQHCs), provide substantial benefits to the nation’s healthcare system by increasing access to primary care services for over 32.5 million people, according to the National Association of Community Health Centers (NACHC). CHCs aim to reduce healthcare access barriers including lack of insurance, distance, transportation obstacles, and language so that more patients can receive quality healthcare.

CHCs provide care to all patients, regardless of their ability to pay for healthcare services. They are a vital part of delivering primary, dental, behavioral health, and preventative services care in the U.S.

“Community Health Centers are a cornerstone of the U.S. health care system, providing critical access to care for the nation’s most vulnerable populations,” said Kathleen Titus, Director of Community Health and Corporate Relations at Henry Schein. “These

health centers serve as a safety net, ensuring that uninsured, underserved, and low-income individuals receive essential health care services.”

It is estimated that 1 in 10 Americans are currently receiving healthcare at a FQHC, according to the NACHC. Health services through FQHCs/CHCs specifically aim to address health disparities and promote public health within urban and rural communities.

“Community health centers are the gate keepers of public

health,” said Dr. Kyu Rhee, President and CEO of the National Association of Community Health Centers (NACHC). “They reach beyond the walls of the exam room to not only prevent illness and reduce costly, unnecessary hospitalizations, but also address the social drivers that negatively impact health such as lack of stable housing, food insecurity, mental health issues, and substance abuse.”

Growth within community health services

Primary care is an essential healthcare service, and the early detection of health issues can help reduce the number of hospital visits and decrease healthcare expenditures. According to HRSA, community health programs assist the nation’s highest-need communities including people with low incomes, pregnant people, children, parents, rural communities, and more by providing quality, accessible healthcare. Primary care accounts for 35% of healthcare visits, according to NACHC, however it currently receives only about 5% to 7% of total healthcare expenditures.

“At NACHC, our focus is to increase the investment in primary care so that health centers expand their reach from one in 10 patients to one in three,” said Dr. Rhee. “This is a key focus of NACHC’s work because we know that nearly one-third of the U.S. population, or 100 million Americans, report they lack access to a regular doctor or source of care.”

The need for CHCs across the U.S. has continued to grow post-pandemic, and in turn, the market for CHCs is currently

growing. According to the Health Resources & Services Administration (HRSA), approximately 1,400 FQHCs are currently operating over 15,000 locations across the U.S. These centers serve more than 31 million patients annually, accounting for over 120 million patient visits.

Increased investment in the future of health centers will not only increase patient access to care but will contribute to economic growth as well. “Beyond their health care impact, CHCs generate significant economic benefits for local communities by creating jobs and engaging with local businesses,” said Titus. “Looking ahead, the market for

Use Disorder (MOUD) to over 230,000 patients.

In fact, the outlook for the growth of CHCs is positive. The 2023 estimated annual CHC revenue was $50 billion, according to HRSA, with funding sourced from patient fees, Medicare and Medicaid, federal grants, and other contributions.

Increasing demand for care

Due to their high use by the population, health centers are facing a rapidly increasing demand for healthcare. Higher patient numbers, along with ongoing industry challenges post-pandemic, have posed unprecedented obstacles for CHCs.

“ Health centers also continuously fight for federal funding to keep pace with the growing demand for affordable primary services. Workforce shortages remain a persistent problem due to the chronic underinvestment in primary care and workforce training programs.”

FQHCs is poised for continued growth, driven by the expansion of Medicaid, increased focus on social determinants of health, and ability to address ongoing public health challenges.”

CHCs serve one in nine Medicaid enrollees, one in five uninsured persons, and one in five low-income individuals (below 200% of the poverty level), according to NACHC. Last year, health centers provided mental health services to over 2.9 million patients, Substance Use Disorder Services to over 300,000 patients, and Medications for Opioid

“Despite their critical role, CHCs face multiple challenges that can impede their effectiveness. Funding fluctuations, particularly in federal and state support, can impact their ability to sustain services,” said Titus. “Additionally, post pandemic workforce shortages, difficulties in retaining qualified health care professionals in underserved regions, and competing with the private sector for providers pose significant hurdles.”

“Health centers are balancing the growing demand for care while navigating thin operating margins

from Medicaid redeterminations and cuts to the 340B federal discount drug program,” said Dr. Rhee. “Health centers also continuously fight for federal funding to keep pace with the growing demand for affordable primary services. Workforce shortages remain a persistent problem due to the chronic underinvestment in primary care and workforce training programs.”

Due to their mission and patient demographics, CHCs are budget conscious. To meet the needs of health centers, suppliers that deliver cost-effective solutions, value-based pricing, and group buying discounts are invaluable to CHCs, according to Henry Schein.

“Reimbursements are generally lower for Community Health Centers than those in the private sector,

“Since its founding more than 50 years ago, NACHC has been the leader in responding to the need for increasing access to affordable, equitable, quality health care. NACHC is committed to supporting innovation in workforce development, outreach and enrollment, population health, targeted emergency assistance, important research and policy work, and more.”

In response to the healthcare industry workforce shortage, HRSA announced a Teaching Health Center Graduate Medical Education Program (THCGME), which awards funding to health centers wanting to develop and train their own residents. According to Henry Schein, the company’s team has played a role in the THCGME planning and development meetings, giving Henry Schein an understanding of what it takes to launch a successful education program and combat healthcare industry issues.

Supply chain and CHCs CHCs provide a wide range of services and care all under one roof. According to NACHC, health centers therefore have supply needs that differ from a traditional physician’s office.

so they rely on federal grants and state funding to operate within tight financial constraints,” said Titus. “A sales team familiar with the specific challenges and regulatory landscape of CHCs can better tailor their offerings, ensuring compliance and reducing the risk of non-compliance, which is critical for maintaining federal funding.”

“Health centers must stock equipment and supplies for all of those services in addition to the innovative services they carry out to address the social drivers of health – nutrition classes or exercise classes to address diabetes, obesity and hypertension; food pantries or gardens to address food insecurity; or transportation services for patients who do not drive,” said Dr. Rhee.

CHCs specific product needs span a wide range of categories, and

health centers must tailor their services according to the surrounding community’s health needs. Primary care supplies, including diagnostic tools like blood pressure monitors, stethoscopes, and exam room equipment, are fundamental products for CHCs, according to Henry Schein. Pharmaceuticals, especially for chronic conditions, and point-ofcare testing supplies, are also in high demand, along with support for the 340B drug pricing program.

Additionally, CHCs require laboratory equipment, patient home monitoring devices, and mobility aids. Dental services are also offered by 80% of CHCs, creating a need for dental equipment, consumables, instruments, and diagnostics. Telehealth technology is increasingly vital for screenings and consultations, according to Henry Schein, particularly as many services have shifted to virtual platforms in response to health care needs during the pandemic.

“Suppliers who align with the mission and values of CHCs, and offer integrated, streamlined solutions, are likely to build trusted, lasting partnerships,” said Titus.

Future of community health

The ongoing mission and future of the community health center system has become more important in light of the hurdles associated with the COVID-19 pandemic, according to NACHC.

To create a structure for addressing ongoing challenges, NACHC recently unveiled its Strategic Framework which sets commitments for advancing the Community Health Center Movement, according to Dr. Rhee. The Strategic Framework lays out ten priorities for CHCs divided between three core areas including Employer

of Choice, Provider of Choice, and Partner of Choice.

“Since its founding more than 50 years ago, NACHC has been the leader in responding to the need for increasing access to affordable, equitable, quality health care,” said Dr. Rhee. “NACHC is

committed to supporting innovation in workforce development, outreach and enrollment, population health, targeted emergency assistance, important research and policy work, and more.”

Other ongoing initiatives related to health centers include

efforts from Henry Schein, that is reinforcing the important role CHCs play in preventive care by launching the Prevention is Power™ campaign in February 2024. This is a multi-year public health awareness campaign from the Henry Schein Cares Foundation, Inc. (HSCF), and aims to help improve health literacy and strengthen patient utilization of integrated, preventive care, with the goal of reducing incidences of chronic diseases as well as overall health care spending.

“To achieve the campaign’s goals, HSCF partnered with a diverse cross-section of leading medical and dental provider associations, including the American Dental Association (ADA), American Medical Association (AMA), National Medical Association (NMA), The Arnold P. Gold Foundation, National Association of Community Health Centers (NACHC), and other trusted organizations,” said Titus. “The campaign kicked off with the Prevention is Power Health Care Screening Program, in partnership with NACHC, through which HSCF provided grants and health care product donations to six community health centers across the U.S.”

Specifically tailored programs and initiatives such as these are key to addressing ongoing issues within healthcare. The primary care landscape continues to rapidly evolve, and community health centers continue to serve the industry to meet these shifting needs equitably. “Looking ahead, the market for FQHCs is poised for continued growth,” said Titus, “driven by the expansion of Medicaid, increased focus on social determinants of health, and ongoing public health challenges.”

Diving into Today’s ASC Market

Leading trends on the rise of ASCs in the U.S. healthcare industry.

 Ambulatory surgery centers provide a much-needed service for both patients and healthcare facilities – a cost-effective, convenient alternative for surgical care and procedures that do not require a hospital stay. At the recent IDN West meeting, Jason Harris, executive director, corporate healthcare development and ambulatory surgery centers for Allergan Aesthetics, hosted an ASC discussion panel with Rena Courtay, MBA, BSN, RN, CASC, vice president of ambulatory surgery at Trinity Health, and Trevin Hunt, MB, RNA, senior consultant for Avanza Healthcare Strategies, where they discussed the current ASC market and how sales reps can develop relationships with leadership at ASCs.

Jason Harris: Can you give us your impressions of what the ASC market looks like today?

Trevin Hunt: Primarily, it’s being driven by the payers. I would say Medicare is the biggest driver of the development of ASCs. When you talk about health systems, if they don’t already have an ASC, odds are they’re going to be either buying a local ASC or developing an ASC with a physician partnership.

One of the other main drivers, if you’re talking about health

systems, is if they have employed physicians with the foundation. That’s an incentive that they have to recruit physicians, if they can bring them in and give them ownership of those ASCs.

Another driver when it comes to health systems is a lot of the smaller ASCs in communities are struggling a little bit, and by bringing on a health system partner, then they get some advantages by partnering with them when it comes to supplies, just economies of scale for the ASC.

Rena Courtay: ASCs have the fastest growth predicted in the healthcare sector. Over the next five years, ASCs are set to grow 22%, which is higher than any other vertical in healthcare. Everybody wants to be a part of this, and that’s what I see.

When COVID happened, ASCs were still open after a certain point and hospitals had to keep closing. All of a sudden, those total joints could be done as outpatient surgeries. Before that, people were

Jason Harris

Trevin Hunt

Rena Courtay

saying, “Oh, we can’t send those people.” Yes, you can! It really accelerated moving some of those big procedures into ASCs, especially for physician groups that were slow to adopt this migration.

Harris: Can you talk about how the ownership model drives behavior, as far as types of cases accepted, contracting, and product decisions?

Hunt: It is going to depend I think more than anything else on the community, because the payer contracting in one community can be way different than another community. A lot of it depends on what’s driving that partnership.

One of the big things that I’ve seen is, if you have a community that has existing ASCs that have been there for years and they don’t have great payer contracts with commercial payers, it really makes that whole community a challenge for even a hospital to partner with it and substantially change it. Whereas if you have a community that doesn’t have a lot of ASCs, the payers and Medicare want to see an ASC in that space, and you can usually get pretty good contracts. The case mix is also something that’s going to really drive it.

Courtay: With physician-owned ASCs, they’re going to bring commercial cases there. They’re going to take some of their government payers to the hospital, especially Medicaid. They’ll take it to the hospital, because we don’t make money on implant heavy cases with government payers. Depending on what it is for Medicare, they may not bring anything. They primarily want to bring profitable cases when it’s a physician owned surgery center.

Harris: Can you tell if there are any service line impairments you see when shifting from the hospital to the ASC setting?

Courtay: The biggest one is total joints and that’s going to continue. I mean, when you look at a graph of total joints in 2014, outpatient total joints were way down. Right now, it’s way up and it’s expected that 60-70% of all total joints over the next 5-10 years will be outpatient. It’s very easy to do these as outpatients. The other specialty that we keep hearing about is that all the cardiovascular is moving out. It’s moved out a little bit, but there are a few factors why that hasn’t really been the big move that everyone thought. Most cardiovascular and cardiologists are employed, so health systems do not want to move – that’s their highest margin business. They

don’t want to open an ASC for their employee cardiologists and EP surgeons, so that’s one reason. The second reason is because of the regulatory environment, many states won’t allow interventional cardiology at an ASC.

Hunt: I did a due diligence project where we were looking at cardiology, and the thing that I found when I interviewed the physicians is that they’re really hesitant to move to an ASC. In addition to what you already said, there’s also resistance on the part of the surgeons. With the total joints, it’s just crazy how fast they’re moving out of the hospital OR. I think in most situations, if possible, you’re going to see a hospital partnering with those physicians, because they just lost a huge chunk of revenue out of the hospital. Getting 51% of it is better than getting none.

Primary Care Clinics Opening in Former Walmart Health Locations

Health systems see opportunities to meet their patients where they already are.

By Daniel Beaird

 Three former Walmart Health locations in Northwest Arkansas have reopened as Mercy clinics. The Missouri-based health system has opened Mercy Clinic Primary Care locations inside Walmart Supercenters in Springdale, Rogers and Fort Smith, Arkansas. These primary care facilities allow Mercy to meet their patients where they are, according to Dr. Lance Faddis, regional physician executive for primary care for Mercy Arkansas Communities.

Walmart Health closed all 51 of its locations across five states in 2024 after it couldn’t operate a profitable business due to a challenging reimbursement environment and rising costs, including labor costs tied to a shortage of healthcare workers in the U.S. The closure announcement came just one month after Walmart announced it planned to open 22 new locations in 2024 and more in 2025.

Walmart is not involved in providing or overseeing care at the new Mercy Clinic Primary Care locations. Mercy and community leaders marked the opening of the new clinics on Nov. 4-5.

“These new locations reflect our commitment to making healthcare

AdventHealth opens telehealth primary care clinic in Kentucky Walmart AdventHealth has partnered with Walmart to open a hybrid telehealth primary care clinic in Kentucky.

AdventHealth Clinic Corbin started seeing patients Nov. 4 for routine checkups, chronic disease management, preventative care, virtual consultations and lab services inside the Walmart Supercenter in Corbin, Kentucky. The retailer recently celebrated a grand reopening for the newly remodeled store with the AdventHealth addition.

Jamie Couch, interim administrator and vice president of operations at AdventHealth Manchester (Kentucky), said the health system is excited to serve the Corbin community with convenient whole-person care. The AdventHealth clinic will leverage the latest technology to connect patients with experienced healthcare providers.

Walmart stores are positioned to provide affordable care in underserved

The retailer recently celebrated a grand reopening for the newly remodeled store with the AdventHealth addition.

more accessible and to supporting the well-being of Arkansas families by providing care in the places they already visit frequently,” Dr. Faddis said.

Each location is between 5,000-6,000 square feet with space to expand. They offer primary for all ages with appointments and walk-ins during regular hours. Services include:

` Medicare annual wellness visits.

` Sports physicals.

` Vaccines and immunizations.

` Health screenings and exams.

` Preventative care and more.

communities and with Walmart Health exiting the stage in 2024, larger health systems have seen the opportunity to fill those spaces. The American Hospital Association (AHA) says technology, partnerships and flexible care models will help determine which players can succeed in healthcare in meeting consumer needs and profitability in the future. Managing the framework alone proved a daunting task for retailers like Walmart as their strategies have to adjust to healthcare regulations, unpredictable reimbursement models and staff shortages.

Facing the Post-Acute Staffing Crisis

Many post-acute care facilities have struggled to recruit and retain qualified staff post-pandemic, highlighting a need for solutions that improve patient care.

By Jenna Hughes

 The post-acute care industry, which includes senior living, home health, and hospice, is currently facing significant staffing shortages. Fewer staff means an overall greater impact on care delivery and patient access within long-term care facilities. The post-acute market share currently consists of 63% nursing homes, 16% assisted living facilities, and 17% other communities, according to Bob Miller, executive vice president of Gericare Medical Supply, and Board Member of HIDA and IMCO. Each of these post-acute facility types are facing unprecedented shortages of staff.

Many factors play into postacute care staffing shortages, including the lingering impacts of the COVID-19 pandemic, an aging U.S. population, burnout, higher rates of retirement in the industry, and an increased demand for care; all of which has left many patients and their families struggling to find adequate long-term care facilities to meet their needs.

Workforce shortages within post-acute care have made it more difficult for hospitals to discharge patients efficiently, keeping many in inpatient beds longer than medically necessary and crowding hospitals.

“Often, long-term care facilities must limit their number of admissions because they

don’t have the staff to care for the current population of residents,” said Amy Stewart, chief nursing officer of the American Association of Post-Acute Care Nursing (AAPACN). “This leads to longer hospital stays, or, for some patients, being forced to receive at-home care, even though what they really need is long- or short-term care in a skilled nursing facility.”

The COVID-19 pandemic especially exacerbated staffing shortage issues for an already stretched-thin post-acute care industry. COVID-19 saw an influx of acutely sick patients in long-term care, and virus-related facility challenges resulted in hundreds of shuttered nursing

homes. Compensation is also not adequate for many staff, and as a result, health care personnel are looking elsewhere and in different markets for employment,” said Miller. “Staffing mandates additionally put unrealistic expectations on nursing staff, hence, burnout has become a huge deal in the industry because overworked nurses can’t sustain their performance.”

Patient impact

Staffing shortages significantly impact the patient experience in long-term care facilities, with fewer staff members resulting in an overall poorer quality of care, increased facility re-admissions, and patient and family dissatisfaction.

“ Many rural facilities struggle to get staff and utilize agency staff,” said Stewart. “Using agency allows for care delivery but it can be costly, and the staff can come and go on a weekly basis.

homes across the U.S. Higher demand within the nation’s remaining facilities has caused patients in need of long-term care to face significant a reduction of available beds.

At least 774 nursing home facilities closed their doors between February 2020 and July 2024, according to the 2024 Access to Care report, displacing over 28,000 residents. There are now almost 60,000 fewer nursing home beds available since the pandemic began.

“The dangers of coming back to work after a deadly pandemic has made many staff rethink working in nursing

“Workforce shortages are devastating to post-acute care facility residents because there is no consistency in their care,” said Miller. “These patients are used to the operations of their facility being standardized, with treatment such as bathing, medication, toileting, changing of undergarments, etc. being given on a routine basis. Workforce shortages impact this consistency and negatively affect patients.”

Already existing labor shortages prior to the COVID-19 pandemic worsened in the pandemic’s aftermath, and now, according to the Access to Care report, more than 66% of facilities are concerned that

if their workforce challenges persist, they may also be forced to close their facility. In 2020, nearly 20% of nursing homes closed a unit or floor due to labor shortages.

In April 2024, the Centers for Medicare & Medicaid Services (CMS) issued the Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment Transparency Reporting final rule. This new rule set a minimum nurse staffing requirement, aiming to reduce the risk of residents receiving unsafe and low-quality care within longterm care facilities.

If the facility cannot get back in compliance, this may result in high costs which may eventually lead to closure of the facility. Many facilities have also closed units or wings, limited admissions or are using agency staff.”

The aging U.S. population is causing extra strain on the longterm care market. “The Baby Boomers generation is here, and the post-acute market is going to continue to grow. The population stands at 243 billion currently and is expected to grow at a 3% increase every year,” said Miller. “The elderly population

“ Workforce shortages are devastating to post-acute care facility residents because there is no consistency in their care,” said Miller. “These patients are used to the operations of their facility being standardized, with treatment such as bathing, medication, toileting, changing of undergarments, etc. being given on a routine basis. Workforce shortages impact this consistency and negatively affect patients.”

CMS set the staffing standard at 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. Facilities can use any combination of nursing staff to account for the additional 0.48 HPRD needed to comply with the total nurse staffing standard.

“Facilities that cannot find or retain staff often find themselves having regulatory compliance challenges,” said Stewart. “This can lead to civil money penalties, and/or denial of payment.

is exploding, and more facilities, products, staff, and nursing personnel are going to be needed.”

Staffing shortages are especially detrimental for rural communities, where access to skilled nursing facilities is already scarce, and persistent closures have created the phenomenon known as ‘nursing home deserts,’ according to the Access to Care report, meaning that there are no long-term care options available at all for certain rural populations. Forty additional counties in the United States

have become nursing home deserts since February 2020.

“Many rural facilities struggle to get staff and utilize agency staff,” said Stewart. “Using agency allows for care delivery but it can be costly, and the staff can come and go on a weekly basis. This makes continuity of care difficult in these communities.”

Maintaining consistent product inventory

Within distribution, maintaining consistent product inventory despite fluctuating staffing levels is an important component of patient well-being in long-term care facilities.

“The post-acute care industry has been changing drastically, and many physician’s assistants (PAs) are now helping in nursing homes. They do rounds, make changes, and are becoming the mainstay for residents in the homes, which is a good thing for the residents,” said Miller.

For distribution reps, however, ensuring that long-term care facilities’ product levels are correct can pose challenges, said Miller, especially when facing constantly shifting staffing levels.

“Newer staff members in long-term care facilities don’t always know the home well or may not have an idea of how much inventory they need to keep, so distribution reps must now look at the orders that are going into homes more frequently, so that they don’t run out of products,” said Miller. “This is very important to get product demand correct within these types of facilities.”

Gericare Medical Supply’s goals for meeting increasing demand within long-term care facilities going forward, said

Miller, include solutions such as looking for products, like electronic medical record systems (EMR), that can help nurses during staffing shortages. “EMR products can transfer key patient information such as blood pressure, tests, and more automatically into charts, making product planning easier and more efficient for each patient.”

Staffing solutions

The problems created by staffing shortages within post-acute care are multifaceted, requiring a varied approach to improve care delivery nationwide. Embracing both technology and telehealth can optimize staff workloads and

provide care to patients remotely, freeing up both staff time and pressure on physical facilities.

“AI is being used more often in the industry than ever before to solve issues and enhance solutions for residents,” said Miller. “Telemedicine is also being used in rural areas, so the resident is able to see and talk to their physician.”

Investing in the workforce by training and developing current staff, as well as improving workplace culture, may also enhance retention rates among long-term care staff. This entails providing staff with continuing education opportunities within or outside of the workplace, assisting staff with the

cost of tuition for nursing school or post-grad education courses, and fostering supportive workplaces with attention to staff development.

Currently, nursing education has “limited openings for a twoyear degree,” said Stewart. “A two-year degree could turn out nurses more quickly than the longer, four-year degree. However, because of long wait times to get into a two-year program, that isn’t happening. Two-year nursing programs could increase the number of nurses employed in the industry as a whole if colleges are able to take on more students.”

The growing aging population of the U.S. will soon present more open job opportunities for nursing graduates and unlimited growth potential for the future of the post-acute care workforce.

“The long-term care industry needs to become more attractive to new graduates,” said Stewart. “New graduates often do not realize the number of growth opportunities available in a long-term care career. Long-term care nurses can become certified in several clinical areas; and often, a nursing home or facility will provide, or pay for, this education for nurses.”

“There must be a career path established for those in healthcare who desire to enter into postacute care,” said Miller. “These students must be informed early on of the details of the profession, including what they can attain if they follow this path, and understand what their salary might be if they accomplish this goal. The long-term care industry must show students, beginning at the high school level into college, that long-term care is an area of growth and potential.”

Your 2024 Infection Prevention Wrap-up

A look at where we were before moving ahead in infection prevention sales.

By Paul Girouard

 Happy 2025! This is the time to reflect on the previous year, adjust, and jump into the new year.

As we look back on 2024, there were several pivotal events that occurred that directly impact infection prevention, many for years to come:

New CDC Guidelines

The Centers for Disease Control and Prevention (CDC) released a draft of the 2024 “ Guideline to Prevent Transmission of Pathogens in Healthcare Settings. ” This is an update of the previous guidelines from 2007 and with changes addressing what we have learned through the pandemic. The guideline provides updates on pathogen transmission, particularly airborne spread, revises recommendations for personal protective equipment (PPE) and other infection control measures. The CDC guidelines are written to address emerging pathogens and look beyond the facility and into the impacted communities. For more information go to cdc.gov.

COVID-19 update

COVID-19 continues to be a challenge globally. Reports from November 2024 estimate the total number of cases recorded since the beginning of the pandemic have impacted over 776 million worldwide. It is estimated that over 17 million doses of the 2024-2025 vaccine have been

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

8:30 – 10:45 am Welcome, Leadershup 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

8:15 – 9:15 am Leadership Panel

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

11:00 am Closing Remarks

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

Registration now open at mypwh.org

Thank You 2025 Sponsors!

administered in the United States through October. Cases have been under reported due to asymptomatic infections, changes in reporting, and limited testing. For more information go to covid.cdc.gov/ covid-data-tracker.

Measles outbreak

In 2024, the CDC reported a significant rise in measle cases. Contributing factors to the outbreak have been declining vaccination rates. As of November, 277 cases had been reported, 89% of the cases were tied to those who were unvaccinated, or unknown vaccination status. In 2024 the vaccination of kindergartners in the U.S. fell to 92.7%. The previous rate was above 95%. The CDC recommends that children receive two doses of MMR vaccine, which historically has been highly effective in preventing the spread of measles.

Want to learn more? Go to cdc.gov/measles.

Tariffs impacting chinese imports

In September 2024, the Office of the United States Trade Representative (USTR) finalized action on Chinese tariffs. Due to timing, this will have a greater impact on infection control products in 2025; particularly face masks, medical gloves, and syringes/needles. In 2025, tariffs on face masks will increase no less than 25%, syringes/needles will increase no less than 50%.

In 2026, medical gloves will increase no less than 25%.

These tariffs are creating an immediate impact on all glove pricing, location of production, supply/demand, and strain on the supply-chain from factory to

the end-user. To stay updated on tariffs, check out ustr.gov.

New administration

No matter the political party, when there is a change in presidential administration there will be impacts on infection prevention strategies. Policy direction, resource allocations, and administration policies will be affected. It is early in the process. As I am writing this, President-elect Donald Trump has nominated Robert F. Kennedy Jr. to serve as Secretary of Health and Human Services (HHS). The HHS oversees key agencies such as the CDC, the Food and Drug

Administration (FDA), and the National Institutes of Health (NIH). There will be changes.

Looking forward

I am optimistic about the future of the infection prevention category. The increase in demand for key areas within the category continues. Clinicians will always look to quality brands that provide safety and security. Staffing in all areas of our industry continues to change. Because of this, there continues to be a need for education, training, and clinical support. We all need to rise to the challenge and have a healthy 2025. Wash your hands first.

Measles cases increasing globally

Measles isn’t just an issue that the U.S. is dealing with. Worldwide, there were an estimated 10.3 million cases of measles in 2023, a 20% increase from 2022, according to new estimates from the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC). Inadequate immunization coverage globally is driving the surge in cases.

Measles is preventable with two doses of the measles vaccine; yet more than 22 million children missed their first dose of the measles vaccine in 2023, the CDC said. Globally, an estimated 83% of children received their first dose of measles vaccine last year, while only 74% received the recommended second dose.

Coverage of 95% or greater of two doses of measles vaccine is needed in each country and community to prevent outbreaks and protect populations from one of the world’s most contagious human viruses.

“Measles vaccine has saved more lives than any other vaccine in the past 50 years,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. “To save even more lives and stop this deadly virus from harming the most vulnerable, we must invest in immunization for every person, no matter where they live.”

“The number of measles infections are rising around the globe, endangering lives and health,” CDC Director Mandy Cohen said. “The measles vaccine is our best protection against the virus, and we must continue to invest in efforts to increase access.”

Patient Access to Care in All Forms

Increased chronic disease, aging populations and behavioral health awareness will accelerate inpatient and outpatient volumes.

By Daniel Beaird

 Workforce demands, capacity constraints and ever-changing payer and policy considerations highlight the enormous obstacles faced by the healthcare industry today. An aging patient population and high acuity rates over the next decade will continue to push lengths of stay longer and put pressure on the industry to adapt and make changes. But how does that look?

Sg2’s Impact of Change report forecasted inpatient utilization to rise 3% and days to increase 9% due to the prevalence of chronic disease and behavioral health conditions that spur demand for complex care and other services. Outpatient volumes are projected to jump to 17% due to outpatient surgical services driven by expanded capabilities and procedural needs.

Behavioral health volumes will grow to 8% inpatient and 26% outpatient visits. Finally, it predicts virtual care will encompass 23% of evaluation and management visits through greater adoption of technology, including home health expansion that is set to increase 22%.

settings before the pandemic, other higher acuity surgeries like cardiac surgery have now joined the trend. Primarily shifting to ambulatory surgery centers (ASCs), health systems are focusing on getting their patients in the right settings and locations for their surgeries.

“They’ve expanded to multiple sites across multiple geographies that connect the dots for the patient care journey so they can have their surgeries done in an ASC or a hospital outpatient department or inpatient depending on the type of procedure and acuity of the patient,” Dr. McDowell said.

As patient care shifts, there has been an uptick to home

Outpatient surgical care is expected to increase 19% over the next decade and physicians have driven growth in the ASC space.

“We’ve seen outpatient shift from the hospital to observation and hospital outpatient surgery gradually occur over the past 20 years,” said Maddie McDowell, MD, senior principal of intelligence for Sg2, a Vizient company. “It has accelerated in the last 10 years due to clinical innovations, payer pressures and changes in CMS payment policy and physician practice patterns, resulting in dynamic shifts across the care continuum and beyond the hospital to lower cost settings, including ASCs, urgent care clinics, virtual visits and the home.

Patient care shifts away from hospitals

While joint replacement surgeries began shifting to outpatient

and remote monitoring as well. “There’s a slow but steady growth in care at home,” she said. “It was rare before the pandemic but spurred by COVID-19, there’s now payment from CMS and artificial intelligence (AI) will augment it over the next decade.”

Dr. McDowell says the model has shown improved quality outcomes, reduced admission rates, shorter lengths of stay and reduced complications. “It’s very successful and some health systems are continuing to grow their programs,” she said. “A lot of experimentation happened during the pandemic because of the necessity to expand hospital bed capacity, and the results were overwhelmingly positive,

resulting in a new care model that will likely continue to grow in the wake of advances in AIenabled remote monitoring.”

With the aging, high-acuity patient population requiring longer stays in the hospital, how many bed days could care at home save? What other capacity constraints could be relieved by a robust care at home offering? Health systems must ask themselves these questions to ensure their resources are deployed for high quality outcomes.

Expanded virtual capabilities also help foster care at home. More services like consultations can be delivered in a virtual setting to help patients manage things like chronic disease and keep them out of the hospital.

“Virtual care was also low volume before the pandemic,” Dr. McDowell said. “But the pandemic accelerated its usage. CMS allocated new payment for it, and as a result we saw a dramatic rise in virtual visits. It’s come down now but it’s still well above what it was before the pandemic.”

CMS extended payment parity for virtual visits to match in-person visits and reduced or limited many of the restrictions originally present. But that’s expiring at the end of this year and it’s causing many organizations to press pause on it, according to Dr. McDowell. “They’re unsure about whether to double down and invest in it going further. They’re just waiting to see what CMS will do.”

But conditions like chronic pain and some parts of cardiovascular where remote patient monitoring can expand local services across broader geographies are predicted to see more uptake

of virtual care, along with better access to behavioral health in rural and underserved communities through virtual care.

However, anything towards surgical services is less likely to be tied to it.

Surgical care increasing

Outpatient surgical care is expected to increase 19% over the next decade and physicians have driven growth in the ASC space.

“ASCs were originally for very low acuity surgeries and highvolume surgeries like cataract surgery, for example,” Dr. McDowell said. “They were oftentimes owned by physicians and sometimes partially owned by hospitals. But over time, health systems and hospitals realized their bread-andbutter surgeries, whether they were inpatient or outpatient, were being connected to ASCs.”

Physicians controlled ASCs and could provide high patient satisfaction because ASCs didn’t have the cumbersome challenges that large hospitals had, along with the complexity, different cases and different staffing models, says Dr. McDowell. ASCs were focused on specific conditions and were very attractive to specialties. So, health systems and hospitals began to partner with ASCs in order to provide the entire continuum of care to their patients.

“Physicians play a large role in ASCs,” Dr. McDowell explained. “They bring in the patients, decide the protocols and execute the operational efficiency piece that can be lacking in large ORs at hospitals. If hospitals do these on their own, they sometimes don’t get the referrals, and they don’t have the same operations and pro-

cesses in place that are successful and that doctors find attractive.”

And if physicians have joint ownership in ASCs, there are financial benefits for them to succeed. So, it’s a beneficial relationship for physicians and health systems to partner together.

“For things like electrophysiology procedures and treating arrhythmias like cardiac ablations, those things are very connected to the hospital,” Dr. McDowell said. “Cardiologists are often employed by the hospital. There’s a lot of care at a clinic or where other cardiology services are given. The diagnostics that are done often require advanced imaging and certain procedures are preferentially done at the hospital.”

ED and in observation as well,” Dr. McDowell said. “But there are dynamic changes in clinical care brought on by pharmacy innovation. The pipeline for new drugs is quite promising for a whole host of chronic conditions.”

Dr. McDowell says that for dementia alone, there are 32 drugs in Phase 3 clinical trials which demonstrates whether or not a product offers a treatment benefit to a specific population.

“In the future, the introduction of targeted, effective drugs coming on board to treat common chronic conditions will impact the rising acuity health systems face today and have been addressing since the early 2000s,” she said.

“In the future, the introduction of targeted, effective drugs coming on board to treat common chronic conditions will impact the rising acuity health systems face today and have been addressing since the early 2000s.”

Higher acuity, aging patients and longer stays

Even before the pandemic, health systems were seeing longer lengths of stay and higher acuity coding in the ED. And since then, trends have manifested into rising acuity rates in hospitals due to chronic disease and obesity as well as an aging general population and more behavioral health awareness.

But the rate of acuity in hospitals has also naturally risen as other patients have been shifted to ASCs, care at home or post-acute programs, leaving behind sicker patients in hospitals. “We’re seeing that in the inpatient setting, in the

Drugs like GLP-1 receptor agonists and SGLT-2 inhibitors which are used to treat Type 2 diabetes and can reduce the risk of cardiovascular disease and kidney failure are a big story too. “These medication classes address multiple diseases, with impressive downstream impacts, such as reducing chronic disease progression, lowering healthcare utilization, decreasing hospitalizations, and generally improving the overall health of patients with cardiac and kidney disease, hypertension, and diabetes,” she said. “They’ve shown efficacy in reducing hospitalizations for

cardiac conditions, including congestive heart failure, and in slowing the progression of chronic kidney disease, even in the short time they’ve been available.”

Cancer drugs, gene therapy drugs, cardiac drugs, diabetes drugs, obesity drugs, dementia drugs and drugs that treat autoimmune conditions are all seeing

new targeted therapies. These will have an impact on the U.S. healthcare system from pricing to utilization and everything in between. They will increase utilization in some cases for services like diagnostics, infusions or chimeric antigen receptor (CAR) T-cell therapy at hospitals, but they could also decrease utilization downstream.

“If you’re getting these drugs for an autoimmune condition and you’re in remission, you no longer need the monthly infusions, the imaging and the regular visits to the doctor,” Dr. McDowell said. “That will affect the U.S. healthcare system in price, volume, overall care pathways and in how we manage patients.”

IDN News

Gartner announces ranking of the Gartner Healthcare Supply Chain Top 25 for 2024 Gartner, Inc. has released its 16th annual Gartner Healthcare Supply Chain Top 25 ranking, which recognizes U.S. health systems that demonstrate leadership in supply chain.

AdventHealth claims the top spot for the first time, jumping two spots from 2023. Stanford Health Care, Bon Secours Mercy Health, Corewell Health and Banner Health round out the top five (see Table 1). Inova, Endeavor Health, St. Luke’s Health System and Vanderbilt Health debut on the 2024 ranking, while BayCare Health System and HCA Healthcare return this year.

For the Healthcare Supply Chain Top 25 for 2024, Gartner has added a quantitative risk management component to the ranking to credit health systems for taking a leading role in their approach to risk management. Twelve health systems in the Top 25 and Masters received a score of 10 out of 10 for risk management and 23 received some credit in this area.

In its seventh year, the Healthcare Supply Chain Top 25 Masters category recognizes sustained supply chain leadership at health systems. This recognition is awarded only to supply chains that have achieved a top-five score at least seven times in the past 10 years. Cleveland Clinic attains Masters status for the first time joining Mayo Clinic and Intermountain Healthcare who have both achieved Masters status for seven years in a row.

The Joint Commission issues Sentinel Event Alert to help prepare healthcare organizations for environmental disasters o support healthcare organizations in implementing proactive risk management strategies, The Joint Commission has issued Sentinel Event Alert, “Environmental disasters: Preparing to safely evacuate or shelter in place.” This alert outlines steps for healthcare organizations to consider as they prepare for weather and climate-related disasters such as hurricanes, tornadoes, wildfires, floods and extreme heat.

Joint Commission Emergency Management (EM) standards require healthcare organizations to have a comprehensive EM program that provides a systematic analysis for planning and decision-making. The EM program structure can respond to any type of emergency through an all-hazards approach.

To assist in safe evacuation or sheltering in place during an environmental disaster, the Sentinel Event Alert suggests that healthcare organizations consider taking the following actions:

1. Revisit and update emergency plans.

2. Establish and build collaborative relationships.

3. Develop a resilient communications infrastructure.

4. Plan how to meet essential needs and provide care to staff and patients.

5. Plan and practice how to evacuate and shelter in place.

When Every Second Counts

Why EMR connectivity is a must-have feature for today’s vision screening tools.

Vision problems can significantly impact a child’s development, learning, and overall quality of life. Many vision problems, such as nearsightedness (myopia), farsightedness (hyperopia), astigmatism, and strabismus (deviation of the eyes), may not be immediately obvious. There is also a gap in communication between patient and caretaker. Children, especially younger ones, may not be able to express or recognize that they are having difficulty seeing clearly.

When it comes to treating vision problems in children, early diagnosis is key. The Welch Allyn Spot Vision Screener enables fast and objective detection of six amblyopic risk factors (myopia, hyperopia, astigmatism, anisometropia, strabismus and anisocoria) in children as young as six months old. It also boosts the efficiency and patient safety efforts of a pediatric office’s workflow.

For today’s clinicians, the manual transfer of information from a diagnostic test or screening to a patient chart is not only cumbersome, but it also creates an unnecessary risk for the healthcare provider.

The antiquated process opens clinicians up to the potential for errors to occur. Typos, missed information, or incorrect entries, can alter patient records and affect subsequent treatment decisions.

Indeed, manually inputting data from vision screenings, rather than using an electronic medical record (EMR) system, has several added disadvantages:

1. Staff headaches: Entering data manually increases the administrative load for the healthcare team.

2. Inconsistent access: Manually entered data might not be immediately accessible to other healthcare providers, leading to delays in patient care or decision-making.

3. Lack of integration: Manually inputted data may not integrate smoothly with other systems, requiring additional steps to align information across different platforms and causing potential disruptions in the continuity of care.

4. Data retrieval challenges: Finding and retrieving specific data points in manual records can be slow and cumbersome, making it harder to track patient progress or generate reports for analysis.

5. Compliance and documentation Issues: EMR systems are

designed to ensure compliance with healthcare regulations (e.g., HIPAA), while manually entered data may be more vulnerable to omissions or inaccuracies in required documentation.

Overall, manual entry requires more staff time and resources, which can increase operational costs, especially in high-volume practices. And with today’s technological advances, it’s an unnecessary burden for healthcare providers.

For example, Baxter’s Spot Vision Screener EMR application streamlines clinical workflows by allowing the EMR to directly communicate with the device to:

` Send orders

` Receive results

` Attach the report to the patient’s chart

When charting is complete, clinicians have the option to delete the information from the device. This feature protects patient data and saves time by eliminating the extra step of manually deleting results from the camera. Clinicians can manage a full day of patients by displaying orders and status, filtered by provider.

Thyroid Health and Stress

Highlighting the importance of thyroid health and stress’ effect on thyroid health for Thyroid Awareness Month.

 Healthy regulation of hormones is critical to an individual’s overall health, and the body’s thyroid gland controls the flow of hormones, maintaining many of its most important functions. The thyroid is a butterfly-shaped endocrine gland located in the lower front portion of the neck.

The thyroid both produces and regulates hormones, which are secreted into the blood and carried into every tissue in the body. This constant system helps to keep a person’s energy stable and temperature regulated. It also keeps the brain, heart, muscles, and other organs working as they should, according to the American Thyroid Association.

Without a properly functioning thyroid gland, patients may experience a wide range of symptoms and health complications such as thinning bones and muscle issues, high cholesterol, and an irregular heartbeat leading to blood clots, stroke, and heart failure.

An estimated 20 million Americans have some form of

thyroid disease, according to the American Thyroid Association, and more than 12% of the U.S. population will develop a thyroid condition at some point throughout their lifetime. Excess stress and certain lifestyle choices have been known to exacerbate thyroid conditions. Thyroid conditions are more prevalent in women than men, with one in eight women estimated to potentially develop a thyroid disorder during her lifetime.

Understanding hormonal imbalance

The major thyroid hormone secreted by the thyroid gland is thyroxine (also known as T4). The body, at times, needs to produce more of these types of thyroid hormones, while other times it may need less. The thyroid gland works with the pituitary gland to control the correct amount of hormones in order to support internal process.

The thyroid and pituitary gland together act in many ways like a heater and a thermostat within the body, according to the American Thyroid Association. When the heater is off and it becomes cold,

a thermostat reads the temperature and turns on the heater. When the heat rises to an appropriate level, a thermostat senses this and turns off the heater. Thus, the thyroid and the pituitary glands, much like a heater and thermostat, turn “on” and “off.”

This delicate internal system, however, doesn’t always function normally, and hormone imbalances can lead to a wide range of health issues. About 1 in 100 Americans aged 12 and older have hyperthyroidism, and nearly 5 out of 100 Americans have hypothyroidism, according to The National Institutes of Health.

Hyperthyroidism refers to when the thyroid gland is producing too much thyroid hormone, and hypothyroidism is an underactive thyroid gland, meaning the thyroid cannot make enough thyroid hormone to keep the body functioning normally. When a surplus of hormones is produced, the body’s metabolism goes into overdrive, and as a result, patients may experience symptoms such as weight loss, sweating, nervousness, or a rapid heartbeat. When not enough hormones are produced within the body, patients may feel tired and weak, lethargic, notice changes in the skin, and experience constipation or menstrual issues, according to the National Library of Medicine.

Other thyroid conditions include goiter, or an abnormal enlargement of the thyroid gland, and thyroid nodules, or an abnormal growth of thyroid cells that form a lump within the thyroid gland that can be benign or cancerous.

Finally, thyroid cancer is a type of cancer that begins

within a patient’s thyroid gland. According to the American Cancer Society, there were about 44,020 new cases of thyroid cancer in 2024 (12,500 in men and 31,520 in women). Certain risk factors include sex, age (most common in ages 30 to 60), hereditary conditions, and family history.

Stress and thyroid health

Hyperthyroidism, specifically, is the result of impaired production and secretion of thyroid hormones. The cardiovascular system is impacted by fluctuations of thyroid hormone levels, according to the National Library of Medicine, and stressful events, or long-term stress, can impact an individual’s psychological and physiological responses within the body, leading to thyroid issues. Graves disease, an autoimmune thyroid disease, is most frequently associated with stress, according to the American Thyroid Association.

“Chronic stress, whether from work, personal issues, or lifestyle, triggers the release of cortisol and adrenaline, leading to health problems, including thyroid gland dysregulation,” according to a MedScape and an American Thyroid Association editorial collaboration titled “Managing Stress for a Healthier Thyroid.”

There are many ways to destress to positively affect thyroid health, such as improving sleep quality, meditation and deep breathing exercises, being outdoors, exercise, and more. Stress mitigation has become an integral approach to managing symptoms for patients with immunemediated thyroid disease.

“In a recent study of 11 patients experiencing hyperthyroidism symptoms and diagnosed with stress-induced Graves disease due to severe emotional stress, nine of the 11 patients achieved clinical and biochemical remission within 1-3 months and 2-7 months, respectively, after self-reported stress relief,” according to the Medscape and American Thyroid Association editorial review.

Treatment and prevention

Treatment for thyroid disease depends on the type of condition a patient has and the cause, and the goal of treatment is to return thyroid levels to a healthy range. Treatments include medication, surgical removal of the thyroid, and thyroid hormone replacement, according to the American Thyroid Association.

Thyroid diseases are often caused by genetics or autoimmune conditions that can’t be prevented; however, there are certain lifestyle changes and prevention tools that can help individuals to maintain a healthy thyroid.

Ensuring better thyroid health, according to the American Thyroid Association, includes eating a balanced diet with adequate iodine intake, limiting processed foods, managing stress, exercising regularly, getting enough sleep, and regularly monitoring your thyroid function through checkups with your doctor; ensuring you receive the right amount of iodine through food sources like fish, dairy, and iodized salt, and improving diet overall.

The Road Ahead

What steps has the med/surg industry taken since the pandemic to handle today’s – and tomorrow’s – supply chain disruptions?

 The U.S. healthcare supply chain and economy at large dealt with a slew of challenges in the fall of 2024. Hurricanes, the temporary closure of a manufacturing facility critical to the supply of IV fluids, and a dock worker strike were just a few of the events that made headlines in the United States. Abroad, conflict in the Middle East and shipping issues continued to plague the global supply chain.

Indeed, each season seems to come with its own set of challenges and marketplace disruptions. But both public and private stakeholders have worked hard during the pandemic and post pandemic to put formal processes in place to tackle these disruptions. In the following interview, Linda Rouse O’Neill Senior Vice President for Supply Chain Policy, HIDA, discussed how preparedness and resiliency initiatives are helping stakeholders tackle the latest round of issues.

What have the last few years (and even last few months) taught us about the importance of preparedness for the U.S. healthcare supply chain?

We already knew that what we do as an industry is crucial for the health of patients. What has changed in the last few years is the broader understanding from outside the industry of the importance of supply chain preparedness and resiliency, as well as the breadth of issues that can impact the medical supply chain. We’ve really seen a wide variety of unusual challenges – including COVID, transportation delays, port strikes, weather events, and

Have the Supply Chain Resiliency Road Map or HIDA’s Traffic Protocol Playbook been used to respond to the recent events (hurricanes, port strike, IV Solutions shortage, etc.)

If so, are there any insights you can share about how they are being implemented? Consultations between federal partners, HIDA, and healthcare distributors have been a frequent and ongoing part of every supply chain disruption

HIDA has been in regular communication with the Administration for Strategic Preparedness and Response (ASPR) at HHS for over a decade. The initial partnership has grown across all aspects of ASPR.

critical product shortages. Preparedness and resiliency should be a continual cycle of learning, testing new models and developing best practices. HIDA manages a broader portfolio of advocacy issues than we did 10 years ago. Our issue advocacy extends deeper into transportation policy, industrial base development, and even environmental and trade.

since Ebola. HIDA advised federal partners about the impact on the medical supply chain during the COVID-19 pandemic, West Coast port delays of 2021, the 2022 railroad labor dispute, and the October 2024 East Coast dockworkers strike. Following the destruction of Hurricane Helene in western North Carolina, HIDA has

Linda Rouse O’Neill

been a clearinghouse of information between manufacturers, distributors, and government officials about shortages of IV solutions and its impact on patients and providers.

The Traffic Protocol Playbook is an effort to transition these informal consultations into a formal process, and implementation of the Playbook is ongoing. HIDA released a communications plan to support the Traffic Protocol Playbook this past fall. The work group held its first meeting in October to begin collaboratively monitoring the supply chain with federal partners utilizing the Playbook

criteria as a guide. The group is working on the operationalizing details so the Playbook and Communications Plan will be utilized going forward.

How has collaboration among public-private partnerships grown over the last few years? What work remains to be done?

HIDA has been in regular communication with the Administration for Strategic Preparedness and Response (ASPR) at HHS for over a decade. The initial partnership has grown across all aspects of ASPR. Now federal partners are regular participants

in several HIDA work groups and councils, including those on shipping, PPE and vaccinerelated products. Additionally, participation by federal partners at our events has grown from a handful to now more than 20 federal partners at HIDA’s MedSupplyChain Conference in February and the Preparedness Summit in June. Another recent development of the partnership is that ASPR has a booth and has led an education session at our Streamlining Healthcare Expo in September, which provides them with a broad group of HIDA members to engage.

Making Transport Effortless

UTILITY CARTS

 Ideal for transporting medical equipment to be used in various areas in your medical facility.

 Stainless steel construction allows for easy cleaning and sanitizing, while resisting corrosion and stains.

Common features include 2-3 shelves, ergonomic height push handles, open construction for easy access, guardrails for securing contents, and 4” swivel casters for easy maneuverability.

Available in Light, Medium, and Heavy-Duty models. IV pole attachment available on all models. Medium and Heavy-Duty models are available as MR Conditional.

What’s New In Washington: Advocacy In 2025

 The new governing coalition in Washington marks a significant political shift. From trade and tariff policies to tax reforms, the Trump administration’s agenda reflects ambitious goals that could reshape economic and regulatory frameworks. As Congress welcomes a diverse cohort of freshmen lawmakers, including healthcare professionals, new opportunities emerge for bipartisan collaboration and advocacy. For HIDA, these changes underscore the critical importance of engaging with policymakers to ensure the healthcare supply chain’s priorities are heard.

New Balance of Power: The inauguration of President Donald Trump ushers in a Republican trifecta – a governing coalition where one political party controls the White House, the Senate, and the House of Representatives. When Democrats held a trifecta in the first two years of President Biden’s term, they were able to enact a number of their legislative priorities into law. We should expect an unusually productive Congress over the next two years.

New Look at Trade and Tariffs: President Trump calls himself a “tariff man.” He has advocated for tariffs on imported goods as a means to raise revenue, promote domestic manufacturing, and as a negotiation tactic to obtain foreign

policy concessions from other nations. His appointments to economic positions (Treasury, Commerce, and U.S. Trade Representative) indicate an aggressive posture towards trade with China.

New Focus on Tax Policy: One of the signature policy achievements of President Trump’s first term was passage of the Tax Cuts and Jobs Act of 2017 – known in Washington as the “Trump tax cuts.” This package of tax cuts are scheduled to expire at the end of 2025. Congress will debate whether targeted tax breaks and deductions for individuals will continue, and whether

the corporate tax rate will remain at 21%.

Director of Congressional and Public Relations; Health Industry Distributors Association

New Faces on Capitol Hill: The new Congress brings a large class of freshmen lawmakers to Capitol Hill – with 13 new Senators and 68 new Representatives. This new cohort is remarkably bipartisan – 7 Senate Republicans, 6 Senate Democrats, 33 House Republicans and 35 House Democrats. Among this class of freshmen are a variety of medical professionals –nurses, family doctors, pulmonologists, and OB-GYNs.

New Opportunities for Outreach: Elections come and go. Four years ago, Democrats had unified political control over Washington. Now the opposite is true. Change is a constant in politics. So is the need to advocate for the medical supply chain.

HIDA serves as the voice for healthcare industry distributors on legislative and regulatory issues, regardless of political party. If you would like to participate in HIDA’s legislative advocacy campaigns, please contact me at ruthven@hida.org.

Wyeth Ruthven,

Industry News

Midmark promotes Scott Denman to VP, supply chain

Midmark Corp. announced the promotion of Scott Denman to vice president of supply chain. In this position, Denman will be responsible for all aspects of the Midmark supply chain, including planning, sourcing, manufacturing and distribution.

Denman has been with Midmark since 2001, when he joined the company in summer production in Versailles. Over the years, he has held a series of key positions, including coordinator in the Midmark Production System (MPS) office, and later, he played a pivotal role in transitioning to MPS at the company’s Glasgow, Kentucky, location. Denman returned to Versailles as MPS office manager and later served as operations manager for Midmark’s medical business. In 2016, he took on the role of plant manager and site lead at the company’s former Lincolnshire, Illinois, location. Most recently, Denman held the position of senior director of U.S. manufacturing, where he was responsible for all domestic manufacturing operations.

“Throughout his tenure at Midmark, Denman has proven himself a trusted and influential leader, consistently driving operational excellence and playing an integral role in the company’s integration efforts,” a Midmark release stated.

“His dedication to improving supply chain processes and fostering a culture of continuous improvement has positioned him for success in this new leadership role.”

MedPro Associates and EZbra enter partnership for MedPro to provide contract sales

MedPro announced a new partnership with EZbra to provide contract medical sales across all major medical markets. Together, the two companies will take EZbra’s products to the entire United States to provide caregivers and patients with EZbra’s innovative wound care device, specifically designed for all post-surgical breast procedures, according to a release. “With a nationwide team of over 60 territory reps covering the Acute, Government and Non-Acute markets, MedPro is perfectly positioned to grow EZbra’s footprint and increase sales to caregivers of all kind,” the release said. “Additionally, Optimal Government Services will serve as the Master Distributor, creating a powerful synergy for sales, support and distribution for the three companies.”

EZbra meets the unique anatomical, medical, and emotional needs of patients recovering from breast procedures of all types. The EZbra mission is to provide patient-focused post-surgical dressings that promote recovery with dignity, provide superior comfort and support, and establish a new standard of care in breast surgery and beyond. Through continuous improvement and a

commitment to quality, EZbra aims to transform wound care with devices that deliver comprehensive solutions for diverse anatomical and medical needs.

“This collaboration is a testament to our shared commitment to innovation and patient care. By joining forces with MedPro, we are taking a significant step toward establishing EZbra as the GOLD standard of care in postoperative breast surgery,” said Efrat Roman, Founder of EZbra.

Bill Sparks, Founder and CEO of MedPro, states, “EZbra is a great product and complement to the portfolio we represent. There is a clear need for post-operative support of breast care procedures, and their innovative approach is sure to provide caregivers and patients with an ideal solution.”

NDC announces Eryn Veronesi as Business Development Manager –Marketing Sales & Service NDC, Inc. announced the hiring of Eryn Veronesi as Business Development Manager – Marketing Sales & Service. “Eryn is a dynamic and results-driven executive with 15 years of experience in business development and digital transformation, specializing in delivering innovative marketing solutions for a diverse range of companies in the healthcare industry,” NDC stated.

Scott Denman

Eryn Veronesi

Cardinal Health completes acquisition of Integrated Oncology Network

Cardinal Health announced that it has completed its acquisition of Integrated Oncology Network (ION). ION is a physicianled independent community oncology network including more than 100 providers delivering care

at more than 50 practice sites across 10 states. ION supports a complete continuum of care across its member sites including medical oncology, radiation oncology, surgical oncology, urology, diagnostic testing and other ancillary services. As part of the transaction ION practices will be integrated

SMI announces 2024 Tom Hughes Collaboration Award Recipients

into Navista, Cardinal Health’s oncology practice alliance, and ION practice management and practice growth services will become part of Navista’s advanced services and technology offering. The ION team will join the Pharmaceutical and Specialty Solutions segment of Cardinal Health.

SMI® presented Concordance Healthcare Solutions and Rush University System for Health (RUSH) with the prestigious 2024 Tom Hughes Collaboration Award. The announcement and presentation of the award took place at the SMI Fall 2024 Forum in Austin, Texas.

The SMI Tom Hughes Collaboration Award is in honor of the late Tom Hughes, SMI Executive Director from 2004 – 2021. This annual award, established in 2021, recognizes exceptional efforts of industry thought leaders collaborating to bring innovation, discovery, and improvements to the healthcare supply chain.

The Award Steering Committee chose SMI members Concordance Healthcare Solutions and RUSH for their collaborative partnership to transform patient care by reducing costs, improving efficiency, and making a positive impact on the healthcare supply chain. Rush and Concordance were able to achieve real-time insights into each of their supply chain processes, utilizing AI to increase resilience, and establishing higher transparency.

This collaboration empowered supply chain teams to make rapid and informed, proactive decisions leading to a more agile, efficient and better prepared supply chain ecosystem.

Lisa Hohman, CEO at Concordance, said “We are honored to receive this esteemed industry award, which reflects the power of teamwork, collaboration and a shared vision. This achievement reflects the dedication and hard work of our entire team and our partners. Together, we are committed to driving positive change and making a lasting impact in the healthcare supply chain in honor of Tom Hughes who was a pioneer for trading partner collaboration.”

Jeremy Strong, Chief Supply Chain Officer at RUSH agreed and explained “This award demonstrates what is truly possible when partners work collaboratively and transparently, creating a mutually beneficial solution by leveraging the strengths of both organizations … it is a testament to what we can achieve when we unite our ideas and resources for a common purpose. This award is truly an honor for RUSH and for our supply chain team.”

According to the US Access Board 1, “Currently, on the market there is one examination chair which reaches a low transfer height below 17 inches, the Midmark 626 Barrier-Free ® examination chair...”

For clinics looking to improve both patient access and caregiver safety, this chair represents a crucial advancement.

01 Seat Height: 15 ½"- 37"

02 Transfer Surface: 28” wide and 19 ½" deep

03 Base Clearance: 23 ½"

04 Transfer Supports compliant to the new standards Learn more at: midmark.com/examchair

Hillrom