REP January 2019 by BOC design Inc

vol.27 no.1 â&#x20AC;˘ January 2019

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Healthy Reminders For 2019, get on the right thing â&#x20AC;&#x201C; and stay on it

Keeping the customer happy.

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JANUARY 2019 • VOLUME 27 • ISSUE 1

PUBLISHER’S LETTER What Will 2019 Bring...................................................6

PHYSICIAN OFFICE LAB

Healthy Reminders For 2019, get on the right thing – and stay on it

Take Heart! Cardiac tests and the physician office lab..........................8

TRENDS Customer Contacts in 2019 Survey: Reps prefer email to texting, but face-to-face contact still strong................................... 12

IDN OPPORTUNITIES Regional, local alliances playing a bigger role Study shows that most are affiliates of national GPOs................................................... 16

24 DISTRIBUTION

Supply Chain Executive Profile Steve Pohlman, Senior Director, Materials Management............................................................ 18

TRENDS Move it! Regular physical activity is essential to our health...... 30

Diverse Companies Find Doors Opening But the rules of the game are the same as those for all suppliers

Bottom line: Obesity itself is harmful.......... 36

CHRONIC CARE MANAGEMENT Oral Arguments Researchers continue to make the connection between oral health and chronic disease...................... 38

repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2019 by Share Moving Media. All rights reserved. Subscriptions: $49.00 per year for individuals; issues are sent free of charge to dealer representatives. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address. POSTMASTER: Send address changes to Repertoire, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors. Periodicals Postage Paid at Lawrenceville, GA and at additional mailing offices.

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January 2019

JANUARY 2019 • VOLUME 27 • ISSUE 1

QUICK BYTES

WINDSHIELD TIME

Automotiverelated news

42 SMART SELLING

Just Give it to me Straight

Technology news

46 REP CORNER

HIDA GOVERNMENT AFFAIRS UPDATE

Medicare Increases Reimbursements for ASCs,Physicians and Home Health Agencies 4

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Ed Draper: The fire within....................................... 48

INDUSTRY NEWS News........................................................................................... 52

You Keep Us Going Some things are essential to win the day. For us, it’s distributors like you who sustain and fuel our success. And we want to thank you. Thank you for providing the high-quality products critical to healthcare professionals’ needs. Because of you, B. Braun is a leading healthcare provider.

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Sales representatives in your area are ready to discuss how to further improve your customer experience.

PUBLISHER’S LETTER

What Will 2019 Bring? There is something about a new year and a fresh start that gets me excited. Regardless

of how 2018 ended, we get to start over and try new things, close new business, and forge a sales year from day one. As salespeople the new year has opportunity to be sure, but it also means new sales goals to meet. I would encourage each of you to embrace 2019 with an aggressive mindset right out of the blocks. After 25 years in sales, I know that making Q1 is probably the most important quarter of the year, so we need a strong effort to ensure we are on track. As always, Repertoire has a full lineup of topics for 2019 to help educate you and give you content to talk about with your customers. We will also continue our educational podcast with interviews from experts on topics such as equipment, lab, infection control, and much more. However, the new podcast series I am most excited about is all about you! “Road Warriors and Their Untold Stories.” This series will feature your fellow sales reps, as well as industry leaders. My goal in each episode will be to find one or two pearls of sales wisdom that we all can use. We will also ask questions about their career path, who their mentors were and what made them great, and some of their funniest stories in the field. I will be recording a few of these a month and hosting them on Repertoiremag.com. Hopefully these podcasts will not only be entertaining, but also educational from a sales standpoint. Here are some of the opening episodes: Brad Connett, Eddie Dienes, Ty Ford, Jay Keene, Chris Verhulst, Tony Melaro, Brian Taylor and several more. We are also launching Med Reps Insights in January. This will be an opt-in newsletter on topics around the industry that impact you the most. For each of these new additions, please be sure you read the Dail-eNews for announcements of new episodes and newsletters.

Scott Adams

Happy New Year, R. Scott Adams Publisher

repertoire is published monthly by Share Moving Media 1735 N. Brown Rd., Suite 140, Lawrenceville, GA 30043 Phone: (800) 536-5312, FAX: (770) 709-5432; e-mail: info@sharemovingmedia; www.sharemovingmedia.com

editorial staff editor

Mark Thill lthill@sharemovingmedia.com managing editor

Graham Garrison ggarrison@sharemovingmedia.com editor-in-chief, Dail-eNews

Alan Cherry acherry@sharemovingmedia.com art director

Brent Cashman bcashman@sharemovingmedia.com

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vice president of sales

Jessica McKeever jmckeever@sharemovingmedia.com (800) 536.5312 x5271 director of business development

Alicia O’Donnell aodonnell@sharemovingmedia.com (800) 536.5312 x5261 sales executive

Lizette Anthonijs Lizette@sharemovingmedia.com (800) 536.5312 x5266

publisher

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

Brian Taylor

Subscriptions

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

2019 editorial board Richard Bigham: IMCO Eddie Dienes: McKesson Medical-Surgical

btaylor@ sharemovingmedia.com

Joan Eliasek: McKesson Medical-Surgical

circulation

Doug Harper: NDC Homecare

Ty Ford: Henry Schein

Laura Gantert

Mark Kline: NDC

lgantert@ sharemovingmedia.com

Bob Ortiz: Medline Keith Boivin: IMCO Home Care

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PHYSICIAN OFFICE LAB

Take Heart! Cardiac tests and the physician office lab By Jim Poggi At this time of year, we are typically in the middle of

respiratory testing season and running hard to keep up with demand. So, why should we focus time on heart disease screening and follow-up tests now (other than that February is right around the corner and is “heart month”)? Because heart disease is the leading cause of death in the United States, and our customers see patients for diagnosis and follow-up for heart disease every day. So, every day our customers will be initiating or modifying a patient treatment plan for a heart patient. We can influence the path to care for a disease that is also implicated in two other serious disorders: stroke and diabetes, which are also leading causes of death in the United States. For additional perspective, 28.4 million Americans are diagnosed with heart disease annually. That’s over 11 percent of the U.S. adult population. Test name Basic/comprehensive metabolic panels Cholesterol/HDL/Triglycerides Glucose

Electrolytes D-dimer hs-CRP

Beta natriuretic peptide PT/INR (prothrombin time)

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In 2015, there were 15.3 million physician office visits with heart disease as the primary diagnosis, and heart disease accounted for 1.9 million visits to hospital outpatient departments in 2015. There were over 1.1 million emergency room visits for heart-related causes in 2015. With that backdrop and the knowledge that lab tests influence 70 percent of all medical decisions, we can be a positive impact in providing lab tests that can help diagnose heart disease quickly and accurately, as well as providing follow-up tests to assess the patients’ response to treatment.

Screening and predictive tests A summary of the most commonly used screening and predictive tests are below:

Indicates Overall metabolic status

Waived? Some

Comments General health screen

Elevated lipids increase risk Elevated glucose increases risk

Yes Yes

Metabolic imbalance can be related to heart disease Clotting risk Inflammation

Some methods

Multiple options are available Some glucose methods are available on lipid panel instruments Electrolytes can indicate heart failure or hypertension More stroke related Can indicate an underlying condition that could lead to heart disease Useful for initial diagnosis of heart failure and follow up More stroke related

Increases in congestive heart failure Clotting risk

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Some methods No

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PHYSICIAN OFFICE LAB Acute markers While a handful of primary care practices also perform either troponin I or arterial blood gas testing in the office, this practice is uncommon. Most primary care practices will perform tests that allow them to treat quickly and effectively during the office visit. As a result, when confronted with the prospect of diagnosis of an acute myocardial infarction (troponin I) or severely compromised blood gases, the typical practice will immediately direct the patient to an emergency room, where appropriate treatment is more readily available.

testing reference labs and not applicable in our market yet. They try to identify, quantify and risk stratify less well understood lipids. Some examples include apo A-1, apoB-100, LDL subclasses and other even more esoteric markers. From my review of the literature, I don’t expect the dust to settle over which of these tests will hit the mainstream in the POL for quite some time. There are a few new tests and test combinations that may become pertinent to us sooner than later. All are making their appearance in the acute care market. First, while high sensitivity Troponin I is becoming available on an increasing number of chemistry system platforms we sell, it is clearly an acute care marker and unlikely to become a mainstream factor in primary care. The next is a new multi-test risk assessment tool (high sensitivity Troponin I, glucose and glomerular filtration rate). This 3-test combination is finding its way into the acute care market to stratify risk of acute coronary syndrome. Due to the number and type of tests in this panel, I doubt it will make a meaningful impact on testing in primary care. Finally, small dense LDL testing is entering the hospital and reference lab market as a newer risk stratification marker. Of all the new tests, it is my impression that this one is most likely to come into our market next. Depending on whether studies in process will demonstrate whether it is a better way to assess risk of a future heart attack, it could well become part of the routine lipid panel down the road. Keep an eye out for that test and I will let you know what I hear as well. While molecular has rapidly advanced in several other testing areas, it is yet to become a factor in heart disease testing. I predict that as things change, it is most likely to find its way in risk prediction and preventive medicine. So far, tests in this area are still in the early research stages. February may be heart month, but heart disease is a year-round leading cause of death, and our customers deserve our best efforts to provide them with the right test mix to diagnose and manage this serious disease. So, stop reading and get selling cardiac tests!

There are a few new tests and test combinations that may become pertinent to us sooner than later. All are making their appearance in the acute care market. Opinion is divided in my experience in both urgent care centers and free-standing ER facilities on these tests. There are some that perform them, but most do not for reasons similar to primary care practices. When dealing with facilities like urgent care and free-standing ER centers, your best approach to positioning the more acute markers is to ask directly where they draw the line on acute tests. This is not only a sound way to qualify the customer, but is clearly in line with the goal of being perceived as a well-informed and well-grounded consultant.

On the horizon With the rapid proliferation of new tests, particularly molecular-based assays in microbiology, infectious disease and respiratory testing categories, what’s new and what’s on the horizon for heart disease testing? There are a ton of lipid fractionation and lipid phenotyping tests out there. Most are performed in specialty lipid

January 2019

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Blackshear, Joseph L., MD, “Appendage Obliteration to Reduce Stroke in Cardiac Surgical Patients With Atrial Fibrillation” <http://www.annalsthoracicsurgery.org/article/0003-4975(95)00887-X/pdf>, The Annals of Thoracic Surgery, 1996;61:755-759

http://www.heart.org/en/health-topics/atrial-fibrillation/what-is-atrial-fibrillation-afib-or-af

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC101077/

MC15639

TRENDS

Customer Contacts in 2019 Survey: Reps prefer email to texting, but face-to-face contact still strong It’s a sign of the times. Email is the

most often-used form of rep/customer communication today, though face-to-face contact remains a strong second. Phone calls are third, and text messaging has yet to catch on, at least in the professional setting. These results are according to reps who responded to Repertoire’s sales survey in December. More than half identified the physician office as their primary call point, while 37 percent said it was the acute-care hospital and 11 percent said post-acute care. When asked, “How many days a week are you in front of providers?” 27 percent responded five days, 22

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Federal legislation – specifically PAMA and MACRA – hasn’t had much of an impact on sales either, according to the respondents percent said four days, 20 percent said three days, 9 percent said two days, and 22 percent said fewer than two days. Despite Amazon being on the lips of many in the industry today, 65 percent of respondents said that the company has had no effect on their sales. Twenty-five percent said Amazon is adversely affecting their sales and dollar volume, while 9 percent said Amazon is adversely affecting sales volume, but not dollar volume. Federal legislation – specifically PAMA and MACRA – hasn’t had much of an impact on sales either, according to the respondents. PAMA – the Protecting Access to Medicare Act – is the federal government’s attempt to bring Medicare reimbursement closer to that of private payers. (In a word, that means “down.”) Nevertheless, 82 percent of the respondents said PAMA has had no effect on their sales. Meanwhile, 80 percent said that MACRA – the Medicare Access and CHIP Reauthorization Act of 2015 – hasn’t affected sales at all. MACRA replaced the Medicare Sustainable Growth Rate (SGR) methodology for updates to the Physician Fee Schedule with a new approach called the Quality Payment Program. Finally, when asked to grade the quality of distributor/manufacturer relationships today, 13 percent said “A,” 40 percent a “B,” 36 percent a “C,” and 10 percent a “D” or “F.”

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January 2019

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IDN OPPORTUNITIES

Regional, local alliances playing a bigger role Study shows that most are affiliates of national GPOs Purchasing through national alliances has somewhat

diminished, according to the authors of a study published this summer in Health Care Management Review. Over 10 years, hospitals have diversified GPO memberships to include regional/local alliances (many affiliated with their national GPO) and engaged in self-contracting. At the same time, hospitals have increased purchases of many categories of supplies/services through national GPOs and endorsed their value-added functions and increasingly important role. The study, “Hospital purchasing alliance: Ten years after,” examines purchasing alliances at two points in time – 2004 vs. 2014 – using surveys of hospital materials managers. It was prepared by Lawton R. Burns, PhD, MBA, the James Joo-Jin Kim Professor, Department of Health Care Management, The Wharton School, Philadelphia, Pennsylvania; and Allison D. Briggs, BA, BSPH, a doctoral student, Department of Health Care Management, The Wharton School. Supported by a grant from the American Hospital Association, the report addresses hospitals’ usage of national GPOs, their use of regional/local GPOs (as well as self-contracting), the ability of GPOs to provide cost-savings and value-added services, and the assessment by materials management executives of GPO business practices.

Some highlights: • In 2004, 71 percent of spending went through national alliances. But in 2014, hospitals reported only 55 percent of purchases through the national alliances, routing some spending through regional (10 percent) and local (5 percent) alliances. • Most of the regional/local alliances used were affiliates of the national GPOs. • Overall, 62 percent of 2014 purchases went through national alliances and their affiliates; 5 percent and 3 percent, respectively, went through non-affiliated regional and local groups. • Most materials management respondents believe their national alliance achieves demonstrable cost savings and margin improvement (mean = 4.10

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out of 5.00). But the level of agreement has fallen slightly over time (4.19 in 2004). • Materials managers report significantly lower satisfaction with GPOs’ ability to get excellent prices on physician preference items, falling from 3.47 in 2004 to 3.33 in 2014. • Unchanged is materials managers’ evaluation of their alliances’ ability to obtain cost-savings through lower prices overall (4.19 in 2004 vs. 4.14 in 2014). • Materials managers report significantly greater satisfaction with the ability of GPOs to achieve cost-savings through contract administration fees shared with the hospital (from 3.57 to 3.71); information technology (from 3.26 to 3.67); and centralized staffing (from 2.74 to 3.60). According to the authors, this suggests a shift in cost-savings from price to non-price sources. • The findings reflect growing use of national GPO prices as market ceilings and use of regional/local alliances to leverage such contracts to extract more discounts. • Materials management report significantly greater satisfaction with their national alliances in the areas of: clinical improvement (3.43 in 2004 vs. 3.65 in 2014), consulting services (3.46 vs. 3.58), clinical expertise and data support for value analysis (3.46 vs. 3.69), direct input into product and service selection (3.45 vs. 3.59), auditing for implant procurement (3.00 vs. 3.19), assisting with contract conversion for PPIs (3.01 vs. 3.21), and item master maintenance (2.88 vs. 3.08). • On the other hand, they report significantly lower satisfaction in three other areas – their national alliance’s safety improvement initiatives (3.57 vs. 3.45), ability to bring innovative products to their attention (3.64 vs. 3.50), and impeded access to innovative devices and manufacturers (2.29 vs. 2.40). For more information on the report, go to Health Care Management Review at https://journals.lww.com/hcmrjournal/ Abstract/publishahead/Hospital_purchasing_alliances___ Ten_years_after.99698.aspx

IDN OPPORTUNITIES

Supply Chain Executive Profile Steve Pohlman

Senior Director, Materials Management Cleveland Clinic, Cleveland, Ohio

He joined Cleveland Clinic as part of the Akron General Health System acquisition in 2015. Prior to that, he held many positions with Akron General Health System, including associate vice president of service operations, director of materials management, director of linen services, manager of procurement and purchasing, and manager of sterile processing. Before joining Akron General, he worked as a sourcing manager for Premier Health Partners in Dayton, Ohio. Currently, he and his wife reside in Northeast Ohio with their two children.

About Cleveland Clinic A native of Southwest Ohio, Steve Pohlman received his undergraduate

degree in industrial engineering from the University of Dayton. He also holds an MBA from Wright State University. Prior to beginning his healthcare career in 1997, he worked in manufacturing in both the auto and welding industries.

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Cleveland Clinic is an academic medical center founded in 1921. In addition to the main hospital campus in downtown Cleveland â&#x20AC;&#x201C; which has 1,400 beds, 101 operating

rooms and 59 buildings – the system has 10 regional hospitals and more than 150 outpatient locations in northern Ohio. Repertoire: Can you describe the most challenging and/or rewarding supply-chain-related project in which you have been involved in the past 12-18 months? Steve Pohlman: Inventory management transformation (or IMT) is an enterprise wide initiative. The enterprise consists of 10 regional hospitals and the main campus. Our goal is to use RFID technology to manage implantable devices (orthopedic implants, cardiac rhythm management devices, etc) across our enterprise. We will do so in the OR, cath lab, EP lab and interventional radiology, so everyone in the system will have complete visibility to what we have on hand. Prior to implementing RFID, our IMT Center of Excellence – which is a group of 10 project managers – is working on a complete workflow redesign in an effort to relieve nurses from managing supplies, so they can focus on patient care.

fast-paced, and we operate in a very matrixed organization. A major part of my responsibility is encouraging my team to be change agents. And a big part of that is listening. When I was younger, I thought I had all the answers. Now, I listen more and react less. And when I do respond or give feedback, I make sure it’s honest. It’s important to be honest, to be yourself, to follow your morals and values Repertoire: In your opinion, what will be some of the challenges or opportunities facing the next generation of supply chain professionals? What should they be doing now to prepare to successfully meet those challenges and opportunities?

Future supply chain professionals will have the same cost pressures that we’ve all had, but they will find new ways to address them, perhaps through third party relationships or new technologies. They will also have to cultivate an environment of customer service.

Repertoire: Please describe a project you look forward to working on in the next year. Pohlman: In 2019, we’ll take the IMT to our main campus – 88 ORs across six buildings. We’re excited about it, because not only will it free up our nurses’ time and help us manage inventory, but it will contribute to our systemwide goal of patient safety. Because all implants will be RFID-tagged, we will have complete visibility for improved implant management.

Repertoire: How have you improved the way you approach your profession in the last five to 10 years? Did you have any help doing so, or was there any particular incident that was particularly significant? Pohlman: I have always been involved in operations and managing change. Over the last five to 10 years, I have gotten better at going into every situation with my eyes – and my ears – wide open. Healthcare is extremely

Pohlman: Future supply chain professionals will have the same cost pressures that we’ve all had, but they will find new ways to address them, perhaps through third party relationships or new technologies. They will also have to cultivate an environment of customer service. I take the attitude that if “my” nurses don’t have what they need to take care of the patient, I’ve failed somehow. Tomorrow’s professionals will have to get out of their offices and meet their customers in their territory. People enjoy telling you what they do and how they do it. It’s a way to build relationships. It’s good to be in tune with technology; but don’t forget the art of conversation and relationship-building.

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January 2019

DISTRIBUTION

Diverse Companies Find Doors Opening But the rules of the game are the same as those for all suppliers There are plenty of opportunities in the healthcare supply chain for diverse

Millie Maddocks

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suppliers these days. “Doors continue to open like we’ve never seen in the past,” says Millie Maddocks, founder and CEO of MAC Medical Supply Co. in Chicago. But business is business. “Diversity may open some doors, but it won’t keep you in the game,” she says. Certified as a Women’s Business Enterprise by the Women’s Business Enterprise National Council, Chicago-based MAC Medical Supply is a supplier of a broad variety of products, including recording media and chart paper, batteries, biodegradable patient bedside products, electrodes, echo gels, blood pressure cuffs and more.

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DISTRIBUTION Maddocks is a long-time advocate for diversity among healthcare suppliers. For several years, she was a protégé in Owens & Minor’s Department of Defense Mentor/Protégé program, gaining experience and knowledge about the healthcare supply chain she otherwise would not have had access to, she says. Through that experience, she learned the importance of expanding her business, which today includes private labeling, master distribution, third-party logistics, and more. She conducts business with the major GPOs and med/surg distributors, as well as the Department of Defense and Department of Veterans Affairs. “I had to come up with innovative, new products to diversify my company,” she says. And just like “the big

“There’s always so much change in the healthcare industry – mergers, acquisitions, hospitals switching from one GPO to another, then from one prime vendor to another,” she says. “As a supplier, you think you are secure in an account, then a change takes place and you have to demonstrate your value proposition all over again. You may have known a buyer for years; then she leaves and a new person comes in.” A small supplier, which lacks the name recognition of big national firms, has to start from scratch, familiarize decision-makers with their products and services, and then get them to trust them. And as any supplier knows, the wheels of healthcare decision-making can turn slowly, she adds. Introducing and implementing a new product in a health system can take forever, and it calls for persistence and patience on the part of the supplier. “Yes, there are people in charge of supplier diversity who can help you get in the door. They definitely are your champions, but they are not necessarily the decision-makers.” “The biggest way any of this works in any GPO, prime vendor or healthcare system is through leadership from the senior team of the organization,” says Maddocks. “If they don’t emphasize diversity, it won’t happen.” Some CEOs do just that, and appoint someone to focus fulltime on the initiative. For their part, supply chain executives should make an effort to understand the favorable economic impact that small, diverse suppliers can have on their health systems, says Maddocks. In most diverse companies, the CEO is close to the customer, is fully engaged in the business, and can make important decisions immediately. “We are more flexible and agile, and we can turn things around much more quickly than big companies.” And beside all that, supporting diverse suppliers is the right thing to do, she says.

“ Just like any company, you have to add value, offer great products and services, and offer something innovative for patients and providers.” players,” she has obtained exclusive rights to many different product lines to do so.

Rules are the same When supplier diversity initiatives were in their infancy, some companies mistakenly believed that their diversity was an opportunity to charge more for their products, she says. That’s no longer the case, nor was it ever. “Just like any company, you have to add value, offer great products and services, and offer something innovative for patients and providers,” says Maddocks. “And you have to offer competitive pricing.” Being a diverse company offers one set of challenges and opportunities. Being a small company – as many diverse companies are – introduces a whole other set.

Editor’s note: Learn more about working with diverse suppliers from: •T he Women’s Business Enterprise National • Healthcare Supplier Diversity Alliance, Council, www.wbenc.org www.hsdafordiversity.org •W omen’s Business Development Center, • National Minority Supplier Development Council, www.wbdc.org www.nmsdc.org

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Healthy Reminder

Healthy Reminders For 2019, get on the right thing – and stay on it

oday’s medical sales reps spend much of their day speaking to providers about supplies and equipment to care for patients with obesity and chronic disease. Meanwhile, they may be neglecting their own health.

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Repertoire asked a handful of sales managers about their reps’ health and well-being. Their thoughts about stress, diet, physical activity and work/life balance should be wake-up calls for healthy habits in 2019. Contributing their thoughts were: •C hris Homan, region director, Cardinal Health, non-acute sales, Patient Recovery. •D avid Marion, regional director, Concordance Healthcare Solutions. • J oey Jackson, sales manager, Atlantic Medical Solutions. •T y Ford, vice president of sales, Western U.S., Henry Schein Medical Group. Repertoire: What are the greatest threats to your sales reps’ physical health or well-being today? Chris Homan: Physical threats to the well-being of our sales force (e.g., the effects of violent weather, an automobile in need of maintenance, unexpected absence from work) have been greatly minimized by close management of travel and fleet activity. With that said, there are factors that cannot be controlled, such as weather, disgruntled customers/ employees, and travel inconveniences. Most factors that threaten the physical well-being of our employees can be closely managed with regard to personal dietary habits, exercise habits, and other personal habits. Long road time and excessive administrative tasks tend to result in a more sedentary lifestyle, but proper planning and time management can largely mitigate the risks associated with such a lifestyle.

as bad for your health as smoking. Stress can also have a negative impact on physical health. Ty Ford: There are many threats today compared to when I first began my career in medical sales. The sheer pace of the world we live in has accelerated and with it, expectations – expectations from customers, stakeholders, corporations, and quite possibly, the desire to maintain a balance in one’s life. As technology has enabled certain enhancements, other aspects of our “convenient lifestyle” have increased the opportunity for threats: poor diet, lack of exercise, increased stress, texting while driving, inadequate sleep. Any of the ones mentioned could have a detrimental impact to one’s overall health. Repertoire: How about threats to reps’ emotional health or well-being? Homan: Driving for results in sales is often synonymous with stress, highlighting the importance of managing stress levels and a work/life balance. In today’s selling environ-

“ While connectivity opens windows for world-class efficiency, it can quickly lead to burn-out and the disenfranchisement of those without a proper work/life structure.” – Chris Homan

David Marion: As we ask reps to take on more responsibility, they have less time for themselves. We may increase the geographies and number of customers, but the hours in the day are the same. Joey Jackson: With such busy schedules, reps can find it hard to carve out time to exercise. Some of our reps have large geographical territories to cover and spend a lot of time driving (that is, sitting), which some studies say is

ment, the greatest threat to our employees’ emotional health is the ability to be “connected” 24/7 and reached at all times. It is vital that a sales representative set firm boundaries with their internal and external customer base outlining when it is and when it is not acceptable to be reached. Clarity of mind is paramount to effectiveness in the selling world, and without proper downtime, results will suffer greatly. While connectivity opens windows for world-class efficiency, it can quickly lead to burnout and the disenfranchisement of those without a proper work/life structure. If one properly utilizes “A” time for “A” activity, they can greatly reduce the need for encroachment of personal time to achieve functions that can be achieved within “work” hours.

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Healthy Reminder Marion: More responsibility adds to added stress and if you are not taking the time to balance your life with things like family, friends, exercise, faith, you run the risk of burnout. Jackson: The stress of managing and maintaining a sales territory can take an emotional toll. Making sure the customer’s expectations are being met, growing the business and meeting sales goals as well as dealing with the “brush fires” that generally happen on a daily basis can derail and sometimes demotivate a sales rep. This type of stress can lead to burnout.

is vital to the physical health of a sales representative. Sales reps will often pay a premium for convenience. That is to say, they may make the easy on-the-spot call for fast food when traveling. But planning meals on the weekend for the upcoming week is convenient too. Develop a plan. Execute on the plan. Stick to the plan, regardless of circumstance. Marion: Adhering to balance, such as eating a variety of foods leading to a healthy lifestyle; eating moderately when it comes to things like red meat and carbs; and keeping it to fruits and veggies routinely. Also, trying to keep away from the drive-through fast-food fix (which can slow them down in the afternoon); drinking water, mostly; keeping caffeine to a minimum; and eating snacks that are high in protein and things that will boost their energy.

“ Nothing in sales or life is certain. The rep who can roll with the flow, handle the situation and get back on track without getting overly stressed or overwhelmed is going to be the most successful.” Ford: I firmly believe that stress is endemic in today’s world, but one that can be controlled. There are necessary steps that should be taken to prevent stress from reaching certain levels. What I have observed from the sales team on how best to manage this are those who: • I dentify priorities. (“If everything is important, then nothing is important.”) •N arrow their “to-be-completed” list. •D edicate time necessary for personal time or personal priorities. Repertoire: From what you have observed, what are the most successful dietary habits among your reps? Homan: Time management is key to maintaining a healthy dietary regimen. This comes back to a core fundamental of sales success – having a strategy and executing upon that strategy. Without a strategy, reps are left to fend for themselves, which can lead to impulsive decisions both in business and in personal health. Just as a pre-call plan is vital to a successful sales call, a meal plan

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Jackson: Eating a well-balanced diet of lean protein and complex carbohydrates consisting of fruits – Joey Jackson and vegetables, and limiting starchy carbs, are essential in maintaining a successful diet. The most physically fit of our reps also eat four to six smaller meals a day and generally try not to eat after 7 p.m. Hydration is also a key. Drinking plenty of water helps to keep you hydrated and helps flush your body of toxins. Ford: This one can be tricky and the easiest to abuse. Those who live on the road have to maintain a certain discipline; otherwise the convenience of life on the road can add inches to your waistline and become detrimental to your health. I have observed a number of “best practices” that certain reps adhere to, including: • Pack your lunch. (Certainly controllable, as you own what you eat.) • Avoid certain foods. (Identify certain restaurants that specialize in health-conscious cuisine.) • Limit alcoholic drinks. (Not to be confused with the stress relievers!) •N o fast food. •N o food after a certain time.

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Healthy Reminder Repertoire: How about exercise habits? Which ones are most beneficial for sales reps? Homan: I have observed that discipline around exercise and physical well-being often leads to discipline in the realm of business. Just as one needs to schedule their week/month in advance from a business perspective, one must account for their physical health in the same manner. Those who exercise “as time permits” never get around to it, as the demands of a sales representative are rarely bound by time. Those who schedule time for exercise are far more likely to follow through and follow through on their commitments and goals. In my experience, starting the day with exercise, before business demands become apparent, is far more consistent than working out when “work is over.” Simply stated, work isn’t over until you say it is, which is a significant challenge for today’s connected sales representative, who ultimately puts physical health on the back burner. Marion: One rep is working to run a 10K, so he does moderate runs weekly and other cardio exercises. Other reps walk, do aerobics, yoga – things they can physically

monotonous. Adding flexibility training such as yoga or Pilates will also keep things fresh. Ford: Apart from eating healthy and avoiding too many alcoholic beverages, this one may be the toughest to balance. I have observed a number of best practices over the years, and some borderline “obsessions.” As with anything else, the proper amount of balance is necessary to achieve an optimal level of physical activity. Those who demonstrate best practices: • Establish goals. • Make necessary time for ANY physical activity. • Utilize technology (Apple watches, apps, etc.). • Engage an accountability partner. (Make it a competition.) • Think outside the box. (Take the stairs, pack your workout gear, choose hotels close to exercise facilities or that have adequate workout space.) Repertoire: Complete this thought: The psychologically fit sales rep … Homan: … has a plan, executes on that plan, and does not make excuses regardless of circumstances.

“ Those who live on the road have to maintain a certain discipline; otherwise the convenience of life on the road can add inches to your waistline and become detrimental to your health.” do while continuing to work our long hours and staying connected with their customers and their families. Jackson: Regular exercise at least three days a week – preferably five days a week – is best. A combination of resistance training with free weights or machines and cardio, (running, rowing, biking, elliptical or stair climbers) seems to produce the best results. Mixing things up by focusing on different muscle groups each day and alternating the type of cardio keeps workouts from becoming

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Marion: … balances work with family, friends and all aspects of the busy world we live in, to be a success not only to their company, but also to the customer.

Jackson: … is able to embrace uncertainty. Nothing in sales or life is certain. No matter how well we may – Ty Ford preplan our day, inevitably, something unexpected will derail that plan. The rep who can roll with the flow, handle the situation and get back on track without getting overly stressed or overwhelmed is going to be the most successful. Ford: …knows their limitations. They know where they can push themselves and when they need to recharge. They maintain a balance of proper healthy activities that incorporate a healthy diet mixed with adequate exercise. They make time for priorities, whether those are professional or personal.

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TRENDS

Move it!

Regular physical activity is essential to our health Physical activity is linked with even more positive

health outcomes than previously thought. Even better, benefits can start accumulating from small amounts of, and immediately after doing, physical activity. Just released, the Physical Activity Guidelines for Americans – issued by the U.S. Department of Health and Human Services – is grounded in the most current scientific evidence and informed by the recommendations of the 2018 Physical Activity Guidelines Advisory Committee, says HHS. This federal advisory committee, which was composed of researchers in the fields of physical activity, health, and medicine, conducted a multifaceted analysis of the available scientific literature. The guidelines complement the Dietary Guidelines for Americans, a joint effort of HHS and the U.S. Department of Agriculture. Regular physical activity is one of the most important things people can do to improve their health, according to the researchers. Moving more and sitting less have tremendous benefits for everyone, regardless of age, sex, race, ethnicity, or current fitness level. Individuals with

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a chronic disease or a disability can benefit from regular physical activity, as do women who are pregnant.

Sedentary behavior The new guidelines address the impact of sedentary behavior on health. Research on the health effects of sedentary behavior is a relatively new area, and was not addressed when the previous guidelines were published 10 years ago. Sedentary behavior has received an increasing amount of attention as a public health problem because it appears to have health risks, and it is a highly prevalent behavior in the U.S. population, says HHS. Data collected in the U.S. National Health and Nutrition Examination Survey (NHANES) indicate that children and adults spend approximately 7.7 hours per day – 55 percent of their monitored waking time – being sedentary. Thus, the potential population health impact of sedentary behavior is substantial. The newly published guidelines discuss the proven benefits of physical activity and outline the amounts and types of physical activity recommended for different ages and populations.

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TRENDS Key guidelines for children and adolescents Children and adolescents ages 6 through 17 years should do 60 minutes (1 hour) or more of moderate-to-vigorous physical activity daily: •A erobic: Most of the 60 minutes or more per day should be either moderate- or vigorous- intensity aerobic physical activity and should include vigorous-intensity physical activity on at least three days a week. •M uscle-strengthening: As part of their 60 minutes or more of daily physical activity, children and adolescents should include muscle-strengthening physical activity on at least 3 days a week. •B one-strengthening: As part of their 60 minutes or more of daily physical activity, children and adolescents should include bone-strengthening physical activity on at least 3 days a week.

• Adults should also do muscle-strengthening activities of moderate or greater intensity and that involve all major muscle groups on two or more days a week, as these activities provide additional health benefits.

Key guidelines for older adults The key guidelines for adults also apply to older adults. In addition, the following key guidelines are specifically intended for older adults: • As part of their weekly physical activity, older adults should do multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening activities. • Older adults should determine their level of effort for physical activity relative to their level of fitness. • Older adults with chronic conditions should understand

Data collected in the U.S. National Health and Nutrition Examination Survey (NHANES) indicate that children and adults spend approximately 7.7 hours per day – 55 percent of their monitored waking time – being sedentary. Key guidelines for adults Adults should move more and sit less throughout the day. Some physical activity is better than none. Adults who sit less and do any amount of moderate-to-vigorous physical activity gain some health benefits. •F or substantial health benefits, adults should do at least 150 minutes (2 hours and 30 minutes) to 300 minutes (5 hours) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) to 150 minutes (2 hours and 30 minutes) a week of vigorousintensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Preferably, aerobic activity should be spread throughout the week. •A dditional health benefits are gained by engaging in physical activity beyond the equivalent of 300 minutes (5 hours) of moderate-intensity physical activity a week.

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whether and how their conditions affect their ability to do regular physical activity safely. • When older adults cannot do 150 minutes of moderate-intensity aerobic activity a week because of chronic conditions, they should be as physically active as their abilities and conditions allow.

Key guidelines for women during pregnancy and postpartum • Women should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity a week during pregnancy and the postpartum period. Preferably, aerobic activity should be spread throughout the week. • Women who habitually engaged in vigorous-intensity aerobic activity or who were physically active before pregnancy can continue these activities during pregnancy and the postpartum period.

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TRENDS • Women who are pregnant should be under the care of a healthcare provider who can monitor the progress of the pregnancy. Women who are pregnant can consult their healthcare provider about whether or how to adjust their physical activity during pregnancy and after the baby is born.

Key guidelines for adults with chronic health conditions and adults with disabilities

Sedentary behavior has received an increasing amount of attention as a public health problem because it appears to have health risks, and it is a highly prevalent behavior in the U.S. population, says HHS.

• Adults with chronic conditions or disabilities, who are able, should do at least 150 minutes (2 hours and 30 minutes) to 300 minutes (5 hours) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) to 150 minutes (2 hours and 30 minutes) a week of vigorousintensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Preferably, aerobic activity should be spread throughout the week.

• Adults with chronic conditions or disabilities, who are able, should also do musclestrengthening activities of moderate or greater intensity and that involve all major muscle groups on two or more days a week. • When adults with chronic conditions or disabilities are not able to meet the above key guidelines, they should engage in regular physical activity according to their abilities and should avoid inactivity. • Adults with chronic conditions or symptoms should be under the care of a healthcare provider. People with chronic conditions can consult a healthcare professional or physical activity specialist about the types and amounts of activity appropriate for their abilities and chronic conditions.

To view the Physical Activity Guidelines for Americans, go to https://health.gov/paguidelines/second-edition/ pdf/Physical_Activity_Guidelines_2nd_edition.pdf.

The benefits of regular physical activity For adults and older adults, regular physical activity can: • Lower risk of all-cause mortality. • Lower risk of cardiovascular disease mortality. • Lower risk of cardiovascular disease (including heart disease and stroke). • Lower risk of hypertension. • Lower risk of type 2 diabetes. • Lower risk of adverse blood lipid profile. • Lower risk of cancers of the bladder, breast, colon, endometrium, esophagus, kidney, lung, and stomach. • Improved cognition. • Reduce risk of dementia (including Alzheimer’s disease).

• I mprove quality of life. •R educe anxiety. •R educe risk of depression. • I mprove sleep. • S low or reduce weight gain. • L ead to weight loss, particularly when combined with reduced calorie intake. •P revent weight regain following initial weight loss. • I mprove bone health. • I mprove physical function. • L ower risk of falls (older adults). • Lower risk of fall-related injuries (older adults).

Source: Physical Activity Guidelines for Americans, the U.S. Department of Health and Human Services (HHS).

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Obesity is common, serious and costly • The prevalence of obesity was 39.8 percent and affected about 93.3 million of U.S. adults in 2015-2016. • Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, which are some of the leading causes of preventable, premature death. • The estimated annual medical cost of obesity in the United States was $147 billion in 2008 U.S. dollars; the medical cost for people who have obesity was $1,429 higher than those of normal weight.

Obesity affects some groups more than others • Hispanics (47.0 percent) and non-Hispanic blacks (46.8 percent) had the highest age-adjusted prevalence of obesity, followed by non-Hispanic whites (37.9 percent) and non-Hispanic Asians (12.7 percent). • The prevalence of obesity was 35.7 percent among young adults aged 20 to 39 years, 42.8 percent among middle-aged adults aged 40 to 59 years, and 41.0 percent among older adults aged 60 and older.

Obesity and socioeconomic status The association between obesity and income or educational level is complex and differs by sex and race/ethnicity, reports CDC. •O verall, men and women with college degrees had lower obesity prevalence compared with those with less education. • By race/ethnicity, the same obesity and education pattern was seen among non-Hispanic white, nonHispanic black, and Hispanic women, and also among non-Hispanic white men, although the differences were not all statistically significant. Although the difference was not statistically significant among nonHispanic black men, obesity prevalence increased with educational attainment. Among non-Hispanic Asian women and men and Hispanic men there were no differences in obesity prevalence by education level. • Among men, obesity prevalence was lower in the lowest and highest income groups compared with the middle income group. This pattern was seen among non-Hispanic white and Hispanic men. Obesity prevalence was higher in the highest income group than in the lowest income group among non-Hispanic black men. • Among women, obesity prevalence was lower in the highest income group than in the middle and lowest income groups. This pattern was observed among non-Hispanic white, non-Hispanic Asian, and Hispanic women. Among non-Hispanic black women, there was no difference in obesity prevalence by income.

Obesity Facts

Source: Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity and Obesity, https://stateofobesity.org/obesity-rate-youth-1017/t

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TRENDS

Bottom line: Obesity itself is harmful A Cleveland Clinic genetic analysis has found that

obesity itself – not just the adverse health effects associated with it – significantly increases the risk of Type 2 diabetes and coronary artery disease. The paper was published in the Journal of the American Medical Association Network Open. Coronary artery disease – and complications that arise from it, such as heart attacks and heart failure – is the leading cause of death in the United States and across the world. While other factors such as high cholesterol have been tied to coronary artery disease, the association between obesity and cardiovascular disease has not been clearly established. For the study, researchers performed a meta-analysis of five studies with more than 880,000 participants. They examined participants’ genetic variations using a method called Mendelian randomization, which offers insight into the relationships between health risks and health outcomes. By relying on genetic data, this method removes confounding, or outside, variables that can extraneously influence outcomes, such as smoking, high blood pressure, or elevated cholesterol. Mendelian randomization cannot prove causality,

but it can be suggestive of a causal association – as was the case in this study. “This study is important because we can conclude that it is not solely factors like high blood pressure, high cholesterol or lack of exercise that tend to come with obesity that are harmful – the excess fat itself is harmful,” said Haitham Ahmed, M.D., the senior author of the study and a preventive cardiologist at Cleveland Clinic. “Patients may think their cardiovascular risk is mitigated if their other risk factors are normal or being treated, but this study suggests you cannot ignore the extra weight. Physicians should take heed and make sure they are counseling their patients about weight loss in a comprehensive and collaborative manner.” According to the Centers for Disease Control and Prevention, 39.8 percent of U.S. adults are obese. Meanwhile, World Health Organization reports 13 percent of the world’s adult population is obese and that the prevalence of obesity has tripled between 1975 and 2016. Obesity rates, along with rates of cardiovascular disease and diabetes, are expected to continue to rise, if current trends continue.

“This study is important because we can conclude that it is not solely factors like high blood pressure, high cholesterol or lack of exercise that tend to come with obesity that are harmful. The excess fat itself is harmful.”

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CHRONIC CARE MANAGEMENT

Oral Arguments Researchers continue to make the connection between oral health and chronic disease Editor’s note: Chronic diseases and conditions – such as heart disease, stroke, cancer, type 2 diabetes, chronic obstructive pulmonary disease, obesity and arthritis – are among the most common, costly and preventable of all health problems. As of 2012, about half of all adults – 117 million people – had one or more chronic health conditions. One in four adults had two or more chronic health conditions. Seven of the top 10 causes of death in 2014 were chronic diseases. As demographics change, and venues of care change for

the chronically ill, so too do sales reps’ call points and the products in their bag. Repertoire continues its series of articles on chronic care management. This month, we explore the connection between oral health and chronic disease. Researchers continue to connect the dots between oral health (particularly periodontal disease) and other chronic conditions, such as diabetes, heart disease and asthma. Payers, regulators and providers are getting the message. Here’s what’s happened in dental/medical research in the last year and a half. •O ct 2018: Dominion National, a dental insurer and administrator of dental and vision benefits headquartered in Arlington, Virginia, released a study indicating people with chronic health conditions such as asthma, diabetes and heart disease who

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received preventive dental care covered by Capital BlueCross’ BlueCross DentalSM benefits had fewer emergency room visits and hospital stays. • February 2018: After reviewing meta-analyses of clinical trials, researchers from the University of Athens (Greece) School of Dentistry reported in the Journal of Clinical Periodontology that periodontal treatment improves glycemic control in people with diabetes. Patients who underwent periodontal treatment had about half a percent lower HbA1c levels three months after treatment than those who did not receive periodontal therapy. • November 2017: Data from a Medical Expenditure Panel Survey (MEPS) revealed that when a preventive dental benefit was provided for adult Medicaid recipients, medical costs for people with chronic conditions were lowered from 31 to 67 percent.

• September 2017: Dental insurer United Concordia released a study examining the medical benefit when an individual absent a chronic medical condition regularly sees their dentist two times a year for checkups and cleanings, compared to those who do not.

More covered mouths More people than ever are covered by dental insurance, reports the National Association of Dental Plans. The percentage of the population with dental insurance – either commercial or public (Medicare, Medicaid, and the Children’s Health Insurance Plan, or CHIP) has increased from 58 percent in 2008 to 78 percent in 2017. “The public sector is the big news,” says Evelyn Ireland, executive director, NADP. Due to expansion of the number of adults covered by Medicaid, and growing participation in Medicare Advantage (which frequently includes dental coverage), the number of Medicaid and Medicare recipients receiving dental coverage grew from about 36.6 million in 2014 to 87.8 million in 2017. (Meanwhile, the number of people with commercial dental insurance grew steadily during that same period, from 155.9 million in 2014 to 166.2 million in 2017.) In 2016, Washington, D.C.-based consulting firm Avalere Health released a study conducted on behalf of Pacific Dental Services Foundation indicating that by adding a periodontal benefit to Medicare Part B, the Medicare program would save $63.5 billion over the period 2016 to 2025 in reduced hospitalizations and emergency room visits by individuals with periodontal (gum) disease and medical conditions, e.g., diabetes, coronary artery disease and cerebrovascular disease. “Research is ongoing and results continue to solidify the evidence of a biological link between periodontitis and [diabetes, coronary artery disease and cerebrovascular disease],” reported Avalere. “While much about these links remains unknown due to biological complexity and the limitations of research design and resources, data suggest that improving periodontal health may have a positive impact on health outcomes….” Approximately 45 percent of adults aged 30 years and older – and an estimated 66 percent of adults 65 years and older – have some form of periodontal disease, Avalere pointed out, citing research published in the Journal of Periodontology.

Dental insurance facts • Twenty-two percent of Americans have no dental benefits. • Thirty-five percent of the uninsured are over 65. • Most of the remaining uninsured are employed in businesses that do not offer dental coverage. • A small fraction of the population has access to dental benefits but do not purchase coverage. • A little more than half of the population gets dental benefits in the private market – through employers or by purchasing as an individual. • Less than 4 percent of the population has individual coverage for dental services. • Just over a quarter of the population gets dental benefits through a public program, i.e. Medicaid, CHIP, Medicare Advantage, or other public programs like Indian Health Services. • A segment of the senior population has maintained coverage from prior employment, and some purchase dental benefits as individuals outside of Medicare Advantage plans Source: NADP 2018 Dental Benefits Report: Enrollment, October 2018

Medical cost savings In November 2017, Avalere’s findings for Medicare were replicated in the Medicaid program by a Medical Expenditure Panel Survey (MEPS) conducted by researchers at the Department of Public Health, University of Maryland School of Dentistry, on behalf of the National Association of Dental Plans. Researchers studied the relationship between the cost of medical care when Medicaid recipients (ages 25-64) with chronic conditions received preventive dental care. “It’s a good indication that dental benefits keep medical costs down and help manage overall costs,” says Ireland.

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CHRONIC CARE MANAGEMENT The research showed that health expenditures for recipients who received preventive dental care were lower than those who did not: • Coronary heart disease: 67 percent lower. • Diabetes: 36 percent lower. • High blood pressure: 31 percent lower. • Heart attack: 36 percent lower. • Stroke: 52 percent lower. • Angina: 45 percent lower. • Other heart disease: 45 percent lower. • Cancer: 67 percent lower. • High cholesterol: 43 percent lower. • Asthma: 37 percent lower.

Private pay Commercial insurers are studying the medical/dental connection closely. The Dominion National study was conducted over a two-year period in partnership with Capital BlueCross and Geneia®. The study analyzed paid claims between July 2015

“ The research we – and others – are doing points to the fact that we’re shining a light on something interesting and important. As time goes on, we’ll make more connections.” – Quinn Dufurrena and June 2017 for individuals with and without BlueCross DentalSM coverage who had a diagnosis of one or more of the following conditions: asthma, cerebrovascular disease, chronic obstructive pulmonary disease, coronary artery disease, congestive heart failure, diabetes, maternity, osteoporosis, renal failure and rheumatoid arthritis. The research compared medical costs and utilization of Capital BlueCross members with chronic conditions and BlueCross Dental coverage who received preventive dental services, versus those who did not receive preventive dental services. It found:

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•P eople with chronic conditions – but no BlueCross Dental coverage – had a 7 percent higher incidence rate of inpatient hospital stays than those with BlueCross Dental coverage who received a preventive dental service. •T hose who had BlueCross Dental coverage – but did not receive preventive dental services – had a 19 percent higher incidence rate of emergency department visits than those with BlueCross Dental coverage who received preventive dental services. “The findings of this study reinforce how integrating medical and dental coverage and care can be associated with improved health and lower costs for those dealing with chronic medical issues,” Capital BlueCross President and CEO Gary St. Hilaire was quoted as saying. “The dental/medical connection has picked up momentum in the past two decades,” says Dominion National Vice President of Marketing Jeff Schwab. The company is in a unique position to study and act on that connection, as it not only provides dental and vision benefits, but administers dental benefits on the part of medical insurance providers. “We’re eager to work with our health plan partners to provide outreach to these high-risk individuals to seek preventive, necessary dental care and improve health outcomes,” says Schwab. For example, Dominion National can identify high-risk members (that is, those with a chronic condition) who might benefit from a dental checkup. “We can also help them find a dental home, and ensure they receive information that emphasizes the importance of oral health.” If there is one obstacle in connecting oral health and systemic health, it is the lack of integration between electronic medical records and electronic dental records, says Schwab. “Overall, oral health professionals and physicians recognize the benefit of closing the information gap between them,” he says. Short of sharing patient records, primary care providers – particularly pediatricians – can continue to promote dental care to their patients; meanwhile, dentists can discuss the oral/medical connection to their patients, help detect signs of several chronic health conditions through oral exams, and refer patients to the appropriate healthcare provider. “Sharing data is a critical key to success in integrating dental and medical care.”

The right direction In 2014, United Concordia Dental published a study in the American Journal of Preventive Medicine showing reduced hospitalizations are possible when individuals with a chronic medical condition, such as diabetes or heart disease, seek and maintain treatment for gum disease. The company followed up that study with another to determine the medical value of visiting the dentist regularly, even for people without a chronic condition. The study population included more than 489,000 United Concordia and Highmark Inc. members with both medical and dental coverage between the ages of 4 and 64. (United Concordia is a subsidiary of Highmark.) Study participants who visited the dentist routinely (defined as two checkups a year that include an oral evaluation, and a cleaning or periodontal maintenance) for three consecutive years saw medical cost savings of $68 per person annually as compared to those who did not see the dentist at all. The savings rose to $157 annually over a three-year period for those who went to the dentist regularly versus those who did so intermittently; $134 for kids ages 4-18; and $219 for adults aged 45 to 64. “We’ve done a lot of research on oral health and people with chronic disease and without chronic disease, as well as the association between periodontal disease and overall health,” says United Concordia Chief Dental Officer Quinn Dufurrena, DDS, JD. At press time, United Concordia was engaged in research on the association between dental care and respiratory or ear infections, as well as the association between dementia and tooth loss. “Studies point to an association between oral health and systemic health, but we can’t say there’s causation, and that’s an important distinction,” he says. “The research we – and others – are doing points to the fact that we’re shining a light on something interesting and important. As time goes on, we’ll make more connections.” In the meantime, exciting developments continue to occur, says Dufurrena. For example, the Harvard School of Dental Medicine’s Initiative to Integrate Oral Health and Medicine is working with partners in academia and healthcare to develop ideas and conduct research around the integration of oral health and primary care. Many medical and dental schools are combining curricula, he adds. “It’s a direction that makes sense.”

The commercial market Given the association between oral health and systemic health, combining medical and dental insurance coverage makes sense. But just how – and when – that will take place remains to be seen. “Standalone dental benefits aren’t going anywhere,” says Jeff Schwab, Dominion National’s vice president of marketing. “Health plans recognize the need for a strong dental component, and a lot of them will look to standalone dental partners to administer their dental plan. It comes down to the bandwidth and resources of the carrier.” A survey published by Chicago-based consulting firm West Monroe Partners in January 2018 found that 96 percent of insurance executives believe the embedding of dental benefits into medical plans is already happening, or will happen. Today, 99 percent of commercial dental insurance plans are purchased through standalone dental insurers. “Competitive margins and profitability, relative benefit simplicity, customer retention, and the increasing proof of correlation between oral health and overall health are driving more health insurers to experiment and invest in adding dental benefits to their plans,” the company said. “Convergence opportunities exist between health and dental insurers, especially as both face significant technical investments necessary to modernize core platforms and address consumer demands. As such, standalone dental insurance plans are attractive targets for health plans – either for acquisition or partnership. In fact, 100 percent of surveyed health plan executives whose companies don’t already offer dental benefits plan to do so in the near future.”

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January 2019

WINDSHIELD TIME Chances are you spend a lot of time in your car. Here’s something that might help you appreciate your home-away-from-home a little more.

Automotive-related news Sedans: Endangered species The sedan appears to be endangered, reports the Chicago Tribune. This year’s list of discontinued cars includes: the Buick Cascada, a four-seat convertible introduced in 2016; Cadillac ATS sedan; Ford Fiesta; Ford Focus; Ford Fusion (though it is rumored to be reincarnated as a sports wagon); Ford Taurus; and Volkswagen Beetle.

The best of the best Edmunds has launched a new section of the Edmunds site designed to answer the question, Which cars are currently the best in their class? Edmunds “Best Car Rankings” are

drive and have a unique personality. Editors also factor in a vehicle’s overall value.

The urge to swerve It’s extremely difficult to avoid an accident by predicting what an animal – such as a deer – will do when it’s on a road, Jim Taylor, head of claims customer experience for Farmers Insurance told the Chicago Tribune. For that reason, if a deer suddenly appears in front of your car, avoid braking suddenly or swerving; that can create a new hazard, such as you hitting a tree or guardrail. It’s best to stay calm and stay the course, said Taylor.

U.S. car owners left in the back seat

new landing pages that will list the top 10 vehicles in descending order in each of more than 50 segments. The rankings are based on the results of Edmunds’ vehicle testing process, which includes evaluation at the Edmunds test track, on a 115-mile road test loop and in day-to-day driving situations. To derive the rankings, Edmunds editors rate vehicles based on more than 30 criteria in five categories including: driving/performance, comfort, interior, utility and technology. In addition, editors give a subjective score on a vehicle’s “fun factor,” awarding extra points to cars that offer a compelling design, are fun to

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It was a rough year for domestic brands – and U.S. car owners – according to Consumer Reports’ (CR) latest Annual Auto Reliability Survey, which collected data from its members about their experiences with more than half a million vehicles. Buick, Chevrolet, Chrysler, and Tesla were among the brands that tumbled in the organization’s predicted new-car reliability rankings. In fact, every domestic automaker landed in the bottom-half of CR’s latest reliability rankings. Ford ranked the highest at 18, down three spots from the previous year. Right below Ford on the list was Buick, which had performed well in recent years and was in the top 10 last year. Cadillac was the worst-rated domestic manufacturer and ranked near the very bottom at 28. Asian brands, led by Lexus, Toyota, and Mazda, in that order, continue to be the best for new car reliability in CR’s survey. Seven of the top 10 brands in this year’s reliability rankings are from Japan and South Korea, including Subaru, Kia, Infiniti, and Hyundai. Three European brands – Audi, BMW, and Mini – rounded out the top 10.

QUICK BYTES Editor’s note: Technology is playing an increasing role in the day-to-day business of sales reps. In this department, Repertoire will profile the latest developments in software and gadgets that reps can use for work and play.

Technology news Hold tight Smartphone owners accidentally broke more than 50 million phone screens last year (that’s nearly two every second), and replacing those screens cost them $3.4 billion, according to SquareTrade, an Allstate company and protection plan provider. A study found that 66 percent of smartphone owners damaged their phones in the past year, with cracked screens leading the way as the most common type of damage (29 percent). Scratched screens (27 percent) and nonworking batteries (22 percent) took second and third place, respectively, with touchscreen issues and chipped corners/sides tying at 16 percent each. By far, the most common cause of smartphone damage is dropping a phone on the ground (74 percent). Others are the phone falling out of a pocket (49 percent), being dropped in water (39 percent), being knocked off a table or counter (38 percent), being dropped in the toilet (26 percent) or falling out of a bag (22 percent).

Up your Wi-Fi! Now’s a good time to upgrade your home Wi-Fi, says D-Link Systems, a computer networking company. Newer routers can connect more devices without slowing down, because they have features such as MU-MIMO, QoS, and 4x4 streaming, according to the company. For homes with multiple smart devices, including voice assistants, the key is whole-home coverage. Better Wi-Fi is especially important for devices that work with voice assistants, like D-Link WiFi cameras, which feature voice casting. With voice casting, you can ask Alexa or Google Assistant to cast feeds from compatible D-Link cameras onto your TV.

Ain’t no way to hide those pryin’ eyes Spy Associates’ SpyFinder® PRO, a security and privacy tool to help find and stop hidden cameras from recording private moments, has been funded by over 375 percent on Kickstarter and is gaining momentum. The SpyFinder® PRO Hidden Camera Detector will locate and expose any hidden camera lens within any room, whether

the cameras are powered on or off and not recording. Every day more stories emerge about Airbnb rentals, gyms, dressing rooms, apartments, hotels, and locker rooms where people thought they were safe and weren’t, says the company.

Best laptop charger The editors at The Wirecutter, a New York Times company, spent 15 hours researching and 41 hours testing five top portable laptop chargers, and concluded that the Mophie Powerstation AC is the best option if you want the ability to charge your computer and smaller devices while traveling, in an emergency, or whenever power outlets are out of reach. It can power laptops as robust as the 15-inch MacBook Pro, it’s compact and lightweight, and it charges via USBC – an increasingly ubiquitous standard. The AC outlet can power over 100 W, plus it has USB-C and USB-A ports for charging smaller devices. It’s the smallest and most stylish option, too, according to the editors. It slips easily into a backpack, briefcase, or carry-on bag.

Can you trust a public Wi-Fi network? As you travel, bouncing from airport to airplane to hotel, you’ll likely find yourself facing a familiar quandary: Do I really trust this random public Wi-Fi network? As recently as a couple of years ago, the answer was almost certainly a resounding “no,” according to the editors at Wired. But in 2018? “Friend, go for it,” they say. “This advice comes with plenty of qualifiers. If you’re planning to commit crimes online at the Holiday Inn Express, or to visit websites that you’d rather people not know you frequented, you need to take precautionary steps. Likewise, if you’re a high-value target of a sophisticated nation state, stay off of public Wi-Fi at all costs. But for the rest of us? You’re probably OK. That’s not because hotel and airport Wi-Fi networks have necessarily gotten that much more secure. The web itself has.”

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January 2019

HIDA GOVERNMENT AFFAIRS UPDATE

Medicare Increases Reimbursements for ASCs,

Physicians and Home Health Agencies The Centers for Medicare and Medicaid Services (CMS) recently released three final

By Linda Rouse Oâ&#x20AC;&#x2122;Neill, Vice President, Government Affairs, HIDA

January 2019

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Medicare payment rules for calendar year 2019. These include the Hospital Outpatient Prospective Payment System (OPPS)/Ambulatory Surgery Center (ASC) Rule, the Physician Fee and Clinical Lab Rule and the Home Health Agencies Final Payment Rule. These rules wrap up the annual Medicare payment regulatory process as inpatient facilities and skilled nursing facilities already received their final updates as they are paid on the fiscal year (October 1, 2018 started the fiscal year 2019 payment cycle). CMS continues its focus on reducing regulatory burdens on providers as well as simplifying quality reporting requirements. Of particular note are the changes and potential opportunities for the supply chain in the ASC and physician office markets. Additionally, CMS modified the definition of

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labs that must now report private payer rates. This is a win for the industry as it has been repeatedly pushing the agency on this issue as it impacts the data CMS uses to set clinical lab reimbursement. The new payment rules also contain key regulatory changes for how home health agencies are paid. Here is a look at these changes:

The agency will also update its MIPS facility-based measurement option that will allow qualifying clinicians to use their hospital’s CMS value-based purchasing results rather than reporting separate MIPS cost and quality data. This appears to be in line with the administration’s promise to ease the impact of regulations on clinicians.

Hospital outpatient departments and ASCs

Home Health agencies

The OPPS/ASC rule increases the annual payment rate for outpatient hospital departments by 1.35 percent. However, CMS is continuing to implement policies referred to as “site neutral” payments which aim to incentivize the use of lower cost settings for the same procedures. Specifically, CMS finalized payment rates for clinical visits in outpatient settings at the lower rate for provider-based departments which will result in lower copayments for beneficiaries and will save the Medicare program approximately $380 million in 2019. The policy would reduce the OPPS payment rate for clinic visits from $116 (with a $23 beneficiary copayment) to $81 (with a beneficiary copayment of $16). ASCs will receive a 2.1 percent increase in its base Medicare payment. CMS has also finalized its proposal to add 12 cardiac catheterization codes to the ASC covered procedures list as well as 5 other codes. As a result of the “site neutral” policies, some analysts comment that this increased competition will make ASCs attractive merger and acquisition (M&A) targets for hospitals. Indeed, a recent survey reveals that nearly one in five healthcare executives are interested in acquiring these providers. Whether this interest will turn into actual consolidation remains to be seen, as HIDA’s own research shows that 70 percent of ASC decision makers do not anticipate M&A within the next two years.

Included in the Home Health final rule was the Home Health Patient Drive Groupings Model (PDGM) which will determine payments using clinical characteristics to assign patients to a payment category in an effort to prioritize value-based payments. The PDGM is designed to reflect the focus on relying more heavily on clinical characteristics and other patient information to allow payments to more closely reflect patients’ needs. CMS

Under the Physician Fee Rule and Quality Payment Program Update, CMS is adjusting the Merit-Based Incentive Payment System (MIPS) to have an increased focus on cost-reduction. Specifically, the agency will increase the weight of the MIPS cost category to 15 percent while lowering the weight of the quality category to 45 percent.

Physician offices Under the Physician Fee Rule and Quality Payment Program Update, CMS is adjusting the Merit-Based Incentive Payment System (MIPS) to have an increased focus on cost-reduction. Specifically, the agency will increase the weight of the MIPS cost category to 15 percent while lowering the weight of the quality category to 45 percent.

believes that this new case-mix system will help Medicare move towards a more value-based payment system. It also finalizes the change in unit of payment under the home health PPS from 60-day episodes of care to 30-day periods of care to be implemented on January 1, 2020 Some industry experts believe the new model may drive how referrals are treated with agencies forming more collaborative relationships with institutional settings rather than community doctor offices. The reason behind this is that institutional settings have sicker patients and the model focuses on resources needs. However, experts also urge home health agencies to ensure a good balance of patients as the new payment model is required to be budget neutral. If you would like to learn more about these payment rules, and the effect they have on your customers, please contact us: HIDAGovAffairs@HIDA.org.

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January 2019

SMART SELLING

DISTRIBUTOR SALES STRATEGIES FROM HIDA

Just Give it to Me Straight

When you’re a customer, which would you rather hear: A) marketing spin designed to

By Elizabeth Hilla, Senior Vice President, HIDA

January 2019

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make you feel good, or B) honest information, even if it’s bad news? If you’re like me, you’d prefer B, the straight scoop. I know my daughter would. She’s a sophomore in college and, last spring, she selected her dorm for the fall semester. Shortly after, she found out that the dorm was being renovated and might not be open until a couple of weeks after the start of school. No worries, she thought, what’s a couple of weeks of inconvenience? Well, that was about five months ago and the project still isn’t complete. Had she known, she could have made a different housing choice. And yet most people – me included – are often guilty of providing unrealistic, best-case information. We tell a friend we’re running five minutes late to meet them, knowing that it’s more likely to be 20 minutes. We tell the doctor we exercise regularly when, really, the trips to the gym have been sporadic.

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We do it in sales too. We tell the customer all the great benefits that a new product has to offer, but we don’t mention its drawbacks. We tell them we expect to fill their back order shortly, when in reality we just don’t know how soon we’ll have product. I’m all for optimism, but I think this kind of overly optimistic, bestcase thinking undermines our longterm relationships with customers. No one wants to tell the customer that the product they want is on back order and may not be available for quite a while. But I think that over the long haul, the customer is going to trust the salesperson who gives it to them straight.

No one wants to tell the customer that the product they want is on back order and may not be available for quite a while. But I think that over the long haul, the customer is going to trust the salesperson who gives it to them straight.

Read these examples and try to imagine yourself as the customer hearing each statement: Instead of: “The back order situation is sure to be resolved by the end of the month.” How about: “We’ve gotten conflicting information about the back order situation. I’m trying to get you the product as

soon as possible, but I’m not sure how soon that will be.” Instead of: “You’re going to love this new rapid test. It delivers superaccurate results in just 15 minutes!” How about: “This new rapid test costs a little more than what you’re using, and it takes about two minutes longer. The benefit is that it delivers results that are 30 percent more accurate.”

Instead of: “I’ve found almost exactly what you were looking for!” How about: “There are a lot of great analyzers available, but I can’t find one that does all the tests you were looking for in the price range you specified. Would you rather revisit the list of tests, or reconsider the budget limit?” You’re the best judge of how to best balance “spin” vs. “brutal honesty” in your sales pitch. But I suspect that adding an extra helping of reality to your communications may pay dividends to you in customer loyalty and trust.

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January 2019

Dinahmight Klicks Photography

corner

Ed Draper: The fire within As a kid in Kaleva, Michigan, Ed Draper knew he want-

ed to help people. And he had a pretty good idea how he would do so – firefighting, like his father. After years of doing so, he found that selling medical supplies and equipment to first responders was another way to help people. He was named Rookie of the Year and Account Manager of the Year for Bound Tree Medical this fall. His father, Mike Draper, had been the fire chief at Maple Grove Township Fire Department in Kaleva. “I always looked up to him,” says Ed. “He was an elementary school teacher by career, but when he wasn’t teaching, he was helping people in what was often the worst moment in their lives. He expressed so much passion and bravery, which were qualities that I wished to have one day.” Before the days of 911 and emergency paging, people could call an emergency number, which would ring in every

January 2019

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emergency responder’s home, he explains. But the ring was distinguishable in that it was constant. “My sister, Tricia, and I were often reminded that we were not to answer the phone until the second ring, because if we did, it would stop the phone from ringing in all of the responders’ homes, which might cause them to miss vital information. “Nothing made me prouder than to see my father race out of the house to the fire station, which was only a few blocks from my home,” he says. “I’d hear the town emergency siren wail and then I’d walk down the street to the next intersection, where the fire engine or rescue truck would speed by with the lights and siren on. “After fires, they would often come fill the trucks at the hydrant by our house. I’d run outside to watch. The firefighters would often still have some of their turnout gear on, with soot smudged on their face and arms. To me,

they looked like warriors, covered in signs of the battle they just won.”

An early start When Ed was 15, the elder Draper created an explorer/cadet program in which teens could perform limited tasks on emergency calls and train with the firefighters at their meetings. “I remember one call where I was helping pull a fire hose on a small grass fire,” recalls Ed. “The fire was mostly out, and the firefighter I was pulling the hose for came back to [me], and said, ‘Ed, I need you to go back to the engine and get the hose stretcher. We’re short about 18 inches and I need it to get around a tree.’ “I ran back to the fire engine and was digging through a compartment when my dad came up to me and asked what I was looking for. I told him. He looked at me funny and said, ‘The what?’ I repeated it. He laughed and said, ‘Get back out there, there is no such thing as a hose stretcher!’ I turned and saw the firefighter who had sent me for the imaginary tool on his knees, laughing hysterically.” As a senior in high school, he took an Emergency Medical Technician course. At 18, he took a formal wildland firefighting course, a hazardous materials course, and formal firefighter I and II class. He worked a handful of jobs as an EMT, gaining experience working in a manufacturing plant and ambulances, and later went to college for paramedic training. He continued to work as a volunteer/paid-on-call firefighter for 11 years, while working full-time as a paramedic for two county and municipal-based EMS services, a casino as a medically training security officer, and a hospital-based service, for whom he functioned as a critical

A firefighter’s proposal For most people, it would be an unorthodox way to propose marriage. But for a firefighter, maybe not. “I’m married to my beautiful wife, Amanda, whom I met when I was bringing patients into the emergency room,” explains Ed Draper, account manager for Bound Tree Medical. “An interesting fact is that when I proposed, my partners and I worked with the trauma team at the hospital and faked me being injured on a fire scene and needing to be transported to the emergency department where she worked. “When we arrived, I pulled the ring out from under my bandaged arm and asked her to spend the rest of her life with me.” Together, they are bringing up three children: 13-yearold Emily, 11-year-old Landen, and 1-year-old Harper.

care paramedic. He went on to take a course to become an EMS instructor. (The state of Michigan requires that individuals who teach EMS hold a state license to do so.) For a short period of time, he and a friend formed a company teaching EMS education and CPR/First Aid courses. For Blair Township, Draper worked as a line firefighter/paramedic, and helped with departmental education. “In sort of a stretch responsibility, the director of EMS, Daryl Case, had me help with some other aspects of the organization, such as state inspections of the EMS apparatus, employee orientation, and EMS committee meetings with the medical control authority,” he says. When Case left the organization, Draper applied for and assumed chief administrative role of the EMS department. He finished his degree in public safety and healthcare management from Siena Heights University.

Never boring “What I loved about the job was the variability of the work,” he recalls, speaking of his years of firefighting and EMS. “You truly have no idea what you might be doing from shift to shift. When responding to one call, you might be caring for an elderly person who is sharing great memories, and the next you might be tearing through a wall with a tool to find a fire. “Not every response is life-anddeath,” he continues. “But when they are, the impact is life-changing, both for the people we are caring for, and for us. These calls are traumatic, and they stick with you. There are calls I’ll never forget – some with good endings, many I’ve learned from, and others I wish I hadn’t experienced.

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January 2019

corner “Regardless, the public safety professional signs up to walk into a bad situation and make it a little better. It showed me that material things are nice, but they are replaceable; lives are not. Never leave a loved one without saying goodbye. Be quick to forgive when you are upset. And never let go of a chance to tell someone you love them.”

they had, when they should be focused on what could be a life-changing event for both the patient and them. “Consistency and confidence were of utmost importance,” he continues. “I still do this today, only I now help the chief administrators of many organizations do this for their teams all over the state of Michigan.”

Into sales

A student of sales

Throughout his career, Draper purchased most of his medical supplies from Bound Tree Medical. For years, he worked with account manager Dave Tomlin, and later, with Don Adams. One day Adams announced he was being promoted, and he encouraged Draper to apply for his old spot. “He

Draper considers himself a student of sales. “I learn something new from everyone I meet and on nearly every interaction with a customer,” he says. “I read books every day, I have an audiobook running all day long in my vehicle, and I ask for tips/critique from my vendor partners. I thrive on getting better, and live for the challenges I encounter. “EMS and fire people will tell you that they love the adrenaline dump they get from rushing to someone and helping during their time of need. Mine now comes from being the best partner to my friends and helping them get the devices and supplies that truly will save or improve their patients’ lives. My friend, Greg Wolf, says it best: ‘My paycheck may come from Bound Tree Medical, but I truly work for my partners.’” After two years in sales, Draper believes that firefighting and medical sales aren’t all that different. “Like firefighting, sales is the art of organizing and controlling chaos,” he says. “Like a pager going off for emergency after emergency while on shift, my phone rings daily with customers’ emergencies and needs. I feel that I have spent my entire life honing my ability to mitigate the emergencies of others, doing whatever it takes with true empathy. It lends itself perfectly to the sales role. “Not every call is an emergency, but the person on the other end of it is looking for someone to understand their situation, to get to know them, and to make their day a little better. I triage the calls based on the priority of their needs, do what I can to help, and work with my team to deliver the patient/customer to definitive care. “In an emergency vehicle, I team up with police officers, dispatchers, and hospital staff. In sales, my team consists of customer service, supply acquisition and distribution.”

was very transparent with me about the day-to-day work of an account manager, and he kept telling me about how great it felt to go around and take care of friends.” Draper’s wife, Amanda, had been telling her husband for years that he ought to be in sales, citing his enthusiasm for the things he is passionate about, he adds. It turned out to be a good fit. “When I was the chief administrator for the EMS department, I felt one of my most important responsibilities was to remove barriers from my team, and to ensure that they had what they needed to treat the people we served efficiently and effectively. I didn’t want them to have to worry about the quality of the equipment and supplies

January 2019

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NEW PAMA CPT codes now available in the app

Pama updated CPT codes 2018 Infectious Disease Tests Test - Panels Basic Metabolic Panel (9 tests) Comprehensive Metabolic Panel (17 tests) Electrolyte Panel (4 tests) Hepatic Function Panel (10 tests) Lipid Panel (6 tests) Renal Function Panel (12)

CPT 80048/QW 80053/QW 80051/QW 80076 80061/QW 80069/QW

2017 Fee $11.60 $14.49 $9.62 $11.21 $18.37 $11.91

2018 Fee $10.44 $13.04 $8.66 $10.09 $16.53 $10.72

Change -10% -10% -10% -10% -10% -10%

Cardiac/Liver/Other Tests Albumin (Serum) Albumin (Urine) ALP ALT Aspirin Therapy AST Bilirubin, direct Bilirubin, total BNP CK,MB CK/CPK GGT LD Microalbumin (Quantitative) Microalbumin (Semi-quantitative) Total Protein Troponin I

82040/QW 82042/QW 84075/QW 84460/QW 85576/QW 84450/QW 82248 82247/QW 83880/QW 82553 82550/QW 82977/QW 83615 82043/QW 82044/QW 84155/QW 84484/QW

$6.79 $7.10 $7.10 $7.27 $29.47 $7.10 $6.88 $6.88 $46.56 $15.84 $8.93 $9.88 $8.28 $7.93 $6.28 $5.03 $13.50

$6.11 $7.78 $6.39 $6.54 $26.52 $6.39 $6.19 $6.19 $41.90 $14.26 $8.04 $8.89 $7.45 $7.14 $6.23 $4.53 $12.47

-10% 10% -10% -10% -10% -10% -10% -10% -10% -10% -10% -10% -10% -10% -1% -10% -8%

Lipid Tests HDL LDL Lp(a) Apolipoprotein Total Cholesterol Triglycerides

83718/QW 83721/QW 82172 82465/QW 84478/QW

$11.24 $13.09 $21.26 $5.97 $7.88

$10.12 $11.78 $21.09 $5.37 $7.09

-10% -10% -1% -10% -10%

Diabetes Tests Fructosamine Glucose on home use meter-type device Glucose Tolerance Test, each additional specimen > 3 Glucose Tolerance Test, initial 3 specimens Glucose, quantitative blood type Hemoglobin A1c

82985/QW 82962 82952/QW 82951/QW 82947/QW 83036/QW

$20.68 $3.21 $5.38 $17.66 $5.39 $13.32

$18.61 $3.28 $4.84 $15.89 $4.85 $11.99

-10% 2% -10% -10% -10% -10%

Renal Function Tests BUN Creatinine Creatinine (Urine)

84520/QW 82565/QW 82570/QW

$5.42 $7.03 $7.10

$4.88 $6.33 $6.39

-10% -10% -10%

Individual Tests Amylase Calcium Ferritin Iron

82150/QW 82310/QW 82728 83540

$8.89 $7.08 $18.70 $8.88

$8.00 $6.37 $16.83 $7.99

-10% -10% -10% -10%

Find the new codes in The Black Book

Other tools available for distributors are: vol.26 no.1 • January 2018

repertoiremag.com

January 2018

2 Minute Drill Videos

Podcasts

PAMA: The Stage is Set — How will the new rates impact providers, distributors and manufacturers?

PAMA: Jim Poggi, Tested Insights, LLC

The Stage is Set

How will the new rates impact providers, distributors and manufacturers?

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Industry news Cardinal releases research exploring issues impacting today’s oncology practices According to new research from Cardinal Health Specialty Solutions, oncologists are growing more confident in their ability to meet the requirements of the Medicare Access & CHIP Reauthorization Act (MACRA). The findings were released in the fourth edition of Oncology Insights, a research-based report series summarizing the views of more than 160 US oncologists about the key trends in today’s oncology practices. The report compares current views about MACRA to responses collected in early 2017, shortly after MACRA went into effect. The number of participating oncologists who said they have some level of confidence in their practices’ ability to meet MACRA requirements while achieving financial success increased from 53% to 77%. Compared to 2017, more oncologists report having the resources and staff needed to manage MACRA (24% compared to 10%). However, nearly one in four participating physicians (24%) still do not have a strategy in place.

FDA to overhaul 510(k) medical-device approvals The FDA announced it plans to overhaul the 510(k) clearance process for medical devices. The FDA wants to nudge companies to base new products on devices that are no older than 10 years old. The agency is considering publicizing devices and manufacturers whose products are based on even older technology, according to CNBC. Congress established the 510(k) pathway in 1976 to allow

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manufacturers to pursue an expedited approval process if they could prove new products were substantially equivalent to those that were grandfathered in at the time. That means some new products entering the market are comparing themselves to technology that’s decades old. The FDA wants to retire those predicates (older base products), which sometimes aren’t even on the market anymore, and make it easier for companies to establish new ones. Last year, the FDA cleared 3,173 devices through the 510(k) system, or 82% of the total devices cleared or approved. Nearly 20% of products cleared through the 510(k) pathway are based on a predicate device that’s more than 10 years old. The FDA plans to finalize its guidance on establishing an alternative accelerated pathway early next year.

Hill-Rom announces new executive appointments Hill-Rom Holdings Inc (Chicago, IL) announced several senior leadership appointments, effective December 3, 2018. Barbara W. Bodem was named SVP and CFO of Hill-Rom. Bodem joins Hill-Rom from Mallinckrodt, where she was SVP, Finance. She succeeds Steven J. Strobel, who will retire as CFO. Andreas G. Frank, currently SVP, Corporate Development and Strategy, and chief transformation officer, was appointed SVP and president of the company’s Front Line Care business, which includes Welch Allyn, Vision Care, and Respiratory Care. Frank replaces Alton Shader. Mary Kay Ladone, currently VP, Investor Relations, was appointed

SVP, Corporate Development, Strategy, and Investor Relations. In this role, Ladone will be responsible for mergers and acquisitions, business development and strategy in addition to her role leading the company’s Investor Relations function.

Partners HealthCare mandates flu shots for all employees Partners HealthCare (Boston, MA) is requiring all 74,000 employees to receive flu shots for the first time, according to The Boston Globe. Under the mandatory flu shot policy, employees who don’t get vaccinated or provide a valid reason for skipping the flu shot could lose their jobs. The policy applies to all hospital-based workers, as well as thousands of employees who work at Partners’ corporate office in Somerville, Massachusetts. The policy took effect this fall. So far, 99 percent of employees have received a flu shot or an exemption for religious or medical reasons. Partners modeled the systemwide policy on a mandatory vaccination policy Brigham and Women’s (Boston, MA) implemented in 2017. The Massachusetts Nurses Association sued the hospital in an attempt to block the policy but was unsuccessful.

PTS Diagnostics announces new wellness brand PTS Diagnostics (Indianapolis, IN) announced the upcoming global launch of PreVantage, an all-encompassing family of solutions and partnerships aimed at addressing the growing demand for the achievement of positive population health outcomes. The configurable solutions of the PreVantage brand are offered under singular umbrella brand and can be customized based upon unique customer needs, the company said. PreVantage is being unveiled in the US and select countries in early 2019. According to the company, the brand “will continue to grow nationally as healthcare shifts from a fee-for-service

model to merit-based incentivization. The brand will also mature globally as PTS Diagnostics assists with meeting unique healthcare needs abroad.”

MedTech/MedCare appointee announcements Scottie Adams, ASC Specialist in Georgia. Adams graduated from Georgia Gwinnett College with a Bachelor’s in Business Administration and a concentration in Management Information Systems. His market focus will be on all ASC products. Jordan Brown, Acute Care in the Pacific Northwest. Jordan Brown is MTMC’s new Northwest acute care territory sales manager. Brown comes with 10 years of LTC Pharmacy experience and 15 years of sales experience. Penny Dermody, Acute Care in New England. Dermody brings 16 years of medical sales and distribution experience in Massachusetts and Rhode Island. She has sold in alternate care and acute care markets. Donna Lynch, Strategic Account Director, will be retiring at the end of 2018. After a long career in healthcare sales, 13 of which were partnered with MTMC, Lynch has decided to retire in her new location, Tucson, Arizona. Kayla Witsoe, ambulatory care rep in Northern California, will be joining the Strategic Account Team. Kayla Witsoe started in the medical industry eight years ago as a sales representative for MTMC in the Northern California territory.

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January 2019

NEWS

USDA to invest $501M in rural healthcare The U.S. Department of Agriculture is putting $501 million into 60 rural healthcare projects nationwide via the USDA’s Community Facilities direct loan program. With the projects, the agency aims to expand access to healthcare for approximately 2 million people in 34 states.

HHS to launch new mandatory bundled payment models HHS Secretary Alex Azar said the agency will roll out mandatory bundled payment demonstrations. The announcement is a reversal of

a decision by HHS in 2017 where it canceled and scaled back major mandatory bundled payment models under the leadership of then-Secretary Tom Price, MD. In a speech at the Patient-Centered Primary Care Collaborative Conference on November 8, Azar discussed some of the current voluntary models, including BPCI Advanced (Bundled Payments for Care Improvement Advanced). However, he said mandatory models are coming.

HHS to implement 340B drug pricing rule in January New Lenox, IL 60451

Territory Sales Managers Wanted Professional Medical, Inc. (ProMed), is seeking talented, motivated territory sales managers with years of experience. ProMed is a Midwest Leader and a Master Wholesale Distributor serving the LTC/Nursing Home industry and the HME-DME/Home Medical equipment and disposable supplies industry. We are a proud Family Owned & Operated company - 2018 marks our 50th anniversary. ProMed is a full-line Healthcare Wholesaler, (One Source Alliance) utilizing a unique & competitive pricing system which will save our valued customers substantially. We supply brand name and quality brand alternative products. Candidates must have a min. of 3 years of experience and an existing customer base of business specifically within the states of MO, IA, MN or OH. She/He should be able to maintain existing business as well as prospect new accounts in their territory within both industries. We can help you become more successful utilizing our many years of expertise. You will be able to differentiate ProMed from any of our competitors and become an ally to our valued customers throughout the Midwest and beyond. Aggressive compensation based on the candidate meeting requirements and performance goals. Additionally, quality BC/BS health insurance and 401K benefits with company match, etc.

Thank you, Terry

Direct all inquiries to Terry Barnes, President Submit your resume to tbarnes@promedsupply.com

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HHS on January 1, 2019 will implement the long-delayed final rule for enforcing 340B drug ceiling price transparency. The rule directs pharmaceutical manufacturers participating in the 340B drug pricing program to disclose the maximum per unit ceiling price that can be charged to 340B hospitals. Enforcement will be maintained through a closed website available to 340B participating hospitals and providers. Federal regulators will post drug pricing information on the site. The rule includes monetary penalties for drug companies that overcharge.

Cigna, Express Scripts delay merger deadline to mid-2019 Cigna and Express Scripts do not expect their deal to close by a December 8 deadline and have extended the deadline six months. The merger’s review process is being held up in three states: California, New York, and New Jersey. The companies’ new merger-termination date is June 8, 2019. Despite the deadline extension, Cigna and Express Scripts do expect their $67 billion deal to close in 2018, according to an SEC filing.

Say hello to the NEW Midmark Workstations. Spending time hunched over a computer screen can have big impacts on a caregiver’s body and a health system’s bottom line. Midmark Workstations are the only products on the market today that truly support the range of motion needed for 95% of users in the clinical setting. Offer your customers an exclusive solution while increasing revenue potential in the exam space—better care is better business. midmark.com/workstationsREPjan

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