vol.29 no.6 • June 2021
repertoiremag.com
Supply and Demand COVID was new. But the economic principles it stirred up were not.
Virtualize Thyself. The pandemic has presented us with unprecedented challenges requiring distributor and manufacturer reps to pivot from traditional selling techniques to virtual interactions. Our experienced sales and service teams are committed to continue as your trusted virtual selling partner and help ensure your success by providing the diagnostic products still critical to you and your customers. Until we can work together in the field again, SEKISUI Diagnostics will be here for you in any other way possible. Because we understand, every result matters.
POINT-OF-CARE READER
RAPID DIAGNOSTICS
IMMUNOASSAY SYSTEM
SEKISUI DIAGNOSTICS IS YOUR PARTNER IN HEALTHCARE 800-332-1042 / sekisuidiagnostics.com © 2021 Sekisui Diagnostics, LLC. All rights reserved. Acucy® and OSOM® are registered trademarks of Sekisui Diagnostics, LLC. Because every result matters™ is a trademark of Sekisui Diagnostics, LLC. FastPack® is a registered trademark of Qualigen Inc.
JUNE 2021 • VOLUME 29 • ISSUE 6
PUBLISHER’S LETTER What You Did Last Summer..... 2
PHYSICIAN OFFICE LAB Tick-Borne Diseases Tick-borne diseases are serious, seasonal and spreading to broader geographic locations.................... 4
DISTRIBUTION Cardinal Health awarded Strategic National Stockpile contract for PPE storage and distribution................................. 7
IDN OPPORTUNITIES Supply Chain Leader Profile Nicholas M Trzeciak, CMRP, administrative director of distribution & logistics – supply chain, Stanford Health Care.........10
Supply and Demand COVID was new. But the economic principles it stirred up were not.
16
HEALTHY REPS Health news and notes...............54
Nicholas M Trzeciak
TRENDS Biden’s Healthcare Agenda Affordable Care Act, telemedicine, home-based care intended to promote healthcare equity and accessibility............26
Home-Based Care Home care’s tent is big, and getting bigger...................................32
QUICK BYTES Technology news............................38
WINDSHIELD TIME
HIDA A Global Pandemic Highlights the Value of Distribution Healthcare industry leaders convene to look forward and reflect on meeting pandemic challenges..................58
NEWS
Automotive-related news........50
Rep Corner
Channeling Grief Jessica Kavanagh fought her husband’s PTSD, and now she fights on behalf of other veterans and their caregivers
42
Industry news....................................60
Subscribe/renew @ www.repertoiremag.com : click subscribe repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2021 by Share Moving Media. All rights reserved. Subscriptions: $49.00 per year for individuals; issues are sent free of charge to dealer representatives. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address. POSTMASTER: Send address changes to Repertoire, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors. Periodicals Postage Paid at Lawrenceville, GA and at additional mailing offices.
www.repertoiremag.com
•
June 2021
1
PUBLISHER’S LETTER
What You Did Last Summer Do you remember what it was like last year heading into summer?
ʯ Everyone was stuck at home trying to survive homeschooling their kids while staying on top of work, but not looking forward to figuring how to keep children occupied without school. ʯ Endless Zoom sales calls, Zoom family calls and Zoom happy hours. ʯ We wiped everything down at the grocery store only to have the checkout person touch it all. ʯ Little to no traveling. ʯ Shaggy hairdos because we couldn’t get haircuts. ʯ Getting used to wearing masks in public places. ʯ Breaking out family recipes and cooking more at home. Probably drinking more too. ʯ Watching the news more than we care to admit.
Scott Adams
Here we are 15 months after the initial 14-day “Flatten the Curve” (yeah right) lockdowns and I’m happy to say things seem to be headed back to a relative state of normalcy. Restaurants are 100% to capacity here in Georgia as well as at the Braves stadium. I’ve flown close to a dozen times this year. I went into Home Depot yesterday without a mask, joined by 10-15 others not wearing a mask. I no longer have to wear a mask while getting my haircut. (It’s still gray by the way). The first live distribution meeting was held, and it was amazing to see so many faces I’ve missed. And finally, our business, thanks to all of you, is back and thriving. I guess the long and short of it is, when all this craziness started, no one knew where it would end up or how to deal with it, and no one ever thought 14 days would turn into almost a year. For me personally so much was learned. One lesson which may be the most important is we all need each other, and I’m thankful for every one of you reading this magazine. Regardless of our differences or our similarities, we all need one another! Here’s to the “NEW NORMAL” just being normal! 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.com; www.sharemovingmedia.com
editorial staff editor
Mark Thill
mthill@sharemovingmedia.com
sales executive
Subscriptions
Amy Cochran
www.repertoiremag.com/subscribe or (800) 536-5312 x5259
acochran@sharemovingmedia.com (800) 536.5312 x5279
managing editor
2021 editorial board
ggarrison@sharemovingmedia.com
publisher
Richard Bigham: Atlantic Medical Solutions
editor-in-chief, Dail-eNews
Scott Adams
Eddie Dienes: McKesson Medical-Surgical
acherry@sharemovingmedia.com
sadams@sharemovingmedia.com (800) 536.5312 x5256
Joan Eliasek: McKesson Medical-Surgical
Graham Garrison Alan Cherry art director
bcashman@sharemovingmedia.com
founder
Mark Kline: NDC
circulation
Brian Taylor
Bob Ortiz: Medline
lgantert@sharemovingmedia.com
btaylor@sharemovingmedia.com
Keith Boivin: IMCO Home Care
Laura Gantert
2
Ty Ford: Henry Schein Doug Harper: NDC Homecare
Brent Cashman
June 2021
•
www.repertoiremag.com
The cultivation of trusted partnerships drives our everyday actions. While Dukal invests in industry leading products, we are equally focused on providing the highest level of value throughout the entire customer journey. We are always striving to improve our customers experience-our new website is the next step in this evolution.
Personalized
Organized order
Live order tracking &
customer dashboard
management
invoicing
Enhanced product
Responsive
E-commerce browsing
pages & assets
modern design
& ordering experience
A website built with our customers in mind, visit our new website Dukal.com
As a leader in the development and manufacturing of medical products, we partner with healthcare professionals to launch innovative solutions to unmet clinical needs.
PHYSICIAN OFFICE LAB
Tick-Borne Diseases Tick-borne diseases are serious, seasonal and spreading to broader geographic locations
In this month’s column I plan to highlight some interesting facts about tick-borne diseases. I will share a little bit
about which tick-borne diseases are out there, where they are most common and, of course, focus on available lab tests appropriate for the POL and your role in making it happen.
Let’s start with a couple of facts about tick-borne diseases.
others less familiar like Powassan Encephalitis, and Anaplasmosis. While we used to think of strict geographiFirst fact about tick-borne diseases cal boundaries for some of these diseases, How many different tick-borne diseases many, including Lyme disease, are being diagare commonly found in the U.S.? We’re all nosed well outside of their initial site of disBy Jim Poggi familiar with Lyme disease and the serious covery. Lyme is now known to be diagnosed in complications it can lead to if left undiagthe Northeast, Northcentral states and Pacific nosed for any length of time. But, did you know there Coast. While less common, it is also creeping into the are at least 10 other tick-borne diseases? It’s a fact. mid-Atlantic states. For Rocky Mountain Spotted Fever, Some names you may know are Ehrlichiosis, Rocky despite its name and earliest diagnosis in the Rockies, it is Mountain Spotted Fever, and Tularemia. There are most common in the Southeastern U.S.
The table below provides a useful summary of the most common tick-borne diseases
Disease
Where encountered
Average Annual Diagnoses
Lyme Disease
Northeast, Northcentral, Pacific Coast, Mid Atlantic
3 million
Babesiosis
Northeast, Midwest, Northwest
200,000
Ehrlichiosis
East, Southeast, Central
200,000
Rocky Mountain Spotted Fever
Southeast, Atlantic Coast
20,000
Anaplasmosis
Northeast, Northcentral, Pacific Coast
6,000
Southern Tick associated Rash Illness
Southeast, Atlantic Coast
Rare; rash mimics Lyme disease
Tularemia
4
Rare, <1,000 cases annually
Colorado Tick Fever
Northwest, Rocky Mountains
Rare; viral rather than bacterial
Powassan Encephalitis
Northeast
Rare; viral rather than bacterial
Q Fever
Throughout the U.S. is possible
Very rare; <200 cases
June 2021
•
www.repertoiremag.com
When Did Adequate Become Acceptable?
Never accept less than the best. Choose Dale.
485 ENFit ACE 475 Legacy ACE
WHY
Choose the ACE Connector® (Access Controller for Enteral)?
Because It Offers Benefits the Competition Just Can’t Match Protects patients and nurses
Works the way you want
Saves clinician time
Helps you provide care without compromise
• Guards clinicians against potentially infectious gastric splashback • Shields patient from external contamination • Available in both Legacy and ENFit styles to improve patient safety and reduce misconnections • In-line feeding, suctioning, irrigation, gastric residual sampling and medication delivery with no need to disconnect • Simple on/off handle that is simple to operate
• High-quality, long-lasting silicone adapter, preassembled within the package • Holds tubes & feeding administration sets securely, yet can be disconnected with ease • For use with wall or portable suction • Dale products mean quality performance which ultimately saves time and cost • Inferior products require more frequent replacement • Fosters greater patient and clinician satisfaction
Always Reach for Something Better
For a free sample of the Dale ACE Connector, call 800-343-3980. Learn more at dalemed.com. Dale and ACE Connector are registered trademarks of Dale Medical Products, Inc. ENFIT is a registered trademark of GEDSA used with their permission. ©2021 Dale Medical Products, Inc. All rights AD-102 Rev A PMSreserved. 660 PMS 7540 C: 85 M: 50 Y: 0 K:0
C: 0 M: 0 Y: 0 K:85
PHYSICIAN OFFICE LAB Second fact about ticks Do ticks REALLY cause these diseases? No, they are the “vector” or carrier. But each disease is caused by a bacterium or virus the tick harbors when it interacts with us. In the case of Lyme disease, the bacterium is Borrelia burgdorferi. So, as you consider lab tests for tick-borne diseases, be sure to check with your trusted infectious disease supplier. Some describe their tests with the name of the disease, such as “Lyme disease”, others refer to the name of the organism that causes the disease.
Practices performing few Lyme tests would be better off considering one of the new instrument-based waived immunofluorescent assays available as a screening test. There is a large and growing number of resources focused on tick-borne diseases, and Lyme disease, in particular, due to its relatively high prevalence and potentially serious aftereffects. One of the best I’ve found is Lyme Disease.org. A link to their home page is below. In addition to your key infectious disease suppliers, this website provides a wealth of useful information to you, and to the customers you serve. LymeDisease.org – Advocating nationally for quality accessible healthcare for patients with Lyme disease
Testing Before I take on the testing side of things, it’s useful to consider the question: How important is it for clinicians to have a quick, accurate diagnosis of tick-borne illnesses? Very important. The most difficult issue clinicians face for most of these diseases is that their symptoms tend to be vague and mimic a variety of other disorders, including autoimmune disease and arthritis. Adding to the situation is that left undiagnosed, a number of serious neurological disorders can occur and dramatically impair quality of life. Finally, many of these diseases require complex and lengthy treatment programs. So, tick-borne diseases pass the test of diseases whose diagnosis in the POL “can be used to initiate or modify a patient treatment program”. 6
June 2021
•
www.repertoiremag.com
It is worth noting that some of these tick-borne diseases produce similar rashes and other nearly identical symptoms which make determining which tick-borne illness the patient has can be particularly challenging. Physician practices which should consider testing for tick-based diseases represent a wide spectrum of locations. Rural practices are likely to see more patients exposed to ticks than urban practices. In addition, rheumatology and other multispecialty practices who encounter patients with vague, difficult to diagnose conditions including muscle and joint aches, rashes that come and go, fatigue, headaches and flu like symptoms would be wise to consider adopting Lyme disease testing along with a range of tests to rule out arthritis including rheumatoid factor (RF), C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR). While there are many tick-borne diseases, given the far greater prevalence of Lyme disease, it is the logical choice for POL testing. The CDC proposes a two-tier testing protocol for Lyme disease. They recommend an EIA (ELISA is an example), an IFA (immunofluorescent assay) as a screen, followed by a Western blot test for confirmation. Both tests are designed to detect IgG and IgM antibodies to a wide variety of proteins associated with Borrelia burgdorferi. EIA or IFA is typically used to screen for Lyme disease and Western blot is considered the confirmatory test for patients positive by the screening test. Both EIA and IFA require specialized equipment and considerable operator skill. Practices performing few Lyme tests would be better off considering one of the new instrument-based waived immunofluorescent assays available as a screening test. Positive screening tests still need to be confirmed by a second method, Western blot. Tick-borne diseases are serious, seasonal and spreading to broader geographic locations. They can also have serious aftereffects, especially if diagnosis and effective treatment is delayed. So, what is the role of the experienced distribution account manager? First off, consider adding Lyme disease and arthritis testing to your core laboratory portfolio. Secondly, be sure to work closely with your trusted infectious disease supplier to form a plan of action early in the spring and make sure to focus on the practices most likely to benefit from adding these key tests to their practice. Good planning, coordination with your key infectious disease lab supplier and timely, effective communication with the customers most likely to benefit from this laboratory solution will help establish you as a lab consultant in the know.
DISTRIBUTION
Cardinal Health awarded Strategic National Stockpile contract for PPE storage and distribution
Cardinal Health announced it was awarded a $57.8 million contract – including options that, if exercised by HHS,
could reach $91.6 million – for the storage and distribution of 80,000 pallets of personal protective equipment (PPE) to support the Strategic National Stockpile (SNS), part of the Office of the Assistant Secretary for Preparedness and Response within HHS.
“Cardinal Health is uniquely positioned to get critical products to healthcare providers and first responders as effectively, safely, and swiftly as possible in response to the COVID-19 pandemic,” said Steve Mason, CEO Medical Segment. “Cardinal Health is proud to help the country by providing this critical pandemic support in partnership with the U.S. government.” With its expansive distribution network, Cardinal Health said it can provide rapid deployment and delivery of SNS product throughout the U.S. and its
territories, as directed by the U.S. government, to assist with critical PPE needs in response to the COVID-19 pandemic as well as other national or localized public health emergencies, the company says. PPE product within the SNS, to be stored across U.S. Cardinal Health medical facilities, includes inventory from multiple manufacturers/vendors under contract with the U.S. Government that is provided to multiple sources and care institutions, according to a release. www.repertoiremag.com
•
June 2021
7
IDN OPPORTUNITIES
Supply Chain Leader Profile Nicholas M Trzeciak, CMRP, administrative director of distribution & logistics – supply chain, Stanford Health Care JHC: What is the most interesting/challenging project you’ve worked on recently? Nicholas Trzeciak: The most challenging project we’ve worked on recently has been our overall pandemic response work. It’s not necessarily a project in the traditional sense, but it brought to light the gaps within the global supply chain.
Nicholas M Trzeciak
10
June 2021
•
www.repertoiremag.com
When faced with the reality, we saw that beyond firefighting in the moment, that we needed to respond in a project management mindset to not just put out the flames, but also build a better house. We designed into the system a governance model heavily weighted toward clinical engagement in which we pulled together all departments (employee
health, infection control, supply chain, nursing, OR, emergency management, etc.) to ensure we had all players at the table. This committee was responsible for all PPE recommendations, educational document creation, conservation efforts, and clinical practice changes. This group then linked with our physician lead group for final approval and roll out. We created a technology integrated model by leveraging our intranet site and posted over 100+ educational documents & videos for training that garnered over 579,000 views from frontline team members. This team also stood up a reprocessing & n95 requesting process, rolled out anchored CAPR/PAPR hardware to direct front-line COVID units, and assisted with numerous community engagement activities (testing sites, vaccine rollouts, and clinical trials). The results from all this work have been incredibly humbling to see what a diverse, clinically integrated team can put together to help serve our clinicians, patients and communities safely and effectively. This is a model that has paid dividends, not only in terms of pandemic response, but also in terms of solving extant process issues that preceded it. JHC: What projects are you looking forward to in the next six to 12 months? Trzeciak: I am looking forward to our continued expansion of our RFID tracking and ordering system. The efficiencies it will bring
Stronger Clinical Performance Takes Lateral Flow Testing To The Next Level
Providing superior rapid results at the point-of-care. Fast, easy, cost effective so you can test and treat in one visit. High Performance Equivalent to or exceeding the performance of reader devices, without the need for an instrument
SENSITIVITY
SPECIFICITY
Results in 10 minutes OSOM® Custom Care Exceptional Support/Training by licensed medical technologists and experienced healthcare professionals Made in the USA Award-winning supply chain capabilities For more information please call us at 800-332-1042 or visit us online at www.osomtests.com © 2020 Sekisui Diagnostics, LLC. All rights reserved. OSOM® is a registered trademark of Sekisui Diagnostics, LLC. Because every result matters™ is a trademark of Sekisui Diagnostics, LLC.
IDN OPPORTUNITIES for not only our team, but our end users are incredible. One of the biggest issues facing distribution these days is this: How do you know when your supplies at point of use are at risk? Not just from the external market, but just from day-to-day utilization patterns. We think these patterns are flat, and for those outside of healthcare this remains relatively true, but within healthcare our utilization is inconsistent at
as value add, but actually takes time away from other areas that need supply chain support. These small but crucial steps can move us from a reactive mindset to a proactive replenishment supply cycle creating value and maximizing our resources. By leveraging RFID to provide this extra level of supply replenishment support, we truly move the needle in becoming a more clinically integrated supply chain.
The pandemic has and will forever change the way we look at everything we do from product sourcing to the resiliency of our distribution & logistics processes. best. Whether it’s days of the week aligning with clinical rotations for things such as line change day, a service lines block in the OR, and more, each scenario has a unique subset of products associated to it. These patterns make us more reactive, especially in today’s environment. RFID has the capability to give us in real time utilization patterns set at specific supply levels. Whether this is by PAR style design (Min/Max) or by criticality of the product, we can set predetermined alerts to align better with supply pulls than only relying on our normal cycle time of replenishment. For our teams, this means a more responsive, proactive, and value-added process. I hear a lot of times that our current model is as good as it can be, but for our patients and clinicians, I choose not to accept good enough as good enough. By looking at each step within the process you find hidden, non-valueadded steps. By looking at an entire process, that on the surface is seen 12
June 2021
•
www.repertoiremag.com
JHC: What is the biggest challenge/change facing healthcare supply chain professionals in the next 5 years? Trzeciak: To me the biggest challenge is we can not think that we will go back to “business as usual” in the post pandemic world. This is simply not possible. The pandemic has and will forever change the way we look at everything we do from product sourcing to the resiliency of our distribution & logistics processes. We have seen how fragile most distributors and supply pipelines are when faced with a global disruption event. The initial global response was almost a case of denial at how much disruption would even occur, but the sobering reality was tough for groups that run very lean LUM programs, track only to high inventory turns, or focus on lowering holding costs for savings. The way forward will require the discipline to answer the following: How will we view the importance of resiliency
within the overall supply chain? More importantly, how do you improve your internal processes to be able to absorb future supply disruptions with minimal impact to the end users? When this is all said and done, I think more people will be focused on a value equation of balancing product multi-sourcing, 3PL strategies, pre-determined substitute products coupled with a deeper review of where and how products are manufactured around the globe. This later point really speaks to the balance between lowering the cost of goods when manufacturers outsource the work versus a full understanding of the risks this can pose to healthcare. JHC: How do you stay motivated despite conflicts and obstacles? Trzeciak: Knowing that every day I get to go into work with this amazing and inspiring team all focused on the mission of helping people is the best way I know of to stay motivated. As the leader of a large team, it’s important for me to be with the team supporting them however is needed. How can I ask someone to do something I am not willing to do myself ? The supply chain team is very much an unseen but vital part of every healthcare institution. At times it may seem like what we do gets overlooked, but our work touches every facet of almost every industry. We have a motto at Stanford Healthcare: “One Team, One Dream.” This is personified by every single one of our team members. They meet every challenge with a smile and a positive attitude that cannot be beat every single day. Their work helps clinicians provide world-class care to our patients and the communities we serve. If this is not motivating, then I do not know what is.
SPONSORED
GOJO
How Hand Sanitizer Aesthetics Affect Hand Hygiene Compliance
Hand hygiene is the primary measure for providing
safer care in healthcare facilities . Hand hygiene in the healthcare environment consists of a combination of washing hands with soap and water and using an Alcoholbased hand rub (ABHR). According to nationally accepted guidelines from the Centers for Disease Control and Prevention (CDC), the majority of hand hygiene events should be performed using an ABHR. 1
The CDC guidelines for hand hygiene in healthcare settings recommend seeking feedback from healthcare workers (HCW) regarding their hand hygiene product’s overall acceptability (skin tolerance, feel and fragrance) in order to maximize product acceptance. Proper hand hygiene is more than just washing and sanitizing regularly. Product acceptability is an important driver of hand hygiene compliance; that is; if HCW do not like the product, www.repertoiremag.com
•
June 2021
13
SPONSORED
GOJO
If poorly formulated hand hygiene products are selected, it could have an adverse impact on HCW acceptance, skin condition, and hand hygiene compliance.
14
June 2021
•
www.repertoiremag.com
The human factor variables of hand hygiene compliance such as product use decisions and patterns of the healthcare worker are complex and must be considered as part of the equation. Even well formulated hand hygiene products will be inherently limited in their ability to reduce germs by their pattern of use in the healthcare environment. Thus, the “best” products are those that meet the required efficacy while optimizing product acceptance elements to ensure maximum product usage.
Figure 1 Cartner, T. Skin Care Science Study 10369. GOJO Industries, Inc. April 2014. Change in Skin Barrier (Lower is Better)
4.5 4 3x per day Cleanser Only
3.5 3 TEWL
they may be less likely to use it, consequently affecting hand hygiene compliance. Published studies support the concept that as skin irritation increases, hand hygiene compliance decreases.2,3 Human factor elements oftentimes do not get the attention that they warrant. While a major emphasis in the selection process for an ABHR product is efficacy, an important determinant of hand hygiene compliance is acceptance of the products by HCWs.5 One study found that a typical sanitizer used at 20 times per day was no more damaging than handwashing with soap and water alone.4 However, once hand sanitizing events increased 5-fold, there was significantly more changes in skin barrier as measured by transepidermal water loss (TEWL). In very high compliance environments, i.e., hand hygiene events in excess of 100 times per day, it is important to select product formulations better suited to meet the skin health needs of HCW. Figure 1 demonstrates the effects of handwashing versus hand sanitizing regimens on skin by evaluating changes in skin barrier, as measured TEWL. As you can see, if poorly formulated hand hygiene products are selected, it could have an adverse impact on HCW acceptance, skin condition, and hand hygiene compliance, which is why some ABHR contain emollients and moisturizing ingredients to counteract this effect. Fragrances, gelling agents, foaming agents, and other ingredients are also added to improve product aesthetics. Since higher levels of alcohol tend to reduce ABHR aesthetics, it is important to choose a product with no tradeoff between efficacy and product acceptance. Once above the recommended 60% alcohol threshold, the total ABHR formulation has a much larger impact on antimicrobial efficacy than alcohol level. The unique blend of non-active ingredients can either enhance or hinder the ability of alcohol to inactivate microorganisms on the skin and play a significant role in the ability of ABHR formulations to meet efficacy standards. Beyond efficacy, product formulation determines other critical aspects such as skin tolerability and aesthetics, which directly affect product acceptance and usage rates, and indirectly affect clinical outcomes.
20X per day Typical Sanitizer
2.5
100X per day Typical Sanitizer
2 1.5 1 0.5 0
Day 3
Fortunately, newer ABHR formulation technology can achieve a balance of properties that enhance the user experience and reduce barriers to use, while exhibiting superior antimicrobial efficacy. Choosing products that are formulated with mild and effective ingredients offers HCW protection against both pathogens and skin damage, which is a critical foundation for a hand hygiene program.
A Difference You Can Feel What If a Hand Sanitizer Could Improve Your Skin? The intense demands on healthcare workers can leave hands dry and cracked, making it uncomfortable to complete critical hand hygiene protocols. That’s why we developed PURELL® Healthcare Advanced Hand Sanitizer ULTRA NOURISHING™ Foam. This unique formulation is clinically proven to improve skin health in only three days, thanks to its unique blend of moisturizers, antioxidants, and other ingredients that help strengthen skin’s natural moisture barrier.1 To learn more, visit GOJO.com/Rep3
1. Skin health study, Study # 2014-12-C10408, December 8-22, 2014, North Cliff Consultants, Inc., Cincinnati, OH. Based on 100 times use per day. ©2021 GOJO Industries, Inc. All rights reserved. | 31634 (4/2021)
16
June 2021
•
www.repertoiremag.com
Supply and Demand COVID was new. But the economic principles it stirred up were not.
Suppliers and providers in the physician market have
learned much about pandemic-era logistics since March 2020. But many challenges remain, and the learning will continue. “The situation for physician practices has improved compared to the massive demand spikes that characterized 2020,” says Cynthia Radford, senior vice president, alternate site programs, Premier Inc. “Alongside PPE conservation measures, ongoing stockpiling efforts and a greater visibility into inventory, providers today are better equipped – but the supply chain remains fragile.”
Access and pedigree Throughout the pandemic, Premier worked closely with its members, including those who operate physician practices, to understand and address their supply chain challenges, she says. “Via direct interaction and numerous member surveys, we uncovered two main issues these providers have been facing with regard to PPE: access to product, and product pedigree. www.repertoiremag.com
•
June 2021
17
Supply and Demand
“On product access, many organizations reported major challenges due to allocation. Since many physician practices and other alternate site providers do not have an extensive history of ordering PPE, their access to product through traditional channels has been limited.” In a survey conducted late last year, most (61%) alternate site providers reported not having their PPE needs met by their traditional med/surg distributors, down from 83% in June 2020. Premier surveys also found that a significant number of non-acute providers were turning to PPE sources such as online retailers (77%), nontraditional distributors (56%) and retail stores (44%). “In many cases, providers had to contend with uncertain sourcing and the possibility of gray market items – heightening their concerns about product quality and pedigree.”
Premier took several steps to address such challenges, says Radford, including: ʯ Implementing a process to bring new suppliers to contract in 14 days or fewer for categories with product allocation or shortages, and signing more than 100 new contracts with manufacturers and evaluating supplies from more than 2,500 brokers. ʯ Working with traditional and nontraditional distributors to make PPE available to physician practices. “Trusted distributors in categories such as office supplies have been able to fill gaps in PPE access,” she says. “And we’ve negotiated supplemental sourcing programs with traditional med/surg distributors in which they can provide and store PPE for non-acute providers.”
PPE clearinghouse for small purchasers Project N95 identifies itself as the national clearinghouse for personal protective equipment, COVID-19 tests and medical supplies – particularly for small purchasers. Based in Brooklyn, New York, the nonprofit organization was founded in March 2020 as a rapid-response to the COVID-19 pandemic, says Executive Director Anne Miller. “Our volunteer-led team has deep experience in procurement, healthcare, government and technology. We have more than 100 volunteers and team members from throughout the U.S. and abroad who have worked to provide more than 6.7 million units of PPE to all 50 states.” PPE is sourced from manufacturers and authorized distributors who undergo a rigorous vetting and verification process, she says. “To allow small healthcare providers, community clinics and individuals to access masks, COVID-19 tests and other critical items in the smaller quantities they need and at prices they can afford, we work with several partners (varies by product) to break down bulk orders, then pick, pack and
18
June 2021
•
www.repertoiremag.com
ship. We stand behind each purchase, supporting last-mile delivery for even the smallest deliveries.” Project N95 has formed partnerships with more than 20 medical associations to make PPE accessible to their members, says Miller. Partners include the American Medical Association, American College of Physicians, American Academy of Family Physicians, American Association of Nurse Practitioners and the Medical Group Management Association.
After the pandemic? “The issue of health equity won’t end with the pandemic,” says Miller. “Barriers
to access will unfortunately persist. As we’ve helped healthcare and frontline workers navigate the search for quality PPE throughout the pandemic and stepped in to assist vulnerable communities access the masks and PPE they needed to stay safe, we’ve learned that they are locked out of access to many services and critical supplies. “Our organization was born out of the question, ‘How can we help?’ If there is a way Project N95 can serve postpandemic, we will continue to fill that role. Right now, we’re focused on the immediate need in front of us, which is protecting people by opening access to quality PPE and COVID-19 tests.”
Test with confidence: COVID-19 test results within 15 minutes BD Veritor™ Plus System: Providing schools with safe, simple, reliable and trusted on-site COVID-19* diagnostic testing
Learn more at BD.com/k12
*The intended use of the BD Veritor™ System for Rapid Detection of SARS-CoV-2 assay only includes those who are suspected of COVID-19 by their health care providers within the first five days on the onset of symptoms, or from individuals without symptoms or other epidemiological reasons to suspect COVID-19 when tested twice over two or three days with at least 24 hours and no more than 48 hours between tests. This product has not been FDA cleared or approved; but has been authorized by FDA under an EUA for use by authorized laboratories. This product has been authorized only for the detection of proteins from SARSCoV-2, not for any other viruses or pathogens; and this product is only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection and/ or diagnosis of COVID-19 under Section 564(b)(1) of the Federal Food, Drug and Cosmetic Act, 21 U.S.C § 360bbb3(b)(1), unless the declaration is terminated or authorization is revoked sooner. Testing is limited to laboratories certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA), 42 U.S.C §263a, that meet the requirements to perform moderate, high or waived complexity tests. This test is authorized for use at the Point of Care (POC), i.e., in patient care settings operating under a CLIA Certificate of Waiver, Certificate of Compliance, or Certificate of Accreditation.
BD, the BD Logo and Veritor are trademarks of Becton, Dickinson and Company or its affiliates. © 2021 BD. All rights reserved. April 2021
Supply and Demand
ʯ Implementing an expedited process to vet gray market suppliers, determining fewer than 10% were legitimate and alerting authorities to hundreds of fraudulent sellers. ʯ Working directly with new and untapped manufacturers around the globe. “For alternate site suppliers, Premier engaged in a forward buy specifically for this market and created a channel for product where it didn’t exist, delivering over 2 million masks, face shields and gowns.” In addition, Premier’s e-commerce marketplace – stockd® – “closed a critical gap in the traditional med/surg supply chain and serves as a trusted, 24/7 resource to access vital PPE,” she says. (Launched in October 2019, stockd is available to any physician or physician practice – not just Premier members.) “Despite the supply chain shockwaves, product pricing on stockd avoided large spikes. The online platform is seeing significant growth, with visitors up three times, sales up 29 times, and the monthly number of orders up six times since March 2020, as compared to the prepandemic baseline.”
Where we stand Many PPE categories are in recovery, said Steve Martin, senior vice president, supplier management for NDC, in mid-April. “Today, we are definitely seeing improvement from the beginning of the public health emergency. We have experienced similar cycles among most of the expected PPE categories: Demand spikes and supply is
unable to keep up. Prices shoot up. Supply is ramped up to accommodate demand. Prices come back down. Many categories are in recovery and we are finally coming out of the hole on products such as masks and respirators.
‘ Historical demand used to be our guide for future stocking and supply levels, and we know that is not always going to be an accurate baseline in 2021.’ “We saw these same general cycles, just with varying lifespans, with gloves and infection control products experiencing the longest cycles. With surface wipes and hand sanitizer, supply is now finally catching up with demand, and demand is starting to soften a little bit,” he says. “Glove prices are just starting to peak. Supply still cannot meet demand, but it’s getting closer, even as other products flood the market since the FDA softened requirements for gloves. We expect supply and demand to equal out towards the back half of this year, with price degradation beginning in Q2 or Q3 of 2021.”
Even as recently as March 19, 2021, the U.S. Food and Drug Administration listed the following PPE to be in limited supply and expected to remain so throughout the public health emergency:
ʯ Latex, non-powdered exam gloves. ʯ Vinyl exam gloves. ʯ Polymer, non-powdered exam gloves (including nitrile).
ʯ Specialty, non-powdered exam gloves (including nitrile). ʯ Exam gowns. ʯ Surgical gowns.
ʯ Non-surgical isolation gowns. ʯ Surgical masks. ʯ Surgical respirators.
Regarding surgical masks and surgical respirators, the agency added this note: “While there is currently limited supply available, public and private mitigations appear to be reducing constraints on the supply chain.” Source: Medical Device Shortages During the COVID-19 Public Health Emergency, U.S. Food and Drug Administration, March 19, 2021.
20
June 2021
•
www.repertoiremag.com
Supply and Demand
‘ We have experienced similar cycles among most of the expected PPE categories: Demand spikes and supply is unable to keep up. Prices shoot up. Supply is ramped up to accommodate demand. Prices come back down.’ NDC Vice President of Sales John Cook says, “Thankfully, we’re seeing fewer brokers in the market now. This subsided with larger spot-buys – and government entities with large purchases allowed product to flow more freely in the market. Healthcare providers that got into the sourcing and supply business skipped normal distribution channels to try to take care of their own. This helped NDC get more products back in our warehouse. That is starting to go away, and we are now seeing more volume pulling through distributor warehouses.”
What happens now? “We don’t know what flu season will look like later this year, or even the next COVID season, for that matter,” says Cook. “There is going to be continued demand for PPE and infection control products, including backto-school demand, as many states hopefully prepare to return to school in the fall, so it’s going to be extremely challenging for distributors to plan.” Many manufacturers implemented strategic SKU consolidations during the pandemic to focus on highdemand, high-volume products in categories such as 22
June 2021
•
www.repertoiremag.com
gloves, wipes, and sanitizer products, he says. “For many distributors and their customers, there wasn’t a big impact at the time, but now, as elective procedures are ramping back up, it could prove to be challenging. And we’re not sure how quickly it will ramp back up to normal, but I expect increased velocity will meet demand, making room for product availability in those areas that we don’t even know yet.” How will manufacturers keep up with capacity as things get back to normal? “That depends on how quickly everything gets back to normal, how many patients physicians are being seen via office visits, and how manufacturers have handled the off-season of those products as they ramp back up,” says Cook. Martin believes distributors will face challenges predicting product demand after the public health emergency ends. “The biggest challenge from my perspective is that for product impacted by the pandemic demand, we can’t forecast our future demand based on anything historical, because this year’s demand is going to be something different. Historical demand used to be our guide for future stocking and supply levels, and we know that is not always going to be an accurate baseline in 2021.” Other factors likely to play a role include a resin factory fire, which affected the availability of sharps containers, as well as the Suez Canal blockage in late March. “In addition to the bottleneck effect from the canal blockage, we are experiencing a shortage of shipping containers due to the trade imbalance between China and the rest of the world,” says Martin. “Now we are seeing containers returning empty and shipping containers sitting in the wrong places around the world. There’s really this perfect storm – supply constraints, the reduction of workforce during shutdowns, equipment in the wrong locations and an increased volume associated with COVID – all contributing to delays in getting product where it needs to be.”
SPONSORED
MEDTRONIC
Medtronic plays big and small in the ASC space
Ambulatory surgical centers (ASCs) have seen steady
growth as the consistent rise in healthcare spending has shifted to outpatient care in the U.S. ASC procedures can cost from 35-50% lower than acute care procedures due to the different cost structure. The growth of ASCs is saving the U.S. healthcare industry an estimated $40 billion a year.1 ASCs handle more than 50% of all outpatient procedures in the U.S. and the overall number of procedures is estimated to hit 27 million this year with growth being driven by orthopedic, spine and cardiovascular procedures.1
Meanwhile, the COVID-19 pandemic serves as a net win for ASCs’ business volumes as hospitals experience some moderation or recalibration, and surgeons and patients are comfortable with procedures in ASCs. These ASC expansions present novel opportunities for medtech companies like Medtronic willing to fit their commercial models to the smaller and more nimble needs of ASCs. “We’re transforming to drive greater innovation and value for our customers by using our portfolio breadth and global scale to ‘play big’ and ‘play small’ in the ASC space,” said Michael LaCasse, Vice President, Specialty www.repertoiremag.com
•
June 2021
23
SPONSORED
MEDTRONIC
Channels for Medtronic. “This is a much more customercentric approach in which we show up as one Medtronic with a broad portfolio of offerings.” Medtronic engages at the corporate headquarters level of the largest ASC-managed groups with a Medtronic enterprise leader, while it may call on the ASC facility level with a resource focused on a specific therapy or a portfolio of related therapies. As ASCs continue to seize more healthcare profits, medtech companies like Medtronic are contracting with closer collaboration and a market segmentation approach. “Our ASC contracting strategy includes managed group contracts, IDN-owned or managed ASC contracts and ASC distributor programs that focus on specific product categories where distributors are best positioned to represent the technology,” said LaCasse. New products and services are being offered to offset pricing pressure for a wide gamut of ASC needs. “We’re continuing to expand our reach and scale to meet the ever-changing needs of the market,” added LaCasse. Medtronic does that multiple ways: through live customer engagement with its sales force and dedicated ASC sellers, an expanding remote sales team, and leveraging the distribution sales channel. “We rely on customer feedback, industry experts, and our own marketing research to deeply understand the current and future state of the ASC market,” said LaCasse. Medtronic has also begun visual case coverage technology in close partnership with companies that specialize in deploying that innovative technology. Medtech companies like Medtronic can also offer inventory management
in addition to its innovative partnerships to help ASCs maintain their smaller business model while focusing on their core business. “We understand the challenges ASCs face today related to inventory space,” explained LaCasse. “Based on the therapy, we can help manage the ASCs’ required inventory in many ways.” Medtronic utilizes the distribution channel, the high level of service and frequency of delivery provided by distributors, consignment programs, and expedited shipping.
“We rely on customer feedback, industry experts, and our own marketing research to deeply understand the current and future state of the ASC market.” – Michael LaCasse, Vice President, Specialty Channels for Medtronic
“We work closely with ASCs and distributors to create a solution that works best for their situation,” concluded LaCasse. Medtech companies like Medtronic are adapting their sales and service models to most efficiently deliver the services that ASCs value. “We’re driving operational efficiency by generating new patient pipelines, optimal care pathway design, and managing patient follow up. Those are areas where Medtronic can offer expertise to ASCs. These types of non-product opportunities are where we believe true partnerships and value are created,” said LaCasse. The ASC channel is a growing and important customer channel, and its influence is set to increase. Medtronic plays big and plays small within the ASC channel through its comprehensive portfolio of products and services backed by clinical and economic evidence – from patient access support to medical education and tools for improving clinical efficiencies and outcomes. It can set an ASC apart with its dedicated team of experts and solutions. “As we develop and deploy ASC solutions, we are focused on addressing the unique clinical, operational and financial challenges of ASC customers,” said LaCasse. Medtronic.com/asc
24
June 2021
•
www.repertoiremag.com
UNITED TOGETHER, IMPROVING PATIENT OUTCOMES
Set your ASC apart with our dedicated team of experts and solutions. Backed by clinical and economic evidence, Medtronic offers a comprehensive portfolio of products and services — from patient access support to medical education and practice development tools. People are at the heart of everything we do — whatever support you, your patients, or your business needs, we’re here to help.
BARIATRICS DEEP BRAIN STIMULATION EAR, NOSE & THROAT GYNECOLOGICAL HERNIA REPAIR LAPAROSCOPIC CHOLECYSTECTOMY UROLOGICAL OTHER PROCEDURAL SUPPORT n Wound Closure, Suturing & Vessel Sealing
CARDIOVASCULAR
SPINAL & ORTHOPAEDICS
AMUS1034 Revision A UC202119524 EN © 2021 Medtronic. Minneapolis, MN. All Rights Reserved. Printed in USA. 4/2021
PAIN THERAPIES
710 Medtronic Parkway Minneapolis, MN 55432-5604 USA Toll-free in USA: 800.633.8766 Worldwide: +1.763.514.4000 medtronic.com
DIGESTIVE & GASTROINESTINAL
Go to our dedicated ASC website for more information Medtronic.com/asc
n
Advanced Energy Tissue Sealing
n
Visualization & Navigation
n
Respiratory & Patient Monitoring
n
Surgical Stapling
TRENDS
Biden’s Healthcare Agenda Affordable Care Act, telemedicine, home-based care intended to promote healthcare equity and accessibility If anyone had doubts about the Biden administra-
tion’s plans for healthcare and payment reform, those doubts were dispelled just eight days after his Jan. 20 inauguration, when Biden issued his “Executive Order on Strengthening Medicaid and the Affordable Care Act.” Of course, even the best laid plans can get derailed. The courts could disembowel the Affordable Care Act, or natural disasters and global political turbulence could divert the administration’s time and resources. But the guiding healthcare principles of the Biden administration can be summed up in three words: Quality. Cost. Equity. For those in the healthcare supply chain, that means more patients are likely to enter the system.
Affordable Care Act In Biden’s American Rescue Plan, signed into law on March 18, the administration pledged to reduce the cost of healthcare coverage for 9 million consumers currently receiving financial assistance. As spelled out in the plan, one out of four enrollees on Heathcare.gov will be able to upgrade to a higher plan category that offers better out-of-pocket costs at the same or lower premium compared to what they’re paying today. What’s more, an additional 3.6 million uninsured people will become eligible for healthcare coverage savings. As if to underscore the administration’s determination, the Department of Health and Human Services was allotted $50 million to fund advertising to bolster the Special Enrollment Period outreach campaign, which was scheduled to run through August 15, 2021. If the Affordable Care Act were indeed to be fortified, what difference would that make to the industry? If history is any guide, the results will be mixed for providers, suppliers, payers, patients and caregivers. In February 2020, Commonwealth Fund researchers reported that the ACA: 26
June 2021
•
www.repertoiremag.com
www.repertoiremag.com
•
June 2021
27
TRENDS ʯ Reduced annual increases in payments to hospitals under traditional Medicare as well as Medicare Advantage plans (which most likely contributed to a slowing down of increases in Medicare expenditures). ʯ Implemented value-based payments for hospitals, including the Hospital Readmission Reduction Program, the Hospital-Acquired Condition Reduction Program and the Hospital Value-Based Purchasing Program. ʯ Encouraged the formation of accountable care organizations, that is, voluntary organizations of providers that agree to take responsibility for the quality and costs of care for a population of patients (generating modest net savings of up to 2% for Medicare while maintaining or improving quality). ʯ Implemented bundled payment programs, giving providers a single, prospective payment for treatment of a surgical or medical condition. (The program for hip and knee replacements appears to have reduced spending, but those savings may not have exceeded administrative costs, according to the Commonwealth Fund.) ʯ Launched a number of experiments to strengthen the nation’s primary care infrastructure. (While most of these experiments produced mixed results, the Independence at Home Demonstration, which provides intensive primary care for homebound patients, had the most promising results, according to the Commonwealth Fund. Emergency department and hospitalizations were down, patient and caregiver satisfaction were up, and Medicare expenditures were down.) Lasting improvements in payment and delivery systems will require persistent effort on the part of public and private stakeholders, concluded the researchers. Repertoire readers can bet the Biden administration intends to make that effort. Telemedicine will probably be a key component of it.
Telemedicine Prior to Jan. 20, the Trump administration promoted efforts to expand telemedicine as a way to cope with COVID19-related lockdowns. Before the COVID-19 public health emergency (PHE), only 15,000 fee-for-service beneficiaries per week received a Medicare telemedicine service. Under a special waiver for the PHE in March 2020, Medicare was authorized to pay for office, hospital, and other visits furnished via telehealth, including those originating in patients’ 28
June 2021
•
www.repertoiremag.com
places of residence. Between mid-March and mid-October 2020, over 24.5 million out of 63 million beneficiaries and enrollees received a Medicare telemedicine service. Services added to the Medicare telehealth list in the 2021 Physician Fee Schedule included “domiciliary, rest home or custodial care services,” home visits with established patients, “cognitive assessment and care planning services,” and “visit complexity inherent to certain office/ outpatient evaluation and management (E/M).” On March 30, 2021, the Federal Communications Commission voted to adopt a $249.95 million federal initiative that builds on a $200 million program established as part of the CARES Act. The FCC said its COVID-19 Telehealth Program will help healthcare providers serve patients by providing telecommunications services, information services, and connected devices. FCC Commissioner Geoffrey Starks sees telemedicine and increased broadband access as essential responses to historical inequities in healthcare.
‘ Wages for essential home care workers are approximately $12 per hour, putting them among the lowest paid workers in our economy.’ “Telehealth can make a difference for all Americans, particularly low-income communities of color,” he said in a statement in March. He pointed to Rush University Medical Center, which is located in a majority Black neighborhood on the West Side of Chicago (“the city with the largest gap in life expectancy in the United States – nearly 30 years”). Between April and May 2020, Rush received more than 600 patient transfers from surrounding safety net hospitals, most of whom were COVID-19-positive, and many of whom were either uninsured or on Medicaid, he said. In response, Rush invested in telehealth technology that allowed doctors and staff to monitor and communicate with COVID-19 patients from the patients’ homes. “Communities of color have been affected in many ways by the COVID-19 pandemic, not only with disproportionate losses of employment and businesses, but also with higher rates of infection and death,” he continued.
NOT NOTYOUR YOURAVERAGE AVERAGEDEVICE DEVICE
Simplify SimplifyBP BPAveraging, Averaging,Improve ImproveHypertension HypertensionDetection Detection If If blood blood pressure pressure (BP) (BP) averaging averaging isn’t isn’t part part ofof your your customer’s customer’s practice, practice, it it should should be. be. Studies Studies show show automated automated BPBP averaging averaging 1 1 can can help help improve improve hypertension hypertension diagnoses. diagnoses. The The American American Heart Heart Association Association agrees, agrees, recommending recommending multiple multiple automated automated 2 2 readings readings during during a single a single in-office in-office visit. visit. (R) (R) (R) (R) The The Welch Welch Allyn Allyn Spot Spot Vital Vital Signs Signs 4400 4400 Device Device is is anan all-in-one all-in-one vital vital signs signs solution solution designed designed toto help help simplify simplify vitals vitals capture capture and and hypertension hypertension screenings. screenings.
See Seehow howsimple simpleimproved improved hypertension hypertensiondetection detection can canbe. be.Learn Learnmore moreatat hillrom.com/spot4400. hillrom.com/spot4400.
1 Robert Robert Smith, Smith, MD.MD. Blood Blood pressure pressure averaging averaging methodology: methodology: Decreasing Decreasing thethe riskrisk of misdiagnosing of misdiagnosing hypertension. hypertension. 2 2 Muntner, Muntner, Paul Paul et al. et “Measurement al. “Measurement of Blood of Blood Pressure Pressure in Humans: in Humans: A Scientific A Scientific Statement Statement From From thethe American American Heart Heart Association.” Association.” Hypertension Hypertension 73,73, no.no. 5. (May 5. (May 1, 2019). 1, 2019). Doi:10.1161/ Doi:10.1161/ hyp.0000000000000087. hyp.0000000000000087. 1
© 2021 © 2021 Welch Welch Allyn, Allyn, Inc.Inc. APR217404 APR217404 R1 R1 ENG-US ENG-US 28-APR-2021 28-APR-2021
Initiate Initiateblood bloodpressure pressure averaging averagingright righton onthe the home homescreen screenwith withone onetap. tap.
TRENDS “Yet these same communities lack equal access to mental health and substance abuse resources. Telehealth has proven it can be a valuable tool to connect our most vulnerable with the resources they need to receive treatment and stay in touch with counselors and other support.”
Home-based care Much has been written about the growing need for healthcare assistance for an aging population. The Biden administration sees home-based care as a big part of the solution. The clearest indicator of its intentions lies in the American Jobs Plan, released on March 31, which calls for expanded access to long-term-care services under Medicaid. “President Biden believes more people should have the opportunity to receive care at home, in a supportive community, or from a loved one,” said the White House in a statement. “[His] plan will expand access to homeand community-based services and extend the longstanding Money Follows the Person program, which supports innovations in the delivery of long-term care.”
‘ Telehealth can make a difference for all Americans, particularly low-income communities of color.’ As with telehealth, the Biden administration considers home-based care to be a tool to promote equity – for patients and caregivers. “Caregivers – who are disproportionally women of color – have been underpaid and undervalued for far too long,” according to the White House. “Wages for essential home care workers are approximately $12 per hour, putting them among the lowest paid workers in our economy. In fact, one in six workers in this sector live in poverty. “President Biden is … calling on Congress to put $400 billion toward expanding access to quality, affordable home- or community-based care for aging relatives and people with disabilities. These investments will help hundreds of thousands of Americans finally obtain the long-term services and support they need, while creating new jobs and offering caregiving workers a long-overdue 30
June 2021
•
www.repertoiremag.com
raise, stronger benefits, and an opportunity to organize or join a union and collectively bargain.”
Equity Biden believes his approach to COVID-19 is another example of his administration’s concerns with inequity. “Equity is at the center of the Administration’s COVID-19 response,” said the White House in a statement about the American Rescue Plan. “The President has set up federally run community vaccination centers in hard-hit areas; sent vaccines directly to local pharmacies and Community Health Centers that disproportionately serve vulnerable populations; launched hundreds of mobile clinics to meet people where they are; and created the COVID-19 Health Equity Task Force.” The plan includes a $6 billion investment in community health centers to expand access to vaccines, testing and treatment for vulnerable populations in underserved communities. But it also sets the stage for future work to address inequities. The Health Resources and Services Administration was authorized to provide funding starting in April to nearly 1,400 centers across the country. Community health centers serve one in five people living in rural communities, according to the White House. More than 91% of health center patients are individuals or families living at or below 200% of the Federal Poverty Guidelines, and more than 60% are racial or ethnic minorities. On the very first day (Jan. 20) of his presidency, Biden addressed healthcare inequity and discrimination on the basis of gender identity or sexual orientation. Rescinding a one-year-old executive order by the prior administration, Biden’s “Executive Order on Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation” stated that “People should be able to access healthcare and secure a roof over their heads without being subjected to sex discrimination. All persons should receive equal treatment under the law, no matter their gender identity or sexual orientation.” In another nod to equity, on Feb. 2, Biden signed the “Executive Order on Restoring Faith in Our Legal Immigration Systems and Strengthening Integration and Inclusion Efforts for New Americans.” The order directed the Secretary of Health and Human Services and other agencies to review an August 2019 executive order, Inadmissibility on Public Charge Grounds, which allowed officials to deny admission to the U.S. for people whom they believed may receive non-emergency Medicaid in the future.
Easy Wrap Apron
WE’VE GOT YOU COVERED Create a safer environment for your team with our industry leading selection of Apron styles. Colors and types that meets or exceeds radiation protection requirements.
• Wolf Easy Wrap Aprons are the professional standard • Standard lead, lightweight lead, and lead-free • weight distribution • Convenient breast pocket for pens, papers, clips, etc. • All sizes, from Pediatric and Small to XX Large • Collars, Apronette and Breast/Scoliosis Stole also available
Visit us online at wolfxray.com
133 Wolf Road • Battleboro, NC 27809 • info@wolfxray.com 631.242.9729 • 800.356.9729 • Fax: 631.242.1001 • wolfxray.com
TRENDS
Home-Based Care Home care’s tent is big, and getting bigger Technology, a pandemic, and patient preference are
forcing providers, suppliers and payers to expand their understanding of “home care.” In April, researchers in the United Kingdom published a study in the Annals of Internal Medicine demonstrating that hospital-level care at home with a comprehensive geriatric assessment led to similar outcomes compared with hospitalization for medically unwell older persons referred to bed-based hospital care. 32
June 2021
•
www.repertoiremag.com
Researchers from the Nuffield Department of Population Health at the University of Oxford randomly assigned more than 1,000 sick older persons referred for a hospital admission at one of nine community and hospital sites to either hospital-at-home care with a comprehensive geriatric assessment, or hospitalization. The assessment allowed a geriatric care team to evaluate patient characteristics and contribute to the care plan. Participants were eligible if they were 65 years or older,
and all had complex medical issues (but did not require emergency treatment, palliative care or surgery). At six months, the researchers found that outcomes were similar between the two groups: ʯ 79% of participants in the hospital-at-home group vs. 75.3% of those in the hospitalized group were living at home. ʯ 16.9% (hospital-at-home group) vs. 17.7% (hospitalized group) had died. ʯ 5.7% (hospital-at-home) vs. 8.7% (hospitalized) were in long-term residential care. According to the study authors, these findings suggest that a health system that includes hospital-at-home
with comprehensive geriatric assessment can create additional acute healthcare capacity for certain older people referred for a hospital admission.
Moving Health Home In March, a group of healthcare providers formed an advocacy coalition intended to make the patient’s home an option for primary care services, behavioral health, chronic disease management and hospital-level care. The coalition – Moving Health Home – said it intended to do so through evidence collection, policy development, direct advocacy, coalition building, events, webinars and media outreach. “We know receiving care at home is the preference of most patients, results in higher quality and patient www.repertoiremag.com
•
June 2021
33
TRENDS
Leading health innovators launch alliance to advance care in the home WASHINGTON, March 3, 2021 – Today, a coalition of innovative health care companies launched a group called Moving Health Home to fundamentally change the way policymakers think about the home as a site of clinical service. Americans want to receive health care in their homes. Evidence from the pandemic shows it’s possible, and data proves it is safe and effective. Therefore, it is time to change reimbursement models and the culture around institutional care to allow for Americans to choose their home as a site of care. The COVID-19 pandemic exposed the untapped potential of home-based clinical care, and the
and family satisfaction, and lowers overall cost,” Compassus CEO Jim Deal was quoted as saying. “[W]e look forward to working with other coalition members to shape federal and state policy related to care at home.” (Based in Brentwood, Tennessee, Compassus provides home health, infusion, palliative and hospice care through a network of community-based programs with 200 locations in 30 states.) 34
June 2021
•
www.repertoiremag.com
opportunity for a more robust set of services ranging from primary care to hospital-level treatment. The advent of telehealth, remote monitoring, digital therapeutics, provider home visiting, medical records sharing, and other technology has shown that care in the home can be at least equivalent to, if not better than, care offered in facilities. Different types of home health services have existed for decades, but these services are short-term and designed to help patients – mainly seniors – prevent or recover from an illness, injury, or hospital stay. Making the home part of the regular options available to patients will allow for primary care, behavioral health, chronic
‘We have just scratched the surface on services that can be rendered in the home.’
disease management and even hospital-level care in the home. Founding members of this coalition include Amazon Care, Landmark Health, Signify Health, Dispatch Health, Elara Caring, Intermountain Healthcare, Home Instead and Ascension. “As a company whose mission it is to transform how care is delivered and paid for, Signify Health welcomes the establishment of this coalition to advance policies and practices that will activate the home as an alternate site of care,” said Damien Doyle, MD, Vice President of Medical Affairs at Signify Health. “Over 17% of Medicare beneficiaries are living with 6 or more chronic conditions. In-home, patient-centered care is critical to managing the complex health needs of our nation’s older adults. We need a public policy agenda that ensures access to innovative in-home care,” said Nick Loporcaro, Chief Executive Officer at Landmark Health. “We are thrilled to be joining forces with other leaders in homebased care to help remove barriers for patients across the nation while improving outcomes and increasing patient and provider satisfaction,” said Kevin Riddleberger, Co-founder, Chief Strategy Officer at DispatchHealth.
“The advent of telehealth, remote monitoring, digital therapeutics, provider home visiting, medical records sharing, and other technology has shown that care in the home can be at least equivalent to, if not better than, care offered in facilities,” said the coalition in a statement. “Although services in the home are traditionally associated with services provided by home health agencies, our members believe that we have
just scratched the surface on services that can be rendered in the home.” Founding members of Moving Health Home are Amazon Care, Landmark Health, Signify Health, Dispatch Health, Elara Caring, Intermountain Healthcare, Home Instead and Ascension. As of press time, seven more members joined: Compassus, UPMC, U.S. Medical Management, the Visiting Nurse Service of New York, Advocate Aurora Health and Vituity.
Home dialysis Meanwhile, Fresenius Medical Care North America and DaVita Kidney Care announced in March an expanded agreement to provide home dialysis technology – including NxStage home hemodialysis machines, dialysis supplies, and a connected health platform – to DaVita patients. The home hemodialysis machines from Fresenius are portable systems cleared for home use in the United
HAS YOUR FURNITURE BEEN DESTROYED BY HARSH CLEANING CHEMICALS?
States, including solo hemodialysis during waking hours and nocturnal hemodialysis while both the patient and care partner sleep. (Home hemodialysis typically requires a care partner. To perform solo home hemodialysis, patients require additional training and an order from their nephrologist.) The agreement also allows patients to access Nx2me Connected Health, a platform designed to simplify the collection and sharing of treatment information with the dialysis clinic and care team. The system accesses treatment information directly from the home hemodialysis machine; including weight, blood pressure, and temperature via Bluetooth; and medication taken, notes, and answers to health assessment questions as entered by patients. “By transmitting treatment information, we hope to help identify irregularities and prevent avoidable complications, thus supporting patients’ desire to stay on their treatment of choice longer,” said Keith Hartman, group vice president for DaVita home modalities.
INTRODUCING
Featuring Endura-Grain, An Easy To Clean Seating Option DURABLE: Non-porous & Bleach Cleanable! STRONGER: Lightweight Aluminum Frame Resists Chips and Dings
GREENER: Endura-grain is 99% Recyclable All Endure products have a Limited Lifetime Warranty and are available to Quick Ship in 2-4 weeks.
Contact your MTMC Rep to learn more! (800) 347-5440 I mtmcid.com
www.repertoiremag.com
•
June 2021
35
SPONSORED
NUANCE MEDICAL
Creating a Safer Physician Office Why reducing chemical exposure is right and required
Doctors’ offices often struggle to maintain compliance with Occupational Safety and Health Administration
(OSHA) regulations, including the Hazard Communication Standard. But following these regulations is essential to healthcare worker safety because they address substantial risks present in the physician office.
“ All it takes is one anonymous call from an employee for OSHA to be on your doorstep.” – Dr. Karson Carpenter, President of Compliance Training Partners
OSHA’s Hazard Communication Standard outlines how healthcare organizations must inform employees about any hazardous chemicals that they may be exposed to at work. It is designed to protect against chemicalsource injuries and illnesses by ensuring that employers and workers are provided with sufficient information to anticipate, recognize, evaluate and control chemical hazards and take appropriate protective measures. “All it takes is one anonymous call from an employee for OSHA to be on your doorstep,” said Dr. Karson Carpenter, President of Compliance Training Partners. Dr. Carpenter has extensive experience designing educational programs to bring medical facilities into compliance with government regulations. “There is a tremendous liability for physician offices,” he added. “Employees understand their rights 36
June 2021
•
www.repertoiremag.com
better than ever before and many physician offices don’t realize their risks.” Dr. Carpenter said these risks can easily be mitigated without using scare tactics. “We sell through better education,” he explained. “COVID-19 created a better awareness of risks in physician offices and those that have been reactive in the past have become more invested during the pandemic.” OSHA requires organizations to provide hazard communication training when a worker is initially assigned to a position that has the potential for hazardous chemical exposure. One example of a hazardous chemical is the topical anesthetic spray ethyl chloride, which is HAZMAT, toxic and extremely flammable.
Eliminate the hazard Fortunately, a safer alternative exists to ethyl chloride. CryoDose TA is a clinical and therapeutic equivalent to ethyl chloride, but is non-flammable, non-toxic and HAZMAT free. Unlike ethyl chloride, CryoDose TA’s safety profile allows it to be used on open wounds and intact oral mucous membranes, and it can be stored and disposed of as a normal aerosol. It is a safer and more economical alternative to ethyl chloride for today’s healthcare practice. “Patients and staff should know about new and safer products,” Dr. Carpenter said. “Owners and managers of physician offices like to tout products they use that are considered safer and it also creates loyalty from employees if they know their employer is protecting them.” By educating physician offices on least-toxic practices and introducing safer product alternatives wherever possible, distributor representatives can help healthcare facilities become models of health for their employees and patients.
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 Galaxy A lineup is cheap Samsung pulled back the curtain on a bevy of new affordable models for the U.S., including the company’s cheapest 5G smartphone yet, reports Engadget. At the top of the range is the $499 Galaxy A52 5G. Like Samsung’s more premium models, this phone will get three years of Android updates. The next step down is the Galaxy A42 5G. And then there’s the A32 5G, which at $280 is the company’s first crack at making a truly inexpensive 5G device. Rounding out Samsung’s lineup are the A12 ($180) and A02s ($110), which share the same 6.5-inch Infinity-V display.
Affordable internet for low-income families New York Governor Andrew M. Cuomo signed legislation in mid-April establishing a requirement for 38
June 2021
•
www.repertoiremag.com
affordable internet for low-income families. The legislation requires providers operating in New York State to offer $15/month high-speed internet to low-income families, including households who are eligible or receiving free or reduced-price lunch, supplemental nutrition assistance program benefits, Medicaid benefits, the senior citizen or disability rent increase exemptions, or an affordability benefit from a utility.
Spot on Verizon said its Hyper Precise Location (HPL) service – real-time kinematics service – would be available in more than 100 major U.S. markets in April. Verizon says the HPL can outperform today’s GPS technology and provides up to centimeter-level accuracy (compared with 3 to 9 meters with global positioning systems alone). It
can be applied to HD mapping, robotics, construction, manufacturing, and can support emerging technologies that depend on high-level location accuracy, such as delivery drones.
Wireless wiring: It’s going to get better Wireless charging has become more widespread, notes TechRadar in a recent article. So where do we go from here? U.S.-based company Aira is said to be looking to create a wireless charging solution that uses multiple coils across a larger area, which can intelligently detect the position of devices placed upon it. The end result is a charging pad that charges multiple devices without you having to worry about careful placement. Then there’s radiofrequency – RF – wireless charging. Energous’ WattUp solution envisions a future in which transmitters are built into larger objects like desktop monitors, which can then charge objects up to three feet away. Meanwhile, an Israeli company – Wi-Charge – is experimenting using infrared beams, which can detect and accurately deliver infrared beams to receivers anywhere in the room (so long as they are in the transmitter’s line of sight).
Disease hunters One day, we will use our cellphones to scan for COVID-19 or flu particles at airports, stores, ATM machines – anywhere. Researchers at General Electric have been awarded a National Institutes of Health grant to develop tiny sensors that can be embedded in mobiles to detect the presence of COVID-19 nano-particles, reports Engadget. “Our sensors are sort of like bloodhounds,” Radislav Potyrailo, a principal scientist at GE Research, was quoted as saying. With the help of the grant, the team will spend the next two years refining their fingertip-sized sensor in the hopes of placing it inside devices – ranging from phones to smartwatches to wall-mounted gadgets.
The pinging won’t stop! “The nonstop ping of notifications has become the daily soundtrack of our working lives,” writes Cognizant’s Euan Davis in a recent issue of Tech Radar. “Video calls have not only replaced regular meetings that would have happened face to face or via phone call, they have multiplied in a bid to compensate for the decline in direct contact. As a result, our days are spent communicating digitally, almost non-stop, about the work that needs to be done or that we are planning to do, which is actually impacting our ability to do the work in question.”
Partner with Integra LifeSciences for your customers’ Advanced Wound Care needs
MEDIHONEY® – Combining the art and science of wound care to help your customers achieve favorable patient outcomes • In a randomized controlled trial,1 the effects of use of a MediHoney dressing were studied in patients with Type II diabetes and Wagner Grade 1 and 2 diabetic foot ulcers (DFUs) over a 16-week period. • Mean duration of healing time was 31 days (± 4 days) in the MediHoney group vs 43 days (± 3 days) in the control group.
Want to know more about how to start the
conversation around MediHoney? View the 2 minute drill and start providing your customers versatile solutions for their advanced wound care needs.
1. Kamaratos AV, Tzirogiannis KN, Iraklianou SA, Panoutsopoulos GI, Kanellos IE, Melidonis AI. Manuka honey-impregnated dressings in the treatment of neuropathic diabetic foot ulcers. Int Wound J. 2012;9:1-7.
For more information or to place an order, please contact: USA 800-654-2873 n 888-980-7742 fax integralife.com
MediHoney, Integra, and the Integra logo are registered trademarks of Integra LifeSciences Corporation or its subsidiaries in the United States and/or other countries. ©2021 Integra LifeSciences Corporation. All rights reserved. XXXXXXXX-EN
SPONSORED
SYMMETRY SURGICAL
Clinically Equivalent, Superior Value Today’s dermatology market is dominated by two high frequency desiccators, with Symmetry Surgical’s Bovie®
DERM 942 the clear winner in a side-by-side comparison with the competitor. While both devices may be clinically equivalent, the advantages offered by the Bovie® DERM 942 include more state-of-the-art electronics, superior ease of use, modern styling, and a much longer warranty. In addition, the DERM 942 delivers all these advantages at a lower price. When they ask for a high frequency desiccator, customers need to know that the best option on the market is the Bovie® DERM 942.
Let’s start with the basics – electronics. The advanced digital design of the DERM 942 allows the user to change from low power to high power in one step, as opposed to up-to four steps required by the outdated technology of the competitive model. The plug-and-play foot switch control is also easier with the DERM 942. The competitor requires the user to purchase both a footswitch and a unique foot-control handpiece, then proceed through a cumbersome 6-step process to set it up. With the DERM 942, one only needs to purchase a footswitch and plug it in. If paying significantly more and taking much longer for setup is not bad enough, the competitor’s foot control format requires the loss of both energy activation and power level adjustment from the hand piece. Paying more and getting less is never an attractive option.
40
June 2021
•
www.repertoiremag.com
How about usability? While the competitor only allows 0.1 watt incremental adjustments in low wattage monopolar energy mode, the DERM 942 offers this precision in the low wattage of both monopolar and bipolar energy modes. The DERM 942 handpiece is slimmer and more ergonomic than the competitor. It also connects to the front panel via a simple two-pin plug as opposed to the antiquated design of the competitor that requires connecting a plug to the front panel and a flylead to the bottom Technologically ing panel. If the user forAdvanced, gets to disconnect both Superior Ease plugs, it will damage the of Use. competitor’s system. The DERM 942 handpiece includes a robust, gold-plated collet that secures the electrode and prevents it from spinning or slipping, as can occur with the competitor’s. The DERM 942 also includes a cleaner and more modern design, not only incorporating contemporary styling for today’s dermatology office, but also providing a much larger LED to allow for optimal visibility no matter the viewing distance or angle. And finally, the warranty included with the DERM 942 covers four years, while the competitor’s warranty only lasts 12 months, which speaks strongly to the design durability and the manufacturing quality of the Bovie® product. Why pay more and get less? When your customer requests a high frequency desiccator, you can confidently respond, “Doctor, I can get you whatever you want, but I would be doing you a disservice if I didn’t show you the Bovie DERM 942.”
The Bovie® DERM 942 Technologically Advanced | Superior Ease Of Use
OPTIMAL CONTROL - Better outcomes The Bovie® DERM 942 is designed and engineered to be the most advanced and reliable desiccator with superior ease of use. Heavy-duty collet to prevent electrode slippage Easy to Read Digital Power Display
Power Output Dial (1/10th watt increment adjustments from 0 - 10 watts)
Power Switch
Ergonomic 3-button Pencil (Rigid 2-pin connection) that works with footswitch
Table, Mobile Stand, and Wall Mountable
Patient Grounding Plate Receptacle
Footswitch Receptacle Bipolar and Monopolar Cord Receptacles
Ask your sales representative for a demonstration today.
customerservice@symmetrysurgical.com • 800.251.3000 • www.symmetrysurgical.com 05.04.2021 v2
REP CORNER
Channeling Grief Jessica Kavanagh fought her husband’s PTSD, and now she fights on behalf of other veterans and their caregivers Prior to meeting her husband, Brian, in 2009, Jessica Kavanagh had never known
anyone in the military. “It was like learning a whole new language and way of life,” says Kavanagh, an account representative for Medline serving post-acute facilities in Baltimore and surrounding areas. “And that was fine. I loved him and was so proud to be a part of something so big and so selfless.”
42
June 2021
•
www.repertoiremag.com
They got married in June 2011. Six month later, Brian was diagnosed with post-traumatic stress disorder following deployments to Iraq and Afghanistan. For the next four and a half years, the couple pursued treatment for Brian, their two young girls, and Jessica, the primary caregiver. But in June 2016, they lost the battle. “While his life did not end with suicide,” she says, “it was directly related to his PTS and substance abuse disorder.” Ever since, surrounded by friends of Brian, and by her own friends and family, Jessica has continued to fight for veterans like Brian and their families. She is the founder and president of VetLinks.org, a nonprofit organization that helps veterans and their families find the help they need to deal with the lingering trauma of war. “If we as a country are going to send our men and women to war, we have got to do a better job taking care of them when they come home,” she told lawmakers in June 2019 while testifying before the U.S. Senate Veterans’ Affairs Committee in Washington. Jessica was born in Williamsport, Pennsylvania. Her father, Robert Curry, coached football for 37 years at Lycoming College in Williamsport, Pennsylvania (which Jessica attended). Her mother, Susan, taught fifth-graders English and Reading for 34 years. Right after graduating from Lycoming College in 2001, she got a job with Total Scope Inc., in Boothwyn, Pennsylvania, which specializes in the repair of endoscopy scopes. “I worked there for 3 ½ years until I got a call from a recruiter about a post-acute position with Medline. Ten-plus interviews later, I was offered the position, and I accepted. www.repertoiremag.com
•
June 2021
43
REP CORNER It was a great move, and I have loved working for this company in so many ways.” Brian was commissioned through the Reserve Officer Training Corps as a Second Lieutenant in the infantry branch of the Army in 2002. He completed the Ranger School, and as a platoon leader, led in garrison and combat, receiving two Bronze Stars during his first deployment in Iraq. He was promoted to 1st Lieutenant and then Captain, at which point he transitioned to the Military Intelligence Branch. He served as an Intelligence Advisor to the Afghanistan Army and received another Bronze Star for service in combat. He finished his active-duty career as the Company Commander for Alpha Company, 308th Military Intelligence Battalion, 902nd Military Intelligence Group, where he earned the Meritorious Service Medal for his service to both Alpha Company and the Aberdeen Proving Ground Military Intelligence Detachment. He transitioned to the U.S. Army Reserve and was promoted to the rank of Major. He was activated to serve as the Chief of Joint Operations for the Joint Reserve Intelligence Support Element to the United Stated Africa Command J2 – Intelligence Directorate.
PTSD diagnosis “After Brian’s initial diagnosis and treatment for PTS, his symptoms steadily worsened,” says Jessica. After he transitioned into federal government service, the Kavanaghs sought treatment with a psychiatrist within the Maryland VA system. “We were assigned a social worker at a local Vet Center, where Brian had regular sessions along with couples’ therapy. Despite what we 44
June 2021
•
www.repertoiremag.com
NEW!
AliGuard Gloves
The new standard in radiation protection…
Hands down. Introducing AliMed® AliGuard Radiation Attenuation Gloves The latest in glove technology, AliGuard features higher attenuation for superior radiation protection and a more finely textured grip to grasp even the most delicate instruments—always in stock, always the right price.
Ask your local
Try them
FREE
rep for details
AliMed.com/aliguard 800.225.2610 | AliMed.com/rep
REPConnect member
REP CORNER
thought were our best efforts to manage his symptoms, they continued to worsen.” In May 2014, Brian acknowledged that he needed something more intensive. “We asked our VA counselor for recommendations, but they were unaware of where to direct us for inpatient help. I called the Veterans’ crisis hotline, but they said that if he was not suicidal, they were unable to assist. I searched for an inpatient unit for veterans with PTS and substance abuse, but none seemed to exist.” Ultimately, Brian received treatment at the Psychiatric Institute of Washington. “It did not seem to be the right fit for him, but we were desperate.” For two weeks, he stayed at this location with 14 46
June 2021
•
www.repertoiremag.com
‘ There are thousands of nonprofits to help our veterans who truly need help. Unfortunately, their caregivers have fewer resources.’ women who suffered PTS from sexual assault. Upon discharge, he began therapy with a private practitioner, at the family’s expense. By July 2015, Brian had become severely depressed, lying in bed for days if not weeks. In mid-September, Jessica got a call from a woman in Houston who had heard about the Kavanaghs’
struggles, and who told her of an upcoming congressional hearing, which former VA Secretary Bob McDonald was scheduled to attend. In October 2015, Jessica traveled to Washington, met McDonald and told him her story. Three days later, the Martinsburg VA Medical Center in Martinsburg, West Virginia, called with news that Brian could enter
WHAT’S THE DIFF? Now is the time to update from a 3-part to 6-part differential.
XN-330™
XN-430™
XN-530™
XN-L Series™ Automated Hematology Analyzers Upgrading to a XN-L Series™ automated hematology analyzer offers much more than a CBC with 6-part differential. 3-part
6-part Technology (WBC DIFF)
Direct current detection method
Fluorescent Flow Cytometry Remote monitoring and support over an encrypted connection. Access to additional Sysmex services and tools.
No
Remote Monitoring
No
BCQMh
No
Continuous Calibration Verification
Calibration status is confirmed every time multiple controls are analyzed, eliminating the need for scheduled calibrations.
No
Reduced Send-outs
All differentials include reportable immature granulocyte count with no additional sample preparation.
Real-time peer group comparison and monitoring of QC, and continuous calibration verification.
Contact your representative today or visit: sysmex.com/PhysiciansOffice © 2021 Sysmex America, Inc.
The XN-L uses BeyondCareSM Quality Monitor for Hematology (BCQMh) and remote analyzer monitoring to provide best-in-class service and confidence in results. Through BCQMh, QC is automatically submitted and calibration is verified every time multiple controls are analyzed, eliminating the need for routine calibration procedures.
a 90-day program there. “Brian seemed to be doing well there, and seemed to enjoy being around other veterans,” says Jessica. At Martinsburg, Brian realized that many of his fellow veterans were not receiving many of the benefits they had earned. “He started holding classes there, showing them with his laptop how to get set up for benefits, until he was told that he was not able to do this, being a patient himself. He continued to do so anyhow.” Three weeks before his scheduled discharge, Brian came home for Thanksgiving, but he had a relapse. “He did not do well at home with me and our two girls, who were three and one at the time,” says Jessica. “I was left with severe angst about his discharge in three weeks. When I spoke with the social worker, she said there really wasn’t anything more they could do. His program lead assured me that we would have a thorough discharge plan to help continue his progress” after the program ended. Brian was discharged Dec. 21, 2015. In January he began seeing a social worker at the local Vet Center, but was limited to only one visit every three to four weeks. Through her private therapist, Jessica found Brian a trauma therapist who was a Vietnam vet and who had previously worked at the VA. “We were paying for two sessions a week for Brian and one session a week for myself – and couples therapy when we could afford it. I applied for support from the VA Caregiver Support Program but was turned down. “Being able to ‘prove’ PTS proved difficult,” she says. “I felt like I was fighting a war on the inside of our household and a war on the outside against the VA, all while working 48
June 2021
•
www.repertoiremag.com
Photo credit: Emily Kane photography
REP CORNER
a full-time job and caring for our two young daughters.” On June 28, 2016, Brian lost his battle to PTS. “I received the phone call from the Baltimore police while driving down I-95. My entire soul was shattered in an instant. Never once did I feel that it would have ended like this. We were always just going to continue our fight. “During my eulogy, I vowed to continue the fight, even if it simply meant saving just one family from the hell that we had experienced. The day after his funeral, I sat around with his best friends [from his hometown, Pittsburg, Kansas] and told them of Brian’s desire to start a nonprofit to help veterans with PTS. Then and there in my living room, VetLinks.org was created.
VetLinks.org “I threw my grief into VetLinks.org, and we officially became a 501(c) 3 on December 20, 2016. A Christmas present from Brian.” “I’m not sure I can speak for any veterans,” she says today. “They go to war. They see their friends and comrades killed in front of them. There’s a lot of guilt for remaining alive. There’s a lot of guilt for having to kill another human. They suffer with nightmares and have moral injury. Their brains are rewired, learning how to survive each day in fight-or-flight mode. At any given moment they could set off an IED or get ambushed while on patrol. They’re on high alert every single moment. And leading a platoon (as Brian was), having to make tough decisions where lives are on the line, is extremely stressful.” With eight board members, two mentors and Jessica herself, VetLinks provides a variety of services to veterans
with PTS, traumatic brain injury and/ or substance abuse, including: ʯ Assistance in finding behavioral healthcare services. ʯ Connections to nationally recognized advocacy groups. ʯ Guidance during the process of submitting paperwork to the VA. ʯ Financial support for counseling, therapy, basic needs and more while awaiting VA assistance.
struggling with depression or substance abuse, the caregiver and the family most likely also need counseling. It’s a family affair – for the good, the bad, and unfortunately, the ugly.” Oftentimes, when a veteran returns home from active duty, people assume he or she should be happy to be alive and ready for life to return to normal, she says. “It doesn’t work that way. They come home and go back to their assignments without a
‘ I felt like I was fighting a war on the inside of our household and a war on the outside against the VA, all while working a full-time job and caring for our two young daughters.’ “We’ve actually found – and this may even be more our niche at this point – that we help the caregiver/ family of that veteran more than the veteran,” she says. “Thankfully, there are thousands of nonprofits to help our veterans who truly need help. Unfortunately, their caregivers have fewer resources.” VetLinks works with peer navigators, who work with the veteran and the caregiver every step of the way, says Jessica. “Most times, when a veteran or a caregiver reaches out for a particular reason, they actually need more assistance than what they called about. For example, if a veteran is looking for help with housing due to being homeless, they most likely need mental healthcare services as well. Or if a veteran is
plan. And there’s a stigma that goes along with asking for help.” The VA and the armed services offer programs for veterans who are depressed or suicidal, but more targeted outreach is needed for those most at risk for suicide, she says. Combat veterans, as well as medics and others who were exposed to trauma in the field, should be given a post-discharge mental-health plan of action, she says. Caregivers should be an important part of that plan. “Veterans are more likely to recover and thrive when their caregivers are embraced, engaged, and empowered in the healthcare system. Listen to the caregiver and families, support them, and you will see the veteran thrive.” www.repertoiremag.com
•
June 2021
49
WINDSHIELD TIME Chances are you spend a lot of time in your car. Here’s something that might help you appreciate your home-away-from-home a little more.
Automotive-related news Fire TV for Auto Amazon was preparing to launch at press time its Fire TV entertainment platform in Jeep’s 2022 Wagoneer and Grand Wagoneer SUVs, which will be the first to feature built-in Fire TV support, reports The Verge. Amazon’s software will be accessible from both the main display and rear seat screens. (Jeep says a privacy filter will prevent the driver from watching content while driving, although they’ll be able to watch when the car is parked.) Fire TV for Auto is designed to work alongside Uconnect 5, with added support for Amazon’s Alexa Auto technology for 50
June 2021
•
www.repertoiremag.com
things like smart home controls. There’s also a custom Fire TV remote with an integrated Alexa microphone and a Uconnect button to easily access in-car temperature controls or maps. Users will also be able to download content for longer trips where they’re not able or willing to use data to stream their favorite shows and movies.
Battery swaps for EV owners Ample, a seven-year-old San Francisco startup, wants to skirt a big hurdle to widespread adoption of electric vehicles by reviving the idea of quick, automated battery
Heroes put PATIENTS
FIRST.
Thank you for making us a small part of your story.
#healthcareheroes www.cepheid.com
WINDSHIELD TIME
swaps, reports Reuters. EV owners would no longer face wait times at charging stations. The system could replace a depleted battery with a fully charged one in less than 10 minutes. And the cost of the modular batteries could be amortized over longer periods of time, which in turn could lower the initial cost of an electric vehicle. Despite Ample’s business model, the roadblocks to success are many. Ten years ago, Israeli startup Better Place launched a battery swapping program. The company raised – and eventually burned through – more than $800 million before closing its doors in 2013 after failing to convince vehicle manufacturers to embrace the concept
manufacture a next-generation battery championed by Tesla Inc. as the key to unlocking cheaper and more ubiquitous electric vehicles, reports BNN Bloomberg. The catch: the thicker and more voluminous 4680 cells, named after their dimensions of a 46-millimeter diameter and 80-millimeter height, are still largely unproven. Industry experts even question whether the batteries are possible to mass produce. Much of the benefit of the new 4680 cells comes from the fact that they are more than five times the size of the smaller 1865 and 2170 cells Panasonic currently supplies to Tesla. This means that the typical 4,000 to 8,000 cells found in an EV today can be reduced to around 500, which, in turn,
Sonos latest audio company in car market Sonos has partnered with Audi to equip the automaker’s Q4 E-Tron with sound, a first for the California-based audio company best known for home speakers, according to The Verge. Sonos joins other audio companies that have made the jump to autos, including Bose, Bowers & Wilkins, and Bang & Olufsen. The partnerships are seen as a way for home audio companies to diversify revenue sources, and for automakers to use brands known for premium audio to sway buying decisions.
Next-gen battery for electric vehicles Panasonic Corp. is betting that close to a century of experience making car batteries has prepared it to 52
June 2021
•
www.repertoiremag.com
Much of the benefit of the new 4680 cells comes from the fact that they are more than five times the size of the smaller 1865 and 2170 cells Panasonic currently supplies to Tesla.
means fewer parts such as bonding pieces used to string individual cells together. The larger capacity, however, is also what makes the cells more difficult to produce. They are prone to overheating because it’s difficult to disperse heat from their center. They’re also more susceptible to particle contamination, a frequent cause of EV battery fires that occur when minuscule metal pieces find their way into the center of a cell.
Google Maps’ new features Google Maps introduced several features designed to make Maps more interactive, including one that makes it easier for users to share photos of locations they visit, reports CNN. The so-called photo updates are intended to give people an up-to-date sense of places they’re thinking of visiting. For example, they can see if a restaurant’s outdoor seating setup is shaded. In the coming weeks, users will be able to go to the new “Updates” tab when looking at a place on the app, snap a quick photo to add and write a caption, without having to leave a full rating or review. Google Maps is also
making it easier to report road changes, adding an option to “Edit the Map” that will let users correct errors, including drawing in missing roads, renaming streets or deleting incorrect roads. (Google says it will vet the changes.)
See what’s down the road with 5G Honda and Verizon have partnered up to research how 5G and mobile edge computing (MEC) can facilitate faster communication between cars, pedestrians and infrastructure, and help drivers avoid collisions, reports TechCrunch. Honda and Verizon’s premise is that 5G technology can handle communication far faster than a car’s computer. Instead of relying on a car’s less capable computer, information generated from connected cars, people and infrastructure would be sent into the 5G network. The payoff: Whereas a car relying on sensors and software might be able to understand the driver is about to hit something and hit the brakes, the MEC can almost see into the future by checking out and communicating what’s happening farther down the road.
MAR-117 (Rev 1)
HEALTHY REPS
Health news and notes Chocolate facts & fantasy Small studies suggest that cocoa, an ingredient in chocolate, may have health benefits. It’s possible that certain nutrients in cocoa could improve heart health and boost brain function, especially in older adults, according to the National Institutes of Health. Researchers think this may be due to compounds called flavanols, which cocoa beans contain in high levels. Flavanols are also found in tea, red wine, apples, and berries. If you eat chocolate as a sweet treat, however, remember that it has a lot of calories, and gaining weight will more than wipe out any benefits you might get from flavanols. Also, avoid white and milk chocolates, which contain little or no cocoa.
54
June 2021
•
www.repertoiremag.com
HEALTHY REPS Alexa is on Amazon’s Halos
Extreme preemies show improvement
Amazon launched a new feature this spring for its Halo fitness-tracking gadget – Alexa integration, reports The Verge. Halo owners can ask Alexa devices for various health stats, such as their sleep score or activity points obtained during the day. The integration will be off by default and owners will need the latest firmware on their Halo bands and the latest version of the iOS or Android app to enable it. Aside from the standard fitness things of tracking your movement and sleep patterns, the $100 Halo has the ability to police the tone of your voice and tell you when you’re being dismissive or condescending with your words. The companion Halo app also has a feature to 3D scan your body through your phone’s camera and measure your fat composition.
More than one quarter of babies who were born extremely premature and displayed neurodevelopmental impairments at age 2 may improve significantly by age 10, according to a study reported on by Reuters. An analysis of data from 802 children who were born extremely premature revealed that 63% of 227 classified as having moderate to severe neurodevelopmental impairment (NDI) at age 2, had none to mild NDI at age 10. Among 108 children classified as having profound NDI at 2 years, 36% had none to mild NDI at 10 years. Overall, 67% of the children had no change in NDI classification between 2 and 10 years of age, 27% improved and 5% worsened. “I hope these findings will allow parents and medical professionals to leave room for optimism when they hear a baby has been born extremely premature with profound neurodevelopmental impairments,” said Dr. Genevieve Taylor, an assistant professor in the division of neonatal and perinatal medicine at the University of North Carolina, Chapel Hill. “The brain is an amazing organ with so much capacity to change and to make lots of gains,” said Kimberly Blair, an associate professor of psychiatry at the University of Pittsburg and senior academic director of the UPMC Matilda Theiss Early Childhood Behavioral Health Program. “If kids start off with disadvantages, like being premature, so much goes into growth – nutrition, stimulation, environment. Getting early supports and services is really important.”
“ At this time, SARS-CoV-2 vaccines are injectable. Several vaccine manufacturers have started initial development of a nasal vaccine spray.” – Dr. Javeed Siddiqui, co-founder and chief medical officer at TeleMed2U.
Take it slow on the energy drinks A team of researchers, led by a Texas A&M University professor, has found that some energy drinks have adverse effects on the muscle cells of the heart. Researchers at the Texas A&M College of Veterinary Medicine & Biomedical Sciences (CVMBS), observed that cardiomyocytes – human heart cells grown in a laboratory – exposed to some energy drinks showed an increased beat rate and other factors affecting cardiac function. With global sales of energy drinks estimated at $53 billion in 2018 and rapidly growing, it is important to understand the potential unintended health consequences associated with these beverages, according to the researchers. Consumption of these beverages has been linked to improper beating of the heart, cardiomyopathy (disease of the heart muscle which makes it difficult for the heart to pump blood), increased blood pressure, and other heart conditions. 56
June 2021
•
www.repertoiremag.com
Next-gen COVID vaccines Millions of American adults have been rolling up their sleeves for the rollout of the three COVID-19 vaccines manufactured by Pfizer-BioNTech, Moderna and Johnson & Johnson. There may be some good news for those who are a bit squeamish with needles. According to Healthline, to make the vaccination process simpler and faster, researchers are working to develop the next generation of COVID-19 vaccines, namely in pill and nasal spray forms. “At this time, SARS-CoV-2 vaccines are injectable. Several vaccine manufacturers have started initial development of a nasal vaccine spray,” said Dr. Javeed Siddiqui, cofounder and chief medical officer at TeleMed2U. “Nasal spray vaccine could be available as soon as 2022, however this is highly variable based on clinical efficacy and vaccine effectiveness in clinical trials,” he said. According to FasterCures, a center of the Milken Institute that’s currently tracking the development of COVID-19 vaccines, five companies are developing oral vaccines. Two of these companies have moved on to phase 1 clinical trials.
SEPTEMBER 21–23, 2021 • CHICAGO, ILLINOIS
Your Opportunity To Connect With All Your Important Trading Partners
A Live Event For:
Distributors, Manufacturers, GPOs & IDNs MEETINGS Schedule private meetings with your strategic business partners.
Visit HIDAStreamlining.org
NETWORKING Connect with attendees through a variety of networking opportunities.
Register by July 6, 2021 to take advantage of early-bird registration rates.
LEARNING Share experiences and insights through interactive ShareGroups.
HIDA
A Global Pandemic Highlights the Value of Distribution Healthcare industry leaders convene to look forward and reflect on meeting pandemic challenges.
Medical product distributors’ perseverance and commitment to their healthcare provider customers were cen-
tral themes throughout the HIDA Educational Foundation’s Executive Conference in March. Leaders came together to look forward and reflect on the importance of a resilient supply chain. More than 600 executives from healthcare distributors, manufacturers, GPOs, technology firms, and provider organizations attended the virtual event.
Four key takeaways: 1. Distributors delivered core and new values. Distributors’ scope of responsibility expanded to a new level by protecting teammates and families while keeping life-saving products flowing to care providers. Panelists noted that in mid-March 2020 New York City and other metro areas were shut down while other
COVID accelerates trends in patient care In a wide-ranging discussion on COVID’s lasting impacts on healthcare market dynamics, CEOs from Henry Schein, Medline, and Premier shared their thoughts on COVID’s impacts on patient care. ʯ Telemedicine and the shift to patient care at urgent care centers and away from hospitals has been accelerated during the pandemic. ʯ The importance of collaboration between the private sector and government has been heightened. ʯ The government has a greater understanding of the uses of diagnostics such as point-ofcare rapid tests. ʯ Distributors who understand the healthcare market and regulatory requirements for medical products showed great value as trusted partners. ʯ COVID accelerated the movement to alternative payment models as providers continue to move away from a fee-for-service model to patient-centered care.
58
June 2021
•
www.repertoiremag.com
parts of the country hadn’t reported a single case of COVID. By working closely with governments and all links in the supply chain, distributors got critical pandemic-fighting products to the points where it was needed most. 2. D istributors reinforced their role as trusted healthcare partners. Medical products distributors responded to the pandemic by reliably delivering record levels of FDA-approved critical medical supplies to healthcare providers. In 2020, HIDA members distributed 51 billion units of PPE including 1,200% more N95 respirators than in 2019, noted HIDA President & CEO Matthew J. Rowan in a panel discussion with other healthcare industry executives. 3. D iversified sourcing strengthens the global supply chain. Ambassador Deborah Birx, M.D., the former White House coronavirus coordinator, said the U.S. will benefit from manufacturing medical supplies such as PPE and becoming an exporter of these critical products. Healthcare CEOs noted that countries working collaboratively outside their borders were able to obtain critical COVID-fighting products much more effectively than countries that put up barriers. 4. F ederal, industry partnership defined pandemic response. By working together, the government and commercial distributors can understand the planned health response for a variety of scenarios and what’s going to be required to save lives. By reviewing processes and reflecting on lessons learned during COVID, distributors, manufacturers and the federal government will continue to support supply chain resiliency, senior Strategic National Stockpile officials told attendees.
How can you help distribution reps sell more while improving outcomes and taking care of the caregivers?
Share Moving Media is committed to providing the med/surg community with timely, important content to help reps thrive during a crucial point in the industry’s history. Reps are turning to Share Moving Media platforms for content in record numbers. Consider the following:
Repertoire’s Web traffic is up 180% over 2019
2-Minute Drills taken are double in 2020 verses 2019
Repertoire Podcasts are up 265% over last year
Repertoire being read digitally is up 225% over 2019
Contact Amy Cochran to learn how Share Moving Media can be your content resource for 2021. 770-263-5279 acochran@sharemovingmedia.com
Share Moving Media is dedicated to providing our customers with the tools to increase their market-share through our publications, educational services and associations for providers, manufacturers and distributors in the business of healthcare.
NEWS
Industry News McKesson commits to set science-based targets to reduce greenhouse gas emissions McKesson Corporation has signed a commitment letter to the Science Based Targets initiative (SBTi), joining over 1,300 companies to commit to setting ambitious targets to reduce greenhouse gas emissions. The SBTi, a collaboration between CDP, the United Nations Global Compact, World Resources Institute, and the World Wide Fund for Nature, drives climate action in the private sector by encouraging companies to set science-based targets that aim to limit global warming to 1.5°C. By developing targets using climate science and the SBTi’s methodologies, McKesson will promote best practice in emissions reductions and demonstrate its commitment to bold climate action. “As a global leader in healthcare, we recognize our responsibility to protect our planet and drive change in climate action,” said Dr. Kelvin Baggett, chief impact officer, McKesson. “We’re committed to being an impactdriven company and are dedicated to setting targets that reduce our own climate impact, improving the health and well-being of the patients and communities we serve.”
BD to spin off Diabetes Care Business BD (Becton, Dickinson and Company) (Franklin Lakes, NJ) announced it plans to spin off the company’s Diabetes Care business as an independent, publicly traded company (“NewCo”). The transaction is expected to create two, independent companies with: ʯ Enhanced focus on strategic, operational and financial drivers to accelerate revenue growth ʯ Optimized product portfolios to better meet customer and patient needs ʯ More efficient resource and capital allocation to pursue each company’s strategic goals 60
June 2021
•
www.repertoiremag.com
Devdatt Kurdikar, who joined BD in February 2021 and is currently worldwide president of BD Diabetes Care, will be CEO of NewCo. Most recently, Kurdikar served as CEO and president for Cardiac Science, a global manufacturer of automated external defibrillators (AEDs) until the sale of the company to ZOLL Medical Corporation, an Asahi Kasei Group Company. Jacob Elguicze, former treasurer and head of investor relations for Teleflex, has joined BD in May 2021 and will be CFO of NewCo. BD says that NewCo’s revenue and manufacturing footprint are geographically diverse. In fiscal 2020, the Diabetes Care business generated revenues of nearly $1.1 billion, with 48% of revenues generated outside of the United States, including 17% of revenues from emerging markets. NewCo will have manufacturing sites in the United States, Ireland, and China, and is expected to have office locations in New Jersey and Massachusetts. Following the spinoff, BD will maintain category leadership positions across its portfolio in the BD Medical, BD Life Sciences and BD Interventional segments. BD Medical, which today includes the Diabetes Care business, will continue to be the global leader in end-toend medication management solutions with its BD Alaris brand of infusion pumps, BD Pyxis brand of medication and supply dispensing solutions, BD HealthSight data and analytics platforms and its breadth of medication delivery devices. It will also continue to be the global leader in prefilled injectable delivery devices through its innovative pre-fillable syringes, self-injection systems, safety systems and needle technologies. BD expects the spinoff to be accomplished through a distribution of stock in NewCo to BD shareholders. The transaction is also expected to be completed in the first half of calendar year 2022.
SAVE NOW! 2021 PROCEDURE ROOM PROGRAM
Your customers can SAVE NOW on Midmark® Procedure Chairs, Ritter® LED Lighting, Midmark® Mobile Procedure Download the promo details and
Carts and Ritter® Stools! Don’t miss this opportunity—be
a patient positioning infographic
sure to tell your customers about these deals!
you can share with your customers at:
(These offers end June 30, 2021.)
midmark.com/CustomersSAVE © 2021 Midmark Corporation, Miamisburg, Ohio USA
Tough on germs™ Meet Ventyv®. Infection prevention is our calling. Ventyv® is the premier brand of Sri Trang USA, Inc., a member of the Sri Trang Group – a proven glove producer protecting the world against infection since 1991. We look forward to protecting your customers and their patients.
.
.
.
Visit ventyv.com/rep or sritrangusa.com/rep for more information Hello@ventyv.com Sri Trang USA, Inc. 5820 W. Cypress St., Ste H Tampa, FL 33607
