vol.27 no.5 • May 2019
repertoiremag.com
Lab sales:
A guide for the well-informed rep Technology’s changing. Economics are changing. Attitudes are changing. Are you?
Keeping the customer happy.
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PLATFORMS
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SEKISUI DIAGNOSTICS IS YOUR PARTNER IN HEALTHCARE / 800-332-1042 / WWW.SEKISUIDIAGNOSTICS.COM © 2019 Sekisui Diagnostics, LLC. All rights reserved. OSOM® is a registered trademark of Sekisui Diagnostics, LLC. Silaris™ and Because every result matters™ are trademarks of Sekisui Diagnostics, LLC. FastPack® is a registered trademark of Qualigen Inc.
MAY 2019 • VOLUME 27 • ISSUE 5
EDITOR’S LETTER Stay on task.........................................................................6
PHYSICIAN OFFICE LAB Consumables
Sweat the small stuff ....................................................................8
IDN OPPORTUNITIES
Lab sales:
A guide for the well-informed rep Technology’s changing. Economics are changing. Attitudes are changing. Are you?
16
Contracting Executive Profile Mark French, Vice president, Vendor Management and Purchased Services, Ochsner Health System.............................................. 12
MATERNAL CARE
Steady Progress An industrywide consortium took a big step this winter in its quest to bring uniformity to the vendor credentialing process.
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A Mother’s Good Health Primary care doctors can play a much-needed role in improving maternal outcomes before, during and after giving birth.................................... 24
repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2019 by Share Moving Media. All rights reserved. Subscriptions: $49.00 per year for individuals; issues are sent free of charge to dealer representatives. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address. POSTMASTER: Send address changes to Repertoire, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors. Periodicals Postage Paid at Lawrenceville, GA and at additional mailing offices.
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MAY 2019 • VOLUME 27 • ISSUE 5
HEALTHY REPS
TRENDS A new kind of medical school for a new kind of doctor Kaiser Permanente School of Medicine to begin accepting applications in June........................... 34
MRSA: The bug all of bugs?....................................... 36
WINDSHIELD TIME
Automotive-related news...........................48
Health news and notes
44
QUICK BYTES
HIDA GOVERNMENT AFFAIRS UPDATE Medical Device Tax Moratorium To Expire At The End Of 2019................................. 53
REP CORNER
Technology news
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The Unstoppable Sonya Kimmet..........54
INDUSTRY NEWS News........................................................................................... 58
We go together like… You play a vital role in B. Braun Medical’s success. And our success depends on each other. Thank you for supplying the products healthcare professionals critically need and making B. Braun a leading healthcare provider.
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EDITOR’S NOTE
Stay on task Many thanks to lab expert Jim Poggi for fielding our questions about selling to today’s
physician office lab. As always, his responses are well-thought-out. But one that sticks out is his response to our question, “Should physician office labs be worried about the impact of increased point-of-care testing in retail clinics?” Our question was prompted by the announcement in January that PTS Diagnostics and Kroger Health (Kroger Company’s nationwide arm of health and wellness facilities) will install CardioChek Plus analyzers for point-of-care blood testing at all Kroger Health locations – more than 2,100 pharmacies and clinics. (The CardioChek Plus system tests lipid profile and glucose simultaneously with one fingerstick.) In a statement, the two companies said, “Its [referring to CardioChek Plus] speed and portability combined with the reach and influence of Kroger Health pharmacies and clinics will increase the number of potential patients who are able to receive preventative health screenings and begin clinical protocols.” We asked Jim, “How will this affect testing volume at physician offices?” His answer, in effect: “Wrong question.” “Physician offices should be more concerned about the level of overall patient services and lab testing they offer their patients than what others, including Kroger, may be doing,” he told us. “With MACRA institutionalizing the need for better patient outcomes and better patient satisfaction, physician practices need to assess how effectively they are meeting customer needs and adjust their services and practices accordingly. “Distributors can help by reminding the practices they call on that they need to be at the top of their game, and offer to be part of the assessment process. The exceptional distributor sales rep should approach this situation as an opportunity to learn their customer’s situation, objectives and needs, and be prepared with some ‘best practice’ consulting ideas to help the customer improve and be competitive in their market.” Yes, physicians – and their distribution partners – always stay tuned into their competitive environment. But not so much that they lose sight of what’s right in front of them – in this case, physician practices who can use your help to stay ahead of the competition while offering up the very best care for their patients.
Mark Thill
repertoire is published monthly by Share Moving Media 1735 N. Brown Rd., Suite 140, Lawrenceville, GA 30043 Phone: (800) 536-5312, FAX: (770) 709-5432; e-mail: info@sharemovingmedia; www.sharemovingmedia.com
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2019 editorial board Richard Bigham: IMCO Eddie Dienes: McKesson Medical-Surgical
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circulation
Doug Harper: NDC Homecare
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Keith Boivin: IMCO Home Care
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PHYSICIAN OFFICE LAB
Consumables By Jim Poggi
Sweat the small stuff
When it comes to the small everyday items that make
every lab run efficiently, the range of consumable products and, even worse, consumable product options seems endless. As a result, I’ve frequently heard even wellrespected distribution account manager pros lament “If I don’t offer everything (for lab consumables), I can’t sell anything.” Yet, since every lab needs these items and they represent a substantial lab spend opportunity, you need to challenge the conventional wisdom if you want to be a lab super star. My contention: If you are managing a lab catalog or simply want to take orders, yes, you do need everything. As a professional distributor account manager, there’s no way you can or want to offer every possible consumable item. But, if your game is selling, you need a quality assortment of the most commonly used products from reliable suppliers. And, you need to work your product formulary every day with every customer until you establish a solid product and customer base. So, what do you do?
Know what your customers buy and develop a “formulary” accordingly Don’t be intimidated by the massive range of possibilities. Take a calm, reflective view and look around your
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customers’ labs for the common items. See what’s in view. The lab appliances – centrifuges, microscopes, rockers, rotators, etc. – are in plain sight and are pretty obvious picks. Figure out which lab appliances are used in most of your labs and the requests you get most often. Then look for the really small stuff hiding in plain sight: microscope slides, pipettes, stains, blood collection supplies, etc. Finally, ask a few qualifying questions. Which items do you use most often? Which seem to provide you with difficulties in performance, have back orders or are just inconvenient to get or use? Where do you buy them now? Why do you buy from that source? Which items would you like to add to your order guide from me, if I can get them for you? Remember the first rule of consolidation: customers are most efficient when they buy the most items from the fewest sources. And, since you are their chosen lab distributor, make sure they choose you for their consumables. Once you know the range of items, make a list. I use Excel and divide the list into two buckets: • Lab appliances: the little gadgets with power cords scattered throughout the lab like centrifuges, microscopes, etc. • Daily use consumables: slides, culture tubes, blood collection tubes.
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PHYSICIAN OFFICE LAB I then try to estimate which items are most common and represent my best opportunities, like this:
Territory Consumable summary for my top 50 customers Lab Appliances Item
Number of labs using the item
Most common choices
Centrifuges
38
6 rotor, fixed angle rotor
Rocker
22
Small rockers are most common
Item
Number of labs using the item
Most common choices
Blood collection tubes
46
SST tube
Blood collection tubes
41
Lavender top (hematology)
Microscope slides
22
Plain, green is most common
Culture tubes
14
10 x 75 plastic is most common
Pipettes/tips
14
100 uL, 1 ml are most common; list brand
Daily Use Consumables
Be a smart boutique Don’t try to be a catalog merchant, order taker or big box store. It’s not possible, not profitable and it puts product selection for simple everyday items in your customer’s control, not yours. Use Pareto’s rule and pick the items that cover the majority of customer spend with products whose price and performance meet the general need. For these types of items, if you have consulted your best consumable suppliers, searched diligently for the private label items that make sense in this category and sought a little coaching from your manager, category expert or highly experienced reps, you should have a solid formulary. If your formulary choices are right, you shouldn’t need to have more than two options for most of the most commonly required lab consumables to manage. That’s a lot easier than trying to manage a catalog assortment. There is no doubt you will need to refine the list from time to time, but if you start with a solid formulary you will create customer loyalty and on-going repeat business.
How do you and your customers win with this approach? Selecting a core of formulary products with the right combination of price, performance and availability is a win for everyone. From a revenue standpoint, you will grow your business consistently and get valuable repeat business. You will also gain loyalty from the suppliers you support most actively. This should open the door to samples when needed, excellent supplier support and even insight to new products
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on the horizon. Your customers win with an order guide you help create that makes ordering high quality products easy, consistent and assures availability of products with competitive pricing when needed. As an added bonus, if you have a good cross section of your customer base ordering the same products, they have the ability to borrow from one another should the need arise. We always hope that doesn’t happen, but we all know it does. A formulary helps you and your customers when the need arises.
Sell, don’t source • Offer high quality options for items on your formulary as replacements for items you don’t have • Don’t be afraid to sample • Make private label work for you The best strategy to manage your customers’ needs for lab consumables is to sell. Know you can influence your customers’ choices of pipettes, microscope slides and stains, which typically have the higher levels of customer preference as long as you know you have high performance options to offer. After that, the culture tubes, sample racks and other simple items are easy because there’s little to no customer preference beyond price and availability. Planning and selecting the right number and mix of products to offer is the “heavy lifting.” Once you do that successfully, implementation of your formulary with your customers will bring you the revenue and customer loyalty we are all looking for. Sweat the small stuff and reap the rewards!
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Contracting Executive Profile Born in Hawaii, Mark French
moved to Northern California with his family when he was 15. He received a bachelor’s degree in exercise physiology from the University of California Davis. While there, he worked in a trauma unit, a physical therapy clinic and an Alzheimer’s care facility (for which he ultimately assumed an administrator role). He received a master’s degree in health administration from Tulane University in New Orleans, Louisiana. After
Mark French
Vice president, Vendor Management and Purchased Services, Ochsner Health System New Orleans, Louisiana
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completing a fellowship and an additional year working in finance at Henry Ford Health System in Detroit, Michigan, he returned to New Orleans and joined the Ochsner Health System in 2000. He began his career at Ochsner as the operations manager in the Department of Renal Services and has served in a variety of leadership roles, including the COO of Ochsner Medical Center – New Orleans. French lives in New Orleans. He is the father of three daughters.
About Ochsner Health System With 30 hospitals owned, managed and affiliated, more than 80 health centers and urgent care centers, more than 18,000 employees, and over 1,200 physicians in more than 90 medical specialties and subspecialties, Ochsner is Louisiana’s largest health system. Each year, more than 273 medical residents and fellows work in 27 different Ochsnersponsored ACGME accredited residency training programs. Ochsner
also hosts more than 550 medical students, 150 advanced practice providers, 1,200 nursing students and 575 allied health students. Repertoire: Can you describe the most challenging and/or rewarding supply-chain-related project in which you have been involved in the past 12-18 months? Mark French: There have been two, one being the replacement of our elevator service and maintenance provider, and the second being the replacement of our courier provider. We have approximately 160 cars or elevators throughout our organization. You learn very quickly that they can be the lifeline of any facility. When they are not operating correctly, it’s an extremely challenging situation. We put our vendor on a performance improvement plan, but ultimately had to sever ties. Transitioning to a new service provider is never easy, but we are in a good place
I realize today there’s so much I don’t know. I learned as a COO that being able to manage stress and maintain a healthy work/life balance is a real thing.
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IDN OPPORTUNITIES now. Service has improved tremendously, and confidence is slowly being restored. We had a similar situation with our courier provider. We brought in a new provider in January, but quickly found they were not up to the task. When something like this happens, it’s a matter of looking at yourself in the mirror, realizing that you’ve made a mistake, taking ownership of that, reassuring the organization that you’ll fix it, and then getting it right – not to mention all the day-to-day firefighting and troubleshooting. We did bring in another provider, and things are now working smoothly.
provider, it could become a new competitive force that will challenge traditional approaches and paradigms. With disruptions such as these, our challenge to remain current and immediately relevant to our community and patients is real. Repertoire: How have you improved the way you approach your profession in the last five to 10 years? Did you have any help doing so, or was there any particular incident that was particularly significant? French: You’re talking to a much humbler person than I was five or 10 years ago. I realize today there’s so much I don’t know. I learned as a COO that being able to manage stress and maintain a healthy work/life balance is a real thing. The challenge is in realizing you may not be able to handle all on your plate the way you traditionally might have. You must prioritize, put life in perspective and understand what’s important.
This is a team sport. If you can’t work within a team construct, or if you don’t believe that every member of the team is valuable, you’re going to struggle. Dealing with purchased services is challenging. You’re dealing with human beings, not widgets. The organization can have wonderful policies and operating protocols in place for each service, but each service provider must execute – and that often comes down to the individuals who are responsible for the delivery of the associated service. It’s never-ending work. Just when you think everything is progressing smoothly, there will be a new challenge to address. You’re excited one moment, and the next you’re asking, “Why isn’t this working?” Repertoire: Please describe a project you look forward to working on in the next year. French: We’re living in a world of disruption. A great example is the merger of Aetna and CVS. That could change the healthcare landscape. Given the new entity’s financial resources, the collective knowledge and understanding of customer service, and the fact that neither is embedded in the industry as a traditional healthcare
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Repertoire: In your opinion, what will be some of the challenges or opportunities facing the next generation of supply chain professionals? What should they be doing now to prepare to successfully meet those challenges and opportunities? French: They will require the willingness to change on a dime; the willingness to fail and not hang onto something too long; and the ability – and I believe this is an ability – to work effectively with other people. This is a team sport. If you can’t work within a team construct, or if you don’t believe that every member of the team is valuable, you’re going to struggle. Also, you can’t hang onto something just because you invented it. The environment is constantly changing; if we can’t change, then in all likelihood we can’t be successful. I think humility is another factor for success. It’s a willingness to say, “I don’t know, but I will find out.” We have a fellowship program within Ochsner; I am a preceptor of a supply chain professional. My constant mantra is, “Be humble, work well with others, be ready and willing to change, and find work/life balance.” Hopefully you run across mentors who will challenge you and call you out when you’re not being humble.
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Experience the confidence that comes with accurate, reliable readings. Contact your Welch Allyn representative today, or visit us online at www.welchallyn.com/ConnexSpotMonitor to learn more. 1
Agency for Healthcare Research and Quality. Multiple Chronic Conditions Chartbook: 2010 Medical Expenditure Panel Survey Data. (2014) Accessed at http://www.ahrq.gov/professionals/ preventionchronic-care/decision/mcc/mccchartbook.pdf
2
Tackling the burden of chronic diseases in the USA. Lancet 2009;373(9659):185. Accessed at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60048-9/fulltext
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Estimate based on standard acquisition times for Welch Allyn sensors: Approximately 15 seconds for blood pressure, 4 to 7 seconds for temperature, and 8 to 12 seconds for SpO2.
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Robert Smith, MD. Blood pressure averaging methodology: Decreasing the risk of misdiagnosing hypertension
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Lab sales:
A guide for the well-informed rep
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Lab sales:
A guide for the well-informed rep Technology’s changing. Economics are changing. Attitudes are changing. Are you?
Lab testing is important to physicians, patients, manufacturers, sales reps, payers and others. But the technology is changing. So are providers’ attitudes. Accuracy remains most important, but costeffectiveness is not far behind. Repertoire asked Jim Poggi about how sale reps can navigate lab sales today and in the near future. www.repertoiremag.com
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Lab sales:
A guide for the well-informed rep Repertoire: Over the past, say, 10 years, how have distributor reps improved the way they sell lab equipment, accessories, etc., to the physician office? Jim Poggi: Distributor reps are doing a much better job today of “quarterbacking the sale,” i.e., being the coordinating force while still using the full range of supplier and their own company’s personnel and assets to close the deal and provide the best comprehensive solution. Examples include offering company-sponsored or COLA-based lab consulting, and working on large instrument and new lab set-ups with broad teams in the field, including sales, service and even the shipping companies.
Poggi: As I see the recommendations of Choosing Wisely and others, the intent is to avoid testing that is either of low diagnostic value OR a needless duplication of testing. Many of their recommendations have been developed in collaboration with medical societies. Ultimately, I believe it is in the best interests of both patients and clinicians to provide “the right test at the right time for the right reason.” While I may disagree with a specific recommendation or two, I believe the dialogue they are creating is important and needed. I do NOT expect their recommendations to detract from appropriate and useful testing. My professional belief is that tests need to be performed “to initiate or modify a patient treatment program.” I believe Choosing Wisely shares this objective.
Ultimately, I believe it is in the best interests of both patients and clinicians to provide ‘the right test at the right time for the right reason.’ Repertoire: In what respect – if any – may reps still be “missing the point” about lab sales? Poggi: A couple of ways: 1) Some folks are still “going it alone,” which is fine for simple transactional sales but not for answering complex customer questions or addressing large system sales effectively; and 2) there are still some “high fear/low activity” product lines, like LIS and proficiency testing. Reps need to focus on the best available opportunities, but I believe there is more opportunity here than the average rep takes advantage of. Repertoire: About 40 percent of patient encounters in primary care offices are said to involve some form of medical test. Meanwhile, the American Society for Clinical Pathology has made 25 recommendations for reducing lab tests, as part of the ABIM Foundation’s “Choosing Wisely” program. Do you think initiatives such as Choosing Wisely, as well as general cost pressures, are having an impact on pointof-care testing in the physician office? If yes, how so? If not, why not?
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Repertoire: In January, PTS Diagnostics and Kroger Health – Kroger Co.’s arm of health and wellness facilities, services and programs – announced the full rollout of CardioChek Plus analyzers for point-of-care blood testing to help identify individuals at risk of heart attack, stroke and diabetes. Should physician office labs be worried about the impact of increased POC testing in retail clinics? If so, how should they respond? And how can distributors help them do so? Poggi: As I see it, physician offices should be more concerned about the level of overall patient services and lab testing they offer their patients than what others, including Kroger, may be doing. With MACRA institutionalizing the need for better patient outcomes and better patient satisfaction, physician practices need to assess how effectively they are meeting customer needs and adjust their services and practices accordingly. Distributors can help by reminding the practices they call on that they need to be at the top of their game, and offer to be part of the assessment process. The exceptional distributor sales rep should approach this situation as an opportunity to learn their customer’s situation, objectives and needs, and be prepared with some “best practice” consulting ideas to help the customer improve and be competitive in their market.
IT’S NOT TOO EARLY TO TEST FOR HEART DISEASE.
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Lab sales:
A guide for the well-informed rep Repertoire: The Protecting Access to Medicare Act of 2014 (PAMA) required CMS to develop a national fee schedule for laboratory tests based on private-payer data. CMS reported that its implementation of the new payment rates could lead Medicare to pay billions of dollars more than is necessary. Yet in a 2018 COLA survey, over 56 percent of participants reported that further cuts in the CLFS will likely cause them to stop providing laboratory services. Who’s right? Poggi: Neither is right, and their opinions are entirely too polar and dramatic to be taken seriously. CMS’ comments centered around clinicians billing automated panel tests at the individual test level to increase reimbursement by over $10 billion – which is an absurd overstatement. I doubt
performed. Ultimately the test of value will be the extent to which these methods will be implemented. At the IDN or large-scale clinical practice level, they would be impactful. But without substantial numbers of clinicians enrolled and patient data being collected, analyzed and utilized, this tool is unlikely to be more than an interesting intellectual exercise. Repertoire: Researchers at Dartmouth-Hitchcock Medical Center recently reported they created a deep learning model that classified lung cancer slides similarly to how three pathologists did. Meanwhile, in January, NIH researchers reported they are pairing artificial intelligence analysis with smartphone cameras to help detect pre-cancerous changes that could lead to cervical cancer. What impact will these kinds of activities have on in vitro tests? Poggi: There is a lot of interest in reducing variables and human error and interpretation, particularly in anatomical pathology. I do expect a lot of challenges from the clinical pathology community as this trend gathers momentum. Ultimately, the obvious determining factor will involve whether “deep learning” and artificial intelligence models have more predictive power and better diagnostic utility. I expect it to take a number of years for our understanding of those issues to be entirely clear. At the same time, I would expect certain pathology procedures (PAP smears, lung cancer aspirates and others) to be evaluated individually, so the adoption curve for this sort of technology is likely to be dependent on evaluation of individual pathology procedures.
Lab test manufacturers are creating tests that enable physician practices to align their decision-making on antibiotic usage with clear evidence needed to make the right choice – prescribe an antibiotic or not. this will become typical, since the jeopardy associated with this practice could be pretty severe. At the same time, cutting testing back by 56 percent would assume clinicians also decrease their dependence on testing by this amount. That choice is equally absurd. I do not consider that decrease to be credible. Important, high-value tests will continue to be used as appropriate. In my opinion, a balance between these two polar views is the most likely outcome. Repertoire: In November 2018, researchers proposed a framework for evaluating electronic trigger tools to detect diagnostic errors. Do you foresee more integration of the EMR and lab tests? And if so, how do you think that might affect in vitro testing? Poggi: Determining whether a lab test result is logical based on prior tests, patient demographics and other factors makes sense and represents a good cross-check to me. In my opinion, it is equally important to search the database for recent tests to avoid or minimize the amount of redundant or conflicting lab tests being requested and
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Repertoire: Wearables are big. We read about connected smartwatches, which can connect to medical devices, such as glucometers or scales, and collect and transmit information. A smartband is being developed (by Empatica) that will detect patterns associated with epileptic seizures. HHS hopes that one day, wearables will be able to detect when someone is coming down with the flu or other illness. What impact will wearables have on in vitro testing?
Poggi: In my opinion, wearables are the latest fashion trend for the worried well and avid fitness advocates. I see that as positive and useful. For wearables to take hold to a greater extent, however, I believe they would need to be targeted to either patients with specific risk conditions requiring realtime monitoring (e.g., diabetes, epilepsy or narcolepsy) or deployment as sentinels for either seasonal illness (respiratory diagnosis) or to signal a threat condition (e.g., chemical or biological weapons). Development of the right applications for needed monitoring is the most critical need, as I see it. Repertoire: Liquid biopsies are said to detect and identify cancer (e.g., colorectal cancer), to reveal whether a replacement heart is failing in the body of a transplant recipient, to predict premature births, even to detect Alzheimer’s. How far in the future is this? Will it ever occur in the physician office? Poggi: The current technology is not suitable for the physician office, but liquid biopsy is here and gathering momentum quickly. I am impressed by it and believe it is becoming a potent diagnostic tool in tertiary care sites. Trickle down to the physician office? At some point, I would expect the technology to become sufficiently easy to use and interpret results to fit into larger oncology or mixed specialty practices. I doubt it would penetrate further than that. Repertoire: Diagnostics is said to be the key to precision medicine, because it can tell us if costly therapies and interventions would be useful on specific patients. The FDA appears to be approving more targeted medicines for specific disease subtypes. Will this change in-office testing? If so, how? Poggi: In the near term, the number of tests designed to determine the utility of targeted medicines and therapies will continue, especially in tertiary care centers. Probably the biggest issue I see is less the availability of appropriate testing methods, since a range of methods – including next-generation sequencing – have emerged, and more a concern that targeted therapeutic choices are becoming more complex than ever before and that clinicians need to overcome the learning curve. My impression is that the growth of targeted therapies will be somewhat dependent on “expert guidance” software and development of complex algorithms to guide treatment (and even testing) choices. I do not see a trickle-down into the testing choices of the average physician practice.
Repertoire: Do you foresee any changes in the way FDA clears diagnostic tests for marketing – or the way in which CMS and commercial payers decide to reimburse? If so, can you describe? Poggi: There is already activity by the FDA to more closely regulate “laboratory-developed tests” – that is, in vitro diagnostic tests designed, manufactured and used in a single laboratory – to assure they are developed and implemented appropriately. FDA issued requests for comment as recently as 2014 and issued a “discussion paper” in 2017. They have not yet decided to create regulatory surveillance, but they have identified what they consider to be potentially serious issues, including inadequate evidence that claims have been proven and inadequate control systems for some assays. It is only a matter of time before they begin to actively regulate this area of lab medicine, assuming they can fund this practice. Cutting edge tests will always be subject to intense scrutiny by the payer community, and I do not expect this pressure to decrease. Rather, I believe it will increase as pressure on the cost of healthcare continues to rise. New tests will be under more scrutiny than ever before to demonstrate that utilizing them will avoid or reduce downstream costs of patient care.
Distributor reps are doing a much better job today of ‘quarterbacking the sale.’
Repertoire: Are antibiotic stewardship programs having an impact on how physician offices conduct lab testing? Poggi: The most evident changes involve respiratory testing, where the range of high quality assays has increased well beyond influenza and group A strep. As test choices continue to become available to differentiate between viral and bacterial causes, the ability to decide whether antibiotic use is appropriate or not will become more based on testing rather than signs and symptoms. It is my impression that antibiotic stewardship has had a more direct impact on lab test manufacturers than physicians directly. Lab test manufacturers are creating tests that enable physician practices to align their decision-making on antibiotic usage with clear evidence needed to make the right choice – prescribe an antibiotic or not.
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MATERNAL CARE
A Mother’s Good Health Primary care doctors can play a much-needed role in improving maternal outcomes before, during and after giving birth
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Childbirth-related maternal health outcomes are get-
ting worse in the United States. That’s true not only during the nine months of pregnancy, but also in the so-called “fourth trimester,” that is, those months (some say as many as 12) following birth. Reasons include rising rates of chronic illness, obesity, C-sections and the advanced age at which some women are having children. As the topic attracts more interest among the public, Repertoire readers may find themselves in discussions about maternal health with their primary care and OB/ GYN customers. “Looking at the numbers, there has been a jump in maternal deaths,” says Ron Yee, MD, MBA, FAAFP, chief medical officer for the National Association of Community Health Centers. But there is a need for better datagathering, he adds. Prior to taking his current position, Yee was a family physician for 20 years in rural central California, where he estimates he delivered hundreds of babies, primarily those of migrant farm workers.
Rates climbing
While controversy exists about the accuracy of measurement of maternal and pregnancy-related mortality, analysis consistently demonstrates that at least 50 percent of deaths are potentially preventable, reports AHRQ. In addition, many more women experience serious pregnancy-related complications during and after childbirth. Such complications are 50 times more common than pregnancy-related mortality. Some blips can be detected in the statistics. For example, higher pregnancy-related mortality ratios during 2009–2011 have been attributed to an increase in infection and sepsis deaths, reports the CDC. Many of these deaths occurred during the 2009–2010 influenza A (H1N1) pandemic. Influenza deaths accounted for 12 percent of all pregnancy-related deaths during a 15-month period.
Women with chronic medical conditions should be counseled regarding the importance of timely follow-up with their OB/GYNs or primary care providers for ongoing coordination of care.
After a dramatic reduction in maternal mortality over most of the 20th century, rates began to climb in the late 1980s, reports the Agency for Healthcare Research and Quality (AHRQ). In fact, the United States now lags behind other industrialized countries in maternal mortality. The rate of severe maternal morbidity (e.g., massive blood transfusion, eclampsia, hysterectomy, heart failure) has also risen in recent decades. The number of reported pregnancy-related deaths in the United States steadily increased from 7.2 deaths per 100,000 live births in 1987 to 18.0 deaths per 100,000 live births in 2014, according to the Centers for Disease Control and Prevention. (CDC defines a pregnancy-related death as the death of a woman while pregnant or within one year of the end of a pregnancy – regardless of the outcome, duration or site of the pregnancy – from any cause related to or aggravated by the pregnancy or its management.) In a study of pregnancy-related deaths from 2011– 2013 in the United States, approximately 30 percent occurred before birth, 17 percent during birth, 18 percent one to six days after birth, and 34 percent more than six days after birth.
Chronic illness Events such as H1N1 aside, many studies show that an increasing number of pregnant women in the United States have chronic health conditions such as hypertension, diabetes, and chronic heart disease. These conditions can put a pregnant woman at higher risk of pregnancy complications. Among causes of pregnancy-related deaths, the following groups contributed more than 10 percent: • Cardiovascular conditions (15.5 percent). • Other medical conditions reflecting pre-existing illnesses (14.5 percent). • Infection (12.7 percent). • Hemorrhage (11.4 percent). • Cardiomyopathy (11.0 percent).
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MATERNAL CARE Government researchers report that compared with reports before 2006-2010, the contribution of hemorrhage, hypertensive disorders of pregnancy, and anesthesia complications declined, whereas that of cardiovascular and other medical conditions increased. Pregnancy can unveil and magnify health issues that were previously undetected, says Yee. For example, a prediabetic woman may develop gestational diabetes during pregnancy, which can lead to type 2 diabetes later in life. Similarly, mild hypertension prior to pregnancy can lead to preeclampsia, which is characterized by high blood pressure and high levels of protein in the urine, and which can increase the risk of kidney failure. And in general, the older a woman is, the higher the risk for chronic disease.
The social determinants of health – e.g., the patient’s socioeconomic status, housing status, ability and willingness to eat healthy foods, and the ability to travel to and from a doctor’s office or hospital – must be considered as well, says Yee. The National Association of Community Health Centers is engaged in a national effort to help health centers and other providers collect the data needed to better understand and act on their patients’ social determinants of health. The program – PRAPARE (Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences) – is intended to help providers define and document the increased complexity of their patients, transform care with integrated services and community partnerships, advocate for change in their communities, and demonstrate the value they bring to patients, communities, and payers.
The United States lags behind other industrialized countries in maternal mortality. The rate of severe maternal morbidity has also risen in recent decades. There’s one more factor at play, points out Yee. The United States has a higher incidence of C-sections than many other countries, and C-sections present a higher risk of hemorrhage, bleeding, infection and anesthesiarelated complications.
The physician’s office and the home Given the role of chronic illness in maternal health, it’s no surprise that primary care doctors can play a big role in improving maternal outcomes before, during and after giving birth. “When I was in practice, I treated any woman of child-bearing age as if she might in the future become pregnant,” says Yee. That calls for sensitivity to conditions that can adversely affect the health of the patient as a mother, as well as her child. “We need to try to get things like hypertension, diabetes and weight under control,” he says. “It calls for a lot of discussion about overall health and well-being.” That includes psychosocial factors, such as depression.
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Postpartum issues
The weeks following birth are critical for a woman and her infant, setting the stage for long-term health and wellbeing, according to the American College of Obstetricians and Gynecologists (ACOG). Postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman’s individual needs. Women with chronic medical conditions such as hypertensive disorders, obesity, diabetes, thyroid disorders, renal disease, and mood disorders, should be counseled regarding the importance of timely follow-up with their OB/GYNs or primary care providers for ongoing coordination of care, says ACOG. During the postpartum period, the woman and her OB/GYN or other obstetric care provider should identify the healthcare provider who will assume primary responsibility for her ongoing care in her primary medical home. Heart Safe Motherhood, a program created at the Hospital of the University of Pennsylvania, makes postpartum, at-home blood pressure monitoring easy, so that providers can catch rising blood pressure earlier and keep patients safe at home. HUP created the program because hypertension was the leading cause of seven-day readmissions for obstetrics patients there. Patients are discharged with digital blood pressure monitors and sent reminders via text message to check
MATERNAL CARE their blood pressure twice daily. In 2017, HUP completed a randomized controlled trial comparing Heart Safe Motherhood to the usual care of one-time, office-based blood pressure checks. The organization found an increase in its ability to obtain at least one blood pressure within 10 days of discharge in 92 percent of patients using text messaging, compared to 44 percent in usual care. HUP met ACOG guidelines in 80 percent of its patients, and readmissions dropped to zero percent among remote monitored women in the trial.
Racial disparities A woman’s race/ethnicity has a big impact on pregnancyrelated mortality, according to government researchers. The burden of maternal morbidity and mortality is especially
As many as 40 percent of women skip their postpartum visits, according to ACOG, and the rate is higher among low-income women of color. high in the African-American community, reports AHRQ. From 2011 to 2014, the pregnancy-related mortality ratio was more than three times higher among black women than white women (40.0 deaths per 100,000 births vs. 12.4 deaths per 100,000). The pregnancy-related mortality ratio was also higher for women of other races (17.8 per 100,000 live births). As many as 40 percent of women skip their postpartum visits, according to ACOG, and the rate is higher among low-income women of color. “Meanwhile, their blood pressure can be way out of control,” says Yee. Further, if a woman returns to work too soon after delivery, missing their follow-up visit, “that’s a setup for a chronic disease to spin out of control,” he adds. Implicit or unconscious bias on the part of individual clinicians or institutions can contribute to morbidity or mortality, says Yee. An individual provider’s attitudes can affect their understanding, actions and decisions in an unconscious manner. Age, race, ethnicity, disabilities, sexual orientation, personal hygiene can all have an impact, not to mention insurance status. “This is something that has to be picked apart,” he says.
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MATERNAL CARE
Interpregnancy Care Interpregnancy care aims to maximize a woman’s level
of wellness not just between pregnancies and during subsequent pregnancies, but also along her life course, says the American College of Obstetricians and Gynecologists in its “Obstetric Care Consensus” document, published online Dec. 20, 2018. (See https://www.acog.org/ClinicalGuidance-and-Publications/Obstetric-Care-ConsensusSeries/Interpregnancy-Care). All women of reproductive age who have been pregnant – regardless of the outcome of their pregnancies – should receive interpregnancy care as a continuum from postpartum care, says ACOG. For women with chronic
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medical conditions, interpregnancy care provides an opportunity to optimize health before a subsequent pregnancy. For women who will not have any future pregnancies, the period after pregnancy also affords an opportunity for secondary prevention and improvement of future health. The consensus statement was endorsed by the American College of Nurse-Midwives and the National Association of Nurse Practitioners in Women’s Health, and was developed by the American College of Obstetricians and Gynecologists and the Society for Maternal– Fetal Medicine.
Condition
Counseling
Test/Screening
Management
Gestational diabetes
Women with gestational diabetes have a sevenfold increased risk of developing type 2 diabetes.
2-hour oral glucose tolerance test (OGTT) at 4-12 weeks postpartum. Screening every 1-3 years.
Women with impaired fasting glucose, impaired glucose tolerance or diabetes should be referred for preventive or medical therapy.
Diabetes
Poorly controlled diabetes damages eyes, heart, blood vessels and kidney. Poor control further increases risk of birth defects in the next pregnancy. Diabetes is a risk factor for future heart disease.
Patients should demonstrate good control of blood sugars with hemoglobin A1c <7.0%.
Preeclampsia
Women with a history of preeclampsia have an increased risk of recurrence in subsequent pregnancies, as well as a twofold increased risk of subsequent cardiovascular disease.
Evaluate blood pressure for resolution of hypertension.
Gestational hypertension
Women with a history of gestational hypertension have an increased risk of developing chronic hypertension, as well as a twofold increased risk of subsequent cardiovascular disease.
Evaluate blood pressure for resolution of hypertension.
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Weight management. Testing for underlying vasculopathy; retinal examination; 24-hour urine protein testing; and electrocardiography. Thyroid screening.
Condition
Counseling
Test/Screening
Chronic hypertension
Hypertensive disease is a major cause of maternal morbidity and mortality. Uncontrolled hypertension leads to end organ damage, renal disease and cardiovascular disease, such as heart attacks and strokes.
Evaluate blood pressure for resolution of hypertension.
Cardiovascular disease
Cardiovascular disease is the leading cause of maternal mortality.
Overweight and obesity
Obesity is associated with increased risk of perinatal and maternal morbidity as well as infertility. Weight loss in between pregnancy reduces that risk. Obesity increases the risk of type 2 diabetes, hypertension, certain types of cancer, arthritis and heart disease.
Renal disease
Pregnancy may be associated with irreversible worsening of renal function in women with moderate to severe renal disease.
Thyroid disease
Poorly controlled thyroid disease is associated with adverse pregnancy outcomes, such as spontaneous abortion, preterm delivery, low birth weight, preterm birth, impaired neuropsychological development of the offspring, and possibly miscarriage.
Immunizations
Immunization against vaccine-preventable diseases is crucial for long-term maternal and infant health.
Management
Optimal contraception counseling. Evaluation and management by a cardiac disease specialist.
Measure BMI. Preventive screening for diabetes and lipids.
Serum creatinine. Urine protein.
Thyrotropin (also known as thyroid-stimulating hormone). Free T4
Management by primary provider to remain ehthyroid. Women with symptoms of hypothyroidism should undergo thyroid screening before attempting pregnancy.
All women should be screened for relevant vaccination opportunities per CDC guidelines.
Other conditions covered in the document: Depression or mental health disorders, HIV, epilepsy, systemic lupus erythematosus (SLE) and autoimmune disease, sexually transmitted infections, tobacco cessation, thrombophilia, psychosocial risks, and antiphospholipid antibody syndrome. (See https://www.acog.org/Clinical-Guidance-and-Publications/ Obstetric-Care-Consensus-Series/Interpregnancy-Care). Source: Interpregnancy care. Obstetric Care Consensus No. 8. American College of Obstetricians and Gynecologists. Obstet Gynecol 2019;133:e51-72.
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VENDOR CREDENTIALING
Steady Progress An industrywide consortium took a big step this winter in its quest to bring uniformity to the vendor credentialing process.
In January, the Consortium for Universal Healthcare
Credentialing (C4UHC) successfully completed the process of certification to develop ANSI (American National Standards Institute) standards for healthcare supplier credentialing through NEMA, an ANSI-standards-setting body. ANSI is the U.S. leader for standards development, says Dennis Orthman, consulting director for C4UHC. “Standards are only certified by ANSI if very specific criteria and processes are followed in their creation,” he says. “As required by ANSI, the Consortium’s standards development process involved all stakeholder groups in an open and transparent discussion. Formal votes were taken, and consensus was reached. In the case of ANSI/ NEMA SC1 2019 Standards for Supplier Credentialing in Healthcare, over 45 different stakeholder entities were
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involved, including healthcare providers, suppliers, distributors, and others. “The Consortium could not be happier with what has been accomplished, and the process used to get there.” NEMA is the association of electrical equipment and medical imaging manufacturers, and is one of numerous standard-setting bodies that are part of ANSI. Its connection to vendor credentialing is a natural one. “Many healthcare providers and suppliers already conform to ANSI/NEMA standards, so there should be some familiarity for credentialing,’ says Orthman. “Virtually every piece of medical equipment – and the hospital electrical systems they are plugged in to – used in the delivery of care of the patient conforms to ANSI/ NEMA standards. This enhances the ease of use and
promotes safety, among other things. If every piece of equipment had a different plug and did not have to meet fire and electrical safety minimums, think what that would mean to everyone? “We would like supplier credentialing to look more like standardized and interoperable electrical components versus [its current state].”
Reps’ personal information protected Adopting the ANSI standards will minimize the exposure of personal and sensitive information from suppliers’ employees, according to the Consortium. The adoption of ANSI standards require suppliers to work with their providers of background checks and other information to ensure that they also meet the ANSI/ NEMA SC1 2019 standard, explains Orthman. Suppliers then can communicate that their employee has met the requirement to the ANSI/ NEMA SC1 standard with “Many healthcare no need to send source documentation, personal providers and information, or sensitive suppliers already health information, miniconform to ANSI/ mizing the exposure of NEMA standards, personal information. so there should be “Adherence to the stansome familiarity dard protects not only the individuals, but any entity for credentialing.” that comes in contact with – Dennis Orthman, the information, thus reducconsulting director, C4UHC ing the risk of exposure or the inappropriate use of the information,” he says. “As with other standards, audits will be conducted to ensure that the organization is conforming to the standard, or they will no longer be allowed to state that they are compliant to ANSI standards. “The next steps are to include additional stakeholders in the continuum of supplier credentialing to show the true value of standardized and interoperable credentialing. Ultimately this will benefit us all, either in our professional roles, or as patients.” The Consortium for Universal Healthcare Credentialing is the successor organization to the Coalition for Best Practices in Healthcare Industry Representatives, which, beginning in 2012, has worked to develop best practices for vendor credentialing. For more information, go to www.c4uhc.org.
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TRENDS
A new kind of medical school for a new kind of doctor Kaiser Permanente School of Medicine to begin accepting applications in June
The Kaiser Permanente School of Medicine was set to
accept applications from prospective students in June 2019, with the intention of opening the doors to its first class in the summer of 2020. It will waive all tuition for the full four years of school for its first five classes. “Our students will learn to critically examine factors that influence their patients’ health in their homes, workplaces, schools, and communities – and become effective health advocates for their patients,” said Mark Schuster, M.D., PhD, founding dean and CEO of the school, to be located in Pasadena, Calif. The school intends to provide students with clinical experiences in Kaiser Permanente’s integrated healthcare system, starting at the beginning of their first year. It will use a small-group, case-based medical curriculum designed to prepare future physicians to become collaborative, transformative leaders committed to prevention, fluent in datadriven care, and adept at addressing the needs of underserved patients and communities, according to Kaiser Permanente. Kaiser Permanente says that the school’s senior leaders have built a curriculum that integrates the school’s three
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academic pillars: Foundational Science, Clinical Science, and Health Systems Science, a discipline that studies care delivery from structural, organizational and interpersonal perspectives, and includes topics such as population health, social inequality, and quality improvement. The core of the curriculum will consist of case-based learning, in which students in faculty-facilitated small groups combine knowledge from each of the three pillars and apply it to promoting health, understanding illness, and providing care. Another feature of the school will be its Longitudinal Integrated Clerkship (LIC) model of clinical education. First-year students will work with primary care preceptors all year, giving them the opportunity to form relationships with patients and clinical mentors over time. Second-year students will continue in their primary care LICs and will also participate in LICs in obstetrics and gynecology, pediatrics, psychiatry, and surgery. Third- and fourth-year clinical education will be dedicated to the students’ exploration of potential specialties and other areas of interest.
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TRENDS
MRSA: The bug all of bugs? FAQs about methicillinresistant Staphylococcus
aureus, put together by the editors of Repertoire, based on information from the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, and the World Health Organization.
Q: What is MRSA? A: Methicillin-resistant Staphylococcus aureus is a staph infection. Staph is a type of bacteria often found on human skin and on surfaces and objects that touch the skin. While the germ does not always harm people, it can get into the bloodstream and cause serious infections, which can lead to sepsis or death. Q: How does one get it? A: The risk for serious staph infection is greatest when people stay in healthcare facilities or have surgery, when medical devices are placed in their body, when they inject
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drugs, or when they come into close contact with someone who has staph. To reduce the spread of staph in the community, everyone should keep their hands clean, cover wounds, and avoid sharing items that contact skin, like towels, razors, and needles. Q: How serious is MRSA? A: Serious. More than 119,000 people suffered from bloodstream staph infections in the United States in 2017 – and nearly 20,000 died. (This new data from the Centers for Disease Control and Prevention reflect rates for all Staphylococcus aureus infections – methicillin-resistant
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TRENDS Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA)) Q: Just how resistant to antibiotics is MRSA? A: Here’s a clue: Many refer to MRSA as a “superbug.” That can’t be good. Q: Can you be more specific? A: A 2015 study, published in the Journal of Global Infectious Diseases, reports that more than 95 percent MRSA worldwide do not respond to first-line antibiotics, i.e., amoxicillin, TMP-SMX, or erythromycin. Several studies have
Q: But what? A: These reductions have recently started to stall. The CDC report showed an almost 4 percent increase in MSSA infections that started outside of a healthcare setting each year from 2012 to 2017. The rise in staph infections in the community may be linked to the opioid crisis. As reported by CDC last year, 9 percent of all serious staph infections in 2016 occurred among people who inject drugs – up from 4 percent in 2011. To decrease staph infections in people who inject drugs, healthcare providers should link patients to drug-addiction treatment services and provide information on safe injection practices, wound care, and how to recognize early signs of infection.
More than 119,000 people suffered from bloodstream staph infections in the United States in 2017 – and nearly 20,000 died. reported MRSA resistance to newer antimicrobial agents like linezolid, vancomycin, teicoplanin, and daptomycin. Pandrug-resistance – i.e., resistance to all antibiotics and drugs in present use – cannot be ruled out, noted the researchers. Q: Sounds ominous. A: In 2014, the World Health Organization issued a report, “Antimicrobial resistance: Global report on surveillance 2014,” in which researchers wrote, “A post-antibiotic era – in which common infections and minor injuries can kill – far from being an apocalyptic fantasy, is instead a very real possibility for the 21st Century.” Q: Is there any good news about MRSA? A: Yes. MRSA bloodstream infections in healthcare settings decreased in the United States by approximately 17 percent each year between 2005 and 2012, according to electronic health record data from more than 400 acute care hospitals and population-based surveillance data from CDC’s Emerging Infections Program. But …
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Q: Are hospitals having any success dealing with MRSA? A: The U.S. Department of Veterans Affairs medical centers reduced staph infections by 43 percent between 2005 and 2017 by implementing a multifaceted MRSA prevention program. The program included MRSA screening, use of Contact Precautions, and an increased emphasis on hand hygiene and other infection prevention strategies.
Q: “Contact precautions?” A: As defined by CDC, Contact Precautions are: • Whenever possible, patients with MRSA will have a single room or will share a room only with someone else who also has MRSA. • Healthcare providers will put on gloves and wear a gown over their clothing while taking care of patients with MRSA. • Visitors may also be asked to wear a gown and gloves. • When leaving the room, hospital providers and visitors remove their gown and gloves and clean their hands. • Patients on Contact Precautions are asked to stay in their hospital rooms as much as possible. They should not go to common areas, such as the gift shop or cafeteria. They may go to other areas of the hospital for treatments and tests. Q: In February, the Agency for Healthcare Research and Quality (AHRQ) reported on research about reductions in post-hospital MRSA infections. What’s that about?
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TRENDS A: The study – known as Project CLEAR (Changing Lives by Eradicating Antibiotic Resistance) – was published February 14 by the New England Journal of Medicine, and included more than 2,000 patients with MRSA who were discharged from Southern California hospitals between 2011 and 2014. Patients in one group received an educational binder with recommendations for preventing infections via personal hygiene, laundry, and household cleaning. A second group received the same educational materials, but for six months also took steps to remove MRSA from their skin and noses with chlorhexidine antiseptic for bathing, chlorhexidine mouthwash, and the nasal antibiotic ointment mupirocin. Participants in the
second group who followed the treatment completely had a 44 percent reduction in MRSA infections and a 40 percent reduction in all infections. Q: One month later, in March, the National Institutes of Health reported on another study regarding MRSA among hospital patients. What happened? A: The ABATE (Active Bathing to Eliminate) Infection trial, the results of which were published in The Lancet, involved about 330,000 adult patients in non-intensive-care units in the HCA Healthcare system. The trial evaluated whether daily bathing with the antiseptic soap chlorhexidine (CHG) – and in those patients with MRSA, adding the nasal antibiotic mupirocin – more effectively reduced hospital-acquired bacterial infections than bathing with ordinary soap and water. While no statistically significant difference between the two intervention groups was seen within the population overall, the researchers did find that one subset of patients – those with medical devices (e.g., central venous catheters or lumbar drains) – experienced a substantial benefit if they received the CHG/mupirocin intervention. Among that subset of patients, investigators recorded a 30 percent decrease in bloodstream infections and a nearly 40 percent decrease in antibiotic-resistant bacteria, including MRSA and vancomycin-resistant enterococcus (VRE), compared to rates seen in similar patients in the standard bathing arm of the trial.
The U.S. Department of Veterans Affairs medical centers reduced staph infections by 43 percent between 2005 and 2017 by implementing a multifaceted MRSA prevention program. The program included MRSA screening, use of Contact Precautions, and an increased emphasis on hand hygiene and other infection prevention strategies.
Q: Are patients with medical devices, such as central venous catheters or lumbar drains, especially susceptible to MRSA? A: Yes. In the ABATE trial, although they represented only 12 percent of the total non-ICU patient population, patients such as these accounted for 37 percent of MRSA and VRE clinical cultures and more than half of all bloodstream infections.
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HEALTH O METER® PROFESSIONAL SCALES SPONSORED
Is it Really Just a Bath Scale? Quality healthcare doesn’t end just because a patient is at home.
Due to recent changes in Medicare
reimbursement of patient weight scales and an increased focus on athome weight measurements, healthcare providers, IDNs and home health companies are seeking quality professional home care scales. Professional home care scales are needed for a variety of patients such as participants in physician monitored weight loss programs, patients with congestive heart failure or those with nutritional problems. Though these scales are intended for home use, patients still need a quality professional medical scale. Providers then require an educated sales representative to teach them about the importance of purchasing quality scales for their programs, which in some cases have thousands of participating patients – a huge earning opportunity for you. Inexpensive, retail-quality bathroom scales pose several potential problems for the user and in turn, pose problems for the provider of the scale. The simple, and usually poor design of these inexpensive scales is not suitable for use with the aging adult population or for home
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SPONSORED: HEALTH O METER® PROFESSIONAL SCALE Along with evaluating a scale’s design, healthcare providers need to consider the manufacturer of the scale. For optimum safety and accuracy, patients need a medicalgrade professional home care scale from a manufacturer that specializes in healthcare products. Reputable medical scale suppliers are ISO 13485:2016 certified and manufacture their products in FDA-registered factories. ISO 13485 applies specifically to medical devices and assures the company operates under strict quality standards by means of a thorough quality management system. A medical scale manufacturer has the knowledge and expertise to design a product that withstands the conditions of the scale’s intended use and provides additional benefits to the user. Purchasing products from a reliable healthcare supplier can give the provider peace of mind when supplying the scales to their patients. Whether the provider’s program needs 10 units or 10,000, Health o meter® Professional Scales provides the products and support that you and your customers need. Under the audited ISO management system, A medical scale manufacturer has the knowledge Health o meter® Professional home and expertise to design a product that withstands care scales undergo strict medical level quality testing at the company’s the conditions of the scale’s intended use and FDA-registered factories. The comprovides additional benefits to the user. pany also has the industry’s highest rated Customer Service with customer calls answered within 15 seconds, calls that you or your corporate headquarters do not have to field. And as the #1 Medical Scale brand in the U.S., Health o meter® Professional Scales understands how to design professional home care scales with the best features producing optimal functionality. Talk to your accounts about their needs for professional home care scales and explain the importance of providing a quality, medical-grade scale for their patients. When choosing the right brand for their at-home patient scale programs, choose the brand that makes it weigh easier for you, the provider, and the patient, Health o meter® Professional Scales. health use where precise and accurate weight measurements are critical. Design elements such as the scale’s feet, placement of electronics, and size of the platform can affect both stability and accuracy. Feet that are small in diameter or height cannot adequately support or protect the scale. Accuracy is also affected with poorly designed feet and made worse if the scale’s electronics are placed below the bottom of the scale platform. The ideal professional home scale has large stable feet built into the scale with electronics located inside the platform. This design protects the scale from water damage and provides more accurate weight readings when used on carpet. In addition to well-designed feet, stability can be increased by the design of the scale’s platform. A wide platform allows patients to find a comfortable and secure stance to help maintain their balance. Platforms with a textured, nonslip surface can provide a stable foothold and traction.
Visit www.homscales.com or call 1-800-815-6615.
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HEALTHY REPS
Health news and notes 44
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ExerciseRx Exercise can lower blood pressure and reduce visceral body fat at least as effectively as many common prescription drugs, according to two reviews of relevant research about the effects of exercise on maladies, reports The New York Times. Together, the new studies (reviewed in the British Journal of Sports Medicine and Mayo Clinic Proceedings) support the idea that exercise can be considered medicine, and potent medicine at that. But they also raise questions about whether enough is known about the types and amount
Birth control app The U.S. Food and Drug Administration issued a final order to classify Natural Cycles – a birth control app – as a Class II device. It uses an algorithm that is sensitive to patterns in a woman’s cycle to determine daily fertility, based on basal body temperature and period data. Natural Cycles is said to be 93 percent effective with typical use, which means that seven women out of 100 get pregnant during one year of use. Natural Cycles is the only app of its kind to be available in Europe and the U.S. for use as a contraceptive. The app can also be used to help plan a pregnancy when the time is right. In August 2018, Natural Cycles’ application for De Novo classification as a Class II medical device was granted by the FDA. The agency’s final order is the last part of the approval process that establishes the required special controls and officially codifies the new regulation for this type of technology.
Healthy contact lens wear More than 45 million Americans wear contact lenses. However, wearing contact lenses can increase your chances of getting an eye infection – especially if you do not care for them properly. The Centers for Disease Control and Prevention recommends taking these simple steps to protect your eyes: 1) Don’t wear contact lenses while sleeping unless directed to do so by your eye doctor; 2) never mix fresh solution with old or used solution; and 3) don’t swim or shower while wearing contact lenses, as contact lenses can carry germs from the water into the eye. The sixth annual Contact Lens Health Week will be observed Aug. 19 – 23, 2019.
After the flood
of exercise that might best treat different health problems and whether we really want to start thinking of our workouts as remedies. The possibility of formally prescribing exercise as a treatment for various health conditions, including high blood pressure, insulin resistance, obesity, osteoarthritis and others, has been gaining traction among scientists and physicians. The American College of Sports Medicine already leads a global initiative called Exercise Is Medicine, which aims to encourage doctors to include exercise prescriptions as part of disease treatments.
Initial damage is not the only risk associated with floods, says the CDC. Standing floodwater can also spread infectious diseases, bring chemical hazards, and cause injuries. After you return home, if you find that your home was flooded, practice safe cleaning. Remove and throw out drywall and insulation that was contaminated with floodwater or sewage. Throw out items that cannot be washed and cleaned with a bleach solution: mattresses, pillows, carpeting, carpet padding, and stuffed toys. Homeowners may want to temporarily store items outside of the home until insurance claims can be filed. Clean walls, hard-surfaced floors, and other household surfaces with soap and water and disinfect with a solution of one cup of bleach to five gallons of water. In addition:
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HEALTHY REPS
The possibility of formally prescribing exercise as a treatment for various health conditions has been gaining traction.
• Avoid driving through flooded areas and standing water. As little as six inches of water can cause you to lose control of your vehicle. • Do not drink floodwater, or use it to wash dishes, brush teeth, or wash/prepare food. Listen to water advisory from local authorities to find out if your water is safe for drinking and bathing. • During a water advisory, use only bottled, boiled, or treated water for drinking, cooking, etc. • When in doubt, throw it out! Throw away any food and bottled water that comes/may have come into contact with floodwater. • Prevent carbon monoxide (CO) poisoning. Keep generators at least 20 feet away from doors, windows, or vents. If you use a pressure washer, be sure to keep the engine outdoors and 20 feet from windows, doors, or vents as well.
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Stillbirth and subsequent pregnancy
Conceiving within a year or even six months after a stillbirth did not increase a woman’s likelihood of having another stillbirth or a preterm or small for gestational age (SGA) baby compared with an interpregnancy interval of at least two years, according to a study published online in the Lancet. The results are from the first large-scale observational study to investigate the interval between stillbirth and subsequent pregnancy, including almost 14,500 births in women from Australia, Finland, and Norway who had a stillbirth in their previous pregnancy. Currently, the World Health Organization recommends that women do not attempt to conceive until at least six months after a miscarriage or abortion and at least two years after a live birth, but there are no recommendations for the optimal interval after a stillbirth (defined as fetal loss after midpregnancy).
TAKING LEADERSHIP TO THE NEXT LEVEL
June 5–7, 2019 | Minneapolis, MN
LEADERSHIP PANEL:
Leading through Emerging Technologies and Disruptive Innovation In a world of digital transformation encompassing rapid emergence of technologies, what are organizations doing to tangibly increase the speed of innovation? What skill sets are they looking for in new talent? Scott Adams will moderate this panel discussion of influential technology leaders.
Scott Adams, MODERATOR Managing Partner, Share Moving Media
Darren Baldwin Director, Organizational Transformation, Midmark Corporation
Amy Brouhle Vice President, Business Development, Sg2
Rodney Haas Vice President, Performance Improvement, University of Minnesota Physicians
Cindy Kay Olson
The Industry’s Premier Leadership Development Event Join professional women & men in the industry for two days of leadership, networking, inspiration & innovation! Whether you are an Aspiring Leader or a C-Suite Executive, the PWH® Leadership Summit will cover a host of relevant topics to take your leadership skills to the next level.
PWH® LEADERSHIP SUMMIT AGENDA Wednesday, June 5th 3:00 pm 5:30 pm – 6:00 pm 6:00 pm – 8:00 pm
Registration Opens New Member and New Attendee Networking Mixer Welcome Reception
Thursday, June 6th 7:30 am – 8:30 am 8:30 am – 8:45 am 8:45 am – 10:15 am
Breakfast Welcome Remarks Rachelle Ferrara, Chair, PWH PWH® Leadership Insights
10:30 am – 11:30 am Make Way for Gen-Z! David & Jonah Stillman 11:30 am – 11:45 am PWH® Awards 11:45 am – 1:00 pm Lunch 1:00 pm – 4:30 pm Breakout Sessions 6:00 pm Networking Reception & Dinner Nicollet Island Pavilion
Friday, June 7th 7:00 am – 8:00 am 8:00 am – 9:30 am
9:45 am – 10:45 am 10:45 am – 12:00 pm
Breakfast Gender Partnership: Healthcare’s Imperative for the 21st Century Mike Kaufmann & Rayona Sharpnack Leadership Panel The Collapse of a Culture… “Lessons from Enron” Cindy Kay Olson
JUNE 5–7, 2019 HYATT REGENCY MINNEAPOLIS
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WINDSHIELD TIME Chances are you spend a lot of time in your car. Here’s something that might help you appreciate your home-away-from-home a little more.
Automotive-related news
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Not the rotary you’re thinking of
Dealer service improving
One thing is for certain: a purely rotary-powered Mazda sports car is not going to happen. Fuel efficiency, or lack thereof, is the reason why. However, Mazda engineers have continued to develop rotary tech, reports Car Buzz, and they may have found a new use for it as a power generator, i.e., a range extender for a hybrid powertrain. According to Australian publication Drive.au, Mazda executive Ichiro Hirose, head of powertrain development, said the automaker has built a flexible rotary hybrid platform with excellent fuel efficiency that could meet the emissions standards set for nearly any global market, even California, where regulations are particularly strict. Hirose also said Mazda was considering the name ‘XEV’ for this rotary-hybrid setup.
Porsche ranks highest in satisfaction with dealer service among luxury brands, while Buick ranks highest among mass market brands, according to J.D. Power. Following Porsche among luxury brands are Lexus (second), Cadillac (third), Infiniti (fourth) and Mercedes-Benz (fifth). Following Buick among mass market brands are MINI (second), Mitsubishi (third), Chevrolet (fourth), GMC (fifth) and Toyota (sixth). Overall satisfaction with services performed by independent facilities has improved 22 points since 2017, compared with a 17-point improvement by franchised dealers. Similarly, satisfaction with service quality at independent facilities has improved 23 points since 2017, compared with a 17-point improvement by franchised dealers.
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Don’t do it! Teenagers who reach for objects, such as food or makeup, while driving increase their risk of crashing nearly seven times, according to researchers at the National Institutes of Health. Their study, which appears in the American Journal of Preventative Medicine, also found that manually dialing, texting or browsing the web on a phone while driving doubled a teen’s crash risk. Researchers followed 82 newly licensed teen drivers in Virginia over a one-year period, equipping their vehicles with cameras and GPS technology to track the driver’s activity and environment. After one year, 43 of the drivers did not experience a crash, while 25 had one crash and 14 had two or more crashes. Using six-second videos of driver behavior prior to a crash, researchers calculated that for every second that a teen’s eyes were off the road, the risk of a crash increased by 28 percent regardless of the type of distraction. Teens manually using a cell phone doubled their odds of crashing. Teens who were reaching for something while driving increased their risk nearly sevenfold, which researchers attributed to a combination of distractions, including taking their eyes off the road and their hands off the wheel.
with Google will bring Google Assistant to Ford vehicles soon. According to Amazon, Ford is among more than 15 automaker brands using Alexa for remote vehicle management, including BMW, Hyundai, Mercedes-Benz and Toyota. Some automakers – including Ford and Toyota – are integrating Alexa directly into their vehicles’ infotainment systems.
Yield to moose More than 500 traffic crashes involving moose occur in northern New England each year, and the injuries sustained by a vehicle’s occupants – because of the height and weight of the animal – can be far more serious and more likely to result in fatalities than collisions with deer,
“ Extending smart home voice control into the connected vehicle is part of an ongoing integration that will pull together home and vehicle personalization,” – Jonathan Collins, research director in the smart home practice, ABI
Connected cars For many people, their two most expensive possessions are a home and a car. Now technology is bringing both together, one as an extension of the other, reports the Consumer Technology Association. In an accelerating trend, smart homes and connected cars are converging. ABI Research forecasts 500 million connected cars on roads worldwide by 2022. And, at least initially, the common factor will be voice control functionality offered by virtual assistants such as Amazon’s Alexa, Apple’s Siri and Google Assistant. “Extending smart home voice control into the connected vehicle is part of an ongoing integration that will pull together home and vehicle personalization,” says Jonathan Collins, research director in the smart home practice at ABI, based in New York. Last January, Ford Motor Co. launched its FordPass Alexa skill, which enables Ford owners to tell Alexa to remotely start their vehicles or fetch odometer, tire pressure and fuel level readings from it. Ford says the partnership
researchers report in a study published on the website of the Journal of the American College of Surgeons. Treating these injuries can pose unique challenges for trauma centers in areas with high moose populations. There has been an average of more than 500 traffic accidents involving moose per year for the last five years, but that’s down sharply from the peak of more than 1,200 accidents in 1998, according to study authors. In Maine alone, the study documented 50,281 collisions with deer and 7,062 with moose from 2003 to 2017. Twenty-six moose collisions resulted in a human fatality, as did 10 deer collisions – an incidence of one in 271 crashes (0.37 percent) for the former compared with one in 5,000 (0.02 percent) for the latter. Deer collisions are much more common, but after controlling for other factors, the researchers’ statistical model demonstrated that a human fatality was more than 13 times as likely after collision with a moose.
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QUICK BYTES Editor’s note: Technology is playing an increasing role in the day-to-day business of sales reps. In this department, Repertoire will profile the latest developments in software and gadgets that reps can use for work and play.
Technology news A matter of life and death
As we live more of our lives online, it’s more important than ever to make sure loved ones can access digital accounts when we’re gone, reports PC Magazine. (“Don’t be the guy who locked cryptocurrency exchange customers out of $250 million after his death because only he knew the password,” cautions the writers.) Here are some ways: 1) Create a password manager emergency kit, which houses the keys to your digital accounts, and which can be passed on to a loved
“Don’t be the guy who locked cryptocurrency exchange customers out of $250 million after his death because only he knew the password.” one (vendors include 1Password, Keeper and Dashlane; 2) add a Facebook legacy account, which keeps a pared-down version of your profile active after your death; and 3) set up Google’s inactive account manager, which automatically turns over control of your account to a designated person after a set period of inactivity. And of course, don’t forget to BACK UP your data on an external hard drive.
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A startup called UbiquitiLink is testing technology that could connect virtually all of the world’s existing smartphones directly to a satellite, reports Light Reading. If it works and it’s widely deployed, such technology would essentially eliminate outdoor dead zones. CEO Charles Miller says that two years ago, the company’s engineers solved the two key problems prohibiting satellites from beaming signals directly to smartphones – the doppler shift, and the extended range that causes a time delay. So UbiquitiLink can blast a 16-pound satellite into space, and that satellite can transmit a standard cellular signal 250 miles down to the surface of the Earth. UbiquitiLink already successfully tested transmissions using 2G signals earlier this year, and this summer it will test a range of 4G signals.
These potential issues can be fixed on the fly, but the real thing you should hold out for is glass, according to Wired magazine. Early folding phone manufacturers are leaning on plastic polymers, because they can bend repeatedly. But plastic is easily scratched, and it creases over time. Corning is working on ultrathin, bendable glass that’s 0.1 millimeters thick and can bend to a 5 millimeter radius, reports the magazine. The trick is to achieve that kind of pinch without losing the toughness that makes glass great to begin with. Aftermarket batteries OK with iPhones
Apple has reportedly updated the rules of its repair program to be a bit more lenient toward iPhones with aftermarket batteries, according to Ars Technica. Internal company documents reportedly instruct its Genius Bars and Apple Authorized Service Providers to repair iPhones with third-party batteries. Previously, official service providers were told to deny service to any iPhones that used third-party batteries. It did not matter if the requested service involved the battery or another component of the handset. Under the new policy, if the service requested does not involve the phone’s battery, Genius Bars and Apple Authorized Service Providers can ignore the battery and service the device as necessary. If the requested service is related to the third-party battery, providers can replace it with an official Apple battery for a fee.
Early folding phone manufacturers are leaning on plastic polymers, because they can bend repeatedly. But plastic is easily scratched, and it creases over time. Corning is working on ultrathin, bendable glass that’s 0.1 millimeters thick and can bend to a 5 millimeter radius, reports the magazine. Apple’s augmented reality
Apple may begin mass production of its head-worn augmented-reality (AR) device by summer of 2020, according to analysts speaking with CNBC. The headset will most likely sync up with an iPhone, which feeds it with the data it needs to provide you information. This is how other current headsets on the market work, such as the Vuzix Blade, which syncs with Android and iPhone devices. Apple has not acknowledged any such device, but Apple CEO Tim Cook has reportedly said he believes augmented reality is the future of computing, which is why the latest iPhones already support AR-enabled apps. Foldable glass
Foldable phones, like Samsung’s Galaxy Fold and Huawei’s Mate X, are coming. The software remains untested or nonexistent, and the prices are either astronomical or unannounced.
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Black Mirror episodes, best to worst
PC Magazine writer Rob Marvin has taken it upon himself to rank every episode of Netflix series Black Mirror, best to worst. He bases his rankings on the ability of the episode to 1) introduce a fresh concept, 2) build an immersive world, 3) pull off a mind-bending reveal and 4) make you think beyond the immediate plot. No. 1? Fifteen Million Merits. “Imagine a world where humans (or at least the ones we meet inside this compound) are all cogs in a system, and workers ride bikes to generate power and receive virtual ‘merits,’” writes Marvin. “They can spend those merits on all manner of content or virtual possessions, or simply use them to skip the mandatory ads and commercials that pervade peoples’ every waking moment, even in their tiny, screen-filled bedrooms.” See PC Magazine for Nos. 2 through 20.
GOVERNMENT AFFAIRS UPDATE HIDA
Medical Device Tax Moratorium
To Expire At The End Of 2019 If you are a distributor or a manufacturer rep, you are likely aware of longstanding
disputes over the medical device tax. This 2.3 percent excise tax created through the Affordable Care Act has been subject to a series of moratoriums, the most recent of which expires at the end of this year. Both chambers of Congress are currently considering legislation to permanently repeal this tax. While there is a lot of bipartisan support for repeal, the political climate is tough and the industry must continue to advocate. Should the medical device tax go into full effect, it will have a ripple effect across the medical-surgical supply chain. It will increase costs for manufacturers, distributors, providers, and patients. Most importantly, it works against efforts to hold down the rising cost of healthcare in America, and new research suggests it hampers industry investments in new medical technology. This tax applies to most devices regulated by the Food and Drug Administration. For these reasons, HIDA members have consistently opposed this measure. If you work in the medical supply chain in any capacity, we encourage you to contact your senators and representatives and ask them to permanently repeal this tax.
By Linda Rouse O’Neill, Vice President, Government Affairs, HIDA
The device tax will be one of the key issues HIDA members address when they come to the nation’s capital for the upcoming Washington Summit (Washington DC, June 5-7). Other key issues attendees will discuss with lawmakers this year include: Tariffs: After testimony by HIDA and over 175 letters from its members, the United States Trade Representative removed over 120 healthcare products from the list of Chinese imports that would be subject to tariffs. During their time in Washington, HIDA members will encourage lawmakers to protect medical products from needless trade interference, and will educate Congress on how medical imports support both emergency preparedness and affordable healthcare.
Competitive Bidding: The Centers for Medicare and Medicaid Services’ (CMS) Competitive Bidding Program has had a significant impact on HIDA members who supply durable medical equipment to nursing homes and home care settings. While HIDA commends CMS for recent steps to improve this program, more work needs to be done. Emergency preparedness: HIDA members will discuss the key role the private sector can play in facilitating an
effective response to natural disasters. With a range of severe weather events and infectious disease outbreaks taking place across the nation, Summit attendees will educate Congress on how vital laws and regulation provide federal agencies with access to the insight and expertise of the healthcare supply chain. To learn more about HIDA’s outreach, or for tips on how you can get involved on key healthcare issues, please email me: Rouse@HIDA.org.
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corner
First, a short history lesson.
The Junior League was founded in 1901 by social activist Mary Harriman. It is a women’s volunteer organization, which today encompasses more than 140,000 women in 291 Leagues in four countries. “We have the responsibility to act, and we have the opportunity to conscientiously act to affect the environment about us,” Harriman said more than a hundred years ago. Understand that, and you understand much about Sonya Kimmet, director, supply chain services, for Concordance Healthcare Solutions in Boise, Idaho, who is an active member of The Junior League of Boise. In fact, that attitude is why she’s in healthcare. It’s why she works for Concordance. And it’s why she, her husband, Chris, and their two kids – six-year-old Henry and four-year-old Sam – live in Boise, even though she and Chris were born and raised in northwest Ohio.
The Unstoppable Sonya Kimmet Kimmet grew up in the country, just about 20 minutes from Tiffin, Ohio, headquarterts of Concordance. Her father, Pat, operates his own trucking company (which he is now handing off to a son). Her mom, Darlene, stayed at home with the kids for years, then went back for a master’s degree. She is now a middle-school counselor, and is working on her Ph.D.
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NEW PAMA CPT codes now available in the app
Pama updated CPT codes 2018 Infectious Disease Tests Test - Panels Basic Metabolic Panel (9 tests) Comprehensive Metabolic Panel (17 tests) Electrolyte Panel (4 tests) Hepatic Function Panel (10 tests) Lipid Panel (6 tests) Renal Function Panel (12)
CPT 80048/QW 80053/QW 80051/QW 80076 80061/QW 80069/QW
2017 Fee $11.60 $14.49 $9.62 $11.21 $18.37 $11.91
2018 Fee $10.44 $13.04 $8.66 $10.09 $16.53 $10.72
Change -10% -10% -10% -10% -10% -10%
Cardiac/Liver/Other Tests Albumin (Serum) Albumin (Urine) ALP ALT Aspirin Therapy AST Bilirubin, direct Bilirubin, total BNP CK,MB CK/CPK GGT LD Microalbumin (Quantitative) Microalbumin (Semi-quantitative) Total Protein Troponin I
82040/QW 82042/QW 84075/QW 84460/QW 85576/QW 84450/QW 82248 82247/QW 83880/QW 82553 82550/QW 82977/QW 83615 82043/QW 82044/QW 84155/QW 84484/QW
$6.79 $7.10 $7.10 $7.27 $29.47 $7.10 $6.88 $6.88 $46.56 $15.84 $8.93 $9.88 $8.28 $7.93 $6.28 $5.03 $13.50
$6.11 $7.78 $6.39 $6.54 $26.52 $6.39 $6.19 $6.19 $41.90 $14.26 $8.04 $8.89 $7.45 $7.14 $6.23 $4.53 $12.47
-10% 10% -10% -10% -10% -10% -10% -10% -10% -10% -10% -10% -10% -10% -1% -10% -8%
Lipid Tests HDL LDL Lp(a) Apolipoprotein Total Cholesterol Triglycerides
83718/QW 83721/QW 82172 82465/QW 84478/QW
$11.24 $13.09 $21.26 $5.97 $7.88
$10.12 $11.78 $21.09 $5.37 $7.09
-10% -10% -1% -10% -10%
Diabetes Tests Fructosamine Glucose on home use meter-type device Glucose Tolerance Test, each additional specimen > 3 Glucose Tolerance Test, initial 3 specimens Glucose, quantitative blood type Hemoglobin A1c
82985/QW 82962 82952/QW 82951/QW 82947/QW 83036/QW
$20.68 $3.21 $5.38 $17.66 $5.39 $13.32
$18.61 $3.28 $4.84 $15.89 $4.85 $11.99
-10% 2% -10% -10% -10% -10%
Renal Function Tests BUN Creatinine Creatinine (Urine)
84520/QW 82565/QW 82570/QW
$5.42 $7.03 $7.10
$4.88 $6.33 $6.39
-10% -10% -10%
Individual Tests Amylase Calcium Ferritin Iron
82150/QW 82310/QW 82728 83540
$8.89 $7.08 $18.70 $8.88
$8.00 $6.37 $16.83 $7.99
-10% -10% -10% -10%
Find the new codes in The Black Book
Other tools available for distributors are: vol.26 no.1 • January 2018
repertoiremag.com
January 2018
2 Minute Drill Videos
Podcasts
PAMA: The Stage is Set — How will the new rates impact providers, distributors and manufacturers?
PAMA: Jim Poggi, Tested Insights, LLC
The Stage is Set
How will the new rates impact providers, distributors and manufacturers?
corner “I have spent my whole life watching [my parents] work hard to establish and grow their businesses,” she says. Her parents own several rental properties and storage units and, with some partners, are revitalizing a campground in Ohio. “But they always taught us that our responsibility wasn’t just to be good people, but also to serve our communities.” Her father has been in the volunteer fire department for more than 30 years.
Lessons in leadership After graduating with a degree in retail merchandising, she got a job with a private label jewelry manufacturer, where she got a valuable lesson in leadership from her two bosses, two female vice presidents.
Med/surg distribution “By working in med/surg distribution, I could have a positive impact on patient outcomes without being on the front lines of patient care,” she says. “By doing my job well, I could have an indirect – yet positive – impact on healthcare.” As a primary care rep, some of the most important things she learned were from peers, she says. For example, one rep, Pam Borgerding, familiarized her with the saying, “The customer doesn’t care how much you know until they know how much you care.” After several years, Chris earned his MBA, and in 2012 accepted a job offer in Cleveland. Says Sonya, “I told Seneca, ‘I love working for this organization, I love what I do. Is there anything I can do in Cleveland?’” There was. “I got my start in the acute-care market,” she says. “My time working in the primary care market was invaluable as I moved to working with IDNs, because I could understand the challenges of hospital-owned physician practices, and I had a good knowledge base of what Seneca Medical could offer.” She also found that working with materials management teams had something in common with calling on physician offices: In both cases, relationships are built on honesty and trust.
“ By working in med/surg distribution, I could have a positive impact on patient outcomes without being on the front lines of patient care.” “They taught me there would be times when they wouldn’t be available to offer guidance or answer my questions,” she says. “They said that sometimes I would have to make decisions based on the information at hand, and that as long as I thought things through, they would support my decision. “It was very empowering, especially for someone right out of school.” In 2009, when Chris was deployed to Afghanistan, Kimmet returned to Ohio from Fort Bragg in North Carolina. (Following his deployment, Chris would pursue an MBA at Ohio State University.) Back in Ohio, she had some time and space to think about her future. “After working in retail, I wanted to work for a company that made more of an impact than just the financial bottom line,” she says. Healthcare seemed like a good fit. In August 2009, she became a primary care rep for Seneca Medical (which, along with Kreisers and MMS – A Medical Supply Company, merged to form Concordance in 2016).
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Boise In 2017, Concordance Chief Customer Officer (and now President and COO) Dave Myers told Kimmet about a potential opportunity for Concordance with a large IDN in Idaho. He said the company could use someone like her to lay the groundwork in Boise, should the IDN contract be signed. “Professionally, the potential opportunity in Boise was intriguing because it provided an opportunity to build on my experience working with physician practices and IDNs, process improvement, and developing programs for our IDN customer base,” she says. “Personally, my husband and I were interested in leading a more outdoors lifestyle and living near the mountains. Moving to Boise would allow us to fulfill both of those things.”
There was a downside, of course: The Kimmets would miss having extended family nearby, especially with two children, ages 4 and 2. The Boise deal was signed, and Sonya and Chris “had to get serious” about making a decision. Chris agreed that if they moved, he would launch a financial planning company in Boise. Together, they decided they could use technology (social media, FaceTime, etc.) as well as air travel to keep connected to family in Ohio. So the family moved to Boise in mid-November 2017. “We started shipping to the IDN on Dec. 19,” says Kimmet. “We learned a lot about the go-live. It’s a large, complex system. And we were doing this the week before Christmas!” “When I came onboard to the project in Boise, my primary focus was to manage the relationship between our IDN customer and Concordance, and to bring our Concordance culture to the West,” she says. “As the relationship has evolved, we’ve developed and implemented several innovative programs that have strengthened our partnership with our IDN customer. I’m so impressed with the level of dedication in launching this distribution center and making it successful. We are so lucky to have a great team of local employees as well as a corporate team who are all supporting the same vision.”
Our parents always taught us that our responsibility wasn’t just to be good people, but also to serve our communities.
Making it work Today, Chris operates Steady Climb Financial Planning (https://www.steadyclimbfp.com). The family has made three trips back to Ohio in 2018, and hosted several family members in Boise. And Sonya finds her work with The Junior League of Boise rewarding. “We empower women through training and connections in the community,” she says. “We love the outdoor lifestyle Boise offers while still being urban,” she adds. “Our kids took ski lessons this winter at Bogus Basin, and we enjoy hiking the foothills on the weekends with our kids and two miniature dachshunds.”
She enjoys being part of Concordance, which she refers to as a family-first organization. “They truly do support working moms,” she says. Michelle Clouse, vice president of customer experience for Concordance, exemplifies the spirit. “She is a great role model, being a mom with a career, and I am blessed to call her my friend,” says Kimmet. And Kimmet is grateful for the partnership she enjoys with her husband. “I’m incredibly lucky,” she says. Recently, during spring break, Chris stayed at home, took the kids to swimming lessons and taught Henry how to ride a bike, while Sonya worked. “It’s never 50/50,” she says. “If you think of it as each person giving more than 50 percent, you end up with more than 100 percent.”
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May 2019
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Industry news Industry leaders launch Healthcare Transparency Initiative (HTI) Several leading healthcare companies and providers – including BD Healthcare Solutions, Trinity Health, and University of Vermont Health Network, as well as Resilinc announced the launch of the Healthcare Transparency Initiative (HTI). HTI is a unique cross-industry collaboration focused exclusively on leveraging data with artificial intelligence (AI) and data science to improve supply chain transparency, lower risks and reduce disruptions in healthcare supply chains in order to improve patient outcomes. HTI will immediately drive lower costs by creating a shared ecosystem and improving visibility and transparency across the healthcare value chain, leveraging AI and data science. The initiative is powered by Resilinc’s trusted platform and healthcare supply chain data, which offers unique transparency and insights for the industry today.
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the cost of treating multidrug-resistant infections in the inpatient setting is at least $2.39 billion annually. When accounting for undercoded infections, this estimate jumps to $3.38 billion.
HSCA names Khatereh Calleja as president & CEO The Healthcare Supply Chain Association (HSCA) (Washington, DC) named Khatereh Calleja as president and CEO of the Healthcare Supply Chain Association, effective April 29, 2019. Calleja joins HSCA from AdvaMed, the world’s largest association representing manufacturers of medical devices, diagnostic products, and medical information systems, where she was SVP of Technology and Regulatory Affairs. She succeeds outgoing HSCA President and CEO Todd Ebert, RPh, who is retiring and moving back to St. Louis after a distinguished career in healthcare spanning more than four decades.
Multidrug-resistant infections cost hospitals at least $2.4B annually
Massachusetts reports its first measles case
According to a study published in Health Services Research, hospitals spend more than $2 billion annually to treat patients with multidrug-resistant infections. Researchers used multivariable regression models to assess hospitalization costs and length of stay for 6.4 million inpatient stays involving bacterial infections in 2014. The study found that at least 10.8% of inpatient stays involving a bacterial infection showed evidence of one or more multidrug-resistant organisms. Researchers estimated
The Massachusetts Department of Public Health confirmed April 1 that one person has been diagnosed with measles in the greater Boston area. The person was diagnosed March 31. It was determined that other people may have been exposed to this person at several locations. The CDC reported 387 total measles cases in 15 states between January 1 and March 28, up from the 372 total cases reported in all of 2018. The number of cases in 2019 is the second highest reported since 2000.
May 2019
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