Repertoire June 22 by BOC design Inc

vol.30 no.6 • June 2022

Shannon Bream’s Journey in American Media The host of Fox News @ Night shares insights on news gathering, team building, and content creation with Repertoire.

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JUNE 2022 • VOLUME 30 • ISSUE 6

Shannon Bream’s Journey in American Media The host of Fox News @ Night shares insights on news gathering, team building, and content creation with Repertoire.

PUBLISHER’S LETTER

TRENDS

Face-to-Face Business...................... 2

PHYSICIAN OFFICE LAB Making the Complex Simple for CLIA Some insights and resources to help you and your customers get more comfortable with CLIA compliance............. 4

NDC

Bolstering Home Care Models Health systems look to expand care delivery services in Hospital-at-Home programs post pandemic............................. 20

Cracks in the Foundation? After years of improvements in patient safety, along came COVID-19.................... 32

IDN NEWS IDNs in the News................................... 36

NDC Exhibition ignites “SIMPOW LIVE”

Courtesy of NDC............................................ 8

HALL OF FAME EVENT Medical Distribution Hall of Fame............................................... 14

TRENDS Stretched to the Limit In long-term-care facilities, who has time to see suppliers when there’s so much work to do?.................................... 40

Housing and Health CVS Health is advancing health equity via affordable housing...................... 47

Breaking the Rules of Healthcare: Following the Science Why today’s doctors will provide the best care by following the science – and listening to patients............................... 48

REP CORNER The Jersey Guy A little serendipity and a lot of talent led one manufacturers sales rep down a successful path............................................ 52

WINDSHIELD TIME Automotive-related news.......... 54

MARKETING MINUTE Why Most Healthcare Content Marketing Fails See better results from your healthcare content marketing by avoiding these pitfalls................................................... 56

HIDA Bipartisan Preparedness Legislation Advances in Congress.................................................. 57

NEWS Primary Care News.............................. 58 Industry News........................................... 59

REP CORNER Angi Muse: Jack of All Trades for Booth Medical................................ 50

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 2022 by Share Moving Media. All rights reserved. Subscriptions: $49.00 per year for individuals; issues are sent free of charge to dealer representatives. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address. POSTMASTER: Send address changes to Repertoire, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors. Periodicals Postage Paid at Lawrenceville, GA and at additional mailing offices.

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June 2022

PUBLISHER’S LETTER

Face-to-Face Business By the time you read this Publisher’s Letter, most of the national sales meetings will be

in the books, with the exception on maybe IMCO’s, because it’s this month. For most of us, this was the first time we were all back together in 2-3 years. It feels good, doesn’t it? Face-toface business is what makes our industry such a relationship business. Hopefully you not only got to see friends and colleagues, but you were also able to learn from your suppliers and peers during these meetings. The summer months tend to slow business down for those of us in medical sales, which makes it a great time to step back and zero in on your selling skills and product knowledge. Even though times have changed, we do still sell products and services to our clients. The ability to bring new and existing opportunities to your end-users, which help their practices and patients, is what sets you apart as a rep and justifies the margin you write. My challenge to you as a professional salesperson is to stop for a minute and write down three things you want to work on during the summer months to improve yourself as a salesperson. It may be taking a sales course or going in to RepConnect and watching one 2-Minute drill a day for 30 consecutive days. It may be listening to a podcast series on selling today or each of the last 10 Repertoire podcasts sponsored by the suppliers who support you. Whatever you choose, do it knowing you’re making yourself better for those you care about the most – your family, your clients, and yes, even yourself. I hope you take the summer challenge and look back on it as the time you invested in yourself, and you see the fruits of that labor in the following months when we head back into selling season. As I close this Publisher’s Letter, I would like to thank Shannon Bream for taking the time out of her busy schedule to let us interview her on my podcast and for this cover story. I’ve known Shannon personally since we were in college, and I can attest that she is the real deal and genuinely one of the kindest, most honest personalities in 24-hour news. I hope you enjoy this read, and if you have time, listen to my podcast with her on Repertoiremag.com. Have a wonderful summer.

Scott Adams

Dedicated to the industry, R. Scott Adams

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

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PHYSICIAN OFFICE LAB

Making the Complex Simple for CLIA Some insights and resources to help you and your customers get more comfortable with CLIA compliance. CLIA ’88 has been in place now since 1992 and is still probably one of the most misunderstood

obstacles to a creating and managing a successful moderate complexity physician office lab. While manufacturers and distributors have deployed an increasingly impressive range of specialist sales personnel and a broad range of consultative resources to help the distributor account manager, customer concerns and reluctance continue to provide a daily struggle for all of us involved in the physician office laboratory market. In this article, I intend to review some of the laboratory license statistics and take a fresh look at the array of resources available to help you and your customers become comfortable with compliance with CLIA, and to manage an outstanding, profitable, and productive physician office laboratory.

What does the CLIA lab license data tell us? The total number of laboratory licenses has grown from about 207,000 in 2008 to 262,000 in 2018, an increase of over 26%. That’s the good news. What about the moderate and high complexity licenses? In 2008, there were 35,673 of them. In 2018,

the number dropped to 33,674, a decrease of about 6%. What are some of the reasons? There are a number of factors in play, and it’s not easy to determine which are the most influential. But, they include factors ranging from consolidation of some physician practices to physician retirements and purchase of practices by IDNs as well as shut

By Jim Poggi

downs related to PAMA reimbursement cuts and inability to keep current with CLIA regulations. While we cannot influence the more macro trends including practice consolidation and IDN practice purchases, we can assure we actively support our current customers and support new customers considering investing in a moderate complexity lab.

Managing and coaching the current customers This should always be our first priority. In last month’s column, I addressed how to prevent the current customer from making the decision to cease testing. Simply stated, you need to work with your key laboratory suppliers and stay in close touch with your customers to assess their lab quality, personnel satisfaction and technical performance. To do so successfully really requires a commitment to thoughtful and frequent business reviews, drawing out small issues before they become significant roadblocks that could endanger the future 4

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PHYSICIAN OFFICE LAB of your customer’s lab. Once you know the lab’s overall performance, you and your key manufacturing partners can develop a program that addresses technical performance, workflow and test menu customization to optimize lab quality and staff satisfaction. Along the way, be sure to gain guidance and recommendations from your lab specialists and home office laboratory product team. You have three key levers to manage: financial results, clinical performance and workflow. If you see each current customer’s concerns through this lens, you can quickly create a list of addressable items that fall under each element of value. In the process, you can also seek to gain customer agreement that these three pillars of value and the most important ones and create programs to provide a better solution.

that as a full test menu keep the lab profitable. From time to time, it will result in retiring an older piece of lab equipment and investing in new equipment more suited to changes in their patient mix and treatment program requirements.

Working to develop new customers While you may at first think it is a matter of you and your key lab supplier “going it alone” to understand the customer’s needs and develop a solution, there are, in fact, a surprisingly large number of other sources of help. As examples, many professional medical associations including the American Academy of Family Physicians manage a library of resources designed to train and coach physicians desiring to manage a physician office

Be sure to check with your colleagues and customers to understand which consultants offer the greatest value for our POL customers. As always, as you propose and implement solutions, seek agreement from the customer that you have selected the key items to resolve and that the proposed solution has created improvements without causing new issues. Most frequently this process involves understanding the training needs of the lab staff, helping them to get the most out of the lab instruments they have invested in and to review technical performance with your key supplier’s technical staff. It also helps to review their testing pattern to help assure they are performing tests that are both needed for patient treatment programs and performing those tests 6

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laboratory including on line programs to guide physicians on how to qualify as a lab director. Some, including AAFP also provide their own proficiency testing programs designed to reduce concerns about how to properly assure test performance. One resource I find that is often overlooked is the Centers for Disease Control and Prevention (CDC). They have an exceptional range of helpful documents and training materials covering the gamut from applying for a license to personnel requirements. The link to their information can be found here www.cms. gov/Regulations-and-Guidance/ Legislation/CLIA/CLIA_Brochures.

COLA has also been a third party educational resource for a number of years. They provide customer training and development resources aimed at developing a quality oriented POL. The link to their home page: www.cola.org. Many experienced distributor account managers have relied on COLA as one of their key customer assistance sources for years. There are also a number of independent lab consultants available. Be sure to check with your colleagues and customers to understand which consultants offer the greatest value for our POL customers. In addition, don’t overlook the assistance your LIS and EMR providers can provide. Their sophisticated range of result management tools can help with storage and retrieval of patient data, quality control program result management and even workflow tools. Some of the more sophisticated LIS providers even offer a turn key program specifically intended to support on line CLIA compliance for the POL. This is becoming a more popular option for a number of customers due to its ease of use and comprehensive but simple method of assuring the POL knows what it needs to do and has the tools required for successful CLIA compliance. When the physician office laboratory is properly implemented and well managed, it is a powerful tool for management of patient treatment programs. Like any other tool, it requires thoughtful attention to detail and refinement over time to maintain its effectiveness. Stay engaged, stay informed, and grow your physician office laboratory business. Your customers will thank you and their patients will benefit.

SPONSORED

B. BRAUN MEDICAL

A Sustainable Approach At the forefront for over 40 years, B. Braun takes aim at chemicals of concern

Embracing a sustainability mindset in healthcare links health systems to safer products for patients and staff and greener operations. Today, it’s a

business approach across many global industries. Distribution representatives must keep sustainability in mind when talking to end users. “Sustainability in manufacturing is a social and economic imperative,” said Rick Williamson, Vice President of Marketing, Channel Development, and a leader of sustainability initiatives for B. Braun Medical Inc. (B. Braun). “Sustainability includes producing zero landfill waste, avoiding use of hazardous substances and contributing to the communities that B. Braun works in.” Sustainability has been fundamental to business for B. Braun for decades. The company’s sustainability goals include achieving a 50% reduction in CO2 emissions globally by 2030 and assessing 80% of its direct supplier spend against global sustainability standards. B. Braun is reviewing its entire portfolio of products and focusing 1

on eliminating chemicals of concern, such as Diethylhexyl phthalate (DEHP) or polyvinyl chloride (PVC) plastic. We are continuously working with our suppliers to identify shortterm safer materials. The changes in product formulation will often result in manufacturing changes as well. “Manufacturing methods are often times reliant on the materials of construction,” said Dawn Kentner, OEM Product Development Manager for B. Braun. “Changes could be as simple as new tooling or as complex as an entire manufacturing line being rebuilt to accommodate material or chemical changes.” This takes significant investment. B. Braun has invested more than $1 billion since 2019 to upgrade facilities in Irvine, CA, Allentown, PA and launch its latest intravenous (IV) solutions manufacturing plant

in Daytona Beach, FL, which manufactures IV bags not made with DEHP or PVC plastic. A growing body of evidence shows that Americans receiving care in hospitals and other settings can be exposed to dangerous levels of phthalates, a family of industrial chemicals used to soften PVC. “DEHP is an ortho-phthalate that’s considered to be a carcinogenic, reprotoxic, and endocrine disrupting chemical (EDC), linked to a growing list of illnesses and disorders that afflict people,” Kentner said. Products not made with DEHP help protect patients, particularly susceptible populations including male pediatric and neonatal patients, pregnant and lactating women, and patients receiving certain chemotherapy medications. PVC contains vinyl chloride which according to California Proposition 651 is a carcinogenic substance, but Kentner says it’s not eco-friendly either. “We’re assessing our products for changes in materials, especially in the case of ortho-phthalate plasticizers like DEHP.” B. Braun containers and bags for IV solutions, medications, and irrigation are not made with DEHP or PVC. The company is committed to reducing DEHP and PVC across its’ extensive product portfolio. “We’re constantly reviewing our product line and seeking alternatives, and I’m proud of our efforts,” Williamson concluded.

EHHA Science for Health California. Proposition 65 Warnings Office of Environmental Health Hazard Assessment: Di(2-ethylhexyl)phthalate O (DEHP). June, 2017. https://www.p65warnings.ca.gov/factsheets/di2-ethylhexylphthalate-dehp

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June 2022

NDC

NDC Exhibition ignites “SIMPOW LIVE” Courtesy of NDC

Over 700 attendees gathered for the two-and-a-half-day NDC Exhibition in Nashville, Tennessee, April 11-13,

2022. The SIMPOW LIVE theme captured the industry excitement of returning to fully live, in-person events after two years of virtual/hybrid meetings.

The Coag-Sense team meets with distributors during the new vendor roundtable format in the manufacturer hall.

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Throughout the exhibition, medical and physical rehab distributors and manufacturers enjoyed educational and networking events – taking the much-needed opportunity to reconnect with colleagues, friends and industry family. During his opening remarks to kick-off the event, NDC President & CEO, Mark Seitz, announced the expansion of the NDC executive leadership team, including NDC’s first Chief Supply Chain Officer, David Mintz, and NDC’s first Chief Transformation Officer, Bruce Horka. Seitz also discussed NDC’s current technology investment underway focused on integrated systems to deliver improved data management and a superior distributor ecommerce experience. These investments aim to position NDC with increased operational competency at every business intersection to better serve distribution partners.

Guests enjoy line dancing lessons to kick off the closing celebration at the Wildhorse Saloon.

New format facilitates strategic conversations This year, NDC introduced a new “vendor roundtable” format, replacing the traditional exhibit floor. Allowing for both pre-scheduled and walk-up meetings, the exclusive vendor-hosted tables provided an enhanced setting to foster strategic business conversations. The manufacturer hall also showcased exhibitor booths for manufacturers who opted for the traditional format, providing product training and demonstrations for distributor attendees.

Making a Difference Together NDC partnered with the Wounded Warrior Project (WWP) to honor military, law enforcement and first responders over multiple events to reinforce military appreciation. The NDC Golf Tournament benefiting

Gerry LoDuca performs with his band, The Defribrillators, with special guest, Matt Rowan.

the WWP brought over 100 golfers out on the greens at the Gaylord Springs Golf Links. Despite the weather, golfers enjoyed networking and coming together for a great cause with great company. NDC attendees collectively raised over $25,000 to advance the WWP mission through charitable events including the golf tournament, silent auction and Military Appreciation Night at Redneck Riviera thanks to gracious sponsors GOJO and B. Braun. The entertainment for the evening featured

Dukal President and Owner Gerry LoDuca and his band, The Defibrillators, with surprise guest, Matt Rowan, president & CEO of HIDA, for a memorable performance.

Recognizing Exceptional Partnerships The annual awards presentation recognized the achievements of NDC’s 2021 top-performing partners. WWP highly decorated soldier Dan Nevins emceed the awards event to honor and congratulate the 2021 NDC Award Winners. www.repertoiremag.com

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June 2022

NDC Supplier Awards: Outstanding Performance Awards ʯ Exel Corporation ʯ Clarity Diagnostics ʯ Mölnlycke Health Care ʯ SteriCare Solutions ʯ Symmetry Surgical ʯ Quidel Corporation NDC Medical Distributor Awards: NDC Fast Track Awards ʯ Smart Medical Solutions ʯ Logic Medical NDC Trendsetter Award ʯ Allied Medical Products ʯ Thomas Scientific

Michael Einhorn accepts Dealmed’s NDC Medical Member of the Year award with John Cook and Mark Remaley.

Medical Member of the Year ʯ Federated Healthcare Supply ʯ Dealmed Medical Supplies NDC Physical Rehab Distributor Awards: NDC Outstanding Warehouse Performance Award ʯ Cornish Medical NDC Equipment Trendsetter ʯ MedQuip NDC Pro Advantage Award ʯ Electro Medical Equipment

Bob Stengele and Bob Stengele Jr. receive the NDC Physical Rehab Member of the Year award, presented by Lori Paulson and Suzanne Swan.

NDC Physical Rehab Manufacturer of the Year ʯ HawkGrips NDC Physical Rehab Member of the Year Award ʯ Advanced Rehab Systems

Powerful Education and Events Presented by Midmark Corporation, Peter Sheahan delivered the keynote address and unpacked how to balance the need for prompt action with the need to maintain the capacity, capability and engagement required 10

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Patrick Thomes enjoys a day on the course with the Clorox foursome.

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NDC to make the most of the massive opportunities that inevitably emerge from crisis. Ian Fardy hosted industry panelists for a session on “Building Better Partnerships”, presented by Mölnlycke, to showcase the acceleration of manufacturer and distributor relationships in today’s environment. Addressing various aspects of sales collaboration – including rep group partnerships – panelists shared ways to bridge gaps to ensure success is delivered through alignment and partnerships in the post-pandemic environment. Gary Corless, Wounded Warrior Project®, in his “Failing Forward” presentation shared real-time experiences on how to drive success through pioneering business growth and transformation even when you fail … as long as you learn and advance forward from that lesson. Karson L. Carpenter presented proven ways distributors and their sales teams are attracting customers to grow their business by offering OSHA, HIPAA and Infection Control Training

B. Braun’s Don Lovre and Jim Oliver and Craig Dudash from 613 Med golf with Wounded Warrior, Jessie Fox.

Ian Fardy and Natalie Martin from NDC with Gary Corless and the Wounded Warrior Project team.

Building Better Partnerships: Chris Fagnani, Rob Saron, Lori Lanning and Bill Sparks.

HemaSource’s Michael Lischka and Michelle Autry enjoy catching up with Rich Baldocchi

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Products. Breakfast speaker and American singer and media personality, Janine Stange took attendees on a journey across the nation that culminated with her historic singing accomplishment in all 50 states. Physical rehab manufacturers presented highly interactive rehabfocused rotations to connect rehab attendees with products and services as well as valuable strategies to keep their bottom line strong.

The exhibition concluded with NDC’s hometown tradition, hosting the Closing Party at the Wildhorse Saloon in downtown Nashville. Guests enjoyed dinner, line dancing and a performance by Nashville Broadway entertainer, Chris Weaver Band, sponsored by BD and Dukal. Next year, NDC Exhibition will hit the road to Dallas, Texas May 15-17, 2023 at the Gaylord Texan Resort and Convention Center.

SPONSORED

SRI TRANG

How the International Labour Organization is Addressing Human Rights Issues Around the World Would you want to know if the companies you’ve partnered with are responsible for human rights violations?

The International Labour Organization is working to identify violations of human rights in the workplace throughout the world, especially in countries like Malaysia where foreign workers are recruited and exploited.

Billy Harris, CEO of Sri Trang USA, recently spoke to Repertoire about how the International Labour Organization is addressing the ongoing human rights issues workers are facing all over the world. In the last few years, six glove manufacturers have been issued withhold release orders by U.S. Customs and Border Protection. Harris uses his insights to discuss what this means for the industry and the workers, and how we can move forward.

What is a withhold release order? A withhold release order (WRO) is used to put a hold on products or services coming out of factories where U.S. Customs and Border Protection believes the worker’s rights are being exploited. Harris explained, “Today, there have been six glove companies subject to Withhold Release Orders. All of them since September 2019. Only two of those companies have worked through the process to have the WRO lifted. Right now, there are four WROs still in place, and we believe there’s a chance that there will be others to be issued in the coming weeks and months.” The International Labour Organization (ILO) represents labor forces across the world, working to identify

“ Today, there are currently six glove companies that have been impacted since September of 2019 that have been issued a withhold release order.” – Billy Harris, CEO of Sri Trang USA

labor violations and worker exploitation. The ILO has 11 indicators of Forced Labor: deception, restriction of movement, isolation, physical and sexual violence, intimidation and threats, retention of identity documents, with holding of wages, debt bondage, abusive work and living conditions, abuse of vulnerability, and excessive overtime. Once the WRO is issued by U.S. Customs and Border Protection, the company must go through an appeals process to get a release. If the WRO is moved to findings, it means the CBP has substantial evidence to support its assertion that forced labor is being used and uphold the WRO.

How should distributors respond? From an ethical standpoint, Harris argues that it should be easy to not offer any brands with WROs. While distancing your organization from those brands may cause a

disruption in supply, it could save the integrity of your business in the eyes of your customers. Harris says, “One of the large distribution companies made a very bold statement and with one of the companies that they were doing business with that was subject to a WRO. The day after, they returned 100% of their inventory to the company and said, ‘We’re not going to do business with you until you have all of these things corrected.’” Making decisions like this won’t be easy, but conducting business with moral integrity can require difficult decisions. The ILO will continue to investigate potential human rights violations, and more WROs will be issued in the coming months and years. What will you do if one of the organizations you partner with is in violation of international labor laws? To hear the full episode, visit reper toiremag.com/resources/ podcasts. www.repertoiremag.com

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June 2022

HALL OF FAME

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HALL OF FAME

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TRENDS

Bolstering Home Care Models Health systems look to expand care delivery services in Hospital-at-Home programs post pandemic. By Daniel Beaird

A recent report from McKinsey & Co. stated that as much as $265 billion worth of care services for Medicare fee-for-

service and Medicare Advantage beneficiaries could shift to the home by 2025, representing a three- to fourfold increase in the cost of care being delivered at home for this population.1 The COVID-19 pandemic accelerated this movement and a significant portion of it came through Hospital-at-Home (HAH) programs, which enable some patients who need acutelevel care to receive it in their homes rather than in a hospital, thus aiming to reduce costs, improve outcomes and enhance the patient experience.

CMS launched the Acute Hospital Care At Home program in November 2020, during the first year of the pandemic. It provided hospitals the flexibility to care for patients in their homes, originally helping relieve facilities of non-COVID patients to assist in tackling the surge of COVID-positive patients. As many HAH programs evolved throughout the pandemic, they shifted to enrolling COVID-positive patients as well to finish their hospitalization at home. Now, COVID-positive patients are enrolled directly from emergency departments. “One driver to more enrollments is the barrier of obtaining reimbursements for short-term oxygen,” Peter Read, MD, medical director of Des Moines, Iowa-based UnityPoint Health’s hospital-athome program, told AHA’s Advancing Health podcast in February.2 “We worked with our ACO to develop a waiver that allows us to dispense shortterm oxygen to overcome reimbursement.” UnityPoint Health has achieved $900,000 in shared savings from just its 20

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hospital-at-home program, and many of its other home-based services were in increased demand due to the pandemic. The Midwestern health system has enrolled over 150 patients in its program and averted over 100 hospitalizations during the pandemic. In January, Baxter International, Global Medical Response (GMR) and Cardinal Health led a $110 million investment round in Boston-based Medically Home, a technology-enabled services company that provides tools to allow medical providers to shift

advanced medical care from hospitals to patients’ homes. Mayo Clinic and Kaiser Permanente also contributed. These partnerships and investments are supporting the evolution of flexible hospital capacity toward hospital care at home and utilization is expanding. Medically Home’s hospital-athome program configures a network of clinical and non-clinical services, medications, equipment and supplies to patients’ homes, enabled by the CESIA Continuum® enterprise

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TRENDS platform for orchestrating highacuity care in patients’ homes. The model is expected to increase demand for a next-generation clinical workforce that combines centralized care oversight by physicians and nurses in medical command centers with nurses, paramedics and technicians in the field. “When supporting home health, many hospital systems either have their own or partner with home health agencies, and the same is true with hospice,” Philip Parks, MD, MPH, vice president of healthcare innovation for Cardinal Health atHome Solutions, said. “Our strategic partnership with Medically Home allows us to work indirectly with health systems to enable the future of hospital-at-home.” “It’s like the ‘Geek Squad’ of healthcare. Patients need at-home providers to come inside, set up the medical equipment and show them how to use it. Patients don’t just want it left on their doorstep – imagine being admitted to a hospital bed… but in your home,” he said. Parks describes Cardinal Health as a healthcare enabler – the logistics and supply chain behind so many patient experiences at scale in large acute facilities. That same philosophy is also how Cardinal Health at-Home Solutions approaches medical supply distribution for care in the home. It ships medical supplies and over-thecounter products to home medical equipment (HME) providers, home health and hospice agencies (HHA), E-commerce providers and directly to patients’ homes across the U.S. Much like the partnerships and investments from Cardinal Health, Baxter International and GMR in Medically Home, the healthcare industry as a whole is advocating for more home care options. 22

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“ In the future, we would like to begin administering monoclonal antibody treatment at home for those COVID-positive patients at high risk for complications.” – Peter Read, MD, medical director of Des Moines, Iowa-based UnityPoint Health’s hospital-at-home program

Philip Parks

Advanced Care at Home Coalition UnityPoint Health is part of the Advanced Care at Home Coalition led by a steering committee comprised of the three founding members, including Mayo Clinic, Kaiser Permanente and Medically Home. Its 12 other members is a list of prominent health systems, including Baltimore-based Johns Hopkins Medicine, which was a leader under Bruce Leff, MD, in these programs in the mid-1990s. The coalition has applauded the recent introduction of the Hospital Inpatient Services Modernization Act, which would extend the Acute Care at Home waivers that have allowed expanded delivery of hospital-level care at home for Medicare beneficiaries during the pandemic. The bipartisan legislation sponsored by Sens. Tom Carper (D-DE) and Tim Scott (R-SC), and Reps. Brad Wenstrup (R-OH) and Earl Blumenauer (D-OR) extends the

waivers for two years beyond the duration of the COVID-19 public health emergency and it requires CMS to issue regulations establishing health and safety requirements for Acute Hospital Care at Home programs within one year of the bill’s enactment. It’s supported by more than 100 health organizations and healthcare associations. “By extending these flexibilities, Congress will create a predictable pathway for medical professionals to fully realize advances in the care delivery system that enable patients to be treated with safe, equitable, person-centered care in the comfort of their own homes,” said Stephen Parodi, MD, executive vice president of The Permanente Federation at Kaiser Permanente, which has provided hospital-level care at home to more than 1,100 patients. “We adapted to COVID-19 by developing pathways to deliver the COVID-19 vaccine to those unable to obtain one through traditional pathways,” added Dr. Read. “We are also testing patients for COVID-19 who are unable to leave their homes. In the future, we would like to begin administering monoclonal antibody treatment at home for those COVID-positive patients at high risk for complications.”

Mount Sinai’s model New York-based Mount Sinai Health System was awarded a Center for Medicare and Medicaid Innovation

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TRENDS (CMMI) award in 2014 to launch its hospitalization-at-home program, building upon its home-based primary care program for homebound patients in Manhattan, N.Y. “I had always been frustrated as a primary care physician in someone’s home where I knew the patient had pneumonia and needed an IV and antibiotic, but because of all the rules, regulations and prior authorizations, I couldn’t treat them with IV antibiotics at home very easily,” said Linda DeCherrie, MD, clinical director of Mount Sinai at Home, told the AHA.3 When Mount Sinai received the project grant from CMMI, the patients they took care of were Medicare fee-for-service patients for three years of the grant. After that, it had to pivot to Medicare Advantage plans, commercial and managed Medicaid. It formed a joint venture with Nashville, Tenn.-based Contessa Health in 2017 for the ability to negotiate with various insurance plans for bundle payments. Contessa Health aids its provider partners in addressing these challenges in the new standard of care. Negotiation challenges are some of the biggest barriers for these programs starting up around the country, according to Dr. DeCherrie, but Mount Sinai’s program has been very successful and popular with patients. “I don’t think we had a single patient decline joining the program,” said Dr. DeCherrie. “People were wanting to get out of the hospital, especially during the height of the pandemic with a no visitor policy. They wanted to go home as soon as they could.”

Negotiation challenges are some of the biggest barriers for these programs starting up around the country, according to Dr. DeCherrie, but Mount Sinai’s program has been very successful and popular with patients. The New York health system launched the second part of its program during the pandemic and called it Completing Hospitalization-atHome. This was aimed at patients who had been in the hospital, even as a COVID-positive patient in the ICU but were on a healing trajectory. Some of the state of emergency waivers allowed Mount Sinai to implement the program. They had it up and running within two weeks of the issued state of emergency. It began with non-COVID patients, but eventually extended to COVID-positive patients. “The pandemic has shined a light on what needs to evolve and modernize in healthcare,” Parks said. “Taking COVID-19 tests in our homes, for example, is an expectation now. Patients’ behaviors have changed and that makes it easier for adoption of new procedures – saving them time and money.”

1. From facility to home: How healthcare could shift by 2025 2. Hospitals at Home with UnityPoint Health 3. Members in Action: Mount Sinai Health System

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“The question is ‘can we create something that the customer wants to use in-person’ and it creates value for them and their experience,” Parks explained. “Milestones are based on asking patients what they would like to have happen in their hospital at home experience. We can make those things happen, test them and find ways to scale them to the broader marketplace.” Parks says it’s still early in the adoption phase, but it’s a different world of expectations from only two to three years ago, and that’s a silver lining from the pandemic. “The broader idea is the continuum of care and how people want to experience health and wellbeing, potentially getting care in the comfort of their own homes,” he said. “And generationally, we have a group of younger people that can’t imagine doing it the old way.”

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June 2022

By Pete Mercer

Shannon Bream’s Journey in American Media The host of Fox News @ Night shares insights on news gathering, team building, and content creation with Repertoire.

Developing a plan for your career is a wise decision in just about every

respect, but it doesn’t mean that the plan is going to come out exactly as you initially thought. You might have gone to school for one thing and ended up in an entirely different field for work. It’s all about the journey, something that Fox News anchor Shannon Bream understands very well. Bream, author and host of Fox News @ Night, recently sat down with Repertoire publisher Scott Adams to discuss the journey and changes of her career, leadership, and content in the realm of journalism.

Building her career Bream attended Liberty University, where she graduated with a business management degree. While she loved the program, Bream was interested in politics, specifically the intersection of law and politics. After graduating, she went home to Tallahassee to attend Florida State Law School, and even practiced law for a few years after that. “I had always had an interest in news from very early on. Staying up all night, watching election returns when I was 8 years old, and my parents always said, ‘This doesn’t concern you, you can’t vote. Go to bed.’ I just loved knowing what was going on in the world. But when I was at Liberty, I studied business because I couldn’t really figure out what I was going to do.” 26

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Shannon Bream

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June 2022

Shannon Bream’s Journey in American Media

This interest in news pushed Bream to pursue an internship at a local TV station in Tampa, but she could only do the internship for college credit. She went to USF in Tampa where she took a course in news writing, giving her a foot in the door with the internship. Bream would shadow reporters, producers, and photographers to learn about the industry and take copious notes. She would often offer to buy dinner for the other person to further pick their brain. Bream said, “I remember one photographer said to me, ‘No, I don’t want you to buy me dinner. I want, when someone comes to shadow you, for you to do the same thing. Just pay it forward.’ I’ve always remembered

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that. We all have opportunities in our careers to help other people.” Eventually, she took a risk and quit her job as a lawyer to pursue a career in media. By “stepping out in faith,” Bream got her first on-air job, working from 2:00 a.m. to 11:00 a.m. She continued to do things like answer phones, make coffee, work the teleprompter, and write scripts for the morning anchors. After a change in management, Bream was told that she was never going to make it in the industry and to go back to law. She hunkered down and eventually got a job offer in Charlotte, North Carolina at WBTV. From there, she continued to develop her career before landing at Fox News in 2007.

“I think if you try to pretend like you’re doing everything yourself, first of all, that’s going to blow up in your face. No one should be that arrogant.” What leadership should look like Bream’s long relationship with Fox News has not only afforded her great success, but it has also given her the opportunity to work with the leadership within her organization, as well as interview incredible female leaders for her show. Because of women like Barbara Walters and Diane Sawyer, Bream never had the thought that she couldn’t go into broadcasting because she’s a woman. They had already broken through that wall. Now, Bream has the opportunity to carry that torch for the next generation of female leaders. She says, “I feel like a lot of the strong leaders I know are very confident,

but not arrogant. Because that’s different. Confident in whatever their mission they or their organization has. They believe in it and have a passion for it.” However, being in leadership doesn’t cure anyone of missing the mark. Thinking about some of the strongest leaders Bream has worked with, she said, “They have confidence, but a lot of humility too. They are willing to listen to people with different viewpoints who can give them good advice, and maybe save some headaches. For me, I don’t want people to just tell me every idea I have is great and wonderful.” Bream also finds significant value in taking counsel from other people, especially when it’s people she works www.repertoiremag.com

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Shannon Bream’s Journey in American Media

with. Her team works with her every day to build the structure and the content for Fox News @ Night, all coming from different backgrounds, age groups, ideas, and viewpoints. This diversity gives her team the opportunity to A/B test the content of the show, improving on the foundation of Fox News @ Night with different perspectives and ideas. “I think being humble enough to listen to people and take their advice is huge. The willingness to always learn will make you stronger in any area that you’re willing to invest time in. I will say, there’s never been a perfect show that we’ve done. It’s live TV, something is going to be flubbed. The important thing is to admit that and leverage it into making yourself and your team better.” 30

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Building content Bream’s team at Fox New @ Night works together to put out daily content in the form of a news show. For @ Night, Bream’s team consists of an executive producer, senior producers, segment producers, a copywriter, and someone who books the guests. “I think if you try to pretend like you’re doing everything yourself, first of all, that’s going to blow up in your face. No one should be that arrogant. We all have teams to us get everything done.” Not only does it take a team of multiple people to produce the content for Fox News @ Night, but the entire network has a vast team of local and global correspondents to cover the news from all over the world. Even now, there are teams of reporters in the Ukraine covering

the war, relaying critical and often time-sensitive information back to Bream and her domestic team of reporters, producers, and writers. Building content is all about understanding the needs and wants of your audience. If you are producing or publishing content that your audience isn’t interested in, they will find someone else who will. Capturing the eyes and the attention of the audience is the biggest obstacle for major news organizations like Fox News.

“I think being humble enough to listen to people and take their advice is huge. The willingness to always learn will make you stronger in any area that you’re willing to invest time in.” At Fox News, Bream and her colleagues are trying to push the most up-to-date, accurate information around the clock. Bream says that Fox Nation, the official streaming service of Fox News, works because they really understand their audience. “We know what our

viewers are interested in and what they’re going to connect with. And we want to feed them content that they feel like they’re not getting anywhere else. That we value them as a viewer, as a customer.” To hear the full interview, visit repertoiremag.com.

The Mothers and Daughters of the Bible Speak: Lessons on Faith from Nine Biblical Families “Have faith” is a phrase we hear all the time. But what does it actually look like to live it out? In The Mothers and Daughters of the Bible Speak, Shannon Bream examines the lives of biblical women to see how God’s plans can turn our worlds upside down. She tells the story of Jochebed, a mother who took enormous risks to protect her son, Moses, from Pharaoh. Could Jochebed have imagined that God’s actual design for her son involved flight into exile and danger? And yet this was all part of the master plan to deliver

Israel from slavery. Another biblical mother, Rebekah, made terrible choices in an attempt to ensure her son’s place in history. And a daughter, Michal, struggled to keep her faithless father, Saul, from sin, while battling pride in herself. The Mothers and Daughters of the Bible Speak shows that faith is more often a twisting road than a straight line. Yet, as the stories of biblical families attest, at the end of these journeys lies greater peace and joy than we could ever imagine. Available on Amazon and other book retailers.

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June 2022

TRENDS

Cracks in the Foundation? After years of improvements in patient safety, along came COVID-19. By Mark Thill Who could doubt the devotion of front-line caregivers, who worked tirelessly during the pandemic under extremely

difficult circumstances? But should the exigencies of COVID-19 necessarily have led to a decline in patient safety? Some industry experts have raised the question.

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Patient safety had been on an upward trajectory in the five years preceding the pandemic. During that period, central-line–associated bloodstream infections in U.S. hospitals had decreased by 31%. But that trend was almost totally reversed by a 28% increase in the second quarter of 2020 (as compared with the second quarter of 2019, www.nejm.org/ doi/full/10.1056/NEJMp2118285). Catheter-associated urinary tract infections, ventilator-associated events, and methicillin-resistant Staphylococcus aureus bacteremia increased as well. Safety also worsened for patients receiving post-acute care, according to data submitted to the Centers

for Medicare and Medicaid Services (CMS) Quality Reporting Programs. During the second quarter of 2020, skilled nursing facilities saw rates of falls causing major injury increase by 17.4% and rates of pressure ulcers increase by 41.8%. The surges of the Delta and Omicron variants of SARS-CoV-2 in late 2021 and early 2022 do not bode well for a return to prepandemic levels for any of these indicators.

A lack of resiliency In mid-February, several experts from CMS and CDC suggested something more than COVID-19 was to blame for the decline in patient safety. In a

New England Journal of Medicine perspective piece, “Health Care Safety During the Pandemic and Beyond – Building a System That Ensures Resilience,” they said the pandemic merely exposed the shaky foundation on which patient safety in the U.S. rests. “We need to re-evaluate whether the health care system has sufficiently invested in ensuring a deeply embedded safety culture and maintaining an unflagging commitment to safety,” they wrote. “The health care system has been challenged by repeated influxes of vast numbers of very ill patients, which have stretched staff and

Patient safety goals Following are The Joint Commission’s 2022 Seven National Patient Safety Goals for Hospitals. 1. Identify patients correctly. Use at least two ways to identify patients. For example, use the patient’s name and date of birth. This is done to make sure that each patient gets the correct medicine and treatment. 2. Improve staff communication. Get important test results to the right staff person on time. 3. Use medicines safely. a. Before a procedure, label medicines that are not labeled. For example, medicines in syringes, cups and basins. Do this in the area where medicines and supplies are set up. b. Take extra care with patients who take medicines to thin their blood. c. R ecord and pass along correct information about a patient’s medicines. Find out what medicines the patient is taking. Compare those medicines to new medicines given to the patient. Give the patient written information about the medicines they need to take. Tell the patient it is important to bring their up-to-date list of medicines every time they visit a doctor.

4. Use alarms safely. Make improvements to ensure that alarms on medical equipment are heard and responded to on time. 5. Prevent infection. Use the hand cleaning guidelines from the Centers for Disease Control and Prevention or the World Health Organization. Set goals for improving hand cleaning. Use the goals to improve hand cleaning. 6. Identify patient safety risks. Reduce the risk for suicide. 7. Prevent mistakes in surgery. a. Make sure that the correct surgery is done on the correct patient and at the correct place on the patient’s body. b. Mark the correct place on the patient’s body where the surgery is to be done. c. Pause before the surgery to make sure that a mistake is not being made.

Source: The Joint Commission, www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safetygoals/2022/simple_2022-hap-npsg-goals-101921.pdf

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June 2022

TRENDS supplies. Health care personnel have responded with extraordinary effort and dedication, adapting with unprecedented speed and developing and modifying treatment protocols on the basis of data that have evolved by the week. They have done all these things while battling workforce-safety problems such as exhaustion and a dearth of personal protective equipment, at great risk to themselves and their loved ones. We have seen an increasing number of media reports about the rising incidence of staff burnout, which is causing health care workers to leave practice, retire, or move into other industries. “The strains on the system have also affected routine safety practices. Overworked clinicians have often had no time for safety rounds, safety audits, or error reporting. Supply-chain disruptions reduced access to personal protective equipment, putting both patients and health care workers at risk. Standard safeguards, such as checklists, quickly became inadequate. Moreover, the pandemic starkly highlighted health disparities, including inequities in the safety of patients and health care personnel. “It is abundantly clear that the health care ecosystem cannot ask clinicians and staff to work harder, but must instead provide them with more tools and an environment built on a strong foundation of wellness and on instilling and rewarding a culture of safety,” they wrote.

Good enough? Ana Pujols McKee, M.D., executive vice president and chief medical officer for The Joint Commission, believes the authors of the New England Journal piece were correct. “We should be proud of the strides we have made in patient 34

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“ There has been tremendous slippage in safety and performance metrics. It speaks to how our approaches to patient safety are not hard-wired. They collapsed under the pressure of the pandemic.” safety [over the years]. The question is, should we have been satisfied?” The statistics showing a decline in safety are “a difficult message to deliver, especially considering that healthcare workers have gone above and beyond to meet the challenges of the pandemic,” she says. “But the data is the data. There has been tremendous slippage in safety and performance metrics. It speaks to how our approaches to

patient safety are not hard-wired. They collapsed under the pressure of the pandemic. “No one has found that magic pill of resilience to patient safety. The sophistication of the skill sets in healthcare in quality and improvement science are way behind that of other highly desirable industries. We know we can move the gauge in patient safety, but the big challenge is sustaining change.

Now what? “I think there is tremendous room for improvement when it comes to quality and safety, but I don’t believe the governing bodies and leadership have taken on the level of accountability that they should,” says Dr. McKee. That’s the missing link. “We need a better infrastructure and better partnership between private and public health systems. We also need a more resilient supply chain, and health care organizations to be better prepared for disruption. Additionally, we need to make sure individuals have the right skill sets, resources, and tools to make impactful improvements in safety. If something goes wrong, no one

remains silent, and instead, they quickly take action. This dynamic change in culture begins with and is driven by leadership.” According to the authors of the New England Journal perspective, “The United States deserves breakthrough thinking about systems built on foundational principles of safety, akin to those used in other industries in which safety is embedded in every step of a process, with clear metrics that are aggregated, assessed, and acted on. We also need renewed national goals of harm elimination throughout the health care system and a core safety strategy that includes promoting radical transparency, addressing workforce shortages,

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and continuing to strive for safety while being sensitive to such tradeoffs as reporting burden and costs. This effort should extend across the continuum of care, beyond the traditional hospital-based safety indicators, and include attention to diagnostic errors and outpatient care. “The health care sector owes it to both patients and its own workforce to respond now to the pandemicinduced falloff in safety by redesigning our current processes and developing new approaches that will permit the delivery of safe and equitable care across the health care continuum during both normal and extraordinary times. We cannot afford to wait until the pandemic ends.”

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June 2022

IDN NEWS

IDNs in the News 1. Midwest: University hospitals, Cleveland Clinic join forces to prevent substance misuse and overdose deaths Substance misuse and unintentional overdose deaths continue to be serious problems in the United States. The National Survey on Drug Use and Health showed most misused prescription drugs were obtained from family and friends, often from a home medicine cabinet. The best way to dispose of unused or expired medications is to take them to an official disposal location. As part of the Drug Enforcement Administration’s National Prescription Drug Take Back Day on April 30, University Hospitals (UH) and Cleveland Clinic are partnering to host collection efforts at 17 locations throughout Northeast Ohio in addition to promoting collection at two police stations. “University Hospitals and Cleveland Clinic have formed a collaborative alliance to advance the health of our communities by focusing on Northeast Ohio’s most pressing public health needs. Preventing substance misuse and overdose deaths are chief among these issues,” said Champ Burgess, Chief Pharmacy Officer at UH. “This Drug Take Back Day is just one example of our joint approach to mitigating the opioid epidemic and reducing unintentional drug overdose deaths because medicines that languish in home cabinets are highly susceptible to diversion, misuse and abuse.” This event gives the public an easy way to rid their homes of potentially dangerous, expired, unused and unwanted prescriptions and over36

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the-counter drugs. Many of these medical disposal locations are open year-round. “We are proud to be working with University Hospitals on a variety of initiatives to control the opioid epidemic in our communities. Collaboration makes us stronger and benefits the health of our communities,” said Samuel Calabrese, Chief Pharmacy Officer at Cleveland Clinic. “Providing the public with a safe and convenient way to remove unused medications from the home is an important step in reducing the risk of accidental drug exposures as well as preventing drug misuse. That is why we are committed to making drug disposal locations accessible on Drug Take Back Day and every day.”

2. South: Baylor Scott & White Health appoints Steven Newton as chief growth officer Texas-based Baylor Scott & White Health has tapped Steven Newton to serve as EVP and chief growth officer, effective April 25. In this role, Newton will drive enterprise growth, creating and enhancing customercentric partnerships that help the organization advance its strategy. Newton has nearly 35 years of healthcare experience – including almost 20 years in several of the system’s key geographies. He most recently led two North Texas regions, including six hospitals, and served as president of Baylor University Medical Center, one of the health system’s flagship academic medical centers. Since joining Baylor Scott & White in 2004, he has also served as president of Baylor Scott & White Medical Center – Grapevine

and Baylor Scott & White All Saints Medical Center – Fort Worth. “Steve is known as a trusted and progressive leader with an unrivaled knowledge of our markets,” said Baylor Scott & White CEO Pete McCanna. “His understanding of competitive opportunities across the state will guide us as we expand access to high-quality care for the millions of Texans we serve.” Over the course of his tenure, Steve has led the development and implementation of high-performing regional growth plans, guiding his teams to improve patient experience and clinical outcomes.

3. West: Intermountain Healthcare and SCL Health complete merger Utah-based Intermountain Healthcare and SCL Health, two leading nonprofit healthcare organizations, have completed their merger, creating a model health system that provides high-quality, accessible, and affordable healthcare to more patients and communities in Utah, Idaho, Nevada, Colorado, Montana, Wyoming, and Kansas. This combination employs more than 59,000 caregivers, operates 33 hospitals (including one virtual hospital), and runs 385 clinics across seven states while providing health insurance

to 1 million people in Utah and Idaho. With the close of this merger, Intermountain Healthcare is the eleventh largest nonprofit health system in the United States. Mike Leavitt will serve as the new Board Chair for the combined organization. In previous roles, he served in the Cabinet of President George W. Bush as Administrator of the Environmental Protection Agency and Secretary of Health and Human Services and as a three-time elected governor of Utah. The Board includes representation from the pre-merger boards of both Intermountain Healthcare and SCL Health. The most recent

Intermountain Healthcare Board Chair, Gail Miller, and most recent SCL Health Board Chair, Michael L. Fordyce, will continue as members of the combined board. Fordyce will serve as Board ViceChair of the Intermountain Healthcare Board and as Board Chair of the Intermountain region board based in Broomfield, Colorado, and Miller will serve as Board Chair of the new region board based in Salt Lake City. The new organization, named Intermountain Healthcare, is headquartered in Salt Lake City, with regional offices in Broomfield, Colorado, and Las Vegas, Nevada. www.repertoiremag.com

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June 2022

SPONSORED

DUKAL

Navigating Today’s Ever-changing COVID-19 Landscape with Comfort and Care children grew up in it, and the transition back to normal may take more time. Many children have become used to having their parents or caregiver by their side at all hours of the day. For some infants, it’s all they’ve known. And as we supported our children through those early days of uncertainty in 2020, we must have the same level of care today.

Plan ahead, but allow for flexibility Planning ahead gives children a sense of safety and security. While making plans for some much-needed family fun, include your children in the discussion to help lessen anxiety.

Take it step-by-step

Children’s lives have been turned upside down by the pandemic. Between remote schooling, wearing masks, canceled playdates and birthday parties, and our regular routines looking anything but routine – it’s essential to realize that the effects of the past two years aren’t over. And, as our lives increasingly return to normal, much remains unknown about the toll the COVID-19 pandemic has taken on everyone – especially children.

While some may say their children thrived through the pandemic, enjoying more time at home and the benefits of added screen time through virtual lessons, others suffered from the lack of academic, social, and emotional support, especially when viewed through a socio-economic lens. Seeing a 20-30% spike in emergency mental health visits, experts 38

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recognize children and adolescents are showing signs of stress from trauma experienced during the pandemic. And as masks come off and summer camps open back up – it’s essential to learn how we can support our younger population during a shift that may often feel overwhelming. It’s important to remember that while we endured the pandemic, our

Big changes can often result in big feelings. Emphasize that reopening is a gradual process. Take it one step at a time, recognizing your child’s comfort level in each new setting.

Validate fears When faced with an anxious child, let them know you recognize their feelings and take steps to help them manage them. Taking the time to answer any questions they have will allow you to correct any misinformation and help them overcome any fears or uncertainties.

Be alert to signs of something more serious Mood changes, sleep changes, or avoiding activities may signify your

child is having trouble adjusting to the quickly changing landscape. Take time to talk and reach out for services if they need more support.

Overcome vaccine anxiety When recognizing post-pandemic anxiety in children, we should also recognize vaccine-associated anxiety. At least two-thirds of children and onefourth of adults have a fear of needles, and when heading to an appointment for a COVID-19 vaccination, that fear can often result in a tearful meltdown. With everyone over the age of 5 approved by the CDC for a COVID19 vaccine, both healthcare providers and parents can help reduce patient anxiety in children. Parents and guardians can provide comfort by holding their child, bringing a stuffed animal, creating a distraction, and helping their child take deep breaths. Clinicians can help reduce anxiety by providing children with a positive patient experience. This includes redirecting the child's attention, familiarizing children with the tools and equipment they'll be using, and including childfriendly themes and distractions. Dukal’s line of licensed bandages offers patients fun characters and designs while offering practitioners

By replacing traditional adhesive bandages, character bandages improve patient experience, reducing anxiety and allow children to wear their vaccine with pride. our trusted Stat Strip® technology. By replacing traditional adhesive bandages, character bandages improve patient experience, reducing anxiety and allow children to wear their vaccine with pride.

Dukal realizes the collective role we all play in helping our children as their world reopens, and it is our hope our pediatric line of medical disposables can bring added comfort and care. www.repertoiremag.com

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June 2022

TRENDS

Stretched to the Limit In long-term-care facilities, who has time to see suppliers when there’s so much work to do? By Mark Thill

It’s no wonder that many people call the current staffing situation in long-term care a crisis. Nursing homes lost

220,000 jobs – 40% – from March 2020 to October 2021, according to the Bureau of Labor Statistics. Compare that to hospitals, which experienced a 1.6% loss during the same period, and home health, which experienced a 1.2% loss.

“I’ve been in this industry for nearly a decade and this is by far the biggest issue facing long-termcare,” says Guy Cunningham, vice president of sales for Clock Medical Supply. “Facilities that never used agency for staff are having to do so while being forced to pay higher wages for directly hired employees. 40

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Additionally, staffing agencies are now having difficulty finding willing participants, which is adding further stress on our market.”

Longstanding issue More than 1.4 million people live in over 15,500 Medicare- and Medicaid-certified nursing homes across

the nation. For years, those nursing homes have been underfunded and understaffed, often delivering inadequate care to their vulnerable residents, according to healthcare policy experts in a recent issue of Annals of the American Academy of Political and Social Science. “The spread of the virus across the country introduced a new

emergency to a long-term care sector that had already been in a state of crisis for multiple decades.” In the past two years, more than 200,000 residents and staff in nursing homes died from COVID-19 – nearly a quarter of all COVID-19 deaths in the United States, according to the White House. “The pandemic has highlighted the tragic impact of substandard conditions at nursing homes, which are home to many of our most at-risk community members.” Staff shortages weren’t the only factor contributing to those deaths, of course. The highly transmissible nature of SARS-CoV-2, the nature of congregate care settings, and the high-risk status of people who reside in nursing homes all played a role. But there is some positive news. According to January 2022 data from the Centers for Disease Control and Prevention, the share of COVID-19 deaths in long-term-care facilities has decreased since the start of the pandemic (though nursing homes did experience disproportionately high case and death rates during the recent Omicron surge). Several factors are responsible, including high rates of vaccination among residents, rising vaccination rates among staff, an increased emphasis on infection control procedures, and declining nursing home occupancy.

A watchful eye The Biden-Harris Administration has every intention of maintaining the trend. In January, the Centers for Medicare & Medicaid Services began posting nursing home staff turnover rates (as well as weekend staff levels) on the Medicare.gov Care Compare website, and the agency will be including this information in the star rating system starting in July 2022. “This information helps consumers better

understand each nursing home facility’s staffing environment and also helps providers improve the quality of care and services they deliver to residents,” according to the agency. In February, the White House ordered steps be taken to ensure that: ʯ Every nursing home has a sufficient number of staff who are adequately trained to provide high-quality care. ʯ Poorly performing nursing homes are held accountable for improper and unsafe care. ʯ The public has better information about nursing home conditions so that they can find the best available options.

needed to ensure safe and quality care. Proposed rules will be issued by February 2023. The White House has also instructed nursing homes to reduce resident room crowding. Most nursing home residents prefer to have private rooms to protect their privacy and dignity, but shared rooms with one or more other residents remain the default option. According to the Administration, multi-occupancy rooms increase residents’ risk of contracting infectious diseases, including COVID-19. CMS will explore ways to accelerate phasing out rooms with three or more residents and to promote single-occupancy rooms.

‘ Directors of nursing, administrators, and non-direct-care staff are being forced to work the floors and do the jobs that others once did, and they don’t have time for personal meetings with suppliers/vendors.’ The adequacy of a nursing home’s staff is the measure most closely linked to the quality of care residents receive, according to the White House, citing one study, published in the Journal of the American Geriatrics Society in June 2020. That study found that in one state – Connecticut – nursing facilities that increased registered nurse staffing by just 20 minutes per resident day encountered 22% fewer confirmed cases of COVID-19 and 26% fewer COVID-19 deaths. CMS intends to propose minimum standards for staffing adequacy and will conduct research to determine the level and type of staffing

A willing staff Some long-term-care facilities have been forced to close for lack of a willing staff, says Cunningham. “The reason is simple: From a monetary standpoint, inflation coupled with a lack of increased reimbursement are crippling the industry. Census was significantly reduced during the pandemic and many [certified nursing assistants] who had previously staffed those buildings left. Some [didn’t] want the vaccine and as a result, left the industry. Now, many facilities can’t accept residents because they don’t have the required licensed nursing and CNA staff to meet government standards.” www.repertoiremag.com

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June 2022

TRENDS Facilities in urban areas, where willing staff are more prevalent, are managing better than others, he says. “However, they are paying up to $7 more per hour for staff than they have historically. This is a result of both supply and demand as well as inflationary pressures. Several of our customers have closed entire wings of their facilities to reduce fixed and ancillary costs as well as staffing relief.”

to increase reimbursement, which will give facilities the ability to pay a competitive wage to those willing to take care of our seniors.”

Nurse practitioners Some believe that recruiting more nurse practitioners will help longterm-care facilities address staffing shortages. In the Journal of PostAcute and Long-Term Care Medicine in February 2022, three researchers

‘ It is never my immediate instinct to look to the government for answers to private sector problems, but in this case, they have caused the problem.’ Staffing shortages among customers affect medical suppliers, says Cunningham. “Directors of nursing, administrators, and non-direct-care staff are being forced to work the floors and do the jobs that others once did, and they don’t have time for personal meetings with suppliers/vendors. My staff used to spend most of their pre-pandemic days in buildings, meeting with long-termcare staff, trying to understand their issues and pressure points while formulating solutions to help. This has been cut by 70%. [But] this is getting better as the pandemic normalizes to some degree.” Reps can help their customers in a few ways, for example, by assisting them make supply choices that can affect outcomes in a positive way and help with cost-in-use, he says. But such help can only go so far. “It is never my immediate instinct to look to the government for answers to private sector problems, but in this case, they have caused the problem. The only way to fix this, in my opinion, is 42

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made the case that the pandemic “revealed the consequences of years of inattention to the many challenges facing nursing homes, including lack of access to primary care providers – physicians or NPs [nurse practitioners] – both of whom bring a complementary skill set to the LTC sector.”

Studies have found that long-termcare facilities with nurse practitioners have lower rates of depression, urinary incontinence, pressure ulcers, and residents with aggressive behaviors, they said. More residents experience improvements in meeting personal goals, and family members express more satisfaction with medical services. “By being onsite, NPs can identify changes in residents’ status, treat acute medical problems prior to progression to more complex, life-threatening situations, prevent adverse outcomes, and reduce resident suffering.”

Better days ahead? COVID-19 has presented serious challenges for long-term-care providers, says Dennis Loflin, director, NH Med Services, an extended care distributor in Denton, North Carolina. But he believes the industry is slowly recovering, to the benefit of their communities, residents and staff. “A nursing home is a living, breathing organism. It is a big part of the larger community and is home to a lot of people. In a sense, COVID took the life out of that for a while, because it isolated staff and residents from the outside community. But we’re slowly recovering. Families are back to visiting on a regular basis, and whether they realize it or not, they are providing care, even if it’s not direct patient care. Their presence gives residents something to look forward to and helps staff feel less isolated in what they do. “If you go back five or 10 years and extract COVID from the equation, you’d find the culture in these communities has been getting better and better. We’ve all worked hard to make them seem more like home instead of institutions. And they are becoming much better places to work too.”

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Revenue Generators The right electrosurgical generator can mean improved clinical outcomes for a customer, and a disposable accessory revenue stream for distributor reps Physicians, clinicians, and surgery center administrators have a host of choices when it comes to selecting a generator for their practice, and a knowledgeable distributor and/or sales representative can help them make the right one.

Generators are known as electrosurgical units (ESU), radio frequency (RF) electrosurgical generators, ‘Bovies,’ and high-frequency (HF) desiccators. These devices are used to cut, coagulate, fulgurate, and desiccate tissue, and there are numerous options available on the market today. The most active practices using electrosurgery in the nonacute space today are dermatology, plastic surgery, OB/GYN, and surgery centers.

Dermatology Dermatologists typically have one high-frequency desiccator in each of their examination rooms. The Bovie® DERM 942 is often their generator of choice for a high frequency desiccator. These are small, relatively inexpensive units used for desiccating, fulgurating, and coagulating tissue (Note: These devices cannot cut), and they result in a revenue stream based on the required number of disposables they consume. These disposables include both sharp and blunt dermal tips, packaged sterile and non-sterile, along with sterile and non-sterile drapes to cover the handpieces.

Family Practice Family practice doctors also use the Bovie® DERM 942 but, unlike dermatologists, they are more likely to purchase a single unit due to the cost. For this reason, Bovie® has created a high-frequency desiccator that is more economical – the Bovie® DERM 102. This device is limited to 10 watts of output but provides wattage in accurate, 1/10th watt increments. The DERM 102 combines monopolar and bipolar power, like all Bovie® generators, but in a smaller, less powerful package.

OB/GYN OB/GYNs who cut tissue are most likely performing a LEEP/LLETZ procedure (Loop Electrosurgical Excision Procedure or Large Loop Excision of the Transformation Zone). The electrosurgical generator OB/GYNs use must be able to cut 44

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and coagulate tissue and maintain enough power to complete the task. The classic device for this procedure is the Bovie® Specialist PRO A1250S-G – a scaled down version of an operating room level electrosurgical generator. This system includes the electrosurgical generator and the Smoke Shark® II smoke evacuator on a mobile stand. As mentioned earlier, these types of devices also create quite a revenue stream of disposables, typically including an electrosurgical pencil, a grounding pad – with or without cord, and electrodes with loop and ball tips for each case.

Plastic Surgery Plastic surgeons need a powerful and versatile electrosurgical generator for the host of procedures they perform. Many select the Bovie® Specialist PRO A1250S, which provides up to 120 watts of power. However, if their surgical techniques require both monopolar and bipolar energy during the same procedure, they must physically switch between monopolar and bipolar energy (either by breaking the sterile field themselves, or by having an assistant make the switch) as the monopolar coagulation energy and the bipolar energy displays are shared when using this device. In these procedures, a better solution is a unit with a dedicated output for bipolar energy to allow the surgeon to easily switch back and forth between energy modalities without delaying the procedure. Bovie® offers the perfect solution – the Bovie® Surgi-Center PRO A2350. While your customer may be tempted to acquire a cheaper, used OR 300-watt generator with a 90-day warranty, the 200-watt Bovie® Surgi-Center PRO A2350, like all Symmetry Surgical ESUs, comes with the only four-year warranty in the industry. 46

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Each facility that performs electrosurgery is an opportunity for a sales rep to capture their disposable accessory revenue stream – and this should be the target of focus. Surgery Centers In the surgery center, the most common electrosurgical generator used is a 300-watt model, like the Bovie® OR PRO A3350, based solely on the surgeon’s familiarity with the same version they use in a hospital OR. However, as many surgical suites could accomplish all their procedures using a 200-watt system, the Bovie® Surgi-Center PRO A2350 (mentioned above) could save a facility a lot of money.

Is your ‘Bovie’ a Bovie®? In physician office and surgery center accounts, perhaps the main task to address is cutting. If the customer intends to cut tissue (as opposed to simply fulgurating and desiccating), they’ll need to ensure that this feature is available on the device, which can range between the 50-watt Bovie® Bantam PRO 952 and the 300-watt Bovie® OR PRO A3350. Devices in this class are frequently referred to simply as ‘Bovies’ – even though they may be manufactured by several other companies. However, Bovie® is the

trusted brand name of the original electrosurgical generator and is a registered trademark of Symmetry Surgical.

Accessories With the exception of the monopolar and bipolar footswitches and the reusable DERM handpieces, which are all manufacturer-specific, most of the accessories in electrosurgical procedures are interchangeable. Electrodes, pencils, grounding pads, and a host of additional accessories work with virtually every manufacturer’s electrosurgical generator. Each facility that performs electrosurgery is an opportunity for a sales rep to capture their disposable accessory revenue stream – and this should be the target of focus. While these facilities are not always in the market for an electrosurgical unit, they are constantly purchasing disposables. Those reps who have invested in the relationship to earn their disposable business will likely be the first ones the facility calls when they are looking for a new ESU.

TRENDS

Housing and Health CVS Health is advancing health equity via affordable housing. Through several recent announcements, CVS Health®

has signaled a commitment to increase access to health care services in underserved communities by investing in affordable housing. The company said it invested $185 million in affordable housing in 2021, and as of March 1 was supporting the development and rehabilitation of more than 6,570 affordable housing units in 64 cities across 28 states and Washington, DC. The investments include funding to help build 736 permanent supportive housing (PSH) units, providing stable homes for individuals and families who may be experiencing homelessness, individuals with physical, intellectual and/or developmental disabilities, youth aging out of foster care, victims of domestic violence, people in need of behavioral health or addiction treatment and individuals challenged by similar life and health situations, CVS said.

PSH residents will also receive access to a wide range of services to stabilize and improve their health, including social, behavioral health and addiction recovery services. In early March, CVS Health announced it would invest more than $15.3 million with Pedcor Investments and WNC to build 312 new affordable housing units in the uptown area of San Antonio. According to the City of San Antonio Strategic Housing Implementation Plan, there are 95,000 households at risk for housing instability due to families spending more than 30% of their income on housing. More than half of these households are renters. The new development, named Crosswinds Apartment Homes, will support individuals and families

earning from 30% to 60% of Area Median Income and provide them with homes and the resources they need to live healthier lives and reach their full potential. “There is a direct correlation between stable affordable housing and the prospects for a family’s long term health outcomes, especially for families at lower incomes,” said Pete Alanis, Executive Director, San Antonio Housing Trust. “CVS Health’s commitment to invest the necessary tax credit equity to bring this community to life demonstrates what is possible with responsible social investment.” In 2021, CVS Health invested in affordable housing properties and programs across the country, including Florida, Louisiana, Texas and Washington, DC. Examples of these investments include: ʯ $7.7 million for Uptown Sky, a new multifamily apartment home development in Tampa, Florida that will provide 61 homes to local families and individuals with demonstrated need. Residents will have access to on-site supportive services, including computer training, homeownership programs, workforce training and financial management programs. ʯ $9.2 million for 17 Mississippi, a 41-unit affordable housing community in Washington, DC. Residents will be provided with health and well-being resources, including counseling and housing insecurity services, recovery and treatment programs, family and youth services and employment resources. ʯ $11.7 million for Espero Austin at Rutland, a development in Austin, Texas that will provide 171 units of much-needed permanent supportive housing to people experiencing homelessness or are at risk of becoming homeless, people with physical, intellectual, and/or developmental disabilities and youth aging out of foster care. Affordable housing investments are also part of CVS Health’s new Health Zones initiative which provides concentrated local investments designed to reduce health disparities and advance health equity in high-risk communities. Health Zones address six key social determinants of health: housing, education, access to food, labor, transportation and health care access. www.repertoiremag.com

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June 2022

TRENDS

Breaking the Rules of Healthcare: Following the Science Why today’s doctors will provide the best care by following the science – and listening to patients. By Dr. Robert Pearl

American doctors today are the beneficiaries of

remarkable medical progress, driven by decades of worldleading research and computerized data analytics. Thanks to these advancements, physicians can avail themselves of scientifically proven and optimized approaches for 95% of medical problems. When followed rigorously, these approaches give doctors the best chance at successfully solving a patient’s problem. This is referred to in healthcare as evidence-based medicine. Research has shown that if every physician followed these algorithmic, science-based protocols every time, Americans would live healthier, longer lives and experience fewer complications from both acute and chronic disease.

Yet, all too often, doctors dismiss the data, preferring an outdated and unreliable approach to medical decisionmaking. This article, the fifth in a series called “Breaking the Rules of Healthcare,” explores an unwritten rule, which doctors have followed for centuries.

prevent and treat most life-threatening diseases. Because of this, they had little choice but to rely on their medical instincts and previous experiences when providing care. Doctors today still proudly listen to their hearts and insist on following their guts, trusting that – despite the data – their intuition will produce the best results. More often than not, that old assumption is proven wrong. The field of behavioral economics proves just how flawed human decision-making can be. Let’s look at an example from the criminal justice system. Evidence-based sentencing (like evidence-based medicine) helps reduce the negative impact of human bias. Though EBS guidelines are not perfect, they lead to decreased recidivism, increased public safety and improved rehabilitation efforts. But despite the data, most judges continue to believe their individual judgement is superior. In contrast to what people in dozens of disciplines think, a Nobel Prize-winning psychologist and economist Daniel Kahneman found that experts are not immune to “the influence of extraneous irrelevant information.” In fact, a series of studies about the judicial system found that when judges had the freedom to follow their “gut,” the harshness of sentencing varied wildly from judge to judge. Not only that, but prison sentences also were swayed by illogical variables, including the time of day and the weather. Judges handed down worse penalties for defendants right before lunch (and lighter sentences after their bellies were full). Likewise, rainy days led to worse punishments than sunny days. Intuition isn’t always wrong, but it’s rarely a better substitute for science.

When doctors overvalue intuition Rule No. 5: Doctors provide the best care by following their intuition For most of medical history, including much of the 20th century, doctors lacked the scientific knowhow needed to 48

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Doctors routinely misjudge the accuracy of their instincts and the relevance of past experiences with patients. These flaws in judgement lead to deficiencies in clinical quality and inconsistencies in treatment.

Take, for example, a famous study from the Oregon Research Institute as detailed in Michael Lewis’ book “The Undoing Project”. Researchers gave radiologists 96 X-rays of stomach ulcers and asked them to estimate the probability of cancer for each. Doctors had no idea there were duplicate studies in the pile. The results, according to the lead researcher, were “generally terrifying.” Not only did physicians contradict each other’s findings. They all contradicted themselves at least once. For further proof of flawed intuition, consider antibiotic prescribing. Using the most up-to-date research, computerbased algorithms can define when and whether antibiotics are helpful or unnecessary for a patient. But rather than rigorously following the science, physicians inappropriately prescribe these medications between 30% to 50% of the time, putting patients at risk of a life-threatening drug reaction. The personal preferences of doctors harm surgery patients, as well. Physicians often recommend surgery for lower back pain, despite numerous studies that indicate physical therapy alone is equally effective 90% of the time (and leads to far fewer complications). Overall, research demonstrates that algorithms beat even the best doctors in nearly all areas: from predicting the life-expectancy of cancer patients to the length of time a patient will need to stay in the hospital to the susceptibility of babies to sudden infant death syndrome, and so on.

Breaking the rule: Doctors provide the best care by following the science and listening to patients Ultimately, doctors who adhere to scientifically derived guidelines make better decisions than when they follow their gut feelings. But this new rule doesn’t mean that every patient should receive the exact same medical care. Rather, it means variation in medical practice should reflect differences in the preferences of patients, not differences between doctors. To practice the “art of medicine” effectively in the 21st century, doctors will need to listen to the values, fears and hopes of their patients – much more than they did in the past. Here are two circumstances when physicians must apply the art of listening: When two approaches can’t be compared because the risks are too different Deciding how much insulin to prescribe a patient with diabetes comes with major risks. There are risks to being too aggressive and overly cautious.

On the one hand, overshooting could lead to hypoglycemia. This might cause a person with diabetes to pass out and crash – a lethal risk when riding a bike or driving a car. On the other hand, looser management leads to excessively high blood-sugar levels, which could harm a person’s blood vessels and organs. This increases the odds a person will die early of heart disease – or suffer kidney failure or require amputation. In this situation, there is no “correct” answer. No clinical algorithm is capable of deciding which is worse for a patient: a small chance of dying in the near future or a high probability of dying from disease complications down the road. Physicians can’t make that choice for patients, either. Instead, they need to have an indepth conversation and find out what matters most to the individual. When patients and families are struggling with end-of-life choices Recent advances in medicine give doctors the ability to extend a patient’s life almost indefinitely. But at what point is it better to end a painful and futile intervention rather than take a chance on a small but highly unlikely chance at a cure? What if the probability for a cure is 5%, 1% or one in 1 million? Does it matter if the person is 20 years old or 90? What if their child or grandchild is going to be married next month and all that matters is making it to the wedding? People’s lives and personal preferences are filled with infinite permutations, which often render algorithms useless and physician preferences irrelevant. In these situations, the art of listening proves essential.

How to practice the art of listening Most doctors today don’t have the time to engage in lengthy dialogues about their patients’ hopes, fears and values. But with the help of computer-derived algorithms, teams of clinicians (including pharmacists and nurses) can do what only doctors could in the past. By relying on a team of healthcare professionals to solve straightforward problems, doctors can free up time to have difficult conversations with their patients. Studies show that if all physicians strictly followed computer-based algorithms, deaths from heart attacks, strokes and cancer would diminish greatly. For this to become the norm, doctors must break the rule of the past and follow evidence-based approaches rigorously. And when there is no single best answer, physicians must value the uniqueness of their patients. www.repertoiremag.com

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REP CORNER

Angi Muse: Jack of All Trades for Booth Medical By Pete Mercer

Angi Muse and her husband at their wedding in St. Thomas. Muse said one of her passions outside work is traveling.

Angi Muse, the Grand Prize winner of IMCO’s 2021 Equipment Performance Incentive Contest (EPIC) Program, is

a sort of jack of all trades for Booth Medical. In addition to being the sole sales representative for the company, her daily responsibilities include things like accounting, accounts payable, accounts receivable, shipping, and receiving, and even making sure that the building is kept clean.

Booth Medical, a family-owned business based in Alexander, Arkansas, sells new and refurbished sterilizers, as well as sterilizer accessories and parts, and provides comprehensive repair services and technical support for their customers. “Most of the vendors that participate in the EPIC Program specifically work with a lot of capital equipment, which is what we focus on. We sell only capital equipment, so it lends itself to what we do very nicely,” Muse 50

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said. “A lot of IMCO vendors are strictly supplies, which we don’t do at all. This program is really catered to companies like Booth Medical.” The IMCO EPIC program is a year-long capital equipment sales program designed to increase vendor sales, while rewarding the top performing member representatives with incentive prizes. Every year, the top performers are rewarded with travel vouchers at the IMCO National Convention. The results are based on

the points that the sales representatives earn through the sale of specific participating products, as well as participating in sales training activities.

Selling autoclaves in a pandemic Like many vendors, Booth Medical has had to navigate filling customer orders during a pandemic for the last few years. Because the company does most of the business online, Muse and her family have not had to do an overhaul on their processes like many others have. Muse said, “We were kind of lucky that we fit in the sterilizer niche because when COVID started, sterilizers were one of the big things people needed. Everyone needed a new sterilizer or an upgraded one with new features.” Muse and her family were fortunate in the beginning of the pandemic, getting ahead of the orders on sterilizers. She said, “We continuously had ten machines on order. So, every couple of months we were getting a new batch.”

“I am more focused on the people than I am making a sale. I will even redirect my customers if I feel that they could find what they are looking for somewhere else.” Customers have been understanding of the challenges the industry is facing, especially lately. Early in the pandemic, Booth Medical had problems getting the cleaning products in, just like everyone else. Muse said that customers have gotten to the point where they are bracing themselves when they are looking for something specific. “They’ve gotten used to the answer, ‘Well, we can’t get that for a few months.’”

Customer service focused Even with many hats that Muse wears daily, she has still focused on improving her customer service. As the sales representative and customer service representative, Muse walks with her customers during the lifecycle of the sales funnel. She said, “It is like a gift for me that I can make them feel comfortable, even in this horrible situation. I am more focused on the people than I am making a sale. I will even redirect my customers if I feel that they could

find what they are looking for somewhere else. I want them to be taken care of, so I try to make sure that they have what we need, even if it isn’t from us.”

The impact of inflation Like many other similar companies, Booth Medical has not been immune to the effects of inflation. Before, Booth Medical was able to make a good profit on the sale of a sterilizer, but inflation has forced them to make some changes. “We used to ship things for free, and now we don’t,” Muse said. “Because the shipping costs have gone up so much, we now have to pass that onto the customer.” Things like credit card charges, surcharges, and fuel charges (both of which have been passed on to the consumer) start to add up. These changes have resulted in Booth Medical getting a little more for the products they sell, especially because customers are looking to get sterilizers now. “I can ask a little more for it now because we have it on hand. I can ship it today. They can probably find one for $6,000, but it will be three months before they receive it. People are willing to pay that extra money to get the products now.” Again, the customers have been understanding. With the way the market is right now, customers have had to make harder purchasing decisions than they might have before. “I have a few customers that I deal with regularly. One called me recently and I had to say, ‘I sold that to you for that then, but I can’t do that now.’ He said, ‘Oh, I know. I know.’ But he still bought it. They understand.” www.repertoiremag.com

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June 2022

REP CORNER

The Jersey Guy A little serendipity and a lot of talent led one manufacturers sales rep down a successful path. By Mark Thill

Art Nahan joined the healthcare industry in June of 1981, shortly after graduating from Boston University with

a degree in marketing. As far as he’s concerned, however, his career took hold about eight months earlier, when he met his future wife, Jeanne, on a blind date. “I always had an interest in healthcare,” he explains. “After graduation, I began working with my future father-, mother- and sister-in-law in Fort Meyers, Florida, selling home care products. In addition to our store in Fort Meyers, we had stores in Lancaster, Pennsylvania, and Reading, Pennsylvania, and I eventually hired sales reps to help increase sales there.”

As it were, Nahan and his wife both grew up in New Jersey, and the thought of raising their children in a setting that felt more like home soon lured them back to the Garden State. He worked for a DME company in Yonkers, New York, for two years, after which he joined a small independent rep group that covered the states of Pennsylvania, New Jersey and New York. “I represented New Jersey for six years before branching out on my own as an established independent rep,” he recalls. “In 1996, my lifetime friend Charles Kellman left his 20-year career in the New York City garment industry to work with me. We became Art Nahan and Associates.”

Art Nahan with his family.

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The company has evolved over time, although some early relics have remained. “To this day, I use my original email Anck1@aol.com,” says Nahan. Eventually Kellman left the company to work for a rep group and then retired a few years ago. “I did pull Charlie out of retirement at one point to help me represent a company in the Metro New York area,” he says. “It’s always been wonderful to work with such a close friend who has been so successful in sales.”

As good as your last sale One of the best parts of being an independent sales rep has been the autonomy, Nahan points out. “You are only as good as your last sale,” he explains. “The relationships I have created with our medical distribution partners the past 40 years have proved to be a tremendous asset for me, especially as it has become increasingly more challenging to work with dealer reps, end users and healthcare networks.” Indeed, in spite of the many technological advances that have taken hold in healthcare over the past several decades, a sales rep’s success “still comes down to owning the relationship with the distribution partners,” he says – an approach that certainly has worked in his favor these past 41 years. “I’ve always maintained transparency on all levels,” he continues. “I routinely discuss with my dealer reps and end users exactly which companies I represent.” The recent supply chain issues that emerged with the Coronavirus pandemic have made it even more essential to communicate thoroughly and plan office setups and equipment purchases many months in advance, he adds.

“I truly enjoy the relationships I have built through the years and look forward to continuing to be part of this great industry for a long time to come,” he says. “Every territory has its challenges, from the farmlands in Lancaster, Pennsylvania, to the busiest parts of New Jersey and metro New York.” But the diversity has made his job interesting and kept him in the Northeast, even as his children have grown up and left home. “To balance my work life, I take walks, and enjoy birdwatching and model trains. And Jeanne and I recently became first-time grandparents.” In retrospect, Nahan knows he couldn’t have made it this far without a solid work ethic, impeccable product knowledge and the ability to represent top-tier manufacturers. That said, his Jersey roots have also worked in his favor, he admits. “Being a Jersey Guy definitely has given me the street smarts to work my territories in an effective way!”

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.

Kia Sportage Hybrid

Automotive-related news Kia introduces electric version of popular SUV model Arriving in showrooms this spring, Kia’s Sportage Hybrid will deliver an ideal mix of fuel efficiency and power along with an abundance of room for gear, the automaker said in a release. Significantly larger than the previous generation Sportage, the Hybrid will allow owners to enjoy class-leading rear seat legroom and rear cargo capacity. Technology features include an expansive list of ADAS features and dual panoramic display screens (12.3-inch instrument panel display and 12.3-inch infotainment touchscreen display) for nearly 25 inches 54

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of viewing. The Sportage Hybrid is offered in three trim levels: LX, EX, and SX-Prestige. Base pricing begins at $27,290 for LX FWD and tops out at $36,190 for the SX-Prestige AWD. The destination charge is $1,255.

Honda focusing on hybrid As the next step in Honda’s electrification strategy in North America, the company will focus on increasing hybrid volume of core models – CR-V, Accord and, in the future, Civic. To make room for these moves, Honda announced it will conclude Insight production in June. Honda will introduce all-new models

of the CR-V Hybrid this year, followed by the Accord Hybrid, which will eventually make up 50% of the sales mix of each model. Hybrids will represent the top and best performing models in the lineup. With the conclusion of Insight production, Honda’s Indiana Auto Plant will focus on building CR-V, CR-V Hybrid and Civic Hatchback, several of Honda’s most popular models.

Michigan looking to enhance roadways Michigan recently announced a pair of pilot programs to advance its roadways with cutting-edge technology,

according to On-Site. The state is working with Cavnue, a subsidiary of Sidewalk Infrastructure Partners, to explore the opportunity and viability of building a dedicated corridor for automated and connected vehicles between Detroit and Ann Arbor. According to On-Site, the vision is to connect Detroit and Ann Arbor, along with key communities and destinations along Michigan Avenue and Interstate 94 in Wayne County and Washtenaw County, with purposebuilt lanes that will allow for more efficient use of the roadways while tapping into the full potential of connected and autonomous vehicles. On a more immediate timeframe, Detroit is looking under one of its roads to enhance the driving experience for electric vehicles. The city will be the first in the United States to install a public wireless in-road charging system when one of its city streets receives an inductive charging system under its asphalt.

Car thefts on the rise Car and Driver reported that car thefts are “way up” in some parts of the country. In Washington state, for example, local law enforcement reported that vehicle thefts are up 88% in the first three months of 2022 compared to 2021: 12,569 so far this year compared to just 6,692 in the first three months of the last year. Over in New Jersey, thefts are up 31%. Other areas of the country are reporting similar statistics. The increases are part of a years-long trend, according to the National Insurance Crime Bureau (NICB), which notes that nationwide car thefts were up 16.5% in 2021 relative to 2019 figures (though that falls to an approximately 5% increase in thefts relative to 2020 figures, per calculations).

Local law enforcement reported that vehicle thefts are up 88% in the first three months of 2022 compared to 2021: 12,569 so far this year compared to just 6,692 in the first three months of the last year. Uber announces fuel surcharge This spring, Uber announced consumers would pay a temporary fuel surcharge of either $0.45 or $0.55 on each Uber trip and either $0.35 or $0.45 on each Uber Eats order, depending on their location. The company said 100% of that money will go directly to workers’ pockets. Uber said the surcharges are based off the average trip distance and the increase in gas prices in each state. The company said they would reassess the charges after 60 days. “We know that prices have been going up across the economy, so we’ve done our best to help drivers and couriers without placing too much additional burden on consumers,” the company said in a release. “Over the coming weeks we plan to listen closely to feedback from consumers, couriers and drivers. We’ll also continue to track gas

price movements to determine if we need to make additional changes.”

The Corvette celebrates 70 2023 marks the 70th anniversary of Corvette. “For eight generations, Corvette has pushed the boundaries of technology, performance and style while remaining an attainable cultural icon,” Chevrolet said in a release celebrating the anniversary. The 2023 model year Corvette Stingray and Corvette Z06 will celebrate this milestone with a special 70th Anniversary Edition package. “Passion for Corvette runs deep at Chevrolet and this anniversary is extra special because of the excitement and sales success we’ve achieved with the eighth generation of America’s iconic sportscar,” said Steve Majoros, vice president, Chevrolet marketing. “Even after 70 years, Corvette still makes hearts race and kids dream of the open road.”

2023 Chevrolet Corvette Z06 70th Anniversary Edition

www.repertoiremag.com

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June 2022

MARKETING MINUTE

Why Most Healthcare Content Marketing Fails See better results from your healthcare content marketing by avoiding these pitfalls.

Anyone can do content marketing, but few get it right. Healthcare distributors and manufacturers can spend

hours on content but never see a single quality return. Thankfully, there is a way to avoid wasting resources on failed content and consistently see positive healthcare content marketing results.

Healthcare content marketing can fail for dozens of reasons, but the most common B2B content marketing mistakes fall within three categories. No. 1: Don’t Understand the Audience If you don’t know who your content is for, it will never connect with your audience. Over 45% of B2B marketers struggle with identifying the audience for their content. Copying the style and format of others in the industry isn’t the answer. For example, if you write healthcare marketing content the same way hospital marketers write their content, you won’t see the same success even though you are both in healthcare marketing. Healthcare manufacturers and suppliers are working with businesses, not individuals. Within healthcare businesses, your specific organization will have a small number of hospitals and healthcare facilities that would use your supplies and products. If you want to resonate with those businesses, you must write to the primary decision-makers, use a higher level of content, and address business challenges like revenue and productivity. No. 2: Don’t Have Scannable Content Physicians work over 50 hours a week on average, with nearly a quarter of doctors working over 60 hours a week. Content that is hard to read won’t resonate with timestrapped hospital workers looking for solutions. Long paragraphs, no headlines, and industry jargon are all ways to turn your target audience off your content. Instead, placing scannable headlines that let healthcare workers easily find the most relevant information and plenty of white space and lists will encourage more of your audience to spend a few minutes of their valuable time reading what you have to say. 56

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No. 3: Content Has No Real Value Marketers often focus on quantity over quality. As a result, many will publish new content multiple times each week. However, if your content only adds to the noise of daily blog posts without bringing any unique value, it wastes time and energy. Healthcare content writing should not be full of fluff or repeat the same information your competitors covered. Instead, if you want your content to stand out, it must present old information in a new way or share new knowledge to leave readers with a fresh perspective and valuable insights that will help them improve their company.

Create a different type of healthcare content Why settle for average conversion rates when you can position your organization among the leaders in your industry? Take a few minutes to evaluate your current content marketing strategies and look for any areas holding you back. Contact us about our publications that provide the latest healthcare insights to help you provide valuable content.

HIDA

Bipartisan Preparedness Legislation Advances in Congress PREVENT Pandemics Makes Political Sense to Voters of All Parties

As HIDA members prepare to meet with our

elected representatives in Congress during our annual Washington Summit, we continue to advocate for passage of S. 3799, the Prepare for and Respond to Existing Viruses, Emerging New Threats, and Pandemics Act (PREVENT Pandemics Act).

By Wyeth Ruthven

PREVENT Pandemics Has Bipartisan Support in Congress The PREVENT Pandemics Act was introduced by Senators Patty Murray (D-WA) and Richard Burr (R-NC). It is intended to be a comprehensive, bipartisan legislative effort to apply lessons learned from the COVID-19 pandemic to strengthen medical supply chains and public health preparedness. ʯ HIDA has worked closely with staff in the offices of Senators Murray and Burr to incorporate policy recommendations from the health distribution industry. ʯ Drafting this bill is the fulfillment of years of collaboration with federal partners on preparedness and the medical supply chain. ʯ In March, the Senate Health, Education, Labor and Pensions (HELP) Committee approved the PREVENT Pandemics Act on a bipartisan vote of 20 to 2.

PREVENT Pandemics Creates a Partnership Between Public and Private Sectors The PREVENT Pandemics Act recognizes the vital role of public-private partnerships in managing medical supplies during a pandemic. Government and the private sector should work together to build a cushion of medical supplies to meet the immediate needs of providers, while giving manufacturers critical time to surge production. ʯ Federal policymakers should embrace its role to fully fund and expand the Strategic National Stockpile (SNS). ʯ Meanwhile, the SNS must work with private-sector distributors to sustain, rotate and replenish their stores of critical supplies. ʯ To invest in capacity, manufacturers need certainty that there will be long-term market demand for certain medical supplies. The Federal government should make long-term contracting commitments to manufacturing partners.

The PREVENT Pandemics Act is focused on strengthening the nation’s public health and medical preparedness and response systems in the wake of the COVID-19 pandemic. A majority of voters – of all political persuasions – support preparedness measures to prevent and mitigate future pandemics. ʯ A poll conducted by Data for Progress on behalf of the organization Guarding Against Pandemics found that 69% of likely voters were either very concerned or somewhat concerned about the emergence of a future pandemic. ʯ Support for preparedness crossed party lines. This included 82% of Democrats, 55% of Republicans and 69% of independent voters. ʯ Among the preparedness measures most supported by voters were access to up-to-date treatments, improvements in vaccine administration, and investment in technologies that stop the spread of disease. HIDA has welcomed the introduction of the PREVENT Pandemics Act, and has continued to share our input with Congress on these issues. Medical products distributors have unique subject matter expertise on this topic. HIDA members deliver medical products and supplies, manage logistics, and offer customer services to virtually every healthcare provider. Future preparedness efforts need to harness the best from the public sector and the private sector. As Congress continues to deliberate on these critical issues, HIDA is proud to remain a voice for our industry and be part of the solution in Washington and beyond. www.repertoiremag.com

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June 2022

NEWS Primary Care News Walmart Health expands to Florida with five new health centers Florida families can now experience convenient access to health care with the opening of five new Walmart Health centers across North and Central Florida. The openings mark Walmart Health’s expansion into Florida, beginning with the new Jacksonville location at 7075 Collins Rd., situated adjacent to the Collins Road Supercenter. At least four additional locations in Florida will open in the Jacksonville, Orlando, and Tampa areas. Situated adjacent to Walmart Supercenters, these convenient state-of-the-art Walmart Health centers provide a range of services, including primary care, labs, X-ray and EKG, behavioral health and counseling, dental, optical, hearing, and more. Onsite Walmart Care Hosts and Community Health Workers will help customers navigate their visit, understand resources and be a familiar presence for regular visits. Walmart is committed to Florida with more than 380 retail locations and 120,000 associates. The company is excited to meet the needs of Florida’s residents as the state’s population grows. From 2010 to 2019, Florida’s population grew 13%, more than double the total U.S. population growth.

AMA: Physicians “enthusiastic” about telehealth An American Medical Association (AMA) survey showed physicians have enthusiastically embraced telehealth and expect to use it even more in the future. Nearly 85% of physician respondents indicated they are currently using telehealth to care for patients, and nearly 70% report their organization is motivated to continue using telehealth in their practice. Many physicians foresee providing telehealth services for chronic disease management and ongoing medical management, care coordination, mental/behavioral health, and specialty care. The survey comes as Congress recently extended the availability of telehealth for Medicare patients beyond the current COVID-19 public health emergency. Additional action by Congress will be needed to permanently provide access to Medicare telehealth services. As physicians and practices plan to expand telehealth services, they say widespread adoption hinges on preventing a return to the previous lack of insurance coverage and little to no payer reimbursement. Payers, both public and private, should continue to evaluate and improve policies, coverage, and payment rates for services provided via telehealth. 58

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“Physicians view telehealth as providing quality care to their patients, and policymakers and payers have come to the same conclusion. Patients will benefit immensely from this new era of improved access to care,” said AMA President Gerald E. Harmon, M.D. “This survey shows adoption of the technology is widespread as is the demand for continued access. It is critical that Congress takes action and makes permanent telehealth access for Medicare patients.”

California study measures the impact of primary care The California Health Care Foundation announced a “first-of-its-kind” study examining the level of primary care investment specifically in the state’s health care market. The study measured primary care spending, as a proportion of overall spending, among eight health plans and their product offerings, covering 80% of commercially insured adults in California (13.9 million). The study also took a deeper look at the primary care spending of 180 separate provider organizations, comprising 8.5 million adults enrolled in HMO plans, or nearly half of California’s commercially insured adults. To measure the impact of primary care investment on care quality, researchers compared provider organizations on measures including the share of members who received recommended breast cancer, cervical cancer, and colorectal cancer screenings; received appropriate medications; and who had their diabetes care goals met. Among the key findings: ʯ The percentage of primary care spending varied more than twofold among the plans, from a low of 4.9% to high of 11.4%, mostly below other states’ recommended levels of 9% to 12%. ʯ Greater investment in primary care among health plans was associated with better quality care and fewer hospital visits. ʯ Among the provider organizations, larger investments in primary care were associated with better quality, better patient experience, and fewer hospital and emergency room visits, as well as a lower total cost of care. ʯ If provider organizations in the lower brackets of primary care spending matched those in the highest bracket of spending, 25,000 acute hospital

stays and 89,000 emergency room visits would be avoided, and $2.4 billion in overall health care spending would be saved in a single year. “This study contributes to the body of evidence showing that health care systems that invest more in primary care as a proportion of their overall budget per-

form better on measures of quality, utilization, and cost,” researchers said. The research was conducted by Integrated Healthcare Association, Onpoint Health Data, RAND Corporation, and Bailit Health Purchasing with support from the California Health Care Foundation, Covered California, and the Milbank Memorial Fund.

Industry News IMCO names Jay Butler as VP of Extended Care IMCO announced that Jay Butler has been promoted to Vice President of Extended Care. He will lead IMCO’s effort in the extended care markets with IMCO’s network of independent medical supply distributors that service these accounts. Butler was previously with Nestle Healthcare prior to joining IMCO in 2018.

Cardinal Health expands medical distribution footprint in Ohio Cardinal Health announced plans to build a 574,670 square foot medical distribution center in the Columbus, Ohio area. The new building will integrate automation and technology to work alongside Cardinal Health employees; improve safety, service and quality; deliver operational efficiencies; and better support fluctuations in volume and labor to provide customers with a predictable and stable customer experience. “We’re building a new warehouse to meet both our customers’ current and future needs,” said James Sembrot, SVP U.S. Supply Chain at Cardinal Health. “The new facility is part of a multi-year strategy to increase U.S. warehouse capacity with expanded inventory space. By increasing our medical distribution footprint, we will provide customers another location in our network for Strategic Stock Solutions and 3PL services,” said Sembrot. The new Columbus facility will replace Cardinal Health’s current 235,000 square foot facility in nearby Obetz, Ohio. The larger warehouse footprint and operations can accommodate a full transition of existing employees, and will create new job opportunities for the Ohio Valley market. In partnership with Duke Realty, a leading owner, developer, and manager of logistics and industrial properties, along with its joint venture partners Columbus Regional Airport Authority and Capitol Square, Cardinal

Health anticipates the new facility to be fully operational by late 2022 or early 2023. “Our public-private partnership between the Columbus Regional Airport Authority and Capitol Square continues to drive our developments in Rickenbacker Global Logistics Park with direct access to highways, the largest dedicated cargo airport in the world and the rail intermodal terminal for Norfolk Southern,” said Ben Struewing, Duke Realty’s vice president of leasing and development for Ohio. “Columbus’ robust talent pool and centralized location make it ideal for Cardinal Health to meet its supply chain and logistics needs to further fuel their growth and success.”

Precision Medical Products announces Steve Ingel as new CEO Precision Medical Products recently announced the appointment of Steven Ingel to President & CEO. Ingel’s official start date was April 4, 2022. At that time, he succeeded Precision Medical’s current President and CEO, Jeremy Perkins, who will remain with Steven Ingel the company and assume the role of Executive Chairman of the Board. In this new role, Perkins will identify strategies, business opportunities, and new technology architectures to grow Precision Medical Products. “Steve Ingel brings a wealth of medical devices and digital health experience with a well-established proven track record of driving growth, margin expansion, and overall financial performance. His broad and deep industry experience combined with his respected leadership and team-building style make him the right fit to continue our important work at Precision Medical,” said Jeremy Perkins. www.repertoiremag.com

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June 2022

NEWS

BD forms Sustainable Medical Technology Institute

Premier: Fluid shortages affecting large numbers of patients

BD (Becton, Dickinson and Company) announced the formation of the Sustainable Medical Technology Institute, a model of practice within the organization that will bring together BD researchers and engineers, as well as quality, regulatory, policy and operational expertise, to focus on reducing the environmental impact of the company’s product portfolio in three areas, including adopting sustainable product design strategies, developing and deploying sustainable sterilization technologies, and addressing materials of concern (MOC). The Institute will serve as an example of how the company continues to advance the world of health by prioritizing high-quality, safe products for patients, while furthering its environmental, social and governance (ESG) strategy. “As part of our ESG strategy, we made commitments in specific areas where we see the most opportunity for BD to create meaningful, measurable change over the next decade,” said Maureen Mazurek, vice president, sustainability and environmental health and safety (EHS) at BD. “In order to achieve these commitments, we established a set of goals to track and measure our success, and this includes how to reduce the environmental impact of our product portfolio and address our customers’ sustainability needs. These priorities led us to form the Sustainable Medical Technology Institute.” The Institute will operate in North America, Europe and Asia, and will collaborate with cross-functional teams within the company’s business units, inclusive of research and development, regulatory, quality, policy and operations roles, with the goal of ensuring accountability and a streamlined approach to sustainability efforts, as well as further address sustainability needs within the industry and global regulatory bodies. Key initial efforts include reestablishing a set of minimum environmental and human health criteria for new products and product changes aligned with the company’s 2030+ ESG commitments and goals, and identifying new ways to reduce, reuse, recycle or replace materials. These efforts will inform the company’s product life cycle roadmap and enable adoption of a sustainable-by-design product development process.

Providers in the U.S. are reporting significant disruptions in the supply of pre-filled saline flush syringes, normal saline injection, and sterile water injection vials, according to Premier. The pharmaceutical space is also experiencing a fluid shortage in reconstitution, infusions, and dilutions of drugs. In early December 2020, a notice regarding the shortage of normal saline prefilled syringes and vials was published by the Infusion Nurses Society. Premier is advocating for three things to mitigate potential or impending shortages:

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1. T he FDA to make sourcing, quality, volume and capacity information publicly available for all medical products sold in the U.S. Different regulations for pharmaceuticals and medical devices are complicating fluid shortages, with the vials and syringes to administer saline classified as medical devices while the bags and solution are regulated as drugs. While manufacturers, hospitals and other stakeholders work to increase production capacity, a streamlined U.S. regulatory framework is needed that makes it easier to collect data, implement workarounds and guide conservation strategies for all products. 2. Outsourcing compounders to continue producing drugs based on specific criteria, such as short-term or regional shortages or demand surges for certain dosage strengths and/or packaging sizes. This proved particularly helpful throughout the pandemic, as it allowed 503B facilities to address capacity gaps and alleviate spot shortages before they became severe enough to spread nationwide. 3. The FDA to fully implement its new authorities granted under the Coronavirus Aid, Relief, and Economic Security (CARES) Act – soliciting a deeper level of reporting on manufacturer quality, contingency, redundancy and risk management plans to mitigate supply disruptions.

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Repertoire June 22

Articles inside

Industry News

Automotive-related news

Primary Care News

See better results from your healthcare content marketing by avoiding these pitfalls

in Congress

A little serendipity and a lot of talent led one manufacturers sales rep down a successful path

for Booth Medical

IDNs in the News

In long-term-care facilities, who has time to see suppliers when there’s so much work to do?

CVS Health is advancing health equity via affordable housing

Health systems look to expand care delivery services in Hospital-at-Home programs post pandemic

After years of improvements in patient safety, along came COVID-19

Some insights and resources to help you and your customers get more comfortable with CLIA compliance

Why today’s doctors will provide the best care by following the science – and listening to patients

Courtesy of NDC