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The New Normal
Shelter-in-place mandates. Unprecedented demand for personal protective equipment. Supply disruption. Allocation. These were just some of the new parameters in which med-surg reps had to navigate in order to deliver product and services to their customers.
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JUNE 2020 • VOLUME 28 • ISSUE 6
The New Normal Shelter-in-place mandates. Unprecedented demand for personal protective equipment. Supply disruption. Allocation. These were just some of the new parameters in which med-surg reps had to navigate in order to deliver product and services to their customers.
18 PUBLISHER’S LETTER Mark Zacur
Reopening..............................................4
PHYSICIAN OFFICE LAB Who, Why, When While the decision whether to test and counsel patients with results during the visit or batch for lower cost and more convenient workflow is a practice decision, our customers deserve and expect guidance from their suppliers................................... 6
IDN OPPORTUNITIES Opening Back Up With a continued reduction in COVID-19 cases, one health system was busy mapping out next steps to resuming elective surgeries and procedures.........................14
THE NEW NORMAL Taking Care of Accounts What distributor reps did during social distancing in their territories...................20
Distribution
COVID-19 and Post-Acute Care
Let’s Go, O&M: Owens & Minor kicks off 2020 with Americas Sales Conference
Limited personal protective equipment for long-term care providers poses a major risk to vulnerable patient-base.......24
10
Reducing the Risk For the foreseeable future, infection prevention will be front and center in conversations with customers..............28
repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2020 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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JUNE 2020 • VOLUME 28 • ISSUE 6
INFECTION PREVENTION Identifying Gaps ECRI Institute’s consulting helps providers respond to a multitude of issues related to infection control and prevention........ 31
Outbreak Response Preparedness is key for hospitals and health systems when responding to an infectious disease outbreak............ 32
Health Focus
Opioids Reducing Airborne Transmission Why UV air filtration units are critical to patient – and caregiver – safety, and how to broach the topic with customers.... 36
Understanding the opioid epidemic, and how the CDC, states, communities and healthcare providers are working to combat it.
42
HEALTHY REPS Health news and notes...............44
WINDSHIELD TIME Automotive-related news........48
Quickbytes Technology news
52 LEADERSHIP
Leadership
PWH® is Here for You
Under Duress
58
How to make decisions in a crisis........... 54
How to Overcome Negative Thoughts and Fear........................56
HIDA GOVERNMENT AFFAIRS HIDA Supports Lawmakers’ Efforts To Strengthen Strategic National Stockpile Increasing supply chain elasticity, improving U.S. production of PPE, and partnering with the private sector to replenish supplies leads to a better prepared America......... 62
INDUSTRY NEWS News ........................................................64 2
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Rep Corner
Building Upon the Fundamentals Things are always changing, but Dan Woods, field sales consultant for Henry Schein, is determined to find solutions for customers.
60
PUBLISHER’S LETTER
Reopening As I write this June Publisher’s Letter, we’ve been back in the Share Moving Media
offices for two days. Georgia opened back up two weeks ago, and last week the state reported its lowest new cases of COVID-19. This past Saturday was my first night out in over two months. I ventured into downtown Duluth, Georgia, to meet my buddy Matt and have a few drinks and dinner. The restaurant was at about 65% capacity with a line out the door waiting to get in. There was a guitarist in the park and families spread out across the field listening to him as kids ran around laughing and playing. I soaked up the images and realized how thankful we should all be for the simple things. We can certainly all sit around and talk about the negativity COVID-19 has brought the world. In fact, I do it probably five times a day in different conversations. But there have been some positives that have come from it as well. For example, I don’t think anyone will ever again take our freedom as Americans for granted. The fact we are such an open and social society has never been more evident. We’ve all made fun of being trapped in the house with our families for 8-plus weeks, but I will always look back on this time and remember the benefits of slowing down. The stories that have come from people helping people like never before have been amazing to hear and watch firsthand. And lastly, I have never been more thankful for the job distribution and manufacturers in our space have done; it has been incredible to witness. Each of you are as big of heroes as the frontline workers. Your countless hours of endless searching for PPE products and things your accounts need during allocation hasn’t gone unnoticed. Thank you so much for being a shining light to the healthcare community. This letter will hit your mailboxes in a little over a month. It will be very interesting to see where the country is in 30 days. Will COVID-19 start to decline? Will it increase? By the models to date, who the hell knows? What is certain is that together we will get through this and be stronger for it.
Scott Adams
Dedicated to the industry, R. Scott Adams
repertoire is published monthly by Share Moving Media 1735 N. Brown Rd., Suite 140, Lawrenceville, GA 30043 Phone: (800) 536-5312, FAX: (770) 709-5432; e-mail: info@sharemovingmedia; www.sharemovingmedia.com
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2020 editorial board Richard Bigham: IMCO Eddie Dienes: McKesson Medical-Surgical Joan Eliasek: McKesson Medical-Surgical Ty Ford: Henry Schein Doug Harper: NDC Homecare Mark Kline: NDC Bob Ortiz: Medline Keith Boivin: IMCO Home Care
WE THANK YOU Hillrom applauds all of the heroes who have joined forces, stepped up to greatness and made a difference for the patients and caregivers who need them now more than ever.
Hillrom Medical Affairs Manager, Sue Mangicaro, volunteers with the International Medical Corps to help Flushing Hospital and Jamaica Hospital treat a growing number of COVID-19 patients in New York. You define and exemplify #HillromStrong, Sue, and we salute you!
hillrom.com/covid-19 Š 2020 Welch Allyn, Inc. APR81902 Rev 1 ENG-US 2020-05
PHYSICIAN OFFICE LAB
Who, Why, When While the decision whether to test and counsel patients with results during the visit or batch for lower cost and more convenient workflow is a practice decision, our customers deserve and expect guidance from their suppliers. Point-of-care testing has always been my passion. I know many seasoned distribution account
By Jim Poggi
managers feel the same way. As we consult with customers to describe the benefits to their practice and patients resulting from point-of-care testing, some customers adopt point-of-care testing readily, while others are more reluctant. I’ve spent many years trying to figure out why.
One reason came down to workflow: whether to provide a test result now during the patient visit or to batch tests later using lower cost per test systems. As the technology to perform point-of-care testing evolved to include liquid chemistry profiling systems and immunoassay instruments for thyroids and therapeutic drug 6
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testing, the dichotomy of cost versus convenience in point-of-care testing first became apparent. Should the clinician test while the patient was in the office using simpler fixed menu meter-based systems, or do batch testing later in the day on more sophisticated systems with broader menus and lower the cost per test? As I sold
batch for lower cost and more convenient workflow is a practice decision, our customers deserve and expect some level of credible and logical guidance from us and our manufacturer partners. In this article, I will try to explore this question and give you some ideas on how to help your customers think about their choices and make a sensible determination.
Patient treatment program As I have considered the question of cost versus convenience, it has led me to think of why the patient is in the office in the first place. Typically, there are three reasons: ʯ A patient presents with acute symptoms (respiratory, physical injury or pain) ʯ A patient is there for an annual physical for routine general health ʯ The patient falls into a “risk-based screening” population based on age, personal or family history, gender or some combination
in-office testing in those days, I was often asked “What’s the value of testing in the physician office if I don’t discuss the results with the patient during the visit?” That was a tough question to which I had no real clear answer. Economics were usually part of the answer then, but for clinicians looking to optimize patient treatment and communication, it simply was not enough. As a result, my story of in-office testing missed the mark for those clinicians driven to improve patient care irrespective of economics. As reimbursement has declined under PAMA and patient outcomes have become more important under MACRA, this challenge has come front and center once again. Over the years, I eventually learned to provide a more sophisticated answer: “You should test at the point-of-care if the test result will help you initiate or modify a patient treatment program.” That helped, but the questions then switched to: “That makes sense, but who do I test now? And who can I wait to test later in the day with more economical testing systems?” While ultimately the decision whether to test and counsel the patient with results during the visit or
Implementing or modifying a patient treatment program still underpins whether to test at the point of care. But the rationale determining whether to test now or batch is based on both available technology and why the patient presents in the first place. Once I realized this, the situation became clearer and I was able to refine my testing recommendations. I offer this reasoning and logic to you. Implementing or modifying a patient treatment program still underpins whether to test at the point-of-care. But the rationale determining whether to test now or batch is based on both available technology and why the patient presents in the first place. Any time the technology can present an actionable answer during the patient visit, there is some credible reason to perform it then and discuss directly with the patient during the visit. www.repertoiremag.com
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PHYSICIAN OFFICE LAB Hematology tests are a perfect example. They are quick, accurate, actionable, easy to perform tests and provide information valuable no matter why a patient present in the office. Rapid respiratory tests no matter whether they are lateral flow, meter based or molecular are a first line of defense when respiratory symptoms present. Stand-alone glucose and hemoglobin A1C tests are also pretty logical choices to perform during the visit for a patient with history or symptoms indicating diabetes, no matter the economics of testing now or later. The rapid rise of type 2 diabetes makes it very important to implement screening and patient counseling broadly for older, more sedentary and overweight patients in particular. Once these easy tests and patient scenarios are out of the way, the line between cost, care and convenience becomes somewhat blurrier. Additional considerations to form the decision to test and counsel now include whether there is a risk that the patient will not return or follow up on healthcare recommendations if test results and treatment plan follow-up are provided after the visit. Community-based clinics, in particular, face this challenge. Institutional/clinical support for risk-based screening is very broad and includes CDC, U.S. Preventive Services Task force, various medical societies. Some of these recommendations include:
ʯ Medicare preventative services (See link for more information on tests and other procedures) www.cms.gov/Medicare/Prevention/ PrevntionGenInfo/medicare-preventive-services/ MPS-QuickReferenceChart-1.html ʯ CDC HIV/HCV/HPV screening recommendations ʯ HCV screening is recommended by CDC for baby boomers (See link for more detail) www.cdc.gov/hepatitis/hcv/guidelinesc.htm ʯ CDC recommends HIV screening for adults between 13 and 64 (See link for detail) https://www.cdc.gov/hiv/testing/ ʯ CDC recommends HPV screening in combination with PAP tests www.cdc.gov/ cancer/cervical/pdf/guidelines.pdf In summary, as we think about how to credibly present the benefits of point-of-care testing, we need to be aware of not just the basic premise that tests should be provided at the point-of-care if their result will be used to initiate or modify a patient treatment program. We also need to consider the patient mix of the practice and use that information to provide more concrete, credible and thoughtful guidance regarding who to test, why to test and when to test. Using this thought process will provide you with the logic and rationale needed to confidently present point-of-care testing. Your customers will thank you as a result.
How technology and the patient situation influences immediate patient testing
8
Technology
Why test?
Recommend testing during patient visit?
Hematology (CBC)
• Upon symptoms • General screening • Risk-based screening
Yes
Rapid respiratory tests
• Upon symptoms
Yes
Glucose, A1C
• Upon symptoms • Risk-based screening
Yes
Lipids
• Risk-based screening
Yes
PT/INR
• Anticoagulant therapy
Yes
Lead testing
• Risk-based screening
Yes
HIV/HCV/HPV
• Risk-based screening
Opinions vary
June 2020
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DISTRIBUTION
Mark Zacur delivered welcome remarks during the sales awards ceremony.
Let’s Go, O&M: Owens & Minor kicks off 2020 with Americas Sales Conference By Victoria Rickman Taylor
Owens & Minor recently hosted its annual Americas Sales Conference in Dallas, Texas. The theme of the
conference, “Let’s Go, O&M,” was inspired by the new strategic focus of leadership on One Company, One Direction. This meeting was unique for the Fortune 500 healthcare solutions company, bringing together the entire portfolio of solutions, which includes medical distribution, Byram home healthcare, global products – including the proprietary HALYARD brand, and services. It was also the first sales conference since O&M launched its enterprise sales structure, designed to harness the power of combining its unique healthcare offering of three strategic pillars – distribution, products, and services. The enterprise structure is a result of the company uniting under O&M’s new mission of empowering its customers to advance healthcare.
The conference began with a motivational opening session featuring updates from the company’s senior leadership about momentum built in 2019 and how their teams will enable the sales organization in 2020. Attendees were then surprised by a visit from a pending wish recipient of the North Texas 10
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This year’s focus was aligning and advancing supplier partnerships through excellence.
Make-A-Wish® Foundation chapter. She and her family accepted a donation from O&M, during which time she was informed that her wish to go to Paris was being granted. “We believe in Owens & Minor, and we believe in our sales team,” said Mark Zacur, executive vice president, chief commercial officer
of Owens & Minor. “Our senior leadership team wanted to start the conference by showing our confidence in this team and what we will accomplish together in 2020. Wrapping up the opening session with the Make-AWish presentation was our way of reinforcing to attendees why we do what we do. Our mission compels us to leverage our skills, talents, and other resources to advance healthcare. Giving back to our communities is part of who we are and how we accomplish our mission.” Another main highlight from the event was the time teammates spent celebrating and engaging valued supplier partners, including an awards celebration, strategy session, and exhibit fair. Each year, O&M invites its top suppliers to attend a strategy session with leadership, followed by an exhibit fair to provide teammates and suppliers with opportunities to create new relationships and strengthen existing ones. This year’s focus was aligning and advancing supplier partnerships through excellence. Award recipients include: ʯ Supply Chain Improvement: Stryker Sage Products ʯ Field Engagement: 3M Products ʯ Manufacturer Partnership: B. Braun Medical Inc. ʯ Owens & Minor Values (Supplier Representative of the Year): Mike Carver, GOJO Industries, Inc. The conference concluded with remarks from Mark Zacur, along with a closing video featuring teammate and supplier interviews and healthcare provider customer quotes about the exciting direction O&M is going in 2020. “Healthcare is constantly changing, and Owens & Minor is remaining agile to the needs of our customers,” said Edward Pesicka, president
& CEO of Owens & Minor. “This is evidenced by our proactive response to the COVID-19 pandemic impacting our nation. O&M teammates are truly living our mission to empower healthcare, and our preparedness in this pandemic is what has enabled us to continue to serve those on the front lines of this crisis. This sales conference was a reflection of who we are and our priorities moving forward.”
Mark Zacur congratulated the Make-A-Wish recipient and her family during the conference’s open session.
The Owens & Minor Values (Supplier Representative of the Year) Award was presented to Mike Carver, GOJO Industries, Inc.
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IDN OPPORTUNITIES
Opening Back Up With a continued reduction in COVID-19 cases, one health system was busy mapping out next steps to resuming elective surgeries and procedures
At its high point, Ochsner Health was located in one of the nation’s COVID-19 hotspots. The New Orleans-based
health system had confirmed inpatient cases that reached into the mid-800s.
But there were positive signs by mid-April. On April 17, the number of inpatient COVID-19 cases had lowered to 573. Another positive trend was more people being discharged home who were COVID positive. Ochsner discharged its 1,500th COVID patient by April 20, just over one month after Ochsner admitted its first COVID-19 patient on March 9. More patients were coming off ventilators and fewer were having to go on them. Warner Thomas, president and CEO of Ochsner Health, said the health system was working with local and state officials on how to open back up some of its operations. “We’re working towards getting ready to get back to do other surgeries or procedures that we’ve had to delay,” he told media members in a conference call. “We delayed them during the peak, but these patients still need care. Cancer surgery, heart surgeries and other things have been delayed, so it’s time to get back to taking care of folks.” 14
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Delay of care Thomas said one of the fears from a public health perspective is there were people delaying their medical care due to COVID-19 concerns. Many people with medical issues were fearful to leave their house. “That has significant implications,” said Thomas. “We’ve heard of people who have had strokes who delayed care out of fear. Minor heart attacks as delayed care. People with broken hips that have delayed care for multiple days. That is not a good situation.” Dr. Robert Hart, chief medical officer, Ochsner Health, said ER physicians had seen cases where a patient with a heart attack stayed at home a few days rather than coming in for treatment. On the surgery side when the stay-at-home order was in place, Ochsner was only performing emergency surgeries. “There are some tiers of surgeries we laid out that could be put off and some that couldn’t,” Hart said. “We’ve
got to begin considering getting people back on the schedule to get them taken care of before we wind up doing more harm than good out of this.” Thomas said Ochsner was taking the right precautions in its ERs and clinics by temperature checking everyone that comes into the organization, whether patient or employee. If anyone has a fever they are getting tested appropriately and sent home. Ochsner had the appropriate amounts of PPE for healthcare personnel, and patients were given masks, he said. “It’s important we don’t see ongoing delay of care, because frankly that’s going to create a bigger medical issue for folks going forward,” said Thomas. “We worry about the escalation of chronic disease or the delay of care that need to be dealt with.”
Testing Testing for COVID had become a routine part of the screening process for patients and employees. By midApril, the health system had tested over 23,000 people for COVID-19, with more than 7,000 confirmed cases – about one-third of Louisiana’s COVID-19 cases. Ochsner had ramped up to conducting 1,300-1,400 tests a day, either same-day tests or point-of-care testing. Thomas said patients being admitted into the ER for any reason were being tested for COVID. People having surgeries were being tested proactively. “We’re making sure to test and screen people as they come in,” he said. The rate of testing was only going to increase as the health system worked to begin surgeries and procedures that had been postponed.
Telehealth takes off Ochsner Health’s telemedicine platform, Ochsner Anywhere Care, is seeing record numbers of enrollments and visits since the COVID19 outbreak in Louisiana, according to the health system. Patients are able to see a provider on-demand, receive assessment and appropriate treatment, all from the comfort and safety of home. In March 2020, urgent care ondemand and behavioral health scheduled appointments increased 852% in enrollments and 933% in virtual visits over February 2020, Ochsner reported in a release. The trend was continuing in April, with daily virtual visits growing significantly. Key highlights include: ʯ March 2020 Ochsner Anywhere Care enrollments: 10,084 (February 2020: 1,059) ʯ March 2020 Ochsner Anywhere Care virtual visits: 3,616 (February 2020: 350)
ʯ April 2, 2020 Ochsner Anywhere Care virtual visits: 2,700 (March 2, 2020: 39) “It is reassuring and evident that those in need of non-emergent medical care are heeding the advice of local, state and federal officials during the COVID-19 outbreak and are sheltering-in-place, leaving only for essential errands,” said David Houghton, MD, MPH, medical director of Ochsner Anywhere Care. “Telemedicine has made it possible to safely and effectively treat illnesses from home and we are seeing thousands of patients choose Ochsner for their virtual healthcare needs.” Ochsner Health was one of the initial six healthcare providers approved by the Federal Communications Commission’s Wireline Competition Bureau approved for its COVID-19
Telehealth Program. Healthcare providers in some of the hardest hit areas like New York could use this $3.23 million in funding to provide telehealth services during the coronavirus pandemic. As part of the recently enacted CARES Act, Congress appropriated $200 million for the FCC to support health care providers’ use of telehealth services during this national emergency “This is changing the landscape around virtual care,” said Hart. “Not only with patients, but physicians are realizing how effective they can be with certain types of virtual care. I think this is going to be something that does not go away when COVID-19 is gone. It’s going to be something that not only the physicians, but patients will be looking at – how does this continue going forward in some fashion that everyone finds useful.”
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IDN OPPORTUNITIES “If you come into one of our facilities you are going to be tested, whether you come in to be admitted, or have a procedure,” said Hart. “If you go to one of our infusion centers you are going to be tested. For instance, if we give you chemotherapy or infusion that may compromise your immune system, we want to know first whether you are positive or not. Because it may be something we want to put off a couple of weeks for your safety.” Ochsner started antibody testing the week of April 20. The initial focus was antibody testing for the front line caregivers such as critical care and ED staff who have been working around COVID-19 cases since at least early March. “There is a sense now with people this was simmering in our community in New Orleans prior to Mardi Gras,” said Hart. “We may find out that a lot of people
Indeed, the elimination of voluntary procedures has had a major impact on the organization’s revenue. Thomas reported clinics, outpatient procedures and imaging were down 60-70%. “It’s had a major impact on our revenue both at the end of March and the month of April.” Thomas said Ochsner was putting into place some expense reduction items, “things we think we can put off, programs we can stop temporarily, hiring we will stop temporarily in some of our areas,” he said. “Certainly not in our clinic areas but other areas.” While the organization was still evaluating the extent of the economic impact, a lot of it would depend on how quickly people come back for medical care and what that looks like over the next couple of months, Thomas said. “We’re going to be watching that carefully.”
Fortunately, the health system has not had to lay off or furlough anyone, Thomas said. “We’ve redeployed a lot of people, taken folks that were less busy and moved them to other areas.” who could well have antibodies to COVID-19 not even realize they were exposed along the way.” From there, testing would expand to other inpatient areas, procedural areas, and into clinics.
Financial impact Thomas said during the peak of the COVID-19 cases, Ochsner had delayed well over 6,000 surgeries and procedures. “We’ll be in contact with those patients to get them scheduled soon,” he said. “We know many of those procedures need to be done. We’ll be having the right conversation with folks coming in and talking through that.” Fortunately, the health system has not had to lay off or furlough anyone, Thomas said. “We’ve redeployed a lot of people, taken folks that were less busy and moved them to other areas.” Many Ochsner employees in areas less busy were taking their paid vacation during April and May. “We’re doing that for a couple of reasons,” said Thomas. “No. 1, because we have time for them to do it; we don’t have as many patients. We also think in the second part of the year, we are going to have to be catching up with these 6,000-plus surgeries and procedures, visits. We want people ready to go in the second part of the year.” 16
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Dynamic Ventilator Reserve Program Ochsner Health was participating in the Dynamic Ventilator Reserve Program that has been put together by the COVID Task Force at the White House in conjunction with the American Hospital Association. The Dynamic Ventilator Reserve Program is “a collaborative voluntary effort led by a group of U.S. hospitals and health systems that has created an online inventory of ventilators and associated supplies, such as tubing and filters, to support the overall needs of combatting the COVID-19 pandemic,” according to the AHA. “Hospitals and health systems will input into the database available equipment that they are able to lend to others in the country. Providers are then able to access this virtual inventory as their need for ventilators increases.”
The New Normal Shelter-in-place mandates. Unprecedented demand for personal protective equip-
ment. Supply disruption. Allocation. These were just some of the new parameters in which med-surg reps had to navigate in order to deliver product and services to their customers. In the following articles, Repertoire delves into some of the facets of the new normal.
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The New Normal
Taking Care of Accounts What distributor reps did during social distancing in their territories In a recent podcast, Dail-eNews editor Daniel Beaird
and Scott Adams, publisher of Repertoire magazine discussed the challenges for distribution reps under the nationwide social distancing measures in place, and how the COVID-19 pandemic has changed the way distribution reps approach their calls.
Staying in front of accounts While there were no more face-to-face meetings amid shelter-in-place orders throughout the nation, Adams said reps were doing everything they could on a regular basis to stay in front of accounts. “It hasn’t been difficult – the accounts are calling them,” he said. 20
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Along with an increased volume of texts and emails, reps were on phone calls 12-14 hours a day with physician practices, nurses, and doctors calling with lots of questions. Reps know that when they are on the phone with customers, there should be no noise. “It has to be a very focused conversation,” Adams said. “It’s all about helping customers. They all told me their relationships have played a huge role in working through the situation, not just with customers, but working upstream with manufacturers as well. Manufacturer relationships are just as important in getting that information so reps can relay it down to the accounts.”
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The New Normal Adams said clear and honest communication with manufacturer partners is key, “especially on the PPE products,” he said. Although difficult to answer during a fluid situation, the more accurate and timely the information manufacturer partners can provide, the better. “I know how difficult that is to answer with how much pressure has been put on these PPE manufacturers, but it does help when they get good clear information to accounts – even when it’s not good news.”
become better at mass communication – getting mass amounts of information out to their accounts on time,” Adams said. “They’re just trying to do everything they can to help these practices stay open and take care of people.”
Lasting impact
The med/surg community is already discussing how the COVID-19 will change supply chain down the road. Many have speculated that Just-in-Time delivery will be a thing of the past. “Having just enough inventory Remaining relevant on hand as a manufacturer, distributor and provider – Indeed, amid the COVID-19 pandemic reps felt they are I don’t know after this if anyone will allow to happen more relevant with their accounts than they have ever again,” Adams said. been. “This is from reps who have been in their territory a One rep provided Adams an illustration of how concouple years all the way up to three decades,” said Adams. versations with customers are changing. “Think about a doctor having 10 gowns and masks for 10 employees,” Adams recounted. “The doctor now knows that in order to stay in business, the practice needs 10 gowns per day, every day that the pandemic could last. In our case in the Metro Atlanta area, for the foreseeable future that’s at least a month. So that doctor needs 220 gowns, 220 masks, 220 visors, 220 boxes of gloves, etc., just to truly be prepared for what’s coming.” The rep told Adams that talking – Scott Adams, publisher of Repertoire magazine with this accounts in this way moving forward will be the top priority to make sure everyone is prepared. Adams provided several reasons. First, reps are helpIf an account hesitates to plan appropriately, the rep ing physician practices find PPE products. “That’s absowould simply remind them of the Spring of 2020, when lutely top of the list.” Second, reps are helping customers it became apparent how important supplies were. “A lot forecast what their real needs are. Third, reps are providof it comes down to not that accounts don’t want to buy ing assistance with business planning. more PPE products, but they don’t have room for them Fourth, “and to no one’s surprise,” Adams said reps in a practice. We’ll have to change how all of that is done,” are just listening to their customers. “They are listening to Adams said. their customers express fears and frustrations. Customers Amid the pandemic, distributor reps have taken their are worried about their jobs and practices. Accounts are role in healthcare seriously. “They know getting these asking ‘How can my practice be more successful?’ ‘How products into the hands of these providers is job No. 1 can we stay in business?’” for all of America right now,” Adams said. “I don’t think Accounts are asking for advice on whether they America realizes it yet, but distribution reps, the wareshould extend hours, how they can learn more about telehouse workers, delivery personnel – are all front and cenmedicine, and even if they should open up drive throughs ter and just as important as the caregivers.” for patients who are scared of coming into an office To listen to the full podcast, visit: http://repertoiremag. amid virus fears. “All the reps I talked to told me they’ve com/dail-enews-podcast-2.html.
“ A lot of it comes down to not that accounts don’t want to buy more PPE products, but they don’t have room for them in a practice. We’ll have to change how all of that is done.”
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The New Normal COVID-19 and Post-Acute Care Limited personal protective equipment for long-term care providers poses a major risk to vulnerable patient-base
While hospitals were at the center of the initial wave
of supply needs for the U.S. healthcare system, survey results released mid-April by Premier Inc. indicated that the U.S. supply chain was facing a second wave, and second front, in combatting COVID-10. Senior nursing and assisted living facilities have limited personal protective equipment (PPE) to care for a greater volume of patients, according to a Premier Inc. survey. This indicates a second critical wave of supply shortages, according to Premier, as hospitals move to reserve beds for severe COVID-19 cases and post-acute settings see an influx of patients. “While senior nursing 24
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and assisted living facilities can serve as excellent sites for less critical cases, such moves cannot overlook supply and resourcing demands,” Premier’s survey suggests. Premier’s survey of nearly 2,500 skilled nursing and assisted living facilities found that at the time of the survey, 24% of facilities did not have N95 masks on hand, and the majority of respondents had fewer than two weeks’ supply of surgical masks, isolation gowns and face shields. Other key products for which they had supply concerns included thermometers, exam gloves, alcohol pads, soap/detergent and hand sanitizer. Ninety-six percent were implementing PPE conservation strategies.
The New Normal “In this next phase of the outbreak, states and healthcare providers are contemplating how they can best provide care for patients who need medical attention but are not critical care status,” said John P. Sganga, senior vice president of Alternate Site Programs at Premier. “Senior nursing and assisted living facilities can provide quality care for these patients, but this shift will increase their resource and supply needs, from PPE and tests to staffing. We already know that active cases of COVID-19 create surge demand of up to 17x for hospitals’ supplies, and our survey shows that nearly half of these post-acute facilities are already dealing with staffing challenges and that PPE remains elusive. Premier’s e-Commerce marketplace, stockd, has created a repository of conservation guidance and alternative production methodologies for key PPE, and we continue to collaborate on other solutions to help providers through this unprecedented period.”
Seventy percent of senior nursing and assisted living facilities in Premier’s survey said they were not fully prepared to treat an increasing number of COVID-19 cases as the virus surges. Furthermore, 48% of respondents say they are experiencing challenges with staff attendance as a result of COVID-19. Premier said states were approaching capacity planning in nursing homes differently, as determined by hotspots. “New York, for example, ordered all nursing facilities to accept hospital discharges, including patients who have tested positive for COVID-19, while Massachusetts is beginning to empty nursing facilities to become dedicated sites for coronavirus treatment,” according to a Premier blog. “States and providers must think strategically about how they admit patients from hospitals or move patients across alternate care sites, particularly since senior citizens are a population already vulnerable to COVID-19,” Sganga said.
Why long-term care providers in particular are facing an incredible challenge in COVID-19. When asked to describe how COVID-19 is affecting the longterm care market, Bob Miller was blunt: “Very severely.” Indeed, the close proximity that the residents are in makes it very difficult to control, said Miller, executive vice president sales/vendor relations, Gericare Medical Supply. Miller discussed this challenge and others to Repertoire. The following were some of his insights: COVID-19 is a danger to residents, and caretakers. “Really it’s twofold, you have the residents and you have the brave
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employees,” said Miller. “The nursing homes are doing an amazing job under the circumstances. You have the employees serving as caretakers and confidants. They are not only taking care of residents, but serving as part-time psychologists in making them feel safe, keeping their spirits up, and communicating with their loved ones.” Getting long-term care providers the PPE products they need is a huge challenge based on their needs. It changes quickly from day to day based on what is occurring
in the nursing home, said Miller. “One day it could be gloves, the next gowns, then masks.” Isolating those that have the virus in separate wings of the nursing home is a big test. “The discipline it takes, changing multiple times of the gowns, mask, and gloves is something that must be done every time,” said Miller. Overall, it’s a very challenging time for the long-term care industry, Miller said. “They are meeting the challenge with extreme vigilance.”
The New Normal
Reducing the Risk For the foreseeable future, infection prevention will be front and center in conversations with customers. In the following article, Repertoire Magazine reached
out to manufacturers for insights on how COVID-19 was affecting their work with distributors and physician offices, as well as their advice on effective infection prevention protocols, and how the COVID-19 pandemic may change healthcare forever. Participating in the discussion were: ʯ B. Braun Medical Inc. ʯ Sri Trang USA ʯ OraSure 28
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B. Braun: Strong interest in collaborative efforts Repertoire: What were you hearing from distributor reps as far as how they were communicating and working with physician offices while most of the country was under shelter-at-home orders? Nina Pittner, marketing manager, Channel Development: Our distributor reps have remained in close contact with customers, doing everything they can to support them with products that are vital to patient care during the crisis. In many ways, through calls and virtual
meeting tools, the level of communication with many of our customers has never been stronger.
Butryn: The pandemic has taught us many lessons. We anticipate that many of the preventive practices put in place during the crisis will continue, and the healthcare system as a whole will be better prepared and equipped to take action quickly to prevent the spread of future disease threats. We have also learned new ways of collaborating with partners across the system to address public health emergencies in comprehensive ways, including government agencies, providers, suppliers, and distributors.
Repertoire: How have suppliers been helping physician offices beef up their infection prevention efforts? Tracy Butryn, associate director, Channel Development: B. Braun has been actively providing guidance and solutions on ways to reduce the risk of clinician exposure to COVID-19. One example is information developed by our Medical Affairs team on the use of additional lengths of tubing with our Space™ and Outlook® large volIt’s a given that representatives will need ume infusion pumps. The extended to pay close attention and adhere to all tubing allows pumps to be kept outphysician and health system safety and side patient rooms, which reduces the prevention practices, now and in the future. time clinicians spend in patient rooms and helps preserve limited PPE. We Beyond that, we expect there will be strong have also provided information on interest in collaborative efforts to plan and the Emergency Use Authorization better prepare for future crises. (EUA) issued by the FDA, allowing for the use of certain B. Braun infusion pumps with nebulizers to treat Sri Trang USA, Inc.: Supportive and responsive COVID-19 patients. The EUA allows for an alternative method to administer continuous nebulized medications Repertoire: What were you hearing from distributo patients on ventilation, helping to protect clinicians by tor reps as far as how they were communicating reducing their exposure to infected patients. and working with physician offices while most of the country was under shelter-at-home orders? Repertoire: When reps return to calling on physiSri Trang USA: Distributor reps want to be supportive cian offices, what are some ways you foresee these and responsive. With the increased demand for PPE and visits changing? social distancing requirements, they have shifted to other Butryn: It’s a given that representatives will need to pay methods of communication whether video or phone close attention and adhere to all physician and health conference calling. And we think they’ve done a good job system safety and prevention practices, now and in the of trying to provide creative solutions rather than hard future. Beyond that, we expect there will be strong interselling. They understand the environment right now. est in collaborative efforts to plan and better prepare for future crises. B. Braun’s Collaborative Care program, for Repertoire: How have suppliers been helping physiexample, offers multiple ways to better understand health cian offices beef up their infection prevention efforts? system needs and provide data-driven solutions. One Sri Trang USA: Suppliers recognize the market and have component of this program is a pump asset analysis conshifted in a variety of ways. Certainly some suppliers have ducted by our clinical consultants who collect data and been able to increase their product share from manufacassess the optimal need for infusion equipment at a facilturers, some have been able to source new manufacturity. The COVID-19 crisis has underscored the need for ers quickly, and some have simply gone to an allocation such planning to occur long before a medical emergency system to ensure certainty for their current customers. so that health systems can ready. The entire supply chain understands the impacts from the pandemic and so you see efforts at all levels to provide Repertoire: In what ways do you think the COVID-19 supplies, resources, and education. pandemic is going to change healthcare forever? www.repertoiremag.com
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The New Normal Repertoire: When reps return to calling on physician offices, what are some ways you foresee these visits changing? Sri Trang USA: Well certainly you will see changes on two fronts. First, you will see some of the hygiene and social distancing practices and protocols in place because of the pandemic stick around many offices. This may be in the form of tighter credentialing or stricter rules regarding in-person visits. Secondly, we think we will see a shift towards a more collaborative and frank relationship between reps and physician offices. Repertoire: Will reps need to wear protective gear? If so, what are the essentials? Sri Trang USA: It is possible, but ultimately it will be up to the facility. We think we will still utilize remote capabilities in the short term. In the long-term, we expect an extension of hygiene practices from clinical staff outwards to office staff, reps, and other visitors.
The med/surg community is responsive and adaptable. We will see collaboration from all points in the supply chain. There will be increased education, training, and advocacy, which ultimately results in increased transparency. Repertoire: What steps will be priorities in effective infection prevention from individuals? Sri Trang USA: First and foremost, we want to follow guidelines published by competent authorities like the CDC and NIH. As always, proper hand hygiene is key, which includes proper hand washing, appropriate use of PPE, and awareness of your surroundings. Repertoire: In what ways do you think the COVID-19 pandemic is going to change healthcare forever? Sri Trang USA: We definitely expect an increase recognition for multi-source contracting and supply, as well as a review of safety or reserve stock management. We have 30
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seen this in other industries. We think we will also see increased involvement from Risk Managers, Quality Control Managers, and Infection Preventionists. Repertoire: How can the med/surg community improve its infection prevention advocacy and efforts moving forward? Sri Trang USA: The med/surg community is responsive and adaptable. We will see collaboration from all points in the supply chain. There will be increased education, training, and advocacy, which ultimately results in increased transparency. And there will be multiple changes, whether immediate and small scale, like adding a hand sanitizing station at entrances, or long term at a larger scale, like sourcing diversification or training investment.
OraSure: Innovation “at the crux” of our new reality Repertoire: In what ways do you think the COVID-19 pandemic is going to change healthcare forever? Todd Grice, national sales director, Infectious Disease and Risk Assessment, OraSure, Technologies, Inc.: The COVID-19 pandemic is having real impacts to how healthcare is offered by practitioners and how patients experience care. Innovation is at the crux of our new reality. The current environment of social distancing and stay-at-home orders is forcing organizations, communities and individuals to find new ways of doing things. Stephen S. Tang, Ph.D., president and CEO, OraSure: Looking ahead, we see individuals wanting more autonomy over their healthcare – and we are responding. For example, the pan-SARS-coronavirus antigen rapid in-home self-test that uses oral fluid samples that OraSure is developing puts control in the hands of the individual. The test would be designed for in-home self-testing by lay users, though medical professionals will be able to use it in clinical settings too. OraSure’s painless oral fluid testing would give users a “lab on a swab,” and fast results – all in the privacy of the home. Bringing an in-home rapid test for current COVID-19 infection to scale, like the oral fluid antigen test OraSure is developing, could be a game-changer. Testing millions of people in their homes, identifying those who are infected with COVID-19, whether or not they are exhibiting symptoms, and isolating them will help protect our communities, restart our economy – and keep it moving forward.
INFECTION PREVENTION
Identifying Gaps ECRI Institute’s consulting helps providers respond to a multitude of issues related to infection control and prevention On any given day in the United States, about 1 in 25 hospital patients has at least one healthcare-associated in-
fection (HAI), according to estimates.
Indeed, there are quite a few areas that create vulnerabilities for infections at hospitals and health systems, said James Davis, MSN, RN, CCRN-K, HEM, CIC, FAPIC, Senior Infection Prevention & Patient Safety Analyst/Consultant, ECRI Institute. For example, lapses in sterilization and high-level disinfection are especially concerning, he said. There are environmental and construction-related factors. Handhygiene is a well-known concern for the spread of infections. “ECRI’s engineering team has performed comparative evaluations in our testing laboratory of automated hand hygiene devices and equipment to help hospitals know which products are best for reducing infection risks,” said Davis. “Other areas of vulnerability involve infection prevention program management, medical device
issues broadly, as well as infection prevention considerations in the selection and procurement of equipment and devices.” Consultation ECRI receives a broad range of requests from hospitals and healthcare systems for infection prevention and control (IPC) consultation. To meet those requests, ECRI has developed an IPC consultation that is led by certified infection control-prepared experts with advanced degrees. “Behind each consultant stands the power of ECRI’s full knowledgebase of multi-disciplinary experts, making ECRI unique in these consultations,” said James Davis, MSN, RN, CCRN-K, HEM, CIC, FAPIC, Senior Infection Prevention & Patient Safety Analyst/Consultant, ECRI Institute.
The following are best practices ECRI helps hospitals and health systems develop for better infection prevention:
ʯ Situational awareness processes, policies, procedures, supply procurement and facility risk assessment – (EBOLA, SARS, Influenza, COVID-19)
ʯ Health IT: For example, modification of the
electronic health record to capture process and outcome measures for infection-related issues. The Partnership for Health IT Patient Safety, a multi-stakeholder collaborative convened and operated by ECRI Institute looks at these types
of issues and our infection preventionists add to the content where/ when appropriate.
ʯ Regulatory and certification preparedness and response to regulators/inspectors.
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INFECTION PREVENTION ECRI Institute’s certified infection preventionists conduct on-site consultations, while ECRI staff of medical device engineers, epidemiologists, architects, accident and forensics specialists, and clinicians review findings and provide additional recommendations. “For example, if we are onsite for an outbreak and the consultant suspects that the potential reservoir is medicaldevice related, we immediately call in the expertise of the clinical engineering staff in our Health Devices group,” said Davis. “That instant expertise advises us, in real time, about the nature of the device and potential mechanisms that would put the device at risk for being a causative factor. If we need an engineer or a medical forensics expert onsite (or any other expert), we fly them out to get the job done right the first time.” Davis said the ECRI Infection Preventionists look at a variety of inputs to develop the gap analysis and action plans from (but not limited to): 1. Systems (physical and electronic) 2. Devices (medical and standard) 3. Mechanicals/plant engineering 4. Staffing 5. Workflow 6. Infection prevention program effectiveness
7. Data validation 8. Surveillance techniques (manual and electronic) 9. Epidemiologic data and analysis 10. Human factors/ergonomics 11. Cleaning and disinfection 12. Sterilization/high level disinfection 13. Environmental factors/industrial hygiene 14. Infection control risk assessment for construction (consultation, planning, program evaluation, onsite and online training) 15. Policy and procedure review 16. Implementation science 17. Infection forensics “ECRI is basically a one-stop shop for infection prevention and control consultation and resources.”
ECRI has been updating its Coronavirus Outbreak Preparedness Center on a regular basis. The resources include very specific information on emergency preparedness supplies.
Outbreak Response Preparedness is key for hospitals and health systems when responding to an infectious disease outbreak. The novel coronavirus (2019-nCoV) is not the first, nor
will it be the last, infectious disease outbreak to make global headlines. “There have been a number of outbreaks that have taught us that routine healthcare infection prevention is not enough when dealing with a novel infectious disease or an infection that has potential for causing a lot of morbidity and mortality,” said Jennifer Anne Hanrahan, DO, an infection disease specialist from the University of Toledo. SARS, MERS-CoV, and Ebola have been transmitted in healthcare facilities, and preventing the spread of infection in hospitals is critical to containing these infections worldwide. 32
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“These outbreaks have shown that emerging pathogen outbreaks can occur with little forewarning and cause disruption to hospitals and their ability to care for patients and keep healthcare workers safe,” Dr. Hanrahan said.
Being prepared The Society for Healthcare Epidemiology of America (SHEA) emphasizes the importance of supporting novel Coronavirus (2019-nCoV) preparedness efforts with rigorous commitment to infection prevention and science-based decision making. SHEA members – healthcare epidemiologists and other experts in infection prevention and infectious diseases working in collaboration with public health – are experienced in outbreak management, having overseen preparedness and management of 2019-nCoV, SARS, MERS-CoV, H1N1, influenza, and other infectious diseases, and are working diligently to ensure safety. SHEA works closely with the Centers for Disease Control and Prevention (CDC), and over the past several years has given particular focus and investment to strengthen the infection prevention and control infrastructure for preparedness and response to emerging pathogens. The SHEA/CDC Outbreak Response Training Program (ORTP), created from 2016 to 2018, is a comprehensive program for hospital epidemiologists to be maximally effective to protect their patients, colleagues, and community from facility-level outbreaks to emerging pathogens, such as 2019-nCoV. The ORTP provides expert-authored and selected resources in incident management, with tools and trainings for development and implementation of policies and identification of resources. “The ORTP was developed to make sure that those working in infection prevention, specifically healthcare epidemiologists and infection preventionists, are knowledgeable in incident management and the structures, frameworks, and resources that help limit facility disruption, supplement resources, and prevent the spread of the pathogen,” said Hanrahan. “These outbreaks showed that education in incident management and preparation to work within an emergency response framework is essential stopping an emerging pathogen crisis.” Being prepared takes time, Hanrahan said. “It can feel overwhelming when starting from scratch, and these tools help make preparation manageable.” There are several different things that hospitals and healthcare workers have to think about in terms of their process for taking care of patients. For example, these
Identifying gaps Both Ebola and SARS demonstrated that routine personal protective equipment was not sufficient to prevent infection in healthcare workers, said Jennifer Anne Hanrahan, DO, from the University of Toledo. “Learning how to don and doff the personal protective equipment properly takes time and practice and is specific to the type of equipment being used. Training is critical to properly donning and doffing PPE.” A number of other issues have also been identified and these are outlined in the SHEA Expert Guidance: Outbreak Response and Incident Management: SHEA Guidance and Resources for Healthcare Epidemiologists in United States Acute-Care Hospitals https://doi.org/10.1017/ice.2017.212 Tool kits: https://ortp.guidelinecentral.com
outbreaks have demonstrated that training in proper donning and doffing techniques for personal protective equipment (PPE) is critical in order to decrease risk of infection to healthcare workers and other patients, Hanrahan said. The ORTP guides healthcare workers in the components of preparedness and response, including successful implementation of policies, and provides quick, direct access to resources and tools selected by experts as the most important and useful. The ORTP was created so the experts tasked with preparedness and response can apply their expertise to stopping the outbreak, rather than spending precious time tracking down resources and navigating new or unpracticed roles. “Every outbreak has taught us a little bit more and it is important to incorporate these lessons into future planning,” said Hanrahan. For more information on the SHEA/CDC Outbreak Response Training Program (ORTP), visit https:// learningce.shea-online.org/content/sheacdc-outbreakresponse-training-program-ortp#group-tabs-nodecourse-default4. www.repertoiremag.com
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MEDPRO ASSOCIATES
The Value of Ride Days Why ride days matter, and how to get the most out of them
The choices for products and services available in to-
day’s physician offices are almost endless. The same goes for distributor reps calling on these accounts. Between traditional selling and automation, distributor reps represent hundreds of thousands of products, combined with an almost 24/7 demand for answers and inquiries from current and prospective clients. Distributor reps are being pulled in a 1,000 different directions. Can an extra hand, a manufacturer rep’s, be a difference maker?
A win/win partnership Indeed, ride days, while less frequently used than in year’s past, can provide a tremendous amount of value to distributor reps. For instance, manufacturer reps can assist with “gap selling,” tracing reports from data to see exactly what products are being ordered, and opportunities for complimentary products and services that the customer may not have thought of to pair with their current purchases. Manufacturer reps can also help the customer save money while increasing GP for the rep by creating a formulary to standardize, and introduce new technologies, equipment, etc. – a win-win for all. Perhaps the most important piece of the manufacturer-distributor ride-day is the opportunity to provide support. Manufacturer reps can focus their discussions on specific products to aid in better patient outcomes and can help educate the customer differently. They can offer an in-depth consultation, and that image of specialized support is a big positive for the distributor rep.
But today’s distributor sales reps have so many irons in the fire, and their time is so important, that devoting an entire day for a co-travel may seem like it would take away from other priorities. So, how can distributor and manufacturer reps make the most of their time together on a ride day, or even a half-day together? The following are some best practices. No. 1 Set the tone. In order to have a successful day of co-travel, it is important to set the right expectations and communicate. ʯ Do you want your manufacturer partner along for a general day of calling on customers, or are there specific customers you want to visit who have specific needs? Either way, a good manufacturer rep is ready and willing to discuss opportunities with every customer. ʯ What are you trying to accomplish? ʯ What don’t you want your manufacturer rep to discuss with the customer? No. 2 Get technical. Manufacturer reps provide an opportunity for your customer to have their more technical questions answered onsite. No. 3 Utilize trust. Once you’ve built up a good rapport and trust with your manufacturer partners, let them go to work for you. Identify accounts that would benefit from a demo day where your manufacturer rep calls on the account and builds the business for both of you. MedPro understands the advantages and efficiencies of distribution, especially when a customer is deciding to select, purchase and receive a product. Our experienced personnel enable us to work side by side with our distributor partners to develop new strategies that both support and enhance the customer experience. Our goal is to make the distributor rep’s job easier, protect and increase sales – all while supporting your distribution solutions.
For more information, visit us at www.mproassociates.com.
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SHOULDER TO SHOULDER MedPro is a contracted sales organization representing industry leading manufacturers, supporting distribution for nearly 15 years. MedPro understands the day-to-day challenges of the modern distributor rep. Representing world-class manufacturers in the non-acute space, we can help bring value to you and your customers.
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INFECTION PREVENTION
Reducing Airborne Transmission Why UV air filtration units are critical to patient – and caregiver – safety, and how to broach the topic with customers Amid the COVID-19 pandemic, conversations on how to reduce airborne transmission of pathogen have come
front and center. UV air filtration units are one solution distributor reps can discuss with their customers. In the following Q&A, Alan Kivia, president of Medical Illumination, and Rob Saron, senior vice president, global distribution, Symmetry Surgical, provide insights on the benefits of the technology, its proper uses in different care settings, and how distributor reps can approach accounts about the topic.
Repertoire: How old are UV air filtration units? That is to say, how long have they been around? The first commercial grade UV-C lamps were developed in the 1930s and were used primarily in hospitals to neutralize viruses, bacteria, and molds. Due to the harmful effects UV-C can have on the skin, they are used only in unoccupied spaces. UV24 was introduced as VidaShield in April 2016. The product line was acquired by Medical Illumination in 36
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April 2019 and was introduced into the distribution market in late 2019. Repertoire: What improvements have been made to the technology in the ensuing years? Being able to use UV-C to deactivate airborne pathogens in occupied spaces was made possible by shielding the UV-C in an enclosed irradiation chamber. In such devices, air is brought into the irradiation chamber
through the use of fans where it is exposed to the UV-C in the appropriate dose to destroy the pathogens, while assuring that no harmful rays escape from the fixture. The units should run continuously, turning the air over in the room approximately every 15 minutes. By incorporating the irradiation chamber into ceiling lighting fixtures, the installation and retrofit of existing rooms is easy. It has also been shown that much of the surface contamination in a facility is due to pathogens settling out of the air. Use of these units has shown to significantly reduce the pathogens found on surfaces within the area. Because the UV-C deactivates molds in the air, odors are often dramatically reduced in the space. Repertoire: Where are they typically installed? Hospitals (and if so, where in the hospital)? Longterm-care facilities? Outpatient surgery centers? Units are appropriate in any areas where people gather, in any location where there may be exposure to harmful airborne pathogens, or in any location where individuals with compromised immune systems may be. In the hospital, studies have shown that the areas with the highest bio-burden are the Emergency Room and the staff changing rooms. Soiled linen closets also are areas where high amounts of airborne pathogens are found. Besides these obvious areas, ICUs, patient recovery areas, nurse stations and corridors around the surgical suite are also prime areas. Outside of the hospital and surgical center facility, such units are beneficial in cancer treatment centers, compounding pharmacies, dental offices, long term care facilities, assisted living facilities, day care facilities, schools, offices and any other areas where groups may congregate. Repertoire: How about physician offices? Does it make sense for a physician to have an air filtration unit in exam rooms? UV-C units not only help to reduce airborne pathogens from transferring between patients, they help to reduce pathogens transferred to the staff. Whenever doctors, nurses, or office staff contract highly contagious diseases, the costs to a practice can be very high due to staff missing work and being unable to treat patients. Any disease contracted at a medical facility can be damaging to the facility’s reputation. Since Medical Illumination acquired this product, it has fairly significantly reduced the distributor’s and thus the end users price.
Repertoire: Who would be the typical decisionmaker(s) to acquire an air filtration unit in: ʯ The hospital? Infection Control departments and facilities departments ʯ Long-term-care facility? Management and facilities departments ʯ Surgery center? Infection Control departments and facilities departments ʯ Physician office? Office Managers, Physicians, facilities departments Repertoire: How about the distributor rep, such as those who read Repertoire? What’s their role? Distributor reps should be on the lookout for opportunities where this technology can help to reduce airborne transmission.
Whenever doctors, nurses, or office staff contract highly contagious diseases, the costs to a practice can be very high due to staff missing work and being unable to treat patients. Other airborne pathogens such as influenza and MRSA, to name a few, are always a threat, and can stay airborne for much longer periods of time than coronavirus. None the less, having this product cleaning the air we breathe 24/7 can only lead to a healthier work environment. This is good for the physician, the staff and the patients. The culture around this product has changed. A month ago when we would talk about this, doctors considered it a luxury item, unnecessary and superfluous. That has changed in short order, and I believe permanently. They weren’t giving enough attention to how quickly contagious diseases can spread through the air and how they, their staff, and their patients can be exposed when a contagious patient is present. Those risks have been more fully exposed by the pandemic. Distribution reps should be talking about this product when the PPE subject is being discussed or when doctors are asking about air filtration systems or UV robots. www.repertoiremag.com
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INFECTION PREVENTION Repertoire: Among hospital customers, what are the most common objections? How do you respond? Costs are typically the biggest objection since many units may be necessary to adequately cover a large area. It is important to make the customer aware that these units are considered Engineering Controls that once installed do not require any effort from the medical staff. The continuous reduction of bioburden in the air does not require the units to be managed actively like surface disinfection units that use UV-C. Such units have to be moved from room to room when the rooms are unoccupied, often requiring a dedicated person to manage this operation. Prior to the coronavirus pandemic, hospitals often felt they were doing enough to manage the quality of the air throughout their facilities by wiping down counters and surface cleaning in combination with robots. Now that we see the effects of what a highly contagious airborne pathogen can do, we realize that more can be done. Repertoire: What about long-term-care facilities? Again, the initial costs to purchase and install units throughout the facility. Protecting the patients, staff, visitors, and reputations are the main benefit drivers. For example, if highly contagious flu were to spread throughout a facility, the costs would be very high.
Costs will always be the main objection, with the benefit being the reduced likelihood transmitting airborne pathogens between individuals. However, you do not need to do the whole office or facility at one time. In long-term-care facilities, there is typically no time when rooms will be unoccupied long enough to do complete disinfection, and even if there were, new pathogens can be introduced the moment someone enters the room. Prior to the coronavirus pandemic, long-term care facilities often felt they were doing enough to manage 38
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The effectiveness of air filtration units and COVID-19 While the unit has not been specifically tested with COVID-19, and therefore not validated, the white paper shows that other coronavirus removal rates from a single pass through the unit are 100%.
the quality of the air throughout their facilities by surface cleaning and purchasing robots. Now that we see the effects of what a highly contagious airborne pathogen can do, we realize that more can be done. Repertoire: And physician offices/clinics? Costs will always be the main objection, with the benefit being the reduced likelihood transmitting airborne pathogens between individuals. However, you do not need to do the whole office or facility at one time. The office could do the waiting room or rooms first and then do exam rooms a few at a time. Repertoire: Is there a consumables trail? What is it? And if so, would the med/surg distributor carry them? Or would it be an HVAC service provider? Units require that the intake filter be replaced every 3 months and the UV lamp be replaced once a year. An annual maintenance kit includes one UV lamp and 4 filters. These kits can be put on automatic reorder annually for each unit at a customer’s facility through the med/surg distributor. Repertoire: Anything else to add that might encourage Repertoire readers to discuss air filtration units with their customers? Medical facility staff spend an enormous amount of time cleaning and disinfecting their facilities on a daily basis, but the air is often overlooked. In fact, the air in a facility is often the dirtiest right after the surface cleaning process is complete as much of the matter that has been on surfaces, linens, etc. become airborne from the cleaning process. Studies have shown that air purification units using UV-C have reduced hospital acquired infections dramatically once installed.
SPONSORED:
BD
Frontline Infection Control Could a healthcare provider’s antiseptic solution itself be a possible source of contamination?
Skin antiseptic products are used to reduce bacterial burden on skin prior to performing invasive medical procedures,
such as injections or surgical incisions. In this role, skin antiseptics, including alcohol, iodine, and chlorhexidine gluconate (CHG), are part of the frontline in infection control.1,2,3,4,5
As our understanding of factors leading to infection has evolved, so have antiseptics and aseptic technique. The goal of any aseptic procedure is to reduce the risk of contamination by pathogens that are prevalent on the skin and in the environment. Appropriately, it is standard practice to use sterile instrumentation and take great care to prevent contamination from the surrounding environment. However, only recently has the antiseptic solution itself been investigated as a possible source of contamination.1
Contamination In a survey, 92% of healthcare providers indicated they were not aware that antiseptic solutions are not sterile.6 Sterile means free of microorganisms (any microscopic organism such as bacteria), and sterile products are treated with a process during manufacturing to eliminate potential microorganisms. The idea of contaminated antiseptic solutions goes against common perception because the primary function of an antiseptic is to kill bacteria. Yet, antiseptics are not “self-sterilizing,” and bacteria can persist for prolonged periods of time within antiseptic products. Unfortunately,
numerous outbreaks have occurred worldwide as a result of antiseptics contaminated with persistent bacteria.1,7 In 2007, a review article summarizing over 50 years of documented patient infections was published. It showed how infections were caused by various contaminated germicides, including patient skin antiseptics and surface disinfectants.1 In 2010, an outbreak of patient infections occurred as a result of contaminated alcohol prep pads. In 2013, the U.S. Food and Drug Administration (FDA) reported that all commonly used antiseptic categories have been linked to infection-causing contamination.8 Documented results included: ʯ Bacteremia in 32 cases ʯ Wound infection in five cases and peritonitis in seven cases ʯ Replacements required for indwelling catheters in 14 cases ʯ Sepsis in two cases ʯ Infection of the injection site in 16 cases ʯ Death of five patients due to B. cereus ʯ Product recalls of alcohol prep pads following 40 out of 60 testing positive for B. cereus
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SPONSORED:
BD
Outcomes associated with contaminated antiseptics may be underreported for a range of reasons, including1: ʯ Disposal of the contaminated product before infection is discovered ʯ Inconsistent contamination within the same product lot Manufacturers are not required to sterilize antiseptics so the risk of bacterial contamination continues to exist; however, sterile and nonsterile labeling allows healthcare professionals to make informed decisions. The majority of preoperative skin preparation components (applicators, sponges, ampoules) are sterilized using an ethylene oxide chemical process; however, the solution itself is nonsterile. CHG is a thermally sensitive compound.9 While heat exposure during terminal sterilization would sterilize the solution, it will also damage its chemical integrity. Thus, any terminal sterilization process must balance the integrity of the CHG molecule (i.e., strength and purity) while achieving thermal exposure conditions necessary for sterilization.
New solutions Standard belief, among most manufacturers, is that it is impossible and impractical to sterilize CHG-based antiseptics on a scale large enough to fulfill surgical needs in the U.S.10 Contrary to this thinking, BD (Becton, Dickinson and Company) (NYSE: BDX) researched and developed a patented sterilization process to achieve the temperature control, precision and scale necessary to effectively sterilize CHG. As antiseptics have evolved to reduce bacterial threats, this new sterilization technology has allowed BD to bring a fully sterile skin preparation option to healthcare providers. BD invested significant resources and research hours to create a patented sterilization process to achieve a minimum sterility assurance level (SAL) of 10-6.11
“We invested six years of effort, more than 50,000 research and development hours and millions of dollars to develop the only commercially available sterile CHG skin antiseptic, because we knew it was the right thing to do for patient safety,” said Gary M. Cohen, Executive Vice President, Global Health, and President, BD Foundation.
As antiseptics have evolved to reduce bacterial threats, this new sterilization technology has allowed BD to bring a fully sterile skin preparation option to healthcare providers. BD ChloraPrep™ Patient Preoperative Skin Preparation with sterile solution is the only commercially available patient preoperative skin antiseptic in the U.S. that combines: ʯ FDA-approved dual formulation of 2% chlorhexidine gluconate (CHG) + 70% isopropyl alcohol (IPA) ʯ Packaged in a proprietary one-step, single-use sterile applicator ʯ CHG-based sterile antiseptic solution The result is BD ChloraPrep™ Patient Preoperative Skin Preparation with sterile solution which builds on the proven history of ChloraPrep™ and its over 4 billion applicators used to date, more than any other 2% CHG/70% IPA skin prep applicator. ChloraPrep™ is supported by more than 50 peer-reviewed publications demonstrating its efficacy in driving patient safety and better clinical outcomes.
Chang C, Furlong LA. Microbial stowaways in topical antiseptic products. N Eng J Med. 2012;367;23:2170-2173. doi: 10.1056/NEJMp1212680. Poole K. Bacterial stress responses as determinants of antimicrobial resistance. J Antimicrob Chemother. 2012;67:2069–2089. doi:10.1093/jac/dks196. 3 Hijazi K, Mukhopadhya I, Abbott F, et al. Susceptibility to chlorhexidine amongst multidrug-resistant clinical isolates of Staphylococcus epidermidis from bloodstream infections. Int J Antimicrob Agents. 2016;48(1):86-90. Doi 1016/j.ijantimicag.2016.04.015. 4 Tansirichaiya S, Reynolds LJ, Cristarella G, et al. Reduced susceptibility to antiseptics is conferred by heterologous housekeeping genes.Microb Drug Resist. 2017. doi: 10.1089/mdr.2017.0105. 5 Rose H, Baldwin A, Dowson CG, et al. Biocide susceptibility of the Burkholderia cepacia complex. J Antimicrob Chemother. 2009;63(3):502–510. doi:10.1093/jac/dkn540. 6 BD, data on file. 7 Weber DJ, Rutala WA, Sickbert-Bennett EE. Outbreaks associated with contaminated antiseptics and disinfectants. Antimicrob Agents Chemother. 2007;51(12):4217–4224. doi: 10.1128/AAC.00138-07. 8 FDA Drug Safety Communication: FDA requests label changes and single-use packaging for some over-the-counter topical antiseptic products to decrease risk of infection. Food and Drug Administration website. http://www.fda.gov/drugs/drugsafety/ucm374711.htm. Published November 13, 2013. Updated February 29, 2016. Accessed July 31, 2019. 9 Zong Z, Kirsch L. Studies on the instability of chlorhexidine, part I: Kinetics and mechanisms. J Pharm Sci. 2012;101(7):2417–2427. doi: 10.1002/jps.23151. 10 Pyrek KM. Sterility of antiseptic products: FDA investigates, deliberates on potential recommendations. Infection Control Today website. https://brnskll.com/ wpcontent/uploads/2013/12/FDA-investigates-Antiseptics-Sterility-and-potential-recommendations.pdf. Accessed April 20, 2019. 11 Degala, et al. United States Patent 9,078,934. July 14, 2015. 1 2
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WITH BD CHLORAPREP™ PATIENT PREOPERATIVE SKIN PREPARATION WITH STERILE SOLUTION AND AN ALL-NEW STERILITY ASSURANCE LEVEL OF 10 –6.* Introducing a whole new level of sterility assurance for BD ChloraPrep™ Patient Preoperative Skin Preparation, the solution that more hospitals count on than any other brand. As pioneers in skin antiseptics, we are raising the performance bar above and beyond FDA skin prep requirements, making our market leading solution even better. Discover the confidence of BD ChloraPrep™ applicators. Discover the new BD.
*The SAL level indicates there is less than one in a 1,000,000 chance (1000x greater than the minimum requirement) that a sterile ChloraPrep™ applicator containing a sterile solution will contain a single (viable) microorganism following terminal sterilization of the ampules through the new manufacturing process of BD.
Discover peace of mind in your antiseptic solution at bd.com/One-Trust BD, the BD Logo and ChloraPrep are trademarks of Becton, Dickinson and Company or its affiliates. © 2020 BD. All rights reserved. 0420/4664
HEALTH FOCUS
Opioids Understanding the opioid epidemic, and how the CDC, states, communities and healthcare providers are working to combat it.
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What are opioids?
The epidemic by the numbers
According to Johns Hopkins Medicine, opioids are a class of drugs naturally found in the opium poppy plant and that work in the brain to produce a variety of effects, including the relief of pain with many of these drugs. Opioids can be prescription medications often referred to as painkillers, or they can be so-called street drugs, such as heroin. Many prescription opioids are used to block pain signals between the brain and the body and are typically prescribed to treat moderate to severe pain. In addition to controlling pain, opioids can make some people feel relaxed, happy or “high,” and can be addictive. Additional side effects can include slowed breathing, constipation, nausea, confusion and drowsiness.
According to the Centers for Disease Control & Prevention, from 1999–2018, almost 450,000 people died from an overdose involving any opioid, including prescription and illicit opioids.1 The number of drug overdose deaths decreased by 4% from 2017 to 2018, but the number of drug overdose deaths was still four times higher in 2018 than in 1999.2 Nearly 70% of the 67,367 deaths in 2018 involved an opioid. From 2017 to 2018, there were significant changes in opioid-involved death rates: ʯ Opioid-involved death rates decreased by 2%. ʯ Prescription opioid-involved death rates decreased by 13.5%. ʯ Heroin-involved death rates decreased by 4%. ʯ Synthetic opioid-involved death rates (excluding methadone) increased by 10%.
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This rise in opioid overdose deaths can be outlined in three distinct waves, the CDC said: 1. The first wave began with increased prescribing of opioids in the 1990s, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increasing since at least 1999.3 2. The second wave began in 2010, with rapid increases in overdose deaths involving heroin.4 3. The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl.5,6,7 “The market for illicitly manufactured fentanyl continues to change, and it can be found in combination with heroin, counterfeit pills, and cocaine,” the CDC said.8
enforcement, to address the growing illicit opioid problem. ʯ Increasing public awareness about prescription opioid misuse and overdose and to make safe choices about opioids. The CDC has built the Overdose Data to Action (OD2A), a 3-year cooperative agreement through which CDC funds health departments in 47 states, Washington DC, two territories, and 16 cities and counties for surveillance and prevention efforts. Funds awarded as part of this agreement will support state, territorial, county, and city health departments in obtaining high quality, more comprehensive, and timelier data on overdose morbidity and mortality and using those data to inform prevention and response efforts.
Combating the epidemic through collaboration Collaboration is essential for success in preventing opioid overdose deaths, according to the CDC. Its work focuses on: ʯ Monitoring trends to better understand and respond to the epidemic. ʯ Advancing research by collecting and analyzing data on opioid-related overdoses and improving data quality to better identify areas that need assistance and to evaluate prevention efforts. ʯ Building state, local and tribal capacity by equipping states with resources, improving data collection, and supporting use of evidence-based strategies. ʯ Supporting providers, healthcare systems, and payers with data, tools, and guidance for evidencebased decision-making to improve opioid prescribing and patient safety. ʯ Partnering with public safety officials and community organizations, including law
Recipients will be able to do a number of surveillance activities to monitor and gather data about the scope and nature of the overdose problem under the new cooperative agreement: ʯ Collect and disseminate emergency department data on suspected overdoses categorized as “all drug,” “all opioid,” “heroin,” and “all stimulant.” ʯ Collect and disseminate descriptions of drug overdose death circumstances using death certificates, toxicology reports, and medical examiner/coroner reports. ʯ Implement innovative surveillance activities to support interventions. These activities help increase comprehensiveness of surveillance data and allow jurisdictions to tailor their surveillance efforts to specific needs. For more information, visit:www.cdc.gov/drugoverdose/ epidemic/index.html.
References
Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2020. Available at http://wonder.cdc.gov. Wilson N, Kariisa M, Seth P, et al. Drug and Opioid-Involved Overdose Deaths—United States, 2017-2018. MMWR Morb Mortal Wkly Rep 2020;69:290-297. 3. Centers for Disease Control and Prevention (CDC). Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008. MMWR MorbMortal Wkly Rep. 2011 Nov 4; 60(43):1487-1492. 4. Rudd RA, Paulozzi LJ, Bauer MJ, Burleson RW, Carlson RE, Dao D, Davis JW, Dudek J, Eichler BA, Fernandes JC, Fondario A. Increases in heroin overdose deaths—28 states, 2010 to 2012. MMWR MorbMortal Wkly Rep. 2014 Oct 3; 63(39):849. 5. Gladden RM, Martinez P, Seth P. Fentanyl law enforcement submissions and increases in synthetic opioid-involved overdose deaths—27 states, 2013–2014. MMWR MorbMortal Wkly Rep. 2016; 65:837–43. 6. O’Donnell JK, Gladden RM, Seth P. Trends in deaths involving heroin and synthetic opioids excluding methadone, and law enforcement drug product reports, by census region—United States, 2006–2015. MMWR MorbMortal Wkly Rep. 2017; 66:897–903. 7. O’Donnell JK, Halpin J, Mattson CL, Goldberger BA, Gladden RM. Deaths involving fentanyl, fentanyl analogs, and U-47700—10 states, July–December 2016. MMWR Morb Mortal Wkly Rep. 2017; 66:1197–202. 8. Drug Enforcement Administration. 2019 National Drug Threat Assessment. Drug Enforcement Administration Strategic Intelligence Section, U.S. Department of Justice. Published December 2019. Accessed March 17, 2020 from https://www.dea.gov/sites/default/files/2020-01/2019-NDTA-final-01-14-2020_Low_ Web-DIR-007-20_2019.pdfpdf iconexternal icon 1. 2.
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HEALTHY REPS
Health news and notes
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Physical health amid a pandemic
Focus on what you can control
The COVID-19 pandemic has likely brought many changes to how you live your life, and with it uncertainty, altered daily routines, financial pressures and social isolation, wrote Dana Sparks for Mayo Clinic’s health blog. “You may worry about getting sick, how long the pandemic will last and what the future will bring. Information overload, rumors and misinformation can make your life feel out of control and make it unclear what to do.” Sparks provided several self-care strategies, including a watchful eye over one’s physical health. Suggestions included getting enough sleep, participating in regular physical activity, eating a well-balanced diet, avoid tobacco, alcohol and drugs, limiting screen time and find ways to relax and recharge.
During a crisis, our minds can often wander to anxious, stress-inducing thoughts. In a post for Piedmont Healthcare’s Living Better blog, Mark Flanagan, LMSW, MPH, MA, a social worker at Cancer Wellness at Piedmont suggested that rather than dwell on nervousness, you should focus on the things you can control. “When you move the locus of control from something outside yourself to inside yourself, you powerfully reduce anxiety and boost confidence.” One suggestion he gave for reducing stress was to create a morning routine. When you’re stuck at home, it can be tempting to let go of basic routines, but Flanagan says a morning routine can help you feel more productive and positive. Consider waking up at the same
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time each day, exercising, showering, meditating, journaling, tidying your home or having a healthy breakfast as part of your morning ritual. Other tips included checking in with loved ones regularly, finding ways to help others, create a daily self-care ritual, and limiting news and media consumption.
A family affair One possible benefit of sheltering in place for your kids? Home cooking. According to an article by Jane Brody for The New York Times, rediscovering home cooking during our weeks spent at home can be an opportunity to foster better eating habits in our kids. Children can be more involved in food preparation. But most importantly, parents need to model the eating behaviors they want to see in their children. “Parents should serve children the same foods they eat, though in smaller portions, and not offer something else saying, for example, ‘There are chicken nuggets in the freezer if you don’t like the broccoli I made’,” one source for the article, Dr. Kowal-Connelly, said in an interview. “Children look up to us, they model our behavior and notice what we enjoy.”
Prevention (CDC) looked at the association between step count, intensity, and risk of death in a broader range of the U.S. population. The team used data from people aged 40 or older who wore an accelerometer – a device that measures step number and cadence (steps per minute) – during their waking hours for a week. Researchers then collected information on deaths for about a decade. They also tracked deaths specifically from cancer and heart disease. In their analysis, the researchers compared the risk of death over the followup period among people who took fewer than 4,000, up to 8,000, or 12,000 or more steps a day. They also tested whether step intensity, measured by cadence, was associated with better health. During the decade of follow-up, 1,165 out of the 4,840 participants died from any cause. Of these, 406 died from heart disease and 283 died of cancer. Compared with people who took 4,000 steps a day, those who took 8,000 steps a day at the start of the study had a 50% lower risk of dying from any cause during follow-up. People who took 12,000 steps a day had a 65% lower risk of dying than those who took only 4,000. Higher step counts were also associated with lower rates of death from heart disease and cancer. These benefits were consistent across age, sex, and race groups.
Taking 4,000 or fewer steps a day is considered a low level of physical activity. A goal of 10,000 steps a day is commonly cited, but recent studies have shown that health benefits accrue even if fewer than 10,000 steps are taken daily. One step at a time Doctors often recommend walking as an easy way for inactive people to ease into better health. Taking 4,000 or fewer steps a day is considered a low level of physical activity. A goal of 10,000 steps a day is commonly cited, but recent studies have shown that health benefits accrue even if fewer than 10,000 steps are taken daily. A research team with investigators from NIH’s National Cancer Institute (NCI) and National Institute on Aging (NIA) and the Centers for Disease Control and
Prepare Your Health
If your health is your most important asset, why wouldn’t you do all you can to prepare and protect it from the ‘side effects’ of a natural disaster, disease outbreak, or other emergency? The Center for Disease Control and Prevention created the Prepare Your Health initiative to encourage personal health preparedness for public health emergencies with practical advice on how to get ready and build resilience. Prepare Your Health is organized into three categories: ʯ Personal Health Preparedness (Be prepared to protect your health until help arrives) ʯ Plan Ahead (Have a strategy for staying informed, healthy, and in contact. ʯ Create Community (Team up with neighbors to help build community health resilience. ʯ For more information, visit https://www.cdc.gov/cpr/prepareyourhealth. www.repertoiremag.com
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SPONSORED:
DUKAL CORPORATION
DUKAL is solving clinical problems with innovative patented solutions.
DUKAL Corporation has introduced its latest innovative
solution, with the Capseus Bone Dust Collector (Capseus BDC-15). Designed to easily provide cost-effective local autograft generated at the surgical site during spinal fusion surgery, the Capseus BDC-15 reduces hospital costs, time, and infection risk, while providing higher-quality bone. Spinal fusion is performed on approximately 400,000 patients in the United States annually. The national rate has more than doubled since the start of the 21st century and is continuing to increase year after year. To facilitate spinal fusion, surgeons require additional bone, known as “graft,” to help two or more vertebrae fuse into a single structure. Different graft options exist, including both “allograft,” which is derived from donor bone, and “autograft,” which is bone derived from the patient’s own body. Allograft products are expensive (est. $1,000 to $10,000 per surgery) and because they are derived from sources outside the patient’s body such as cadavers, disease transmission and rejection risks exist. Importantly,
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using allograft in spinal fusion can be less effective than using the patient’s own bone. Further, most patients do not like the idea of cadaver bone being used for surgery in their body, especially when autograft options exist. One way to obtain autograft from a patient is by creating a second surgical site on the patient’s hip and harvest this “non-local” autograft from the patient’s iliac crest. However, there are significant issues with this approach including longer operating times and increased blood loss. Along with extended hospital stays and additional pain and infection risk from having a second surgical site, leading many surgeons to move away from this option. DUKAL was introduced to the clinical need for a bone dust collector that could easily and cost-effectively collect local autograft generated at the surgical site by Dr. Abrahams of Northern Westchester Hospital in New York and Michael Bielski, a medical device entrepreneur. DUKAL, along with Dr. Abrahams and Mr. Bielski, successfully brought the Capseus BDC-15 to market in September 2019.
Unmatched bone dust collecting experience. Eliminated Allograft Related Complications
Eliminated Non-Local Autograft Related Complications
Reduced Hospital Costs and Time
> Lower rejection risks > Lower disease transmission
> Less pain > Lower infection risk > Single surgery site > Lower blood loss
> Less operating time > Shorter recovery > Lower cost than allograft products
Today, the Capseus BDC-15 allows surgeons to quickly and easily collect any volume of locally drilled autologous bone directly at the point of suction without any additional pressing steps. Capseus BDC-15
Pressing Devices with Downstream Collection
Setup
Immediately, ready for use.
Setup requires multiple steps.
Process
Collection of autograft occurs in direct view of surgeon, no bone loss in tubing. Freshly drilled bone harvested with minimal processing. Simply remove freshly-drilled bone from filter. Bone immediately ready for use as graft.
Bone can be lost in suction tubing, and downstream nature may lead to accidental loss. Characteristics of bone can be affected due to processing and clotting. Lengthy, complicated suctioning and pressing process to prepare bone for harvesting, due to bone storage in blood/saline.
Characteristics Use
Since its 2019 launch, the Capseus BDC-15 has successfully been used in cervical fusions, lumbar fusion, craniotomies, and other orthopedic procedures.
DUKAL is bringing new technologies to life. DUKAL’s approach to healthcare innovation is to provide
the highest quality manufacturing, sourcing, and quality regulation to solve real clinical problems through new healthcare technologies. Working collaboratively with healthcare professionals, DUKAL turns innovative ideas into practical patented-solutions.
An inside look into DUKAL’s Innovation With over 28 years in healthcare manufacturing and logistics, DUKAL is a trusted partner in creating healthcare solutions. From invention and patent application to prototype development and design – from supply chain to branding, marketing and sales, our team offers partners a full range of capabilities.
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WINDSHIELD TIME Chances are you spend a lot of time in your car. Here’s something that might help you appreciate your home-away-from-home a little more.
large work space is beneficial.
Detroit auto show
Automotive-related news The show must not go on The North American International Auto Show (NAIAS), a staple for auto makers and enthusiasts, announced in late March that it would cancel its June 2020 show in Detroit due to the coronavirus pandemic. The venue, Detroit’s TCF Center, has been turned into a temporary field hospital by the Federal Emergency Management Agency (FEMA). “Although we are disappointed, there is nothing more important to us than the health, safety and well-being of the citizens of Detroit and Michigan, and we will do what we can to support our community’s fight against the coronavirus outbreak,” said NAIAS Executive Director Rod Alberts. “With the more than 100 convention centers and facilities around the country being considered to potentially serve as temporary hospitals, it became clear to us that TCF Center would be an inevitable option to serve as a care facility to satisfy our community’s urgent health needs,” he said. In a release, NAIAS said it will hold its next annual show 48
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in June 2021. 2020 NAIAS Chairman Doug North said show officials are also discussing plans for a fundraising activity later this year to benefit the children’s charities that were designated as beneficiaries of the 2020 Charity Preview event.
A ‘handshake-free’ environment As of press time, CarMax, the nation’s largest retailer of used cars, planned to keep its stores open amid the COVID-19 pandemic, and provided customers with information on precautions it was taking to maintain a safe environment. “We are actively monitoring developments, adhering to all governmental mandates, and will continue to take action to reduce the spread of the virus,” the company said in a release. In a letter to customers, CarMax President and CEO Bill Nash wrote that the company put precautions in place to keep its facilities clean and well sanitized for safety. Customers would be allowed to test drive alone. CarMax is also
Need More Space? No Problem. Did you know our Tech-Med Instrument Stand ®
features 25% more surface space?
Tell that to your customers!
Features & Benefits: • California-style base for easy positioning • High Grade Stainless Steel Tray (18/8, 304) • Height adjusts from 37”-53” • Base Width: 21” Base Depth: 25” • Tray size is 16 ¾” x 21 ½” vs Standard Tray size of 12 ½” x 19” • Weight capacity is 50 lbs. vs Standard Instrument Stand of 15 lbs
To learn more about the set-up solutions DUKAL offers, Visit our website www.DUKAL.com
25% Larger Tray
WINDSHIELD TIME offering home delivery at many of its locations, where customers can choose to complete the car-buying experience from home and have the vehicle delivered by a CarMax associate. “Additionally, many stores offer expedited pickup, so you can complete more of the car buying process online in advance and spend less time in store,” Nash wrote. Customers that had been negatively impacted by illness due to COVID-19, and needed additional assistance with their account, were asked to contact the CarMax customer service team. For customers that did want to visit a local store to car shop, the company provided a few guidelines. “We are currently a handshake-free environment and are working to keep 6 feet of distance between people at our stores,” CarMax said on its website “You may be asked to explore our display lot to ensure we maintain appropriate distance inside our stores. You’re invited to test drive vehicles on your own. Please know we are monitoring guidelines and will continue to adjust our policies as needed.”
Hyundai Hope On Wheels® is a 501(c)(3) non-profit organization committed to finding a cure for childhood cancer. Launched in 1998, Hyundai Hope On Wheels provides grants to eligible institutions nationwide that are pursuing life-saving research and innovative treatments for the disease. CarMax said it is following recommended guidance from the CDC regarding cleaning and hygiene. “Associates who are uncomfortable being at work can stay home,” the company said in a release. “Associates who are ill are being asked to stay home. We are currently paying our associates who are quarantined or impacted by a store closure for up to a 14-day period. Associates who are diagnosed with COVID-19 are paid under our short-term disability plan and other applicable benefits policies.” For the latest updates, visit www.carmax.com/covid-19-response
Hope on Wheels This spring, Hyundai Hope On Wheels® (HHOW), one of the largest non-profit funders of pediatric cancer research 50
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in the country, and Hyundai Motor America announced expanding COVID-19 Drive-Thru Testing Centers to 11 children’s hospitals throughout the U.S. and grants totaling $2.2 million. “The COVID-19 pandemic has created a particular threat to children with cancer, many who have compromised immune systems,” Hyundai said in a release. The COVID-19 drive-thru testing centers provide a safe and efficient way for children who present risk factors to receive the care they need. Hospitals receiving Hyundai COVID-19 Drive-Thru Testing grants are: 1. The Hyundai Cancer Institute at CHOC Children’s, Orange, California 2. UH Rainbow Babies and Children’s, Cleveland, Ohio 3. Children’s National Hospital, Washington, D.C. 4. Dana Farber / Boston Children’s Hospital, Boston, Massachusetts 5. Seattle Children’s Hospital, Seattle, Washington 6. Columbia Medical Center, New York, New York 7. Joseph’s Children’s Hospital, Tampa, Florida 8. Children’s Hospital of Colorado, Aurora, Colorado 9. Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 10. Texas Children’s Hospital, Houston, Texas 11. University of Alabama Children’s, Birmingham, Alabama “The Hyundai COVID-19 Drive-thru testing grants are designed to get urgent financial support to institutions on the front-line in the fight against the coronavirus” says José Muñoz, President and CEO, Hyundai Motor North America. “Children who are diagnosed with cancer are particularly at higher risk. That’s why it was important to us to join forces with several children’s hospitals around the nation to combat this threat to the health and well-being of children. We are pleased to expand to 11 institutions.” Hyundai Hope On Wheels® is a 501(c)(3) non-profit organization committed to finding a cure for childhood cancer. Launched in 1998, Hyundai Hope On Wheels provides grants to eligible institutions nationwide that are pursuing life-saving research and innovative treatments for the disease. Primary funding for Hyundai Hope On Wheels comes from Hyundai Motor America and its more than 835 U.S. dealers. Since its inception, Hyundai Hope On Wheels has awarded more than $170 million toward childhood cancer research in pursuit of a cure. nationwide, each with a $200,000 grant.”
Delivering for you, so you can deliver a difference. Every day you’re making a difference in patients’ lives. We want to help make that easier. From our teams packing boxes to the ones bringing them to your door, we’re all-in to support the work you do. While you deliver care to those in need, we’ll deliver for you.
mms.mckesson.com/coronavirus © 2020 McKesson Medical-Surgical Inc.
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 COVID-19: There’s an app for that Apple announced it had released a new screening tool and set of resources to help people stay informed and take the proper steps to protect their health during the spread of COVID-19, based on the latest CDC guidance. The new COVID-19 website, and COVID-19 app available on the App Store, were created in partnership with the CDC, the White House Coronavirus Task Force and FEMA “to make it easy for people across the country to get trusted information and guidance at a time when the U.S. is feeling the heavy burden of COVID-19,” the company said in a release. The COVID-19 app and website allow users to answer a series of questions around risk factors, recent exposure and symptoms for themselves or a loved one. In turn, they will receive CDC recommendations on next 52
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steps, including guidance on social distancing and self-isolating, how to closely monitor symptoms, whether or not a test is recommended at this time, and when to contact a medical provider. This new screening tool is designed to be a resource for individuals and does not replace instructions from healthcare providers or guidance from state and local health authorities. Along with the new COVID-19 app and website, customers across the U.S. may also ask Siri, “How do I know if I have coronavirus?” to access guidance and resources from the CDC and a curated collection of telehealth apps available on the App Store. Also, travelers landing at select international airports throughout the U.S. would receive notifications on their iPhone to remind them of current CDC guidance to stay home and monitor their health.
Lessening the sticker shock Samsung’s Galaxy S20 boasts a lot of juicy features, including 8K Video Snap, 5G connectivity and Space Zoom up to 100x. It also has starting price tag of $999. According to CNET, the South Korean company is letting customers use that investment to take the sting off their next upgrade with a buyback scheme that promises to credit 50% of the full retail price to your payment account if you buy directly from Samsung and return your device within two years. Samsung’s website lists exactly how much you’ll get for each S20 series model so you can plan ahead. An S20 will get $500. The S20 Plus will be worth $600 for the 128GB model or $675 for the 512GB one. And the S20 Ultra is worth $700 for 128GB or $800 for 512GB.
A big WHOOP to study the effects of COVID-19 According to TechCrunch, a study conducted by the Central Queensland University Australia (CQUniversity), in partnership with the Cleveland Clinic, will employ data collected by a wrist-worn fitness and health tracking wearable of volunteers who have self-identified as having contracted COVID-19 to study changes in their respiratory behavior over time. The data to be used for this study has been collected from WHOOP’s 3.0 hardware, which has also recently been validated by a University of Arizona external study conducted specifically to determine the accuracy of its measurement of respiratory rates during sleep, which the device uses to provide quality of sleep scores to its users. That study showed it to be among the most accurate measurement tools for respiratory rate short of invasive procedures, which is what has led researchers behind this new study to hypothesize that it could be valuable as a sort of early-warning system for detecting signs of abnormal respiratory behavior in COVID-19 patients before those symptoms are detectable by other means.
nuptials. Zoom – the enterprise video streaming platform that was used in pre-coronavirus days mostly for business meetings – has become the venue of choice for couples hosting digital weddings. It’s relatively easy to use, even for the less technically savvy, and it allows people to mute and unmute guests to moderate their participation, The Verge reported.
Staying upright With more people spending less time meeting face to face with customers and more time seated in their home offices, posture is surely to suffer. One product, the UPRIGHT GO 2™, promises to build core strength and posture awareness in three simple steps. Simply place the UPRIGHT GO 2™ onto your back using one of our hypoallergenic adhesives. These reusable, hypoallergenic strips are made from medical-grade silicone and won’t leave marks on the skin. You can get about 3-10 uses per adhesive (depending on skin type). If you run out, you can always order new adhesive refill packs here. UPRIGHT devices are small, discreet, and won’t show under most clothes, according to the manufacturer.
UPRIGHT GO 2™
Saying ‘I do’ virtually As COVID-19 continued to spread around the globe, the basic tenets of a wedding had become dangerous, if not illegal, according to The Verge. Asking a large group of people, including elderly relatives, to travel on planes and spend days in close proximity now sounds less like a celebration and more like a death sentence. Many couples have simply decided to postpone their weddings. But others, have moved their ceremonies online. A search for #ZoomWedding on Instagram turns up over 100 photos of couples who’ve live-streamed their
UPRIGHT GO 2™ has two modes: training and tracking. In training mode, your device will gently vibrate whenever you slouch. You can adjust the sensitivity and vibration in the app. Tracking mode turns off vibration alerts and keeps accurate stats on your posture throughout the day using enhanced, multi-sensor technology. For more information, visit www.uprightpose.com. www.repertoiremag.com
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LEADERSHIP
Under Duress How to make decisions in a crisis By Lisa Earle McLeod “In every deliberation, we must consider the impact on the seventh generation… even if it requires having skin
as thick as the bark of a pine.” The seventh generation principle comes from the Native American culture, where it was used to make decisions large and small. Putting yourself in the position of future generations provides a frame that helps you do the right thing.
As I reflect upon where we are and where we might do good, I find myself thinking deeply about leadership; the type of leadership that got us here, and the type of leadership we need going forward. We’re in a defining moment. Whether you are in public service or the private sector, the decisions you make today will define you for years to come. Here are three frames I’m using with my leadership clients to make decisions during a time of uncertainty, plus a fourth question for all of us to ponder.
1. Who does your organization serve? In a crisis, leadership decisions have outsize impact and importance. We’ve seen what happens when leaders focus 54
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on short-term quarterly capitalism. It erodes morale and creates a transactional relationship with employees and customers. During a crisis, focusing on short-term earnings will erode reputation and trust overnight.
2. I f you were an employee, what would you want your leader to do? Leaders are being called upon to make tough decisions. Many have watched their business evaporate overnight. Financial decisions and health decisions have suddenly become comingled. Leaders will do well to consider, if I were in the shoes of the lowest level employee in my organization, what would I want my leader to do? What safety precautions would I want them to take?
What financial measures would best serve the team? To make it even more personal, here’s a question I’ve used in challenging situations: If one of the people in question were my child, how would I want their leader to handle this?
times before, when things are at their worst, people are often at their best. Lastly, here’s a question I was thinking about before this crisis that I find myself asking even more urgently today.
5. Who does our government mean to serve? 3. How do we want to be remembered by our customers? You don’t have to give away the store. You do want to think long and hard about how your customers are going to look at your actions. One of our clients in retail made the decision to close, another in healthcare made the decision to stay open, others, like some of our banking clients, are doing a hybrid. The lens they are using is, what’s best for our customers? Notice, there’s a nuance to that. It’s not, what do our customers want? They may want your restaurant to stay open. It’s about asking, what’s best for people and how do we want them to remember our actions?
4. How can you express empathy?
Does our government exist to reward our top producers? Or is the purpose of government to serve the least among us? My spiritual beliefs tell me it’s the latter. A question I often ask myself is, how would I want my children treated if they had been born poor? It’s only by accident of birth that I was born to a college educated couple with good jobs and a hard work ethic. I didn’t create that for myself, any more than my children chose their parents. What kind of world do we want to provide for less fortunate children?
As I work with our clients to help them make good decisions, I continue to be impressed by their deep-seeded desire to do the right thing. As we’ve seen many times before, when things are at their worst, people are often at their best.
Any teacher or parent will tell you that empathy is a hard skill to teach. The ability to lean into and understand the feelings of another is crucial for leaders, and it’s critical for successful personal relationships. Lately I’m thinking about the impact empathy (or lack of it) has on our collective spirit. I’ve worked with organizations where empathy is in short supply. At first, it coarsens the culture, then eventually it poisons it, as people turn against each other. When leaders lack empathy, it’s contagious. People double down on their own agendas as a way to self-protect. When everyone is focused on short-term self-interest, organizational failure follows. As I work with our clients to help them make good decisions, I continue to be impressed by their deepseeded desire to do the right thing. As we’ve seen many
As I think about our future, I find myself thinking deeply about wisdom of the 7th generation principle. As Oren Lyons, Chief of the Onondaga Nation writes: “We are looking ahead, as is one of the first mandates given us as chiefs, to make sure and to make every decision that we make relate to the welfare and well-being of the seventh generation to come.” When they look back in time, what will the seventh generation think about us?
Lisa Earle McLeod is a leading authority on sales leadership and the author of four provocative books including the bestseller, “Selling with Noble Purpose.” Companies like Apple, Kimberly-Clark and Pfizer hire her to help them create passionate, purpose-driven sales organization. Her NSP is to help leaders drive revenue and do work that makes them proud. www.repertoiremag.com
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LEADERSHIP
How to Overcome Negative Thoughts and Fear By Jon Gordon
“Do you struggle with fear?”
Every hand in the audience went up when I asked the question. “Do your negative thoughts come from you?” Most said “Yes.” 56
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“Are you sure,” I asked? “Who would ever choose to have a negative thought?” Eyes widened, some heads shook and a few people smiled. They were having an Aha moment. I then explained that your negative thoughts don’t come from you. They come from consciousness. They pop in at random times or, for some, more frequently.
A thought’s power only comes from the power you give it. You don’t have to give your negative thoughts power.
They are like an unwanted surprise guest that shows up at your front door to tell you how weak, unworthy, insignificant and incapable you are. But here’s the deal. Like any unwanted surprise guest, you decide whether or not to entertain them. A thought’s power only comes from the power you give it. You don’t have to give your negative thoughts power. You can ignore them. You can see them for what they truly are: lies, lies, lies.
Always remember that just because you have a negative thought doesn’t mean you have to believe it. Fear is a liar and if you struggle with fear and negative thoughts, it’s because you believe the lies that they tell. Fear stands for False Evidence Appearing Real. Fear looks and feels true but it isn’t. Fear says you aren’t strong enough, good enough, successful enough, wealthy enough, happy enough, smart enough, talented enough. Well, I say enough with fear. Instead, know the truth. You have everything you need inside you to be successful. You weren’t meant to be average. You have a desire to be great because you were created and born to do great things. You have a purpose. There’s a plan for your life. You may be going through a hard time now but the best is yet to come. When fear and negativity pop in your head you can ignore them or speak truth to the lies. That’s what I do and I was thrilled to hear that’s what the singer Jewel does as well. I was recently listening to an interview she did on The Finding Mastery Podcast and she said she makes a list of all the lies fear tells. Then she writes down the truth next to the lies. She said it has given her a lot of power and freedom. It can do the same for you. There is a tremendous amount of freedom in knowing that negative thoughts are not coming from you. There’s a ton of power in knowing that you don’t have to believe the lies. You can know and live the truth and just keep moving forward with belief, optimism, faith and grit. During the Australian Open Championship a few years ago, Roger Federer lost the first few games of the 5th and deciding set to Rafael Nadal. Federer said that at the time he thought “It’s probably not going to happen for me tonight.” A thought popped in and then it popped out. He didn’t energize it. He just kept playing one point after another and eventually won the set and the match. You can do the same. No matter what thoughts come your way, you have everything you need to accomplish your task. Thoughts will come and go, but you just stay in the game and keep moving forward. The truth is that the best is yet to come. Do you believe it?
Jon Gordon’s best-selling books and talks have inspired readers and audiences around the world. His principles have been put to the test by numerous Fortune 500 companies, professional and college sports teams, school districts, hospitals, and non-profits. He is the author of 20 books including 8 best-sellers: The Energy Bus, The Carpenter, Training Camp, You Win in the Locker Room First, The Power of Positive Leadership, The Power of a Positive Team, The Coffee Bean and his latest Stay Positive. His clients include The Los Angeles Dodgers, Campbell’s Soup, Dell, Publix, Southwest Airlines, Miami Heat, The Los Angeles Rams, Snapchat, BB&T Bank, Clemson Football, Northwestern Mutual, West Point Academy and more. www.repertoiremag.com
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LEADERSHIP
PWH is Here for You ®
In this time of great uncertainty and medical need, Professional Women in Healthcare® (PWH®) wants the indus-
try to know, “We are here for you.” Although the leadership development organization had to cancel its annual Leadership Summit, PWH® leaders immediately secured dates for next year (May 17-19, 2021) and found new ways to continue the organization’s mission virtually.
“We formed a COVID-19 Task Force,” said PWH Chair Elect Vicky Lyle (who also serves as Op VP, Service Line Strategy). The PWH COVID-19 Task Force is dedicated to helping the industry during this time of quarantine, delivering relevant webinars and providing forums to share insights. From technology to personal wellness, this content is free for the industry, updated weekly and available at www.mypwh.org/Resource-Series. “We have built a strong culture of leaders who are behind our mission to empower women to lead and succeed – especially during critical times,” said PWH Chair Rachelle Ferrara. “We’ve also reached out to our corporate partners to find out what these organizations are doing to inspire their teams and protect their employees.”
Midmark Midmark provides essential equipment, technology and services that its customers need to diagnose and treat 58
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patients. To manage this safely, Midmark created a dedicated COVID19 task force to monitor developments of facilities, supply chains and required guidelines. To help ensure the safety of Midmark employees, Vice President of Clinical Affairs and Chief Medical Officer Dr. Tom Schwieterman immediately produced informational videos to clarify and contextualize public health information into consumable and actionable content. He, along with a team of senior leaders also visited the majority of Midmark production facilities to talk with essential employees and plant leaders. “These conversations helped those employees feel confident that their company and its leaders know what they are doing,” said Dr. Schwieterman. “Policies put in place have stuck. Temperature taking is now routine.” “One resonating attribute of Midmark’s culture is the running to the ball concept,” said Dr. Schwieterman. “From the head of human resources to the head of production
workflow, in every circumstance there was leadership savvy. You simply had to say: ‘Here is the problem,’ and the leaders just did what needed to be done.” Vice President of Sales Matt Bourne demonstrates that savvy. “Major conferences, very routine milestone meetings and appointments just got cancelled,” Bourne said. “Right away we looked introspectively to consider the effects on our workforce and workflow.” Bourne crafted a model of a salesperson’s working from home workweek to ensure his team knew how to access resources and remain productive. Bourne also helped devise a system of internal sales communication. A commitment to it ensures all contributions get recorded and shared, so all team members realize their importance. “This process gives our team members a new sense of purpose,” said Bourne. “They are our intelligence, and that intelligence gets communicated vertically and horizontally.”
Vizient In February, Vizient leaders recognized a pandemic heading for the United States and immediately put together a “war room.” In addition to working closely with government agencies, hospitals, associations and other GPOs, the 70+ cross-functional team at Vizient relentlessly explores all possible opportunities to source and facilitate contracts to help support its member healthcare providers. “Our member-driven mentality drives everything we do,” said Vice President, Strategic Communications & Public Relations Angie Boliver. “All employees see ourselves as extensions of the hospitals we serve, and everyone is giving their all to support caregivers and their patients.” Vizient also continues to update the White House and FDA with findings about drug shortages and is one of several helping to build a new ventilator exchange program. “We are going to come out of this and need a materially different healthcare supply chain,” said Group Senior Vice President, Sourcing Analytics, Operations, and Center of Excellence Cathy Denning.
Owens & Minor Owens & Minor also took early action to mitigate risk. According to Execute Vice President & Chief Human Resources Officer Shana Neal, “We were continually monitoring the situation and made sure to take swift and proactive measures to ensure the safety of our teammates in all environments, including our distribution and manufacturing facilities, our teammates working onsite at hospitals and those in our office environments.” The company implemented new remote work for those able to do so. For the
teammates working every day to manufacture and distribute essential products, Owens & Minor is providing PPE, conducting temperature checks, instituting social distancing and elevating sanitation protocol for all facilities. “We know that this is a trying time for all teammates,” said Neal. “We’ve enhanced benefits and are providing extra support, including training, for teammates across the organization.” In addition to adjusting sanitation measures and limiting visitors to all locations, Owens & Minor is offering telehealth consultations, flexible leave options, and access to an Employee Assistance Helpline for all teammates. Owens & Minor is also focused on maintaining business continuity to support the best possible patient outcomes.
NDC Inc. As a unique healthcare supply chain company, NDC also remains devoted to the industry, its distributor and manufacturing partners, and its employees. “Throughout this pandemic, NDC remains committed to our core values,” said President and CEO Mark Seitz. “These values are providing a guiding light as our leadership team adjusts the business and leads our teams in response to these unprecedented times.” NDC’s employees and customers remain the organization’s top priority during the COVID era. Corporate employees have transitioned to remote work environments wherever possible, and enhanced procedures have been implemented to protect those essential functions that require working from the office and distribution centers. NDC warehouses remain fully operational, with safety measures such as temperature checks and mandatory PPE during shifts. “The dedication and loyalty exhibited by our ‘warehouse warriors’ is nothing short of heroic,” said Chief Commercial Officer Mark Kline. “We are committed to continuing to operate, serve the frontlines of healthcare, and navigate the challenges of allocations, supply shortages and ongoing distribution challenges. NDC’s unique independent position in the supply chain allows us to not only service large hospitals and institutions, but also support those distributors delivering to rural hospitals, family physicians and specialty practices – providers that are a staple in the communities they serve.” PWH thanks its corporate partners and members for their heroic efforts. Please join PWH online and in person next summer at the PWH Leadership Summit May 17-19, 2021 in Denver, Colorado, to empower women to lead and succeed even during critical times. www.repertoiremag.com
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REP CORNER
Building Upon the Fundamentals Things are always changing, but Dan Woods, field sales consultant for Henry Schein, is determined to find solutions for customers. By Mark Thill
Do you want to learn how to get a really firm fix on your customers’ wants and needs? Try selling health and fit-
ness aids to consumers. Dan Woods did it for three years at The Vitamin Shoppe in Pittsford, New York, and he’ll never regret it.
“Working for The Vitamin Shoppe taught me a lot about face-to-face selling and one-on-one selling,” says Woods, a field sales consultant for Henry Schein in Charlotte, North Carolina. “This was the position that confirmed my interest in selling in person. It was great connecting with different customers, learning what their goals are, and ultimately providing a few different solutions for them to reach their end goal.”
Strong communication skills
Daniel Woods
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Woods was born and raised in Upstate New York, about 15 miles south of the Lake Ontario shore. At Fairport High School, he was on the varsity golf team, and he was varsity basketball manager for two years. In college, he majored in communications, and for a couple of months while at St. John Fisher College in Rochester, was an assistant producer for a couple of radio programs for Clear Channel Communications. “I decided to go with communications as a major because I felt it could apply to many different professions,” he says. “In school, most communication programs are thought to be more for public relations professionals,
media roles, etc. However, communications are also critical in the sales field, especially in the medical sales arena. Things are changing at lightning speed, and by having strong communication skills, it only helps me be the best I can be for my customer base.” If sports and communication were in his blood from way back, so was sales. Growing up, he enjoyed seeing his father, Daniel, interacting with corporate customers, to whom he sold business process solutions. “There were never two of the ‘same’ day, and I can remember wanting to get into sales at a young age due to the ever-changing, fast paced lifestyle,” he recalls. His mother, Christine, is a seventh-grade special education teacher. “In her position, she has the opportunity every day to change students’ lives for the better. I try to implement those same characteristics with my customers daily by teaching, tailoring and showing empathy throughout the whole sales process.” In 2014 he became an inside sales representative for the PGA TOUR in Jacksonville, Florida, selling ticket packages at designated Championship Management events, conducting on-course appointments and tours, and generating leads among regional businesses and prospective customers. Ten months later, he became a sales representative for the Wyndham Championship in Greensboro, North Carolina, one of the PGA’s oldest events. “My leadership team really taught me the fundamentals of how to sell,” says Woods, referring to those in the golf industry. It turns out those fundamentals built upon the ones he had learned at The Vitamin Shoppe. “Every sales call is like taking someone’s temperature,” he says. “You have to measure the ‘temperature’ of the customer, that is, his or her wants and needs, and base your solutions on that.” It’s not a one-size-fits-all proposition, he adds. He did not take lightly the decision to leave Wyndham Championship for a career in medical sales with Henry Schein in April 2017. “It was one of the toughest decisions I have ever made, but it was worth it for a few different reasons. When corporate objectives line up with personal ethics standards, and feature the opportunity to grow professionally, there is nothing more an employee can ask of its employer. Simply put, I feel lucky to rep the Henry Schein brand day in and day out. With this industry seeing so much change in such a short amount of time, there are endless opportunities to learn. “When I entered this medical sales role, one of the biggest adjustments I had to make was learning/understanding
the numerous product lines we sell and the different solutions we offer,” he continues. “To be completely honest, I was lost in the beginning, but over time, through customer interactions and numerous training modules, I was able to start putting the puzzle pieces together. After an insanely fast 3 years of working in the industry, it’s the people within Henry Schein that have helped me become the best I can be. Once I was able to understand our fully integrated sales team model, results started to show.” Woods believes one of his customers’ biggest concerns is simply trying to stay ahead of rapid changes in healthcare. Those whose practices are owned or managed by healthcare systems are feeling some pressure to cut costs by, among other things, standardizing the products and equipment they use.
When corporate objectives line up with personal ethics standards, and feature the opportunity to grow professionally, there is nothing more an employee can ask of its employer. For some, it’s not an easy adjustment. “It can be extremely hard to navigate this space, but when it is done, customers are forever thankful,” he says. His communication skills help. “Keeping the communication channels open, whether it be with in-person meetings, phone calls, or email (providing information in a fast and effective way), is how I am able to make sure customers can rely on us for their healthcare needs. “I think the most effective way to address customer concerns is by being a student of the industry,” he adds. “Things are always changing, but we need to adapt to the market. By sharing best practices, communicating effective solutions when certain issues arise, and being a true partner to the practice, we can address customer concerns. It is important to convey the fact that we are all in it together.” Woods is engaged to be married to Libby Lechner, a licensed practical nurse who is studying to become an RN. www.repertoiremag.com
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HIDA GOVERNMENT AFFAIRS
HIDA Supports Lawmakers’ Efforts To Strengthen Strategic National Stockpile Increasing supply chain elasticity, improving U.S. production of PPE, and partnering with the private sector to replenish supplies leads to a better prepared America Strengthening the Strategic National Stockpile (SNS) will enhance the nation’s medical supply chain and its elas-
ticity. A new bipartisan bill introduced this spring by two congresswomen is designed to do just that. It builds on the work HIDA and its federal partners have been collaborating on during the last several years.
“Creating a continuous and elevated level of demand for key preparedness products requires a strong private/public partnership,” said HIDA VP of Government Affairs Linda Rouse O’Neill. “HIDA applauds these lawmakers’ efforts that continue to improve our nation’s medical products supply chain." The measure was introduced in April as H.R. 6531 by Rep. Debbie Dingell (D-MI) and Jackie Walorski (R-IN) amid the backdrop of the coronavirus pandemic. The Medical Supplies for Pandemics Act of 2020 amends a 2019 preparedness bill and underlying public health service act. It also authorizes $500 million annually through fiscal year 2023 to implement a supply chain flexibility manufacturing program that would create incentives for U.S. manufacturers to improve supply chain elasticity. The program would be charged with: ʯ Creating incentives for the domestic manufacture of medical supplies to enhance supply chain elasticity ʯ Establishing and maintaining domestic reserves of critical medical supplies like personal protective equipment and diagnostic tests ʯ Working with distributors of medical supplies to manage domestic reserves held by the Strategic National Stockpile by refreshing and replenishing supply stocks. 62
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The legislation is designed to ensure the U.S. is better prepared to avoid shortages of critical supplies and to create a reliable domestic reserve of lifesaving medical equipment so the nation is ready for the next crisis, Rep. Walorski said. Rep. Dingell noted that modernizing the stockpile and the medical supply chain is key to ensuring frontline healthcare workers and first responders have adequate supplies of PPE. HIDA and its members have been working with SNS and the Office of the Assistant Secretary for Preparedness and Response (ASPR) for years. HIDA and its members have provided executive-level subject matter experts to share commercial supply chain manufacturing capacity, challenges, and industry requirements for ancillary products in the SNS. The SNS has hosted multiple workshops and tabletop exercises with HIDA that have led to better communications and collaboration among manufacturers and distributors in responding to emergencies and disasters. (See HIDA’s article in the April issue of Repertoire magazine on collaborative efforts that was co-written by a former SNS director and HIDA’s VP of Government Affairs.) H.R. 6531 builds on language included in the Pandemic and All-Hazards Preparedness and Innovation Act (PAHPAI) that President Trump signed into law in June 2019. PAHPAI formalizes public/private partnerships to ensure continuity during a disaster, which addressed understanding product availability for medical countermeasures and market capacity as well as identifying substitutions and alternative products.
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NEWS
Industry News U.S. hits 1 million coronavirus cases, one-third of all world’s cases The U.S. crossed the 1 million case threshold April 28. That is nearly one-third of all the world’s known coronavirus cases. President Donald Trump has attributed the high number of cases to heightened testing and less transparency in reporting cases in countries like China.
Matt Bourne named vice president global sales for Midmark
Matt Bourne
Midmark Corp., announced Matt Bourne was promoted to vice president, global sales. In this leadership position, Bourne will lead the Midmark sales organization across all three of its business units – medical, dental and
animal health. Bourne started his career at Midmark in 1997 as a sales representative and regional manager for the medical division. In 2010, he was promoted to director of sales, animal health, and was instrumental in the development of Midmark’s fastest-growing division. Most recently, Bourne served as vice president of sales for the medical business.
HHS awards close to $165M to rural hospitals, telehealth centers HHS, through the Health Resources and Services Administration, is awarding rural hospitals the telehealth resource centers nearly $165 million to combat COVID-19. Funds will go to 1,779 small rural hospitals and 14 HRSA-funded telehealth resource centers. The funds target smaller, rural hospitals and is separate from the CARES Act. Approximately $30 billion in the CARES Act was recently distributed to hospitals nationwide.
Product Spotlight OraSure’s OraQuick ADVANCE® Rapid HIV-1/2 Antibody Test Great strides have been made in the fight against the HIV epidemic. However, many are still vulnerable to infection. According to the CDC, 14% of Americans with HIV do not know they are infected, and 61% have never been tested. Detection is the first step to prevention. OraSure’s OraQuick ADVANCE® Rapid HIV-1/2 Antibody Test can help bring an end to the epidemic by testing the untested and getting proven results in as early as 20 minutes using several specimen types, including oral fluid, fingerstick whole blood, venipuncture whole blood and plasma. For more information, visit orasure.com/smm.
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SAVE NOW! 2020 PROCEDURE ROOM PROMOTION Extended to December 18 th
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