REP May 21

vol.29 no.5 • May 2021

repertoiremag.com

COVID Leaves its Mark on Ambulatory Surgery Centers COVID-19 has tested the resilience of ambulatory surgery centers, but ASCs appear to be emerging stronger than ever.

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SEKISUI DIAGNOSTICS IS YOUR PARTNER IN HEALTHCARE 800-332-1042 / sekisuidiagnostics.com © 2021 Sekisui Diagnostics, LLC. All rights reserved. Acucy® and OSOM® are registered trademarks of Sekisui Diagnostics, LLC. Because every result matters™ is a trademark of Sekisui Diagnostics, LLC. FastPack® is a registered trademark of Qualigen Inc.

MAY 2021 • VOLUME 29 • ISSUE 5

PUBLISHER’S LETTER A Shot in the Arm for Sales...... 2

PHYSICIAN OFFICE LAB CLIA Update 2021 What recent CLIA changes mean for reps and their customers............ 4

IDN OPPORTUNITIES Women Leaders in Supply Chain................................10

COVID Leaves its Mark on Ambulatory Surgery Centers

Janet Watson

SALES Your New Bucket Challenge Three mistakes, three buckets, and how to conquer them when calling on customers......................16

COVID-19 has tested the resilience of ambulatory surgery centers, but ASCs appear to be emerging stronger than ever.

20

TRENDS In the Name of the Patient Differing views on ‘scope of practice’.....26

A Reset for Infection Prevention Protocols

QUICK BYTES Technology news............................34

TRENDS

Infection prevention took a hit this past year, but rebuilding is already taking place.............................28

State of PPE GPO examines PPE supply one year into COVID-19........................42

WINDSHIELD TIME Automotive-related news........44

HIDA GOVERNMENT AFFAIRS Shipping Challenges Wallop Industries Around the Globe.....46

NEWS

Rep Corner

A Body of Work Selling, bodybuilding or blogging, Jennifer Taskan commits to the process

Industry news....................................48

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PUBLISHER’S LETTER

A Shot in the Arm for Sales It’s hard to believe we’re already in May. Things are opening back up, travel is increas-

ing both personally and professionally, and our first live industry meeting is happening this month in Nashville, Tennessee. Needless to say, all of this makes me so happy!

As I talk with reps across the country, it’s nice to hear they are seeing things normalize in their territories. Electives are back online in most areas, driving sales of things other than PPE and COVID tests. Backorders and fire drills seem to be slowing down, paving the way for face-to-face meetings with accounts.

In this month’s cover story, you will read about some of the positive things happening as we open back up. The combination of vaccines and heard immunity should help sales bounce back for our industry as a whole, so even if you’re not selling to an ASC, I believe this story is for us all.

Despite all of its difficulties, COVID-19 might have provided a shot in the arm for ambulatory surgery centers, Todd Johnson, who leads the medical device sector for management consulting firm Bain & Company, told us for the cover story.

“COVID has really changed the game,” he says. “Doctors who might have been reluctant to perform total joints or other higher-acuity procedures in the ASC were forced to do so, because of capacity reasons or simply because patients were afraid to go to the hospital.

They have become more comfortable with ASCs, which they’ve found are more convenient for doctors, payers and patients. So we expect continued growth.”

This past year has been one for the ages, but almost halfway through 2021 life seems to be popping all around us like springtime. Keep sending me your stories about face-to-face selling, traveling for work, and living in general. If I learned one thing last year it’s to take none of this for granted!

Scott Adams

Have a great month!

Dedicated to the industry, R. Scott Adams

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

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PHYSICIAN OFFICE LAB

CLIA Update 2021 What recent CLIA changes mean for reps and their customers

By Jim Poggi 2020 and 2021 (so far) have been years of great change for us and our customers, largely precipitated by the COVID-19

pandemic. But there have been other far-reaching impacts on the laboratory business and our customers for other reasons.

In this month’s column, I will shed some light on CLIA changes and what they mean for reps and their customers.

CLIA lab certificate fees increased by 20% at the end of 2018 With so many other fundamental changes in our market, while this change did not exactly slip by without notice, it has not generated the level of noise I might have expected.

Arguably, the reductions imposed by PAMA on payment for tests performed under the Clinical Lab Fee Schedule have had more discussion and more impact than the 20% increase in CLIA certificate fees.

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What does the 20% increase look like? Taking the example of a customer performing 50,000 non-waived tests annually, their fee before the increase was $1,100 every two years. It is now $1,320.

What is the net impact? Based on 50,000 tests, the cost of the CLIA certificate increases cost per test by less than one quarter of a cent. It went from $0.011 per test to $0.0132 per test. This analysis assumes 50,000 tests per year for the biennial period against the new fee structure.

number including newer analytes such as BNP, hs-CRP and others were added. In addition, criteria for acceptable performance were tightened for chemistry, immunology and hematology assays due to improved performance of analytical platforms since CLIA was enacted in 1982.

Further changes impacted management of CLIA waived assays by CLIA moderate and high complexity labs. For microbiology tests, the proposal would create new broad categories of tests subject to proficiency testing owing to the substantial number of new test methodologies now available for microbiology assays compared to 1982. It is not clear whether these changes have already been enacted, but your key lab suppliers should be in a position to update you for their specific test platforms.

While there is an increase, it should be immaterial for most customers and have a negligible impact on their lab operation. As the first cost increase since CLIA was implemented in 1982, the 20% increase is a downright bargain. The cumulative price increase experienced on the general U.S. economy since 1982 has been 87.5%, so in contrast this increase is well below that of other products, fees and services we have experienced in that time. At the same time, the legislation that set CLIA into motion requires that the program be self-funding. So, while I am speculating, it is not unreasonable to assume we will not need to wait another 25 years or more before the next fee schedule increase. Imagine, if you will, what it would be like if we could buy a home, a car or any other major purchase with only a 20% increase beyond the cost of that item in 1982.

Changes in proficiency testing In February 2019, CMS proposed rule changes for proficiency testing under CLIA to improve quality of results, especially for newer analytes. In summary, a few tests were exempted from proficiency testing, but a larger

The tests now available to our customers, regulations pertaining to their performance and the costs associated with our customers’ CLIA licensing have undergone considerable transformation.

An extraordinary increase in Multianalyte Tests with Algorithms Most of these tests are molecular tests for cancer or other genetic pre-dispositions (heart disease, epilepsy, hearing loss, and a myriad of other clinical conditions). This has been an astounding break through and has dramatically changed diagnostic, treatment and management of a large number of diseases, though cancer and respiratory conditions have been the big beneficiaries. Cancer deaths have declined by 29% from 1991 to 2017, with the largest drop in history of 2.2% realized in 2017. In addition to Americans quitting smoking and improving their overall commitment to a healthy lifestyle, new diagnostic tests have made meaningful impact here.

Interestingly, these new tests are not limited to genotyping the patient for either predisposition to a disease state or to their tumor cells. They also look at changes in protein expression of tumor cells and metabolic changes www.repertoiremag.com

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PHYSICIAN OFFICE LAB

that result from development of cancer. We have also seen genotyping of SARS CoV-2, HIV, HPV and other pathogens, owing to the recognition that different pathogen genotypes have differing levels of pathogenicity, ease of transmission and predisposition to further co-morbidities. This is a relatively new frontier and progress is being made meaningfully across the health care spectrum for cancer and other clinical conditions, including identification and classification of infectious agents, particularly respiratory pathogens. SARS CoV-2 is a classic recent example.

More than 100 MAAA test profiles have been added to the CLFS since 2019, and the number is sure to continue growing rapidly. This increase does not include the new SARS ColV-2 tests introduced in the past months under Emergency Use Authorization. More than 300 new RT-PCR, antigen and antibody tests for COVID-19 have been introduced to the U.S. market as a response to the COVID-19 pandemic.

It is important to note that not only are the new wave of MAAA tests highly clinically significant, providing diagnostic information undreamed of a few short years ago, they also command the highest level of reimbursement in the CLFS. A sampling of the top 288 MAAA tests showed an average reimbursement of about $900, with a range from $12,000 to $145.

Will they migrate from their current position as high complexity tests mostly performed in tertiary care settings to the physician office setting? Time and trends in simplification of test systems and methods will tell, but past trends indicate that the most clinically useful tests certainly will.

As test requests for more clinically valuable tests continue to increase, the number of sites performing them typically increase as well, with manufacturers creating simpler, more 6

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accessible testing platforms. As an example, genomic classification of prostate cancer tissue (which can help determine whether a specific prostate cancer will be aggressive or not) has increased three-fold in the past 10 years and continues to increase as awareness in the clinical community and among the public sheds light on its usefulness.

As test requests for more clinically valuable tests continue to increase, the number of sites performing them typically increase as well, with manufacturers creating simpler, more accessible testing platforms.

In summary, the tests now available to our customers, regulations pertaining to their performance and the costs associated with our customers’ CLIA licensing have undergone considerable transformation. Contact your key lab manufacturers to get their insight and be sure to inform your customers. The well-informed distributor is a valuable consultative resource. Staying informed keeps you relevant and assures your customers have the information they need to run an excellent laboratory.

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IDN OPPORTUNITIES

Women Leaders in Supply Chain Editor’s note: The following interview is from The Journal of Healthcare Contracting’s focus on women leadership in the supply chain.

Please tell us about a key mentor or key event in your life.

Watson: I was fortunate early in my career, 10-12 years ago when I worked at BP, that I was nominated for a mentoring program. The company signed up three young women leaders at BP to be in this program as a pilot to see how it worked. It was a year-long program. You answered some questions and added what you thought your goals and objectives were of mentoring. Then they matched you with a mentor. I was matched up with Bruce Burdett at Cargill. He was a senior executive and oversaw and led the Central America food operations. I was a little intimidated when I got matched.

They matched me with a C-suite level person, and I was amazed that he had time to do this. We had calls every other month that lasted about an hour-and-a-half to two hours.

It was so beneficial because I was used to being mentored by leaders at my own organization such as my boss, or my boss’s boss, or my boss’s peers. BP was very into mentoring, but it was kind of through an inner chain of command, so this mentoring program was really different for me. I was able to articulate areas that I thought I needed to focus on. We were also able to talk about areas in my day-to-day work where I might have thought I was struggling or having challenges as a leader. My mentor didn’t know any 10

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Janet Watson, vice president of strategic sourcing, Baylor Scott & White Health

of the people I worked with, and he didn’t know the company culture, so that removed a whole dynamic that is there when you’re being mentored by somebody in your own organization.

He would ask me questions and it would drive the conversation: “Why does that make you feel that way?” or “Why did you approach it this way.” A lot of times, my answers were rooted in what I thought somebody else would think. He told me I had to get over that and quit thinking about what everyone else was going to think. Instead, think about what the objective is, and how you are going to get from A to Z leading people. That was a key mentoring event in my career.

I’ll never forget going into a meeting on a Monday morning in March. It wasn’t about COVID19, just normal work, but by that afternoon the floodgates opened.

All of a sudden it was, “We’ve got to get ready.”

What have you and/or your supply chain team learned working amid the pandemic?

Watson: My team is full of rock stars. We’ve learned a lot, and I definitely learned that I had the right people in the boat for this.

I’ll never forget going into a meeting on a Monday morning in March. It wasn’t about COVID-19, just normal work, but by that afternoon the floodgates opened. All of a sudden it was, “We’ve got to get ready.” It seems like somehow that was a flip-the-switch day, and everything started just falling into place after that. That very next weekend, I remember being at home and my phone started ringing at 7 a.m. I went

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IDN OPPORTUNITIES into my office at home and I didn’t come out until that evening. I was getting phone calls from doctors, CMOs, hospital presidents – all kinds of people who had connections with people who said they could get us PPE. I’m sure every health system had hundreds of supplier leads of people wanting to help us find PPE. Our team rallied together because no one person could do this by themselves. We are structured into commodity categories. I’ve got a team of people with a commodity director, contract manager, and procurement specialists to handle med/surg. But we couldn’t expect one or two people to source all of that PPE, so we spread it out.

I spread it out across my leadership team, and they spread it across their staff. We split it up into categories, assigned it out, and then we would have check-ins every morning, and sometimes every afternoon. For about three or four weekends in March and April, I don’t think anybody even knew what day it was. We just kept working just like it was a Monday or Tuesday.

I’ll never forget going into a meeting on a Monday morning in March. It wasn’t about COVID-19, just normal work, but by that afternoon the floodgates opened. All of a sudden it was, “We’ve got to get ready.”

We couldn’t have done it without the tremendous support of the Baylor Scott & White senior leadership and the C-suite, as well as the physicians and the clinicians, nurses, and infection preventionists. They helped keep the focus where it needed to be. It really was a test of the system’s ability to collaborate and integrate. The collaboration across the system was like nothing I’ve seen before. It’s helped Baylor Scott & White, even on the other side of the crisis, to be much more collaborative and engaging with each other to get things done.

Across the supply chain, we learned how to integrate quickly. When you think of all those leads, you think of having to vet the suppliers and whether you’re going to do business with them. You have to think about the interaction with accounting, finance, purchasing, demand planning, 12

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inventories, all of this. You talk about integration forever.

But you always kind of wonder: Are we there yet? We’ve really improved on those processes and it’s in so much better shape than it was before COVID-19. Our Baylor Scott & White Supply Chain is stronger and our visibility into inventory and modeling is significantly improved.

Describe key characteristics of the successful supply chain leader of the future.

Watson: I’ve been at Baylor Scott & White almost four years now. Before, I was in the energy industry, where 10-12 years ago we were doing the things that we have been doing in Baylor Scott & White Supply Chain over the last three years.

I’ve heard people in the industry and across health systems make the comment, “Well, supply chain is finally getting a seat at the table.” I keep thinking to myself, “OK, you’ve got a seat at the table. What does that mean?”

What that means to me is you can get a seat at the table, but what are you going to bring to the table?

It can be a very short-lived dynamic if you’re not bringing something to the table or offering something different than what you were bringing before.

Getting things put in place that address your technology, processes, and the skill sets of your people is tremendously important. I told Tony Johnson about nine months ago that we have reached the point where the plan we put in place is now in Year 4 and this is the year that we need to stabilize and start reaping the benefits of all of this work with data, systems, and skill sets. Supply Chain leaders of the future definitely need to have their eyes on data, what it tells you and how you automate.

You’ve got to lead from a point of flexibility to adapt to market changes, industry changes, cost challenges and other unknowns. If you have stable processes and systems, you can flex. Through COVID-19, the whole world has recognized that we must be nimbler. We all need to find ways to sustain our health systems and businesses.

I’ve never worked for a company that just does supply chain. So, I always say to myself and my team, “This company is not about you. It’s not about supply chain.” How do you learn the business you support from a financial perspective? What are the goals? The objectives? What’s the roadmap? Then, how do you support that and affect it from a financial perspective? When you really peel the onion back in business and get to the true objectives, that’s when you will find success. Supply Chain should be saying “These are the things that we will do to help you achieve the objective,” not “What do you want me to do?”

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MEDPRO

How to Sell Better in a Post-Pandemic Healthcare Landscape The circumstances of the past year forced healthcare

Full Attack Mode

reps to change almost every aspect of how they do business – and some of those changes are here to stay.

So as we settle into a new normal, what are some key things that reps can do to sell more in 2021? On a recent podcast, Repertoire publisher Scott Adams talked to MedPro’s Manny Losada and Gino Liongson, as well as Brian Sullivan, a former Welch Allen rep who’s become a leading sales trainer with his company, PRECISE Selling, to discuss actionable things that listeners can implement into their daily routine.

Brian said last year he noticed that while some companies were laying low or taking a “wait and see” approach, there were others who took advantage of the situation and shifted into full attack mode. “Those are the companies who last year actually did really well,” Brian said. “And those are the ones who were totally primed to crush it in 2021.”

So what is this attack mode? To Brian, it’s simple: “If you’re reaching more people than your competitors, you’re going to do better than them.”

New Skills Brian said his hope is that the last year forced us to be better at both picking up the phone and selling virtually.

“If we can do virtual presentations that save a whole bunch of time, yet still accomplish the goal, then we should be doing more of those than ever,” he said. “I hope it doesn’t change because frankly, I seem to be looking in more people’s faces throughout the course of the day now than I was last February at this time. People will take meetings through Zoom where otherwise, maybe they wouldn’t let you walk through their front door.”

What the Future Holds Adapting to the Reality of Virtual Meetings The abruptness of the changes brought on by the pandemic left sales reps in a lurch. Trying to do things that had worked in person didn’t always translate to being effective in a virtual setting, said Manny. In short, virtual “happy hours” and other similar tactics just weren’t cutting it. Circumstances had changed, so the approach had to change as well. “We knew we had to be dynamic,” Gino said. “We had to be able to pivot and be creative in order for us to grow on the opposite end of this.”

When it comes to the “new norm” and what the future is going to be, Manny had a few insights. “Think about the impact of who we’re becoming now – better communicators. That’s going to lead to better sales leaders,” he said.

“And when that combination comes back together, where we do have access and have the ability to get back in front of customers and combine that with who we are today, the aggregate is going to be a much more successful resource in sales reach, communicating, relationships, and networking than ever before… I think the combination of some of that coming back, coupled with what we were forced to experience and learn is going to be powerful.”

For the full conversation go to http://repertoiremag.com/virtual-field-sales-tactics-with-medpro-and-precise-selling.html

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BACK ON BASE Our manufacturer reps cover all the bases with every tool and resource needed in today’s selling environment.

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SALES

Your New Bucket Challenge Three mistakes, three buckets, and how to conquer them when calling on customers

By Sandler Systems, Inc.

The lure of “easy money” that comes from commission selling, i.e. “eating what you kill,” entices many people to

try sales. But selling isn’t easy, is it? More so than ever, both novice and experienced salespeople encounter obstacles in selling, especially in the difficult but vital area of prospecting.

Sandler has developed a “Success Triangle” concept with three areas of focus or “buckets” to help salespeople see where they could improve their prospecting skills.

The buckets that add up to success are behavior, attitude and technique. Let’s take a look at what’s in each bucket and how they’re related.

BUCKET No. 1: Behavior Behavior is often considered the most important bucket, the leading indicator of prospecting success. Maybe, but this bucket has some common leaks!

Behavior leak No. 1: Not maintaining a consistent schedule mindset. Time blocking is a time-management concept that allows you to accomplish your daily and weekly tasks, and make progress on your goals. Successful salespeople don’t allow distractions to interrupt prospecting time.

Behavior leak No. 2: Not having a goal for meaningful conversations. When you talk with a prospect, you should have a goal in mind, and make meaningful progress in every conversation. These conversations should take place with decision makers, and your goal should be for them to make a purchase decision with clear next steps. Every call should have an agenda and an outcome.

Behavior leak No. 3: Losing sight of the importance of first time appointments. By placing importance on

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SALES booking first-time appointments with new prospects, you’re helping your business more than if you were focusing on existing customers; new business brings new referrals and new opportunities to your pipeline.

BUCKET No. 2: Attitude Attitude is the belief system that determines how you act, which ultimately affects your results. Just like with behavior, it’s easy to have a clouded view of your attitude and actions if you’re not focused on the process. Here are the three most common “leaks” in the Attitude bucket of prospecting activities.

Attitude leak No. 1: Having a scarcity mindset. Prospecting is about numbers, persistence and consistency. Focus on what an ideal prospect looks like in your business. The more you prospect, the more you discover what the ideal is, which streamlines your activities, increases your chances of success, and improves your prospecting attitude!

Attitude leak No. 2: Thinking you’re not worthy of their time. Selling has a lot to do with a positive mindset. To be of value to your clients or prospects, you must know your own worth. The goods or services you provide have been beneficial to clients in the past – take that to heart and it adds value to those you engage with. Remember, you have equal business stature with your buyer!

Attitude leak No. 3: A shape-shifting ego. Don’t try to show your audience how smart you are by dominating the conversation. Ask questions and discover their pain points before you save the day. Alternatively, some people don’t want to prospect because of the “stigma” of being a salesperson. We’ve all been there, and it’s part of the process. Power through and don’t let your own “head trash” get in the way of vital prospecting.

BUCKET No. 3: Technique Technique is what you say and how you say it, and the actions and words you use to increase sales. Leaks in your bucket of Technique can have just as many negative effects as the other buckets, though they’re governed by different rules.

Technique leak No. 1: Not knowing your talk tracks.

Salespeople should have a few things down pat; you should be able to jump to the correct talk track at a moment’s notice, regardless of the scenario. You should have predetermined language and an “info flow” to overcome objections and lead the prospect to a purchase decision.

Technique leak No. 2: Not controlling every sales call.

Productive sales conversations that start well tend to end well and need participation from both sides. As soon as you engage with a prospect, cover the purpose of the meeting and the expected duration of your time together.

Lay the groundwork, the topics you wish to cover and the expected outcome. This will allow you to get through everything you want to cover and lets your target know what to expect and why.

Technique leak No. 3: Failing to uncover compelling reasons to do business. The quickest way to solve your clients’ needs (and make a sale) is to uncover their pain points and provide solutions. If you don’t help them discover what their pain points are, and see if your solutions are a fit, there’s no sale. You need to ask good questions to determine what ails them; don’t prescribe a solution before you understand the symptoms.

So there’s your new “Bucket Challenge!” By filling your buckets of the Sandler Success Triangle® and maintaining the necessary habits surrounding your Behaviors, Attitudes, and Techniques, you can avoid the leaks that the average salesperson experiences, and you’ll be on your way to redefining how you add prospects to your funnel.

Interested in building better habits both professionally and personally? To schedule a complimentary 30-minute advisory session on Behavior, Attitude, Technique, or other sales or sales management challenge, send your request and contact information to SalesTips@repertoiremag.com with “Free Consultation” in the subject line.

Sandler Training: With over 250 local training centers around the globe, Sandler is the worldwide leader for sales, management, and customer service training. We help individuals and teams from Fortune 500 companies to independent producers dramatically improve sales, while reducing operational and leadership friction. © 2021 Sandler Systems, Inc. All rights reserved.

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COVID Leaves its Mark on Ambulatory Surgery Centers COVID-19 has tested the resilience of ambulatory surgery centers, but ASCs appear to be emerging stronger than ever.

“Certainly, the last year has been difficult for ambulatory

surgery centers,” says Todd Johnson, who leads the medical device sector for management consulting firm Bain & Company. “Most of their procedures are elective – and those were postponed by law or patient preference for months [due to COVID-19.] But our clients are looking at 2021 as a bounce-back year, given the pent-up demand for cataract surgery, knee procedures, colonoscopies, etc.”

In a 2019 report, Johnson co-wrote a report for Bain predicting that single-specialty centers focused on orthopedics, cardiology and spinal surgery would see the fastest growth in volume of procedures. That prediction is still on track.

Orthopedics At the time, commercial payers had begun reimbursing total joint replacements in ASCs, which led to an eightfold increase in the number of surgery centers performing such procedures. In December 2020, the Centers for Medicare & Medicaid Services added 11 procedures to the www.repertoiremag.com

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COVID Leaves its Mark on Ambulatory Surgery Centers

ASC-covered procedures list, including total hip arthroplasty, under its standard review process. The agency also finalized its proposal to eliminate the Inpatient Only (IPO) list over a three-year transitional period, beginning with the removal of approximately 300 primarily musculoskeletal-related services. The IPO proposal would extend Medicare coverage to procedures performed in the hospital outpatient setting, and experts believe it will lead to increased coverage in ambulatory surgery centers as well.

Given these developments, perhaps it’s not surprising that growth in outpatient orthopedics continues to climb, despite COVID-19. In fact, total joint procedures in ambulatory surgery centers grew over 40% in 2020, in an overall market that was flat, says Johnson.

‘Our clients are looking at 2021 as a bounce back year, given the pent-up demand for cataract surgery, knee procedures, colonoscopies.’

ASCs received a vote of confidence in 2016 from the American Academy of Orthopaedic Surgeons. In a position statement, the AAOS voiced its support for ASCs, “regardless of ownership, so long as all potential conflicts of interest are fully disclosed to the patient, payers, and other providers.” The Academy also voiced support for “physician and non-physician investment in facilities that deliver high quality and cost-effective healthcare.”

The Academy’s position remains just as strong today, says Daniel Murrey, M.D., FAAOS, chair of the AAOS Health Care Systems Committee, and chief medical officer for Surgical Care Affiliates, a division of Optum. “Orthopedic surgeons regard ASCs as an 22

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extension of their practice. We become deeply engaged from a clinical, customer service, patient experience and affordability standpoint.”

AAOS is supportive of Medicare’s intent to remove the inpatient-only list, he says. “But we have concerns about unintended consequences,” such as payers or health systems pressuring surgeons to perform procedures in an outpatient setting without consideration of risk, says Murrey. “We believe the physician should be the one to decide whether a case is more appropriately performed in the inpatient or outpatient setting.”

Cardiovascular Diagnostic cardiology procedures began shifting to outpatient settings in 2005 with Medicare’s approval of outpatient arterial endovascular interventions, according to Bain & Company. In the first half of 2019, CMS added 12 cardiac catheterization procedures to its ASCcovered list, leading Bain to predict that ASCs would be performing between 30% and 35% of all cardio procedures by the mid-2020s.

“As payer support, technological advances and care redesign enable care to be delivered in lower-acuity and lower-cost settings, the opportunity to shift procedures such as electrophysiology, interventional cardiology and vascular services to ambulatory settings is top of mind for providers,” says Chad Giese, associate principal, cardiovascular intelligence, Sg2, a health system consultancy.

“Similar to the overall shift to ASC settings, however, the pace and extent of the shift is highly market-dependent.

A complex combination of forces, including federal and local regulations, workforce, patient population, and the current market landscape, must be assessed to understand if this shift aligns with and supports the broader goals of an organization’s cardiovascular program.

“Moreover, for cardiovascular services, this is more complex than just a shift to the ASC,” says Giese. Many organizations have pursued a hybrid facility model, operating both as an OBL (office-based lab) or an ASC, depending on the type of procedures scheduled for the day, the resources and staffing needed, and the optimal reimbursement for cases.

OBLs accommodate primarily vascular procedures, while ASCs can accommodate diagnostic catheterizations, percutaneous coronary interventions (formerly known as angioplasties with stents), even pacemaker insertions or generator changeouts.

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COVID Leaves its Mark on Ambulatory Surgery Centers

Insofar as ASC procedures are concerned, cardiology is where GI was 10 or 15 years ago, says Rick Snyder, M.D., FACC, president of HeartPlace P.A., a minority owner of Medfinity ambulatory surgery centers in Texas, and past president of the American College of Cardiology Texas Chapter. “When I started, Medicare wouldn’t reimburse me for an angiogram or PCI.” But that’s changing, and with good reason.

“Clearly, there are some circumstances where you will want to do procedures in hospital outpatient departments,” for example, for patients with certain comorbidities, such as kidney disease, or if interventionalists anticipate difficulty with a particular vessel. Safety is always first, he says, citing a consensus statement – of which is a co-author – from the Society of Coronary Angiography and Intervention.

‘Orthopedic surgeons regard ASCs as an extension of their practice.’

But in most cases, the ASC has the same equipment and staff as the hospital outpatient department, or HOPD, and costs a fraction of the latter. Furthermore, during the pandemic, cardiovascular patients who were directed away from the HOPD or inpatient OR to a surgery center found they loved them, he adds. “From a safety standpoint, cost, quality and patient satisfaction, ASCs are a home run.”

Where it’s headed For distributors and manufacturers more accustomed to servicing large acute-care hospitals, ASCs present “a much more complicated customer environment to cover, and call for a much smarter, more agile supply chain,” says Johnson. But they are adapting.

Cardinal Health has a dedicated sales team focused on serving the needs of the ASC market, says Greta Marston, national vice president of ambulatory surgery center sales.

The company anticipates continued growth in total joint replacements, says Marston, citing the 2020 Ambulatory Surgery Center HIDA Report, which projects the number 24

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of procedures performed in ASCs to grow from 32% in 2020 to 37% in 2022. “An additional area of growth is newbuild facilities,” she adds. “We’re seeing investments across the country to expand through new-build facilities focusing on multispecialty, ortho and cardio procedures.”

“Changes by CMS will be one of many factors that accelerate the ongoing shift to the ASC setting,” says Ryota Terada, consulting director, orthopedic intelligence, Sg2.

“That said, a variety of factors act as brakes or accelerators for the rate and extent of shift to the ASC setting across markets and service lines,” including: ʯ Patient acuity. ʯ Physician comfort (or lack thereof) with ASCs and patient selection criteria. ʯ Workflow challenges, including accommodating surgeons’ schedules between hospital-based ORs and ASCs. ʯ State-level regulatory restrictions, such as Certifications of Need (CON), overnight stays and procedures permitted to be performed in ASCs. ʯ Space restrictions (which could limit the type of procedures offered.) ʯ Physician alignment models and/or equity and reimbursement considerations. ʯ Commercial payers’ site-of-care policies for select elective procedures.

Says Giese, “Opening a new site sounds appealing, but how you’re going to staff it needs to be part of the discussion.”

Bill Prentice, CEO of the Ambulatory Surgery Center Association, says, “The health and comorbidities of patients are key in determining where patients safely get the best care. We would argue that many Medicare patients are good candidates to get care in ASCs, and if they did, the system would save billions of dollars.”

Despite all of its difficulties, COVID-19 might have provided a shot in the arm for ambulatory surgery centers, says Johnson. “COVID has really changed the game,” he says. “Doctors who might have been reluctant to perform total joints or other higher-acuity procedures in the ASC were forced to do so, because of capacity reasons or simply because patients were afraid to go to the hospital.

They have become more comfortable with ASCs, which they’ve found are more convenient for doctors, payers and patients. So we expect continued growth.”

TRENDS

In the Name of the Patient Differing views on ‘scope of practice’ “Scope of practice” is a term describing the services that a health professional is deemed competent to perform

and is permitted to undertake in keeping with their professional license. Sounds straightforward. But in fact, as medicine evolves, so too do the discussions around scope of practice. And they can get quite heated.

Nurse practitioners, physician assistants, nurse anesthetists and others believe that expanding scope of practice is in the best interest of the patient. Here’s the rub: Physicians, anesthesiologists, ophthalmologists and others believe that limiting expansion of scope of practice is in patients’ best interest.

It’s not a new debate. The American Medical Association formed the Scope of Practice Partnership back in 2006. To date, the Partnership has awarded more than $2.3 million in grants to members (national, state and specialty medical associations) to fund advocacy tools and campaigns.

In that same year – 2006 – 14 healthcare professional organizations formed the Coalition for Patients’ Rights to “monitor the legislative and regulatory environment to identify efforts to limit the scope of practice of the 26

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healthcare professionals it represents,” including criticalcare nurses, nurse practitioners, occupational therapists, hospice and palliative nurses, and pharmacists.

The divisions fester today. For example, in May 2019, the American Association of Nurse Anesthetists launched a campaign – “CRNAs: We are the Answer” – which included these words: “Anesthesia services are provided the same way by nurses and physicians; in other words, when anesthesia is provided by a CRNA [certified registered nurse anesthetist] or by a physician anesthesiologist, it is impossible to tell the difference between them.” The American Society of Anesthesiologists took exception, calling AANA’s campaign “malicious” and “irresponsible.”

Scope-of-practice struggles are playing out in state legislatures and in the courts today. In January, Massachusetts

became the 23rd state to allow nurse practitioners to practice independently. In March, Hawaii lawmakers advanced a bill to allow advanced practice registered nurses (APRNs) to perform abortions.

Also in January, however, New Jersey lawmakers rejected legislation that would have allowed APRNs to prescribe without physician oversight, reports the American Medical Association. And in March, a measure in South Dakota that would have allowed physician assistants to diagnose and treat patients and prescribe substances without physician involvement died in committee.

In her testimony before the South Dakota committee, AMA President Susan Bailey, M.D., said the proposed measure would move healthcare in the wrong direction by removing physicians from care teams. “And when you remove the most highly educated and trained health care professional from the care team, you put patients at risk,” she said.

What’s next?

“The removal of unnecessary barriers to CRNA practice is an ongoing effort,” says Anna Polyak, RN, JD, senior director of state government affairs for AANA. “While CRNAs work collegially with physicians and other providers every day to provide optimal patient care, barriers such as unnecessarily restrictive physician involvement in CRNA practice do not improve care or increase

patient safety. Studies have consistently shown that CRNAs and other APRNs, when allowed to practice to the full extent of their education and training, provide increased access to safe, cost-effective patient care.

“There is a great shortage of anesthesia providers around the country,” she says. “So, this is not about replacing one provider with another, but rather about improving access to care by allowing all providers to practice to the full extent of their training and education.”

The number of nurse practitioners and advanced practice registered nurses is expected to grow faster than that of physicians for the rest of the decade. AANP estimates the current number of nurse practitioners in the United States to be close to 300,000, while the National Commission on Certification of Physician Assistants estimates the number of PAs to be 139,000. The U.S. Bureau of Labor Statistics predicts that the job outlook through 2029 for PAs and CRNAs will be much better than average. So will their median pay ($115,800 for APRNs in 2019, and $112,260 for physician assistants in 2019).

Given all that, this statement about scope of practice from the American Nurses Association sounds accurate: “In a profession as dynamic as nursing, and with evolving health care demands, changes in scope of practice and overlapping responsibilities are inevitable in our current and future health care system.”

Scope of practice: A concern for many specialties Scope-of-practice disputes span many medical specialties, including eye care and behavioral health care.

In September 2020, for example, the Arkansas Supreme Court cancelled a scheduled public referendum that would have asked voters to repeal a 2019 bill that allowed optometrists to perform a variety of in-office procedures (with the exception of cataract surgery, LASIK surgery, or other major eye surgeries that ophthalmologists regularly perform). The referendum, backed by Safe Surgery Arkansas, an ophthalmologist-backed advocacy group, was rejected by

the high court on technical grounds related to the procedure by which signatures had been collected.

In January 2019, members of the U.S. Congress introduced the Medicare Mental Health Access Act (HR 884), which would have given psychologists independent practice authority in all Medicare treatment settings, and would have expanded the definition of “physician,” for purposes of the Medicare program, to include a clinical psychologist with respect to the furnishing of qualified psychologist services.

The American Medical Association, American College of Physicians,

American Psychiatric Association, American College of Surgeons and others voiced displeasure with HR 884.

In a September 2020 letter to Congressional leaders, the organizations wrote that the proposal “jeopardizes the safety of patients in the Medicare program and would create silos in the delivery of appropriate mental and physical health care,” and that the legislation “runs counter to efforts to coordinate and integrate the delivery of care to patients with mental illnesses and co-occurring health conditions.”

The bill failed to pass the 116th U.S. Congress, nor has it been reintroduced in the 117th Congress.

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TRENDS

A Reset for Infection Prevention Protocols Infection prevention took a hit this past year, but rebuilding is already taking place Is it fair for Medicare to penalize the bottom 25% of hospitals because of patient infections or other avoidable

medical complications? Fair or not, in February, the Centers for Medicare & Medicaid Services did just that, announcing that 774 hospitals would lose 1% of their Medicare payments over the next 12 months (based on pre-COVID performance, from mid-2017 to 2019.) It’s part of Medicare’s Hospital Acquired Condition Reduction Program.

The American Hospital Association believes the six-year-old program is flawed, for a number of reasons: Some quality measures are inaccurate, and the program fails to take into account patient safety improvements that hospitals have made, says AHA. What’s more, it unfairly penalizes teaching hospitals, large hospitals and small hospitals.

Even the Medicare Payment Advisory Commission, which provides the U.S. Congress with analysis and policy 28

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advice on the Medicare program, has criticized the socalled “tournament model” penalty system, in which providers are scored relative to one another, “despite the potential availability of clear, absolute and prospectively set performance criteria.”

The HAC Reduction program is just one of several government programs that are intended to reduce healthcare-associated infections. Others include the National Action Plan to Prevent Health Care Associated

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TRENDS Infections, the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use, and CDC’s U.S. National Action Plan for Combating Antibiotic-Resistant Bacteria.

Do we need so many programs to monitor and (it is hoped) reduce healthcare-acquired infections? Do they work? And even if they did, how has COVID-19 affected them?

“Each of these programs provides a framework for the infection control and epidemiology communities in hospitals and other settings,” says Lynne Batshon, director of policy and practice for the Society for Healthcare Epidemiology of America (SHEA). “Adoption of new measures is a key component toward progress, [but] the measures have to be the right measures, they must be reliable, and they must be properly risk-adjusted.”

Progress The CDC’s 2019 National and State Healthcare-Associated Infections Progress Report offers some evidence of progress. At the national level, acute care hospitals achieved: ʯ About 7% decrease in central-line-associated bloodstream infections (CLABSIs) between 2018 and 2019. (Largest decrease: 13% in NICUs.) ʯ About 8% decrease in catheter-associated urinary tract infections (CAUTIs) between 2018 and 2019.

(Largest decrease in ICUs: 12%.)

Counting the cost of infections According to a CDC report, more than 2.8 million antibioticresistant infections occur in the U.S. each year, and more than 35,000 people die as a result. In addition, 223,900 cases of Clostridioides difficile occurred in 2017 and at least 12,800 people died.

Additionally, according to a collaborative CDC study, the estimated national cost to treat infections caused by six multidrugresistant germs identi-

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fied in the report and frequently found in health care can be substantial – more than $4.6 billion annually.

“Dedicated prevention and infection control efforts in the U.S. reduced deaths from antibioticresistant infections by 18% overall and by nearly 30% in hospitals.

However, the number of people facing antibiotic resistance is still too high,” the CDC said. “More action is needed to fully protect people.”

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ʯ A 2% increase in ventilator-associated events (VAEs) between 2018 and 2019. (Increase observed in ICUs.) ʯ No significant change in hospital onset Methicillin-resistant Staphylococcus aureus (MRSA) bacteremias between 2018 and 2019. ʯ About 18% decrease in hospital onset C. difficile infections between 2018 and 2019.

“This won’t be our last healthcare crisis.

Healthcare systems need to be prepared to maintain and sustain their existing infection prevention programs and techniques.”

In addition, a study published in February 2021 found that hospitals using the AHRQ Safety Program for Improving Antibiotic Use decreased usage of antibiotics and reduced C. difficile infections, a potentially deadly condition of the colon and digestive system. More than 150 million antibiotic prescriptions are written annually in the United States, according to AHRQ. If antibiotics are overused, they can become less powerful over time as some bacteria grow resistant. (The Centers for Disease Control and Prevention estimates that at least 2.8 million infections and 35,000 deaths a year are caused by antibiotic-resistant bacteria in the United States.)

The COVID impact Perhaps not surprisingly, COVID has had a dramatic impact on providers’ ability to prevent healthcare-associated infections, says Batshon. Particularly in facilities and locales that experienced surges in the coronavirus, professionals who had been responsible for overseeing infection prevention protocols had to turn their attention to caring for COVID-19-positive patients. “We learned that without sustained infection prevention programs, even in places where programs had been effective, quite frankly, you’re going to see slippage,” she says. In addition:

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TRENDS ʯ Some hospitals had to staff provisional ICU units with people who weren’t familiar with the ICU or its infection prevention protocols. ʯ Staff were overworked, exhausted, and forced to care for more patients than they normally would. ʯ Many hospitals experienced shortages of personal protective equipment.

The COVID-19 pandemic has required hospitals to take unprecedented measures to maintain continuity of patient care and protect healthcare personnel from infection, the CDC noted in December. Yet “[t]his outbreak highlights that multidrug-resistant organisms can spread rapidly in hospitals experiencing surges in COVID-19 cases and cause serious infections in this setting.”

“What I’m hearing from experts is that a lot of ground was lost since 2020, when a lot of energy was directed toward patient safety,” says Batshon. “And this won’t be our last healthcare crisis. Healthcare systems need to be

prepared to maintain and sustain their existing infection prevention programs and techniques.”

In January 2021, SHEA joined the Association for Professionals in Infection Control and Epidemiology and the Society for Infectious Diseases Pharmacists in requesting that CMS refrain from using 2020 quality data for the HAC Reduction Program for payment determination. In a letter to the deputy secretary of the Department of Health and Human Services, representatives from the three organizations wrote, “As the number of COVID19 cases surge, hospitals are becoming overwhelmed with more patients than can be managed with typical care standards. Requiring reporting and enforcing penalties on hospitals related to quality measures during the pandemic will only shift critical resources to non-essential surveillance activities and result in reduction of resources and funding available to support necessary patient care and staffing.”

A CMS spokesperson told Repertoire that CMS will make an announcement on the HAC Reduction Program for the fiscal year 2022 program year later this year.

COVID collides with safe protocols In a case report, CDC researchers and the New Jersey Department of Health described an outbreak of carbapenemresistant Acinetobacter baumannii (CRAB) at an unnamed New Jersey hospital, which affected 34 patients and was linked to 10 deaths. Investigation of the outbreak, which occurred during a COVID-19 surge that lasted from March through June 2020, found that pandemic-related resource challenges severely limited the hospital’s infection prevention and control policies:

ʯ To conserve equipment during

the surge, the hospital’s respiratory therapy unit instituted a policy to extend the use of ventilator circuits and suctioning catheters for individual patients, replacing them only if they were visibly soiled or malfunctioning.

(Prior to March 2020, ventilator circuits and suctioning catheters were changed at specified intervals of every 14 days and every three days, respectively, unless malfunctioning or visibly soiled.) ʯ To conserve PPE, gown use was suspended for care of patients with vancomycin-resistant Enterococcus spp. and MRSA.

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ʯ Anticipating shortages, the

hospital adopted an extendeduse PPE protocol for N95 respirators and face shields. ʯ To prioritize personnel resources, activities of the

multidrug-resistant-organisms (MDRO) workgroup were suspended, along with biweekly bedside central venous catheter and indwelling urinary catheter maintenance rounds. ʯ Routine audits of appropriate PPE use, hand hygiene compliance, and environmental cleaning were temporarily discontinued. ʯ Responding to COVID-19related care needs also resulted in unintentional changes in standard practices, including less frequent patient bathing with chlorhexidine gluconate and a 43% reduction in ICU CRAB screening tests.

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 Watch that tone of voice Amazon has announced a new feature for its Halo fitnesstracking gadget: Alexa integration. Halo owners will be able to ask Alexa devices for various health stats, such as their sleep score or activity points obtained during the day. The integration will be off by default and owners will need the latest firmware on their Halo bands and the latest version of the iOS or Android app to enable it. The Halo band is Amazon’s first fitness-focused product and it’s had a less than stellar reception since it was announced last fall. Aside from the standard fitness capabilities, such as tracking your movement and sleep patterns, the $100 Halo also has the ability to police the tone of your voice and tell you when you’re being dismissive or condescending with your words. The companion Halo app also has a feature to 3D scan your body through your phone’s camera and measure your fat composition.

in 2017, which lets you authenticate purchases without ever touching a keypad. However, Samsung said the cards will adopt a new security chipset from Samsung’s System LSI Business that integrates several key discrete chips, rather than using Mastercard’s current tech. The aim is to increase security while reducing physical contact points, as your fingerprint is scanned directly from your own card and not an external point-of-sale (POS) device. The card will be compatible with Mastercard’s authentication tech, and function at any Mastercard chip or POS terminal.

WhatsApp for desktops One-on-one voice and video calling is now available on WhatsApp’s desktop app for Windows and Mac. Until last year, the Facebook-owned messaging service only offered the feature on its mobile app. At the moment, the company is testing one-on-one, end-toend encrypted calls on the desktop. WhatsApp promises to expand the feature to include group voice and video calls in the future.

Teleport to your next sales call Facebook CEO Mark Zuckerberg believes that by 2030, people will use advanced smart glasses to “teleport” to locations and speak to them as if they’re physically present, allowing in-person meetings to be replaced by a headset-based digital experience, reports CNBC. Most big technology firms, including Apple, Microsoft and Google, are reported to be working on augmented reality technology, which overlays computer-generated graphics on images of the real world. They’re all competing to shape the next major computer interface after the smartphone and touchscreen.

T-commerce Samsung, Mastercard to offer biometric payment card Samsung is collaborating with Mastercard on a biometric scanning payment card with a built-in fingerprint reader, reports EnGadget. The technology appears to be similar to Mastercard’s biometric payment card, unveiled 34

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Amazon executive Albert Cheng says the era of “T-commerce” – the sale of goods through TV screens – is finally dawning. He made the remarks during a panel hosted by the Interactive Advertising Bureau, reports Deadline. The company has long sought to “leverage the reach of Prime Video and marry that

with commerce,” he said. Though T-commerce is in its early days, Cheng said he is encouraged by Amazon’s partnership with pop star Rihanna’s fashion brand Savage x Fenty. Starting in 2019, Amazon has streamed its star-studded fall shows and embedded those streams with buying opportunities.

Phone-based video chats Google Meet’s group video chats have had a tile layout on large screens since the start of the pandemic, but you’ve had to endure a far less practical (and less egalitarian) view if you wanted to participate on your phone.

Now Google is rolling out the grid view for mobile users on iOS, with Android coming soon, reports EnGadget.

Instead of focusing primarily on one caller at a time, Meet now gives equal treatment to several participants.

It’s a relatively simple move, but it’s also an acknowledgment that video chats have changed as a result of social distancing and the shift to working from home. You’re less likely to be watching a boardroom presentation and

more likely to be holding running conversations with coworkers, family and friends.

Manage your Zoom calls A newly launched Mac app called Superpowered aims to make it easier to stay on top of all your Zoom calls and Google Meets, without having to scramble to find the meeting link in your inbox or calendar app at the last minute, reports TechCrunch. Instead of relying on calendar reminders, Superpowered offers a notification inbox for the Mac menu bar that alerts you to online meetings just before they start, which you can then join with a click of a button. To use Superpowered, download the app and then authorize it to access your Google Calendar. The app currently works with any Google account, including G Suite, as well as subscribed calendars. Once connected, Superpowered pulls all your events into the menu bar, which you can view at any time throughout the day with a click or by using the keyboard shortcut Command+Y.

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critical, yet fleeting moment of the physical exam.

Ophthalmoscopy (eye exam) provides a window into the patient’s underlying microvascular system. Abnormal findings may lead to the early diagnosis of retinal and systemic diseases, including the effects of hypertension, diabetes or raised pressure, among others. A fundoscopic examination with an ophthalmoscope can help quickly identify a life-threatening condition or a health concern with long-term implications if not properly treated.

Meanwhile, otoscopy (ear exam) includes a thorough evaluation of the outer ear and tympanic membrane, which is key to identifying perforation of the tympanic membrane, otitis media, and other pathologies where diagnostic skills are critically important. Identification of otitis media (ear infection) is challenging and cannot be diagnosed by symptoms alone, highlighting the importance of otoscopy for more accurate diagnosis and treatment. And accurate diagnosis of otitis media is important in helping reduce over-prescription of antibiotics.

Simply performing these exams can lead to earlier detection, diagnosis and treatment, improve patient referrals, and drive better patient outcomes. So why is it that the physical exam of a patient can often be overlooked or hurried?

Despite eye and ear exam proficiency standards in medical schools, the tools being ubiquitous, and clinicians understanding the importance of the exam, non-specialists are performing these exams less frequently. Exams using 36

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traditional physical exam tools, offer smaller views of the eye and ear and provide only a fleeting image, and in many cases clinicians aren’t as confident in what they see.

A closer look To address these challenges, Hillrom consulted over 1,300 clinicians in the U.S., Australia, Canada, UK, Netherlands, France and Germany for input on creating an enhanced experience for each physical exam. Providers’ suggestions included: ʯ The need for better visualization of the eye and ear for less ambiguity ʯ Increased confidence in performing the exam in primary and urgent care facilities ʯ Ability to consult with experts and share data to improve care and referrals ʯ Document findings in the EMR system for tracking and reflecting back on changes from one exam to the next or post-treatment Using those insights, Hillrom went about redesigning its otoscopes and ophthalmoscopes. For instance, the new Welch Allyn® MacroView® Plus Otoscope provides a three times larger viewing area and lets clinicians switch from optical to digital in a few clicks. If the clinician sees something of interest upon the initial ear exam, they can easily attach the Welch Allyn iExaminer® SmartBracket™ add their smart device and open the free Welch Allyn iExaminer Pro app to zoom in, save and share images of the ear with a specialist for consult referral, save the image to the patient record or show it to a worried parent to explain that nothing is wrong.

The Welch Allyn PanOptic™ Plus Ophthalmoscope offers a twenty times larger viewing area and features Quick Eye™ alignment technology to help clinicians overcome one of the challenges with eye exams. Two lights on the patient side help guide the patient’s gaze to support faster, easier exams from better alignment with the optic disc.

Indeed, the innovations in Hillrom’s new Welch Allyn PanOptic Plus ophthalmoscope and MacroView Plus otoscope will help visually enhance and transform how clinicians examine the eye and the ear, to support the treatment of acute and chronic conditions with extremely cost-effective tools.

LET US CHANGE YOUR VIEW 20X LARGER VIEWING AREA

NEW

Standard Ophthalmoscope Welch Allyn PanOptic™ Plus Ophthalmoscope

3X LARGER VIEWING AREA

Standard Otoscope

NEW Welch Allyn MacroView® Plus Otoscope

From a name doctors use most and inventor of the world's first direct illuminating ophthalmoscope, we're excited to introduce new Welch Allyn® physical assessment tools to help clinicians take their exams to a new level. We've listened to countless providers and have re-designed our new devices with a familiar form and feel, longlasting LED technology and views you have to see to believe.

Connect with your Hillrom representative today to see more. ©2021 Welch Allyn, Inc. APR115601 R1 02-APR-2021 ENG – US

REP CORNER

A Body of Work Selling, bodybuilding or blogging, Jennifer Taskan commits to the process Jennifer Taskan had never walked

Jennifer Taskan

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into a gym until she was 39. Four years later, she’s a successful amateur bodybuilder, looking to earn her IFBB pro card. Much as she loves it, though, she’s not leaving her day job as district sales manager, Upstate New York, for Medline Industries.

Her father, Al Woods, is a Vietnam veteran who worked for 35 years as an engineer. Her mother, Maryanne Woods, worked at the local phone company for the same length of time.

Her brother, Frank, is a retired captain in the U.S. Army who also works for Medline.

Born and raised in Rochester, New York, Taskan graduated from the Rochester Institute of Technology with a bachelor’s degree in applied science and a minor in communications. She wanted to be a writer, but found a calling in sales while still at RIT. “In my first year of college, I disputed a grade with the dean of my department, and after he heard me out, he told me I needed to go straight into sales.” In his 42 years of teaching, he told her, no one had ever convinced him to change a grade.

She followed the call, and got a job selling commercial airtime for a local “love jams” radio station. After seven years of doing so, she needed a break, and managed a Bally Total Fitness center for three years. Eager to get back into selling, she sold Internet services and magazine ad space, and in the middle, opened a concierge business in Orlando, Florida.

“I had my third child and took a few months off working,” she recalls. “I wanted to take my time

and find the perfect job for me.” She decided to look at medical sales. “Up until then, I had always sold a ‘want,’ but I felt that medical sales would be selling a need.” She started looking, and found her way to Medline, which she joined in 2014.

“Selling radio was hard. You are selling air, basically.

If you can sell that, you can truly sell anything. I learned very early in my career that … you have to believe in what you’re selling, regardless of what it is. For me that was the key to success. I never worked for a company selling a product that I didn’t believe could truly help a business succeed.”

The gym as outlet As a kid, Taskan was always athletic, playing soccer most of her young life, dancing at her aunt’s dance studio in Rochester for 16 years, cheerleading throughout high school. “I actually never walked into a gym until I was 39. I was always naturally fit, so I hadn’t thought about

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Prep work Preparing for a bodybuilding competition is similar in some ways to preparing for a sales call, only it involves eating more green vegetables and drinking a couple of gallons of water a day.

Beginning 12 to 15 weeks prior to a competition, Jennifer Taskan gets up at 5 a.m. and works out for an hour and a half, comes home, works on emails, gets the kids ready for school, then leaves for appointments. After work, she has dinner with the kids, does an hour of cardio, then works for a bit after the kids go to bed. “I have a pretty tight schedule,” she says.

During prep, she eats six times a day. Her diet consists of chicken or fish, white rice, green vegetables, rice cakes, peanut butter, oatmeal and eggs. When she’s in the field, she brings her meals with her, and keeps a cooler and food warmer in the car. “The best thing is when you get a refeed meal, where you eat something normal, like a burger and fries or pancakes,” she says.

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REP CORNER needing or wanting to work out. But after my third child and a horrible divorce, I needed an outlet.” That first trip to the gym turned out to be more than that.

“From that very first day, my entire life changed.

I felt completely different. I walked out happy. I felt amazing. I felt like I could conquer anything that was placed in front of me. I felt renewed.” And that feeling is still with her today.

‘ You trust in the process to get on that stage, standing next to anywhere from 10 to 30 other females, hitting your poses, waiting for your number to be called.’

“I don’t do a lot of things for myself,” she says. “I’m a single parent to three young children, so that really doesn’t leave a lot of free time in my life. And as a sales rep, your job isn’t an 8-to-5 job. You don’t work 40 hours a week. It’s more like 60 or 70, and you almost always work at night, and typically on the weekends. So the gym is my one hour a day to let go of the stress and daily struggles of life, and just focus on my mind and body.”

The deeper she got into her workout routine, the more interested she became in competitive bodybuilding.

She found a coach, Casey Marshall, of Team Boss Bodies, and entered into her first competition in June 2018. She has competed in four regional shows and two national shows.

The Arnold Classic She competed in the Arnold Classic – a national sports and fitness competition – in 2019 and recently competed in the bikini division of NPC (National Physique Committee) Universe, which is a national show. Her 2021 goal is to earn her IFBB (International Federation of Bodybuilding and Fitness) pro card. She will have five opportunities this year to compete in national shows to earn it. “I look at a pro card like a college diploma,” she says. “It’s something that you and only you can earn.

And once you earn it, you’ve earned it for life. It can never be taken away.

“I love bodybuilding. I love the commitment to it. I love the changes you see daily. It’s pretty cool when you see tangible proof in the mirror of the dedication and hard work you put into the process. You and only you are in control.

“If you put in 50% effort, you will only see 50% results, whether it’s bodybuilding or sales. If you put in 100% in diet and working out, you will see 100% of the results you’re looking for. You trust in the process to get on that stage, standing next to anywhere from 10 to 30 other females, hitting your poses, waiting for your number to be called. Making it to the top five is indescribable.”

And it’s kind of like selling – beginning with the opportunity and ending in the sale. “You have to dedicate yourself to the process. There are obstacles along the way, bumps in the road, but closing that deal or winning first place, there’s nothing sweeter!”

Balancinglove.com In addition to her kids, medical sales and bodybuilding, Jennifer Taskan has another passion – blogging. Her blog, Balancing Love (www.balancinglove.com), is intended to help people find a balance in their lives with love and their relationships with others.

Following her divorce, “I was back out there, a fish in the ocean, trying to juggle a new life as a single parent with a full-time job, ready to date, and it was overwhelming,” she writes in the blog. She searched the Internet but

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all she found were a few articles on how to date or how to recover from a breakup. “I got to thinking, ‘How do people start over? How do they start out?”

“Whether you’re single and 20, or divorced and/or widowed in your 50s, male or female, everyone needs help balancing love,” she told Repertoire. “Love is many different things – not just being in love with someone.

It’s about having a good, healthy, loving relationship with our spouse, children and most important, ourselves.”

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TRENDS

State of PPE GPO examines PPE supply one year into COVID-19 Premier, Inc. (Charlotte, NC) recently released a report that analyzed new data from its supply chain forecasting

technology to assess the long-term impact on the supply chain one year into the pandemic. Has the situation improved compared to the demand spikes that characterized 2020?

The short answer is that while most hospitals are seeing greater availability of many types of PPE, the healthcare supply chain remains fragile and constrained.

“Massive increases in global PPE demand created the imbalance in the supply chain and have driven up raw materials prices, which impacts the cost of finished goods,” Premier said. “This has cascaded to providers 42

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who have incurred additional costs to acquire PPE, adding to existing margin pressures.”

For example, the American Hospital Association (AHA) estimates the additional costs associated with purchasing needed PPE for hospitals and health systems was $2.4 billion over a period of just four months, from March through June 2020, or roughly $600 million per month.

Supply

Inventory Days on Hand During COVID-19 Spikes in 2020

Inventory Days on Hand (March 1, 2021)

Percent Change in Purchase Order Spend for March 2020 vs. March 2019

Percent Change in Purchase Order Spend for March 2021 vs. March 2020

N95s and KN95s

23 days

200 days

+14,302 percent

+715 percent

Surgical Masks

30 days

45 days

+1,310 percent

+93 percent

Isolation Gowns

20 days

40 days

+428 percent

+96 percent

Exam Gloves

15 days

30 days

+51 percent

+225 percent

“Massive increases in global PPE demand created the imbalance in the supply chain and have driven up raw materials prices, which impacts the cost of finished goods.

This has cascaded to providers who have incurred additional costs to acquire PPE, adding to existing margin pressures.”

PPE supplies Related to specific product categories, Premier provided the following insights: N95s and Surgical Masks. “N95 respirators and other masks have been among the most challenging products for healthcare providers to source and secure amid COVID-19. Active COVID-19 cases drove N95 demand spikes of up to 17X during the first wave.” One year later, the N95 market remains constrained but not in active shortage. Premier data shows that the average member now has about 200 days of N95 respirators on hand, even though N95 usage nearly quadrupled between April and December of 2020. “This greater on-hand availability is due, in part, both to health systems’ supply conservation measures as well as stockpiling efforts during periods of case decline.”

Isolation Gowns. “By mid-April 2020, global manufacturing ramped up to help meet the unprecedented demand spike for face masks and respirators, but this also produced an unintended consequence for isolation gowns supply.

Both N95s and many gowns are made using the same spunbond meltblown spunbond textile processing capabilities (also known as SMS textiles). When manufacturers

prioritized capacity to produce N95s and other masks in the spring of 2020, isolation gown supply compressed.”

As a result, a Premier member survey found that isolation gowns surpassed N95 masks as the top PPE shortage concern in mid-April 2020, with 74 percent of respondents citing gowns access as their No. 1 concern. By May 2020, most health systems had only about 20 days of isolation gowns on hand.

Gloves. “Exam glove supply has been constrained throughout the COVID-19 pandemic, and availability challenges are expected to persist into 2023. Global demand for nitrile exam gloves currently exceeds existing production capacity by an estimated 215 billion units, or nearly 40 percent. Raw material scarcity, port closures and delays, and a two-fold increase in gloves usage since June 2020 have exacerbated ongoing shortages. In a January 2021 survey, Premier members cited access to exam gloves as the No. 2 greatest challenge to care for COVID-19 patients, after clinical staffing. And as of March 1, 2021, most Premier members have fewer than 30 days on hand.”

To read the report, visit www.premierinc.com/newsroom/ blog/premier-data-the-state-of-ppe-supply-one-year-into-covid-19. www.repertoiremag.com

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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.

Bridgestone’s Non-Pneumatic Tire Technology “Air Free Concept”

Automotive-related news

44

EV charging off-peak hours

Navigation is easier than ever

As electric vehicles proliferate, so will the demand for EV charging – and electricity providers are trying to figure out how to accommodate it. Wallingford, Connecticut has launched SmartCharge New England, described as “a data acquisition, behavioral reward and public outreach program aimed at encouraging customers to charge electric vehicles during off-peak period.”

The program is initially limited to 25 participants, who will receive a connected car device that can be installed without a professional by inserting the device into the vehicle’s diagnostic port. Once installed, the device will connect to the local cellular network and transmit data to a cloud-based platform.

Factory-installed navigation systems offer better accuracy, more features and better integration than ever, according to a report in The New York Times. Take the navigation system in the 2021 Cadillac Escalade, for example. If you select audio driving directions in the system menu, the voice underscores the required action.

When approaching a right turn, the voice comes from the right side of the vehicle. As you approach the intersection, volume increases. If you’d rather listen to the vehicle’s 36-speaker surround-sound system, you can turn off the voice and depend instead on the large, high-resolution display on the vehicle’s 16.9-inch infotainment screen. A heads-up display of route directions

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supplements it in the windshield. The system also provides pictures of road signs at key intersections, indicating, for example, which way you should go at a fork in the road. Switch on augmented reality and the vehicle’s cameras provide a picture of the road ahead with a map superimposed. Luxury brands have such systems, as expected. But Chrysler’s Uconnect navigation systems get high marks in Consumer Reports too.

Speeding will catch up to you Automotive technology is advancing rapidly. But one thing never changes: Speeding kills people – more than 9,000 people every year, per the Insurance Institute for Highway Safety. And speeding has become even more acute during the COVID-19 pandemic, as less traffic has prompted some motorists to drive at high speeds on highways and city streets, according to Governors Highway Safety Association Executive Director Jonathan Adkins.

Based on preliminary 2019 data, GHSA projected the year would see the highest number of pedestrians killed in more than 30 years. Riders of electric scooters and bicycles are also at risk.

Rooftop solar panels on Hyundai Hyundai’s Ioniq 5 electric car comes with optional solar panels on the roof. Hyundai says that the solar panels can add up to 2,000 km per year (around 5-6 km per day) of additional range if driven in sunny environments, such as Spain or the south of France, reports Tech Radar.

The Ioniq 5 also has the ability to charge other electric vehicles. If its battery level is above 15%, you plug the new Hyundai into another electric car to charge it. Once the Ioniq 5’s battery depletes to 15%, it will automatically stop charging the other vehicle, so it can preserve a little bit of range for itself.

Tires are important too!

Electric vehicles, self-driving cars and alternative fuels are sexy solutions for future mobility challenges. But tire-maker Bridgestone says tires can be pretty cool too, according to the Consumer Technology Association. For example, the company’s airless tires use a spoke structure along the inner sides to support the weight of the vehicle. No more flat tires or tire punctures – and the tires are more recyclable than conventional ones. Meanwhile, the company’s run-flat tires allow drivers to safely continue for up to 50 miles at 50 mph after a puncture or flat tire.

Reinforced sidewall supports help support the weight of the vehicle.

Drive a Porsche to work Here’s your chance to drive a Mercedes-Benz or Porsche to your next call. Both companies are among several others (including Ducati and Harley-Davidson) who are catching the wave of electric bikes. Credit the coronavirus pandemic, which has ignited bike sales of all stripes, but none so much as e-bikes, according to The New York Times. While retail unit sales of bicycles from January to October 2020 were up 46% from a year earlier, electric bikes were up 14%. Measured in dollars, regular bikes were up 67% and e-bikes 15% – so don’t expect a discount. Though car companies traditionally have failed in previous attempts to sell electric bikes, they might encounter more success today, given cities’ efforts to manage pollution and restrict motor traffic in overcrowded streets.

No more flat tires or tire punctures – and the tires are more recyclable than conventional ones.

Meanwhile, the company’s run-flat tires allow drivers to safely continue for up to 50 miles at 50 mph after a puncture or flat tire.

Plug into the streetlight Kansas City plans to piggyback electric vehicle charging on existing streetlights as a way to improve access in areas currently lacking charging options, reports Energy News Network. A federally funded pilot project is being led by the nonprofit Metropolitan Energy Center, whose partners include the city and utility company Evergy. They hope to install chargers on 30 to 60 streetlights before the end of the year. As envisioned, the light poles would be equipped with one charger each. Customers would pay for each kilowatt-hour of power. Planners want to locate the charging stations near “points of interest,” such as stores, apartment buildings, schools and churches. They collaborated with the Missouri University of Science and Technology to map those sites and found about 300 lights that met the criteria. www.repertoiremag.com

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HIDA GOVERNMENT AFFAIRS

Shipping Challenges Wallop Industries Around the Globe Late 2020 bottlenecks were predicted to disappear by March, paving the way for smooth sailing. That hasn’t hap-

pened. Extreme weather, container shortages, port congestion, material scarcity, and staffing shortages due to sick and quarantining workers are problems piling on top of already complex COVID-related logistics.

Multiple factors pressure supply chains The disruptions underscore how multiple forces are squeezing the world’s supply chains. They are affecting all industries, not just high-demand medical products. Toyota cried foul in the spring due to February’s Texas storms affecting petrochemical supplies. Honda and Samsung cited the semiconductor shortage for their supply woes. “The pandemicdriven rise in consumer demand for tech goods to a backlog of imports at clogged California ports to U.S. factory outages caused by weather woes” are all factors creating delays and price hikes, reports the Wall Street Journal.

California’s Los Angeles and Long Beach ports, which are two of the biggest in the U.S. that receive shipments 46

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of PPE and other medical supplies from Asia, expect the rush and related congestion to continue into the early summer. L.A.’s port experienced a 47% increase in containers from February 2020 to 2021 and Long Beach saw a 44% jump – its largest ever yearly increase, according to media reports. Southern California’s ports are responsible for about 50% of all imports into the U.S. from China.

Pandemic-related e-commerce boom overwhelms ports As COVID kept many consumers at home, they replaced vacations and restaurant meals with video game consoles and cooking and exercise equipment. Port of

Los Angeles Executive Director Gene Seroka said at a press conference that there is a shortage of truck drivers and warehousing outside the port to handle the goods from Asia and elsewhere. A Port of Oakland spokeswoman said the surge in e-commerce has significantly increased the volume of incoming cargo – showing that smaller ports are beginning to experience some of the challenges of their larger neighbors as container operators look for alternate routes. Before the pandemic, the total shipping time from Asia to all U.S. destinations was about 30 to 45 days, but by midMarch it’s as high as 95 days.

The surge of exports from China to the west, combined with port disruptions due to COVID has left many shipping containers out of position, resulting in queues of ships at ports and increasing freight rates. A New York Times report in March cited experts predicting the container shortage will continue through the end of 2021. The amount it costs to send a 40-foot container from China to the U.S. has more than quadrupled over the past year, according to the Financial Times. And, even in normal times, the airfreight is approximately eight times the cost of sea shipment – with most airfreight secured in the cargo holds of passenger jets.

No imminent relief in sight

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Even as consumers are predicted to ease up on e-commerce as COVID vaccinations become widespread and they venture out more, retailers are going to begin building up inventory for the 2021 holiday shopping surge.

And, as new economic stimulus checks get into the hands of Americans, there could be another, separate buying boom.

As one expert summed it up for the New York Times: “You are potentially looking at some shortages for quite some time.”

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NEWS

Industry News Henry Schein furthers commitment to vaccine equity by partnering with the Black Coalition Against COVID-19 Henry Schein, Inc. (Melville, NY) announced its partnership with the Black Coalition Against COVID-19 (BCAC) in support of the BCAC’s recent virtual town hall, “Making It Plain: A COVID-19 Town Hall for Minority Health Professionals.”

Henry Schein says its collaboration with the BCAC reinforces the company’s advocacy for vaccine equity and the vital role primary-care physicians and other officebased healthcare practitioners play in expanding COVID19 vaccinations nationwide.

Launched in 2020 by the BCAC, Making It Plain is a national-level series of educational, open-forum virtual town hall conversations led by senior government officials and leading minority health professionals on the epidemiology, prevention, treatment, and vaccination efforts for COVID-19. Henry Schein has supported two of the BCAC’s Making It Plain events: ʯ December 17, 2020 – Making It Plain: Minority Health Professionals and COVID-19 Vaccine Dissemination ʯ March 23, 2021 – Making It Plain: A COVID-19 Town Hall for Minority Health Professionals The latest town hall, “Making It Plain: A COVID-19 Town Hall for Minority Health Professionals,” emphasized the vital resource primary-care physicians are in the COVID-19 vaccination effort because of the high level of trust they have with their patients, their understanding of a patient’s health history, and their physical presence in every community across the country.

Ann Marie Gothard, VP of Global Corporate Media Relations at Henry Schein, spoke at the event, discussing the need for office-based partnerships in minority communities to have access to the vaccine and the opportunity to complement existing distribution efforts by 48

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ensuring that all health care providers – in close partnership with Community-based and Faith-based organizations – have ready access to vaccines to administer to their patients.

For the past several months, Henry Schein and the BCAC have partnered closely to determine recommendations and strategies to accelerate equitable access to the COVID-19 vaccine. Henry Schein supports a broad array of providers in a variety of settings, many of whom are frontline office-based and community health providers.

Being close to this critical part of the healthcare infrastructure has given the company insights into the public health needs of underserved populations.

In addition to its participation with BCAC, Stanley Bergman, chairman of the board and CEO of Henry Schein, recently issued a statement of support for congressional efforts to expand COVID-19 vaccine distribution, highlighting these significant lags in vaccination rates, particularly in communities of color, rural communities, and among the elderly and disabled. The company continues to speak with government officials, calling for more effectively involving primary-care physicians and other office-based healthcare professionals in the vaccine dissemination process.

BD receives EUA for combo COVID-19, Flu A/B rapid antigen test In late March, BD (Becton, Dickinson and Company) (Franklin Lakes, NJ) announced the U.S. Food and Drug Administration (FDA) has granted emergency use authorization (EUA) for a new, rapid antigen test that can detect SARS-CoV-2, influenza A and influenza B in a single test.

The BD Veritor System for Rapid Detection of SARSCoV-2 & Flu A+B assay takes about 15 minutes to run on the BD Veritor Plus System and distinguishes between SARS-CoV-2, influenza A and influenza B, by providing definitive positive or negative individual digital display readouts for all three. BD plans to launch the new test this summer for the 2021-2022 flu season.

Patient positioning can make all the difference for consistent BP measurements.

We know you realize the importance of blood pressure capture, the effects it can have on diagnosis and the impact to patients. However, following AHA/AMA recommendations for patient positioning during BP capture will help ensure more consistent, accurate and repeatable BP measurements. Something as simple as the patient’s feet not resting flat on the floor can increase the measurement by 5 to 15 points.1

May is National High Blood Pressure Education Month and we want to help bring awareness to this important topic. Download the Point of Care Ecosystem BP Checklist and share with your customers.

Visit: midmark.com/MAYis4BP

1

https://www.ncbi.nlm.nih.gov/pubmed/10450120

© 2021 Midmark Corporation, Miamisburg, Ohio USA

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Increasing global demand for gloves and PPE created a tidal wave of inexperienced and unreliable entrepreneurs entering the marketplace, sourcing and marketing products without provenance, quality or proven compliance in the US. times like these you must protect yourself and your customers by ensuring “Inthey have the authentic, reliable infection prevention products needed. ” Ventyv® is the premier brand of Sri Trang USA, Inc., a member of the Sri Trang Group.

Sri Trang is a proven glove producer that has been protecting the world against infection since 1991.

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