REP May 2023

Meet the Disrupters

New entrants are reshaping the physician market.

Meet the Disrupters

Relationships and Problems

The headline does not say “relationship problems.” This is an industry magazine, not Dr. Drew and Adam on Loveline. I said relationships and problems. In the new norm, are relationships still important?

Last month one of our longtime clients and a close friend was disappointed in us due to some deadline issues. I will leave all parties unnamed and just give you a 30,000-foot view of the problem. We write two blogs a month for this organization. Like many of you reading this, they have strict legal guidelines that must be met before they publish anything. Therefore, we set up an editorial calendar with deadlines in order to deliver on our promise of two blogs a month. For various reasons we missed a few deadlines. As you can imagine, the client was not happy due to this problem we created for them.

Here’s where relationships come in and save the day. Our client could have fired us and outsourced their blog to someone else. Instead, she texted me and asked if I had 10 minutes for a call. During those 10 minutes she laid out the problem, we came up with a plan, and I went to work figuring out where the bottle neck was so we could fix it.

Due to our relationship, we were able to take a problem and solve it, while at the same time, show the customer they are priority No. 1. The moral of this story is you bet your bum relationships are important. Thanks to my relationship with this person, we avoided losing one of our top clients.

My challenge to you this month is what are you doing to grow your client relationships and your manufacturer relationships? Stop selling for a week and just do relationship-building activities and watch your sales grow overnight.

Dedicated to the Industry,

R. Scott Adams

editorial staff editor

Mark Thill

mthill@sharemovingmedia.com

managing editor

Graham Garrison ggarrison@sharemovingmedia.com

editor-in-chief, Dail-eNews

Pete Mercer pmercer@sharemovingmedia.com

art director

Brent Cashman bcashman@sharemovingmedia.com

circulation

Laura Gantert lgantert@sharemovingmedia.com

sales executive

Amy Cochran acochran@sharemovingmedia.com

(800) 536.5312 x5279

publisher Scott Adams sadams@sharemovingmedia.com (800) 536.5312 x5256

founder Brian Taylor btaylor@sharemovingmedia.com

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The Signs Are All Around Us

How reps can deliver greater value while growing their lab business.

For me, there are few experiences as exciting and rewarding as presenting a new test to a customer, having them adopt it and finding out later how valuable they found it for their practice and their patients. I am sure those of you who focus your time selling lab solutions feel the same way and can reflect upon a few examples in your own career. We get a sense of accomplishment from helping these clinicians select tests that are in line with their staffing capabilities, lab expertise and the budget of their practice to provide their patients with improved diagnostic and treatment options.

By Jim Poggi

Obvious examples include specifically meeting the needs of pediatric practices, men’s health and women’s health practices. There are core tests that make sense for nearly all practices including urinalysis, fecal occult blood, respiratory tests, diabetes and lipid tests, but there are also tests such as PSA for men and cervical and breast cancer screening tests for women that require more in-depth understanding of the practice and the patients they serve. But sometimes, those of us who are firm believers in point-of-care testing wonder if we are the lone voice working to explain the value to clinicians. With the proliferation of information on the internet, television and other media, I am convinced we are not only not alone, but that there are several influencers at work we need to think about and capitalize upon. With a little creativity I believe we can uncover and take advantage of the help these “hidden persuaders” are providing us. In the process, we may even be able to solve the mystery of increases in demand for current tests or customers asking us to provide tests we have not previously discussed. In this discovery process, we need to ask ourselves whether we are listening enough to the practice, and to “the signs all around us”. This column will examine other influences that may very well determine which tests your physician practices are interested in, sources of information that may be driving demand for tests your customers are currently ordering from you, and why you sometimes are asked “the head of the practice wants to know whether your company offers a test for (something we have not discussed before).” I hope to open your eyes to some of the influences

we should be listening to and figure out how we can deliver greater value to the practices we call on while growing our lab business and customer respect as a valued consultant.

Prominent influencers

One of the most prominent influencers of both patient and clinician behavior is TV. Every day we see TV ads asking the audience to “ask your physician if one medicine or another is right for you.” From my vantage point it is not so much the prescription medicine I pay attention to. Rather, it’s what the ads say about which tests may need to be performed prior to using the medication or which side effects may occur that could be subject to lab tests.

migrating to internal medicine and other practice specialties. These treatments are growing in popularity rapidly, offering novel ways to treat and relieve these conditions while offering us a chance to explore companion testing opportunities.

At the same time, there are at least two new drugs targeted at treating type 2 diabetes. Lest we forget, diabetes is a growing problem in the U.S. Diabetes alone contributes to 25% of health care system costs directly, with 37 million Americans diagnosed with diabetes and another 96 million estimated to be prediabetic, having blood sugar or hemoglobin A1c levels above normal but not yet at the level required to be diagnosed as diabetic. That represents roughly 40% of the

A couple of examples will make the point. There are multiple drugs with ads on TV, radio and the internet for psoriatic arthritis and psoriasis. These are novel medications, and each one reminds the viewer of two things: use of this medicine may expose the patient to risk of tuberculosis, and is not recommended for patients with a compromised immune system. This is a “twofer” in my opinion: if you offer tests for tuberculosis and/or immune system tests as simple as total protein, albumin and A/G ratio, you have options to offer. But, offer to whom? While rheumatologists are a clear target, treatment of these patients is

total U.S. population. So, any significant treatment advance that improves outcomes for type 2 diabetes is bound to get attention.

What’s in it for us? The ads clearly point out that one of their benefits is a reduction in hemoglobin A1C. As these drugs become ever more popular for treatment of type 2 diabetes and also increasingly used as part of a weight loss program, there is significant opportunity for us to make sure A1C testing is performed on these patients. Our customers need to provide a baseline followed by monitoring of A1C levels along with other clinical signs and symptoms. Is your A1C business growing with no apparent connection to

Be aware of the signs all around you, think creatively about how they influence the needs of your customers, ask the right questions, and engage in novel dialogue with your customers.

your recent efforts? I wonder why. Actually, I don’t wonder why. It is more likely than not a result in the increase in use of these type 2 diabetes medications. Asking a few questions of the clinicians you call on is warranted. “Are your patients asking about the new type 2 diabetes drugs? Have you begun prescribing them? How are you currently assessing their baseline A1C levels and monitoring treatment program progress? We have multiple choices available to provide rapid and accurate A1C levels. We also offer several other diabetes related tests including routine urinalysis, creatinine and albumin/creatinine ratio testing. We can provide you with a full range of tests needed to diagnose and manage your type 2 diabetes patients. Can we set aside time to discuss these options?”

As a counterexample, we are all familiar with the decrease in prothrombin time testing (PT) based on the use of newer anticoagulant medications. Beginning about 10 years ago, use of these new agents has reduced the need to perform PT testing significantly. From a patient and clinician perspective, this is certainly a positive step forward. But, what is changing from the perspective of coagulation testing we need to think about? First, once again COVID-19 provides part of the answer. The CDC estimated that at least 146.6 million Americans contracted COVID-19, with over 7.5 million hospitalized. What does this mean to us? From a coagulation testing viewpoint, medical researchers have determined a causative link between COVID-19 and excess coagulation, sometimes leading to stroke. This certainly provides a case for careful monitoring of former COVID-19 patients, especially the elderly, for

coagulation as well as organ testing (liver and kidney especially).

In addition, newer medications widely promoted in the media may also lead to further testing opportunities. Certain new anti-depression medications indicate an increased risk of stroke. Prothrombin testing, along with testing for platelet aggregation studies and lipid testing, may well make sense for patients on these medications. It is worth your time to begin asking more questions related to patient management post-COVID as well as thinking actively about how to open up discussions with your customers about newer medications they may be prescribing and related needs for lab testing.

this category. Newer tests for home STIs and abused drugs are likely to result in additional patient visits. Each of these situations can lead to further lab opportunities as long as we stay mindful of the “signs all around us” and take the time to open up new and unique conversations with our customers.

The skilled and successful lab consultant recognizes the signs all around us early and tailors their customer conversations to include not only the time honored discussion points related to point of care testing, but to also open the door to discuss and consider new opportunities as they arise, whether from advances in prescription drugs,

Home testing

Finally, the law of unexpected outcomes leads us to home testing, and how increased patient accountability for their health may be leading them to ask questions of their health care providers related to tests they perform at home. Pregnancy and urinalysis have been with us for years and are often gate keepers leading to physician appointments and either confirmation or reflex testing to further understand the patient condition and the most appropriate treatment program. No doubt, home testing for COVID-19 will fall into

changes in incidence of chronic disease states such as type 2 diabetes and the emerging trend of patients being more engaged in their health care and asking questions of our mutual customers.

Be aware of the signs all around you, think creatively about how they influence the needs of your customers, ask the right questions, and engage in novel dialogue with your customers. This level of creativity will be noticed by your customers and set you apart as a leader in the field. Be informed, ask the right questions, and be a leader. Your success depends upon it.

The skilled and successful lab consultant recognizes the signs all around us early and tailors their customer conversations to include not only the time honored discussion points related to point of care testing, but to also open the door to discuss and consider new opportunities as they arise.

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The Show Must Go On

The importance of role-playing for medical sales success.

By Brian Sullivan

There is a difference between an Academy Award winning actor and the rest. Sure, having natural talent certainly helps, but the stars in any profession separate themselves by rehearsing and practicing more than average performers. Do seasoned Oscar winners stop practicing later in their career because they have already, “been there, done that?” Do they simply rely on natural talent to deliver another award-winning performance? Of course not.

And like great actors, there are two things that separate top performing sales teams/salespeople from the pack. That is a great script and lots of PRACTICE. Which means our industry’s top performing companies don’t just talk about improving performance, they commit to a sales system/process, and then practice the hell out of it. Think about it.

If you put 10 trained and rehearsed salespeople up against 10 who never hone their skills, who will win more often? It seems too easy.

So, who wins when medical salespeople practice the art of selling? Your company and your commission check, of course, but don’t forget that you also play a crucial role in the healthcare industry. You are responsible for introducing new medical products and devices to healthcare providers and ensuring that patients receive the best possible care. Patients win when you do your job well. To be successful in your role, you must be knowledgeable about your products, be able to

communicate effectively, and build strong relationships. And you need to do it repeatedly.

In this article, we will explore why it’s important for you to practice “showtime” role-playing and how it can benefit you in the long run.

No. 1: Improving Communication Skills

Role-playing allows you to practice your communication skills in a safe environment, where you can receive feedback and adjust your approach.

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Role-playing is an error-making and error-correcting process. Why not make the error while practicing with a peer/teammate rather than do it “when the lights come on?”

No. 2: Building Confidence

Role-playing creates confidence. When you feel more confident in your abilities, you are more likely to approach potential clients and make a strong impression. There is a great quote from former Pittsburgh Steeler’s Coach Chuck Knoll that says, “Pressure is what you feel when you don’t know what the hell you are doing.” I believe that pressure is what bad salespeople feel when they don’t know what to do or say next in a sales call. Practice takes away that pressure.

No. 3: Developing Product Knowledge

Role-playing can help you develop your product knowledge by allowing you to practice presenting your products in a realistic setting. By roleplaying, you can learn how to answer complex questions and address any concerns or objections.

No. 4: Perfecting Sales Techniques

By practicing different scenarios, you can learn how to adapt your sales pitch to different clients and situations. This can help you close more deals and improve your overall performance.

No. 5: Overcoming Objections

To effectively role-play objections during a sales pitch, it is important to

anticipate objections that may arise. Here is a list of common objections that can be encountered:

ʯ “I’m too busy right now” or “I don’t have time.”

ʯ “I’m not interested.”

ʯ “We don’t have the budget/ money right now.”

ʯ “We already have a provider for that service.”

ʯ “We’re not looking to make any changes right now.”

ʯ “Just send me your information.”

ʯ “You’re too expensive.”

ʯ “Call me back in X months.”

ʯ “I need to think about it.”

ʯ “I don’t see the value in your product/service.”

to your industry or product. By anticipating objections and preparing responses, you can be better equipped to address them. But all this great objection handling preparation only works if you PRACTICE, DRILL and REHEARSE.

So, this week, think of one of your upcoming sales calls. Imagine yourself on that phone/Zoom or standing at a nurse’s station with a bigwig decision-maker staring you in the eye. Think about what your greeting will be, what curiosity building “hook” will follow, what questions you will ask, what materials you might use to support your presentation, what objections you may

Do you know exactly what you would say in response to a client who dropped one of those lines on you? It’s important to identify specific objections that may arise within your market or with your specific product. It’s recommended to add 5 to 10 additional objections to this list that are relevant

hear, and how you will move them to the next stage of the sales process. Then find a mirror, a peer, or manager to practice SHOWTIME. Because the only thing separating you from standing on the red carpet at your next National Sales Meeting’s Awards night is a commitment to do what average performers will not.

As

Founder of PRECISE Selling, Brian Sullivan, CSP creates top performers in sales, customer service, negotiations, leadership, and presentation skills through seminars and Internet training programs. He is also the author of the book, 20 Days to the Top-How the PRECISE Selling Formula Will Make You Your Company’s Top Sales Performer in 20 Days or Less To learn more, go to www.preciseselling.com.

It’s important to identify specific objections that may arise within your market or with your specific product. It’s recommended to add 5 to 10 additional objections to this list that are relevant to your industry or product. By anticipating objections and preparing responses, you can be better equipped to address them.

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Meeting Expectations

Understanding the difference between customer service and customer experience.

By Pete Mercer

Much has been made of improved customer service and the hyperfocus on the customer experience in the last several years. Companies across the world have been focusing on tactics that are meant to improve their relational approach to bringing in customers and driving leads for the organization, focusing on improving the customer experience and strengthening their customer service processes.

But what’s the actual difference between customer service and customer experience? Have we lost the thread on what’s important to the customer as opposed to what’s important to the organization? How is internal and external communication involved in the customer experience?

Laurie Brown is a communications coach and customer service expert who has worked in a wide range of sectors for over 30 years. From working with bull semen salesmen to teaching customer service skills to the government of the kingdom of Bahrain, she has literally seen it all.

Brown recently sat down with Repertoire Magazine to discuss the difference between customer service and the customer experience, where companies get the idea of the customer experience right and wrong, and how companies can improve their communication processes.

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Breaking down the idea of the customer experience

According to Brown, the difference between customer service and customer experience is all in how you look at the customer. “I walk into a coffee shop, ask for a cup of coffee. I ask for something, I get it. That’s customer service. Providers of customer service think of it as what they do and how they do it. The customer experience is every touchpoint that I experience when I’m getting that cup of coffee. When you think of it this way, it’s action and reaction. What action does the person providing that service do, and how do I experience and react to it?”

While you may not be intentionally creating an excellent (or not so excellent) experience for your customers, the customer experience is an inevitability. There will be an experience at every interaction and every turn, which means that your company needs to be intentional with

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“Communication is the lifeblood of any organization,” Brown said. “You can’t have good external communication if you don’t have good internal communication, and you can’t have great external customer service unless you have great internal customer service.”

every moment of engagement. “People often receive a customer experience inadvertently because it can just be something that happens. It is every touchpoint from my first encounter, whether it’s an email, a phone call, your website or the experience of meeting you as a sales rep. All these things happen whether someone is managing these things or not.”

There may be detractors out there that might argue that their products speak for themselves, but the customer experience is one of the most important concepts for an organization to pay attention to right now. The customer experience matters more now than it ever has before, and it’s only going to become more important.

As far as Brown is concerned, there are three things that customers want, no matter where they are. “They want interactions that are easy, processes that are easy. (Second) They want the experience to be personal, which means meeting me where I am. And last, they want people who are nice. What’s your likeability? If I’m going to spend time with you in my office, you better be nice. There’s no time to deal with people who aren’t nice.”

Getting it right versus getting it wrong

While the primary difference between customer service and customer experience is a pretty simple concept, there are plenty of companies that are still missing the mark on the customer experience.

The best indicator for whether a company is getting the customer experience right or not is how they care about the customer. When a company cares more about the customer than themselves, the customers will feel that at every touchpoint.

Basing all of your interactions with your customers on their preferences is a powerful technique to give them the agency they need to engage with your brand in their own time and convenience. “We want our customer experience to be easy,” Brown said. “I don’t want to interrupt you in your workday. That’s not easy, so I need to develop a better understanding of what your preferences in form and time of communication.”

Alternatively, if the company does not care about the customer, that will also reflect in the customer experience. There are plenty of obstacles and complications in everyone’s day-to-day life, which makes it even more important that you do not create any friction for your customers.

It’s all about building trust between you and the customer – without trust, there’s no reason for the customer to be interested in what you offer, or even what you have to say. If business is built off communication and relationships, trust is the bridge between the company and the customer. Without that connection, there is no business relationship.

is every touchpoint from my first encounter, whether it’s an email, a phone call, your website or the experience of meeting you as a sales rep. All these things happen whether someone is managing these things or not.”

Improving communication in the workplace

More than likely, all of the challenges your company is facing stem from poor communication habits and processes within the organization. Whether it’s a break in the communication lines from the top to the bottom or simply due to the use of outdated tools, fixing those communications problems internally will help you to better communicate externally.

Internal communication is what sets up the external communication for success. It’s impossible to have one without the other, and anyone who has figured out how to make the best of a bad situation is doing too much work for one person. Communication is intrinsically linked to the customer experience, which makes it a critical resource for your organization.

“Communication is the lifeblood of any organization,” Brown said. “You can’t have good external communication if you don’t have good internal communication, and you can’t have great external customer service unless you have great internal customer service.”

Just by rephrasing the way you answer questions from customers can greatly improve your communica-

“People often receive a customer experience inadvertently because it can just be something that happens. It

Laurie Brown

tion processes. “When I teach customer service, what I’m really teaching is persuasive communication,” she said. “That’s all customer service is – good communication. Am I saying things in a way that isn’t people-focused? Do I say things like, ‘Well, that’s our policy,’ or, ‘Can’t do that,’ instead of saying, ‘Here’s what we can do.’”

What makes a great communicator?

Because the nature of communication is so specifically linked to customer service and the customer experience, it’s important to be a good communicator. If you’re not a good communicator, it’s never too late to improve your skills. According to Brown, there are four habits of great communicators:

1. They are exceptional listeners

Listening is a critical component of communication. If your audience is expected to care about what you want to say, they need to feel heard. “Great communicators listen to understand. They don’t have agendas. They watch for facial expressions. They listen with their ears, eyes, heart and mind.”

2. All communication is personalized

Personalized communication can help to remove any potential barriers or obstacles that might be in between you and your audience. By personalizing your message, you are meeting the customer where they are with the information that is most important to them.

3. Communication is easy to consume

Whatever medium or mode you are using to connect and communicate with your audience needs to be accessible and easy for them to use. Any difficulty creates a barrier, and barriers aren’t conducive to good communication. However you decide to communicate, make sure that it meets the needs of your audience and doesn’t waste their time.

4. They manage expectations through clear communication

Everyone can come into a partnership with their own expectations, but they should be reasonable and clearly communicated. “If there is something I expect from you or that you can expect from me, make sure that it is stated very clearly.”

Creating a personalized, stress-free experience for your customers isn’t going to be the easiest thing in the world. You’re going to need to be constantly thinking of every touchpoint, considering every word that you choose because it all matters. “And don’t forget to be nice,” Brown said.

New Developments in Hand Hygiene Guidelines

The updated guidelines include seven essential practices that should be a part of all HAI reduction programs.

By Paul Girouard

This was a highly coordinated effort from the following:

ʯ The Society for Healthcare Epidemiology of America (SHEA)

ʯ Infectious Disease Society of America (IDSA)

ʯ Association for Professionals in Infection Control (APIC)

ʯ American Hospital Association (AHA)

ʯ The Joint Commission (TJC)

ʯ The Centers for Disease Control and Prevention (CDC)

Major changes to the guidelines include categorization of seven “essential practices” which should be included in all HAI reduction programs. Each of these seven have several clinical studies that strongly support the new recommendations. Although the essential practices were developed with acute care in mind, they would be appropriate to use in any healthcare setting.

Essential practices

Hand hygiene is a critical component in the reduction of hospital acquired infections (HAIs). A lot has happened in health care over the last few years, yet the guidelines used by providers hadn’t been updated since 2014.

So, it’s exciting to see recognition and progress with the collaboration in the updated Hand Hygiene Guidance published in February 2023: “SHEA/ IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update”. Additionally, the CDC and WHO Guidelines were published over 14 years ago. So much has happened during this time, and the latest recommendations consider newly available evidence.

Here is a brief overview of the seven essential practices with a few key highlights from the compendium:

1. Promote the maintenance of healthy hand skin and fingernails. The recommendation is the use of alcohol-based hand sanitizer (ABHS) and hand care products that promote healthy skin.

2. Select appropriate products. Make sure ABHS has at least 60% alcohol and is dispensed with appropriate volume and time to be effective.

3. Ensure the accessibility of hand hygiene supplies. Dispensers should be accessible within the workflow of healthcare professionals and easily accessible where patients receive care.

4. Ensure appropriate glove use to reduce hand and environmental contamination. Gloves should be used when in contact with a patient and hands should be cleaned immediately after removing glove.

5. Take steps to reduce environmental contamination associated with sinks and sink drains. Use dedicated sinks for handwashing if possible. Disinfect and clean sink bowls daily with an EPA registered hospital disinfectant.

6. Monitor adherence to hand hygiene. Use multiple methods to measure hand hygiene program.

7. Provide timely and meaningful feedback to enhance a culture of safety. Measure the program’s effectiveness. Provide real-time communication/training after observation.

One of the most important goals within infection prevention is

to reduce/eliminate HAIs, and this is done by improving compliance of proper hand hygiene. Programs that drive compliance are driven by making sure there is a connection between the staff and the products they use. Proper hand hygiene products provide safety, comfort and are easy to use.

Use this update from SHEA as an opportunity to create dialog with your accounts. These essential practices offer selling opportunities. What can you do to help provide education and compliance? You are a part of their culture of safety and can help drive success.

To get the complete details of the latest Hand Hygiene Guidelines from SHEA, visit: shea-online.org/publications.

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Healthcare Workers as Hand Hygiene Leaders

Globally, hand washing is an easy and effective way to curb the spread of disease.

By Jenna Hughes

Hand washing is a simple but extremely effective way to prevent illness. Many diseases are spread through touch. Keeping yourself and those around you healthy can be achieved by washing hands thoroughly with soap and clean running water.

Each year, the World Health Organization recognizes May 5 as World Hand Hygiene Day. The global annual day of recognition highlights the benefit of improving hand hygiene in health care settings. The 2023 focus, according to the WHO, is to “accelerate implementation of lessons from the COVID-19 and galvanize action on preventing infections and antimicrobial resistance in healthcare.”

The WHO will work to implement these year-long goals through engagement with communities of healthcare workers and policy makers. Specific focus will be on the role of civil society organizations (CSOs), such as the United Nations, in hand hygiene. CSOs are called to accelerate the implementation of healthy handwashing practices locally and internationally.

The importance of handwashing

Handwashing with soap and running water removes infectious bacteria and viruses from the hands. Microorganisms that cause disease can be transferred from an individual touching their eyes, nose, or

mouth onto other objects like handrails and tabletops, resulting in the spread of disease.

Healthcare workers and individuals who assist in healthcare settings can contribute to increased safety and sanitation of medical facilities through consistent hand washing.

matter the field, they are potentially exposed to many diseases. “Healthcare associated infections (an infection caught by a patient while receiving healthcare) are a major global patient safety concern,” says the WHO. Washing hands thoroughly between the care of each patient is the most effective way to reduce the chance of these types of infections.

Healthcare workers can be leaders and role models on effective hand washing within the workplace. There should be an adequate supply of sanitizer dispensers and access to sinks, soap, and towels throughout a medical facility. Patients can also play a critical role in maintaining the hand hygiene of a medical facility. Patients should be encouraged by healthcare workers to engage in proper handwashing while at a facility.

Additionally, those involved in healthcare can encourage and lead in proper handwashing for disease prevention. “Feeling empowered to talk about hand hygiene is important to ensure clean hands in the context of organizational safety,” according to the WHO.

How healthcare workers can be leaders in hand hygiene

While performing their day-today jobs, doctors, nurses and other healthcare workers often encounter a wide variety of patients, and no

In previous years, the hand hygiene campaign set forth by the WHO dramatically increased hand washing awareness globally and overall reduced healthcare associated infections. For instance, according to the WHO, in 2022, the country of Saudi Arabia had more than 2,100 registered hand hygiene coordinators. “The country is ensuring hand hygiene requirements are integrated into health systems and that all tools for prevention are accessible to control of infections.” These results are reflected across nations and are proven to ensure the reduction of healthcare associated infections.

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Supply Chain Leader Spotlight

Laura Johns, Administrative Director for Supply Chain and Support Services, Cleveland Clinic

Editor’s note: The following interview first appeared in The Journal of Healthcare Contracting

Please tell us a little bit about your role and responsibilities within your organization. As the Administrative Director for Supply Chain and Support Services at Cleveland Clinic, I lead a team responsible for all aspects of our business operations, including budget and workforce management, communication, employee engagement, strategic planning, goal setting, project management and compliance, for our global department that spans sourcing, materials management, data and technology, and patient support services. I also lead our supplier diversity, sustainability and resiliency initiatives. My team thinks of ourselves as “the glue”, working closely with our CSCO, leadership team and stakeholders across the organization, and externally, we make connections and help the department achieve objectives.

In what ways has the supply chain changed for the better over the last 2-3 years?

I like that wording, “for the better,” because I think, when it comes to supply chain, we focus a lot on the negatives that have come out of the pandemic. When I think of things that are “for the better”, the renewed energy around resiliency comes to the top of my mind. As we come

’s Women Leaders issue.

Laura Johns

out on the other side of the pandemic those impacted have had time to regroup and think, “How do we prevent this from happening in the future?” It takes trust, transparency, and communication among the providers, suppliers, GPOs and distributors to find solutions together.

The goal of our resiliency program is to eliminate backorders – it’s ambitious and requires a different level of partnership with our stakeholders. We are embarking on a journey to understand exactly where our products are coming from and as far back in the network as we can, so we can predict disruptions, plan for how to handle them, and respond effectively. From the suppliers we have spoken to, nearly everyone has been willing to help us get there. They may not be able to commit right away, but they are willing to work with us and move toward that goal.

It’s not just Cleveland Clinic that is having success on this journey, in my position as a board member of the Healthcare Industry Resiliency Collaborative (HIRC), I get to see this happening all over the industry. I think it has the power to really transform care delivery and provide the best possible care to our patients.

What about the challenges?

What are supply chain leaders worried about right now?

We’re still dealing with shortages. We’ve heard the time directly after the pandemic described as the “new normal,” and I think there was this undertone of, “eventually this will go away.” But the reality is we are still seeing back orders at 10 times of what we did pre-pandemic levels. Each shortage requires hours to resolve and it’s incredibly reactive – it puts a huge strain on our employees. Couple that with staffing shortages and you have an environment ripe

for burnout. I worry about our teams and that one day the product a clinician needs won’t be there. It’s why we are so focused on building a strong resiliency program.

When you hear your words like diversity, equity, inclusion in the workplace, what does that mean to you, and how can those things contribute to the success of an organization?

I look at this question from two lenses. In my role in workforce planning I think about the diversity of our employees and talent pipelines as well as how we are creating an inclusive environment for everyone to come to work fully as themselves. It is critical to the future of our organization to have different backgrounds and perspectives.

In my role as supply chain supplier diversity liaison, I think about the impact local and diverse purchasing can have on our community. Cleveland Clinic’s main campus is considered an anchor institution within an underserved area. When we are able to bring on a local, diverse supplier, we make a big impact on the community. I feel excited about these projects because they can create impact on a macro-level. Ultimately, a focus on diversity, equity and inclusion is about enabling us to better care for our patients, community, organization and one another.

What about mentorship?

Have you had anyone who’s mentored you, come alongside you during your career?

I’ve had several incredible mentors throughout my career. Having somebody “in your corner” who believes in you and whom you trust is invaluable, especially when you’re trying new things or getting outside of your

comfort zone. My mentors have helped to bolster my confidence and provide space that it’s OK to fail. Or as I heard recently, “a first attempt in learning,” which I loved, because it’s so true. Trying new things is how you grow and mentors help provide guidance and guiderails to navigating new roads.

What are some ways that you try to grow as a leader?

In general, I have a growth mindset where I am always trying to learn new things and take on new challenges. It keeps things exciting and I feel fortunate to be in healthcare where the landscape is constantly changing and presenting new opportunities. Being a leader takes this to the next level because it’s not just “you” to think about – you have a team that’s relying on you to help them grow in their careers, too. As I take on new responsibilities, for example resiliency, I need to make sure I’m growing my team to take on new responsibilities so I can devote time to new initiatives. And as the team grows, you have to adapt your leadership style to their new skillset. It’s a constant evolution.

What project or initiative are you looking forward to working on in the next few months?

I am really excited about our resiliency initiatives. Next year, we are working to implement a multi-network solution, which is common in other industries but very novel in healthcare. It will enable us to better predict demand, match that to available supplier inventories, and understand potential impacts due to world events. It will give us the extra time needed to make inventory or substitute decisions and start to solve for the challenges I mentioned. I think it has the potential to completely change the industry.

Scalable Strategies to Heart Health

New Mass General Brigham study finds ways to improve outcomes for heart failure patients.

By Pete Mercer

A recent study conducted by Mass General Brigham, a Massachusetts-based integrated academic healthcare system, looked at a new approach to improve medical therapies to reduce the risk of worsening symptoms and extend the lives of patients with heart failure. A virtual care team of physicians and pharmacists was put in place to help guide treatment strategies for these patients, while looking for a scalable approach to help adopt these therapies into general practice.

IMPLEMENT-HF (Implementation of Medical Therapy in Hospitalized Patients with Heart with Reduced Ejection Fraction) started at Brigham Women’s Hospital before expanding to include patients at Brigham and Women’s Faulkner Hospital and Salem Hospital.

Dale Adler, MD, co-author of the study and executive vice chair of the BWH Department of Medicine and a specialist in Cardiovascular Medicine, said in a press release, “What we learned when we took this to the community hospitals was that cardiologists were eager to work with us to improve adoption of guidelinedirected medical therapy to help their patients. Many physicians had read recent studies about therapy for heart failure and knew the ideal therapy combinations, but they hadn’t had the chance to implement them with supervision. This study and the virtual care team we assembled gave them the opportunity to do so.”

The patients included in the study were admitted to one of the hospitals between October 2021 and June 2022, whether they were admitted for a heart failure-related condition or not. The condition in

question is heart failure with reduced ejection fraction, which is where the heart pumps less blood than the body needs. There were 198 unique patients and 252 clinical encounters across all three hospitals included in the study. Of this group, 145 encounters received usual care while the virtual care team provided guidance for 107 other patients.

That virtual team is a critical piece of the puzzle, consisting of a

centralized physician, study staff and local pharmacist at each site where patient cases were evaluated daily to improve GDMT practices. They made 187 unique recommendations based on the patient data they were working with, which allowed for more patients to initiate new treatment or receive a more appropriate dosing of GDMT than before.

“We have been interested in identifying the most effective, safe, and scalable strategies to better implement medical advances in the treatment of heart failure and other cardiometabolic conditions,” said lead author Ankeet S. Bhatt, MD, MBA, ScM, a former BWH Cardiovascular Medicine fellow who is now a cardiologist at Kaiser Permanente San Francisco Medical Center. “To see that a virtual care team could help improve guideline-concordant care across three diverse system hospitals and do so in a manner that was both safe and did not prolong hospitalization was a very encouraging finding.”

Using this project as a foundation, the authors are looking to scale up the study to see if they can reproduce with different variables like hospital type, geography, and population.

Combatting the Opioid Epidemic with Rapid Testing

The opioid epidemic has profoundly impacted public health in the United States. In addition to alarmingly high rates of overdose deaths, we have seen a sharp increase in the rates of infectious diseases, such as HIV and hepatitis C virus (HCV), as a direct result of opioid use. In addition, the COVID-19 pandemic has further exacerbated the situation, creating new challenges for healthcare providers, patients, and communities alike.

CONSIDER THE FACTS

ʯ According to the Centers for Disease Control and Prevention (CDC), in 2018, approximately 10% of new HIV diagnoses in the United States were attributed to injection drug use.1

ʯ The CDC also reports that hepatitis C is a leading cause of liver cancer and liver transplants in the United States, and injection drug use is the most common risk factor for HCV transmission.2

ʯ Many hospitals have reported critical staffing shortages over the course of the pandemic, particularly when case numbers were high. During the Omicron surge in January and February 2022, the 7-day average of hospitals reporting critical staffing shortages peaked at 22% during mid-January 2022.3

Diagnosis is the first step to treatment. For example, rapid point

1 www.cdc.gov/hiv/group/hiv-idu.html

of care testing for HIV can detect the virus within minutes and can be performed in a variety of settings, including community health centers, family medicine practices, and emergency departments. This testing is critical to identifying individuals with HIV, starting them on antiretroviral therapy, and reducing their risk of transmitting the virus to others. Even people who test HIV negative can link to PrEP offering providers a care pathway to support on-going HIV prevention. Similarly, rapid point of care testing for HCV can detect the virus within 20 minutes, allowing healthcare providers to identify individuals who may benefit from treatment and reduce the spread of the disease.

During the COVID-19 pandemic, rapid point of care testing has become even more important in identifying and isolating individuals with COVID-19 to prevent the spread of the virus. Rapid antigen tests can provide quick results, making them an essential tool for healthcare providers to quickly diagnose COVID-19 cases.

As a rep, understanding the importance of point of care testing and the opportunity it presents to improve health is key. With the opioid epidemic causing a surge in infectious diseases, there has never been a more important time to talk to healthcare providers about testing their patients. By emphasizing the

2 www.cdc.gov/hepatitis/hcv/cfaq.htm#transmission

benefits of rapid point of care testing and providing the right tools and resources, you can help healthcare providers identify undiagnosed individuals quickly, start them on treatment, and improve health outcomes for individuals and communities.

Rapid point of care testing can be done through OraSure’s family of products which includes testing for HIV, Hepatitis C, and COVID-19. OraQuick Rapid HIV-1/2 Antibody Test, OraQuick HCV Rapid Antibody Test, and InteliSwab COVID-19 Rapid Test4 offer easy, flexible, and accurate testing options for providers across diverse settings to engage a range of patients.

CONVERSATION STARTERS

To start a conversation with your customers, consider asking the following questions:

ʯ How has the opioid epidemic impacted your patient population?

ʯ How are you currently addressing the challenges of infectious disease testing and treatment?

ʯ How might rapid testing improve the lives of your patients and communities?

By engaging your customers in these conversations, and by offering rapid point of care diagnostic solutions, you can help healthcare providers diagnose infectious diseases, and grow your business at the same time.

3 aspe.hhs.gov/sites/default/files/documents/9cc72124abd9ea25d58a22c7692dccb6/aspe-covid-workforce-report.pdf

4 This product has not been FDA cleared or approved; but has been authorized by FDA under an EUA. The emergency use of this product has been authorized only for the detection of proteins from SARS-CoV-2, not for any other viruses or pathogens. This product is only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection and/ or diagnosis of COVID-19 under Section 564(b)(1) of the Federal Food, Drug and Cosmetic Act, 21 U.S.C. §

impacted by the opioid epidemic

impacted by the opioid epidemic

CDC recommends routine HIV and HCV testing for all people who inject drugs

CDC recommends routine HIV and HCV testing for all people who inject drugs

Meet the Disrupters

New entrants are reshaping the physician market.

All roads in primary care medicine appear to be leading toward consolidation. Blame the “disrupters,” such as CVS Health, VillageMD, Amazon, Optum and Aledade, as well as health systems and IDNs around the country. Each has its own strategy. Some acquire physician practices and employ physicians, others work on a contract basis to provide independent practices with support for IT, marketing and administration. Either way, the impact of the disrupters on medical care is growing. So is their impact on medical sales.

“Sales representatives can no longer rely on one or two individuals in a practice to make buying decisions,” says Bruce Penning, executive director, medical field sales, Henry Schein. “They need to understand the alignment further ‘upstream.’ For example, is there a single person making decisions at the corporate level for all the satellite locations? Is there a Board? Is there an exclusive arrangement, or can these locations use multiple distribution partners? How often are formulary decisions made or updated? Is there flexibility in what can be purchased?”

Says Christian Flohr, corporate account executive, group purchasing organizations, Henry Schein, “The sales cycles for large customers are longer and more comprehensive. It can be a much simpler process to retain the business of an independent physician practice compared to the owned practices of a large IDN/health system or

Meet the Disrupters

group practice. Often there are request-for-proposals and legal agreements involved, which can create the need to involve other teams such as implementations, operations, and legal. Much more planning and coordination is needed to service these types of customers.”

Kattrina Richardson, national vice president, sales, Edgepark, a Cardinal Health business, says, “There is still a lot to learn about how these ACOs [accountable care organizations] will drive strategy and initiatives across their providers. What is the decision-making process? Who are the key decision makers? How can our sales reps influence in the most efficient way? By understanding the overall ACO strategy, sales reps can align their offering based on goals and needs.”

“Our team expects consolidations to continue, regardless of who is doing the buying,” says Brad Hilton, senior vice president of primary care for McKesson Medical-Surgical. “Either way, we need to continue to show our value, being an expert in our field, and build strong, trusted relationships.”

Happening fast

The consolidation tango has heated up in the past six months, with major acquisitions and partnerships formed by national players like Optum, VillageMD, Amazon, CVS Health and Aledade. Activity has picked up at the local and regional level too.

Last year, consulting firm Bain & Company predicted that, along with the shift from fee-for-service to fee-for-value reimbursement models, physician shortages, consumerism and digital disruption will redefine market share in primary care. In its study, “Primary Care 2030: Innovative Models Transform the Landscape,” the company predicted:

1. Risk-bearing, population-specific models will grow nationally. They mitigate administrative complexity for clinicians and help bring about improved patient outcomes through tailored offerings and enhanced care coordination.

2. Primary care-owned by payers and payer-owned services companies will become one of the largest models, capturing up to 15% of the primary care market.

3. Retailers will grab 5% to 10% of primary care by 2030, outperforming traditional primary care providers on patient experience, increased access and convenience, particularly in geographically underserved areas.

4. Traditional fee-for-service will still be the largest model in 2030, but it stands to lose 15% to 20% of market share to alternative models that can provide enhanced patient experiences, better physician experiences and more collaborative, team-based care.

5. Virtual health will likely be embraced by young healthy patients and could climb to 20% market penetration by 2030.

“The populationspecific focus allows the provider to tailor its capabilities,” says Erin Ney, M.D., Bain expert associate partner and co-author of the study. “In traditional settings, a clinician or clinical team takes care of a heterogeneous patient population, not simply in terms of patient characteristics, but in payer mix too. This complexity makes it more difficult to succeed in a value-based-care model.”

One firm pursuing a population-specific approach is Chicago-based Oak Street Health, which focuses on the Medicare Advantage population. (At press time the company was in the process of being acquired by CVS Health.) Meanwhile, Brooklyn, New York-based Cityblock manages care for Medicaid patients in five states and the District of Columbia.

Some companies focus on managing care for selffunded employers, that is, those that assume risk for making healthcare available to their employees, she adds. One such company, Denver, Colorado-based Everside Health, pledges to analyze employers’ population data and needs, identify and build health center locations, and hire provider teams.

The enablers

Another group in today’s changing market are so-called “enablers,” such as agilon health, Privia Health and Aledade. Enablers believe traditional independent providers need assistance moving toward value-based care, and they offer them population health analytics, data integration and care coordination tools, as well as processes and people, according to Bain.

Dr. Erin Ney

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Meet the Disrupters

Enablers fill a valuable niche, says Dr. Ney. According to Bain & Company’s 2022 Frontline of Healthcare Study, 80% of physicians say they want to provide value-based care, but as the upside and downside risk of doing so grows, their interest declines. “It’s not because they don’t see the merit,” she says. “It’s because making the transition is hard.” For example, independent practices may need assistance fulfilling multiple payers’ documentation requirements and implementing electronic solutions to help in aggregating and analyzing patient data. They may also need help improving the customer experience.

Says Bruce Penning, “Healthcare continues to be more consumer-driven, and IDNs need to have many offerings to separate themselves from their competition. Patient care will continue to be pushed outside the four walls of the hospital whenever possible – just as we have seen a proliferation of urgent care, freestanding emergency rooms and surgery centers open across metro areas.

“I believe we will also see more IDN-branded specialties – cardiology, oncology, dermatology, gastrointestinal – make a push into ‘local’ neighborhoods,” he says. “Sales representatives will have to adapt by better understanding the corporate IDN ‘mission’ with how these practices are buying, while simultaneously providing the one-to-one service that independent practices have grown used to over the years. It is important to continue providing the ‘human touch’ in a space that is becoming more formularies-driven.”

One so-called enabler, Bethesda, Maryland-based Aledade, works with more than 1,500 independent primary care practices and health centers. In February the company acquired analytics company Curia, which uses artificial intelligence to find risk gaps and predict the chances of adverse health outcomes in patients. In a pilot program, Aledade used Curia’s predictive algorithm to identify more than 8,000 patients with the highest risk for mortality, then worked with its primary care practices to enroll them in comprehensive advance care planning.

Sales challenges and opportunities

“We believe there will be continued consolidation of provider practices over the coming years,” says Kattrina Richardson. “There will be some shifting from productonly discussions to strategic opportunities around condition management, focusing on driving adherence to prescribed devices to help support better patient outcomes.

“Healthcare professionals need to focus first on patient care, but finding time on top of that to deeply know and understand individual insurance plan requirements is challenging,” she says. “Our team provides this education, which helps healthcare professionals with patient selection based on the requirements of the policy and helps speed up the time to therapy.”

Christian Flohr says, “Our sales teams must be astute business professionals. They can no longer rely solely on work ethic and product knowledge. They have to be trained and have knowledge on selling into complex corporate environments. It is more complicated now to reach decision-makers than it used to be. The time we have with those decision-makers is often limited. Our representatives must know how to navigate these settings in an impactful way.

“Henry Schein has done an excellent job at building a sales team that is ready and able to effectively reach these customer segments at various levels through the strategy of the fully integrated service team,” he says. “Our teams must constantly be learning and growing in order to understand the needs of today’s sophisticated non-acute customers.” An implementations team works with sales to ensure successful customer migrations, he says.

“Consolidation will continue to change our industry’s landscape in ways we can foresee and ways we cannot. The ability to adapt to those changes is vital. Sales representatives will need to continue to evolve as the industry does. Henry Schein’s leadership continues to follow the trends of the industry and works to prepare its sales teams for changes on the horizon.

“Representatives must continue to be industry leaders, serving as expert resources who can help customers select the best solutions for their needs, while having their finger on the pulse of trends in customer segmentation and where the market is heading.”

‘Consolidation will continue to change our industry’s landscape in ways we can foresee and ways we cannot. The ability to adapt to those changes is vital.’

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Meet the Disrupters

The consolidation tango

Consolidation in primary care has heated up in the past few months. Some examples:

ʯ October 2022: Optum, part of UnitedHealth Group, acquired physician group Kelsey-Seybold, which comprises more than 650 physicians and allied health professionals practicing at 35 locations in the Greater Houston area. The reported price was $2 billion.

ʯ January 2023: VillageMD (whose biggest shareholder is Walgreens) finalized its $8.9 billion acquisition of Summit Health-CityMD, a provider of primary, specialty and urgent care, bringing the number of VillageMD’s provider locations to 680 in 26 markets.

ʯ February 2023: Amazon completed its $3.9 billion acquisition of One Medical, gaining access to more than 200 brick-and-mortar medical offices in 26 markets and 767,000 members. Amazon and One Medical immediately began offering $144 year-long memberships, which include in-person office visits, drop-in lab services, 24/7 virtual chat capabilities and on-demand video chats.

ʯ February 2023: CVS Health announced its intention to buy Oak Street Health for $10.6 billion. Oak Street employs 600 primary care providers and 169 medical centers in 21 states. Oak Street’s Canopy technology is said to be fully integrated with the company’s operations and used when determining the appropriate type and level of care for each patient. CVS reports having more than 40,000 physicians, pharmacists, nurses and nurse practitioners in its network.

ʯ March 2023: CareFirst BlueCross Blue Shield in Baltimore formed what it called a “strategic alliance” with Bethesda,

Maryland-based Aledade, an independent primary care network that provides more than 1,500 primary care practices in 45 states with tools (e.g., data analytics, guided workflows, payer relationships and onsite business support) to help practices deliver value-based care. The agreement came just four days after Aledade signed a 10-year agreement with Humana in which the insurer’s Medicare Advantage members will receive primary care from Aledade physicians using valuebased arrangements.

Much is happening on the local and regional level too. For example, in January, Los Angelesbased Cedars-Sinai formed an agreement with Tia, which provides in-person and virtual care for women. Tia recently opened its second Los Angeles-area clinic, in Santa Monica, in collaboration with

Cedars-Sinai following the success of its first local clinic in Silver Lake in 2021. The agreement with Cedars-Sinai calls for Tia to provide primary care, mental health care, and gynecological health and wellness services, while Cedars-Sinai will provide specialty care through its network of specialty providers and inpatient services. Tia will partner with the hospital system to open additional clinics this year in Pasadena, Studio City and Culver City. Tia now has operations in California, New York and Arizona.

In February, Lexington Clinic, a multispecialty medical group with 25 locations in Central Kentucky, signed an agreement with Austin, Texas-based agilon health to assist in Lexington’s transition to a fullrisk, value-based care model beginning in 2024. agilon health provides technology, capital and other tools to a network of more than 2,200 primary care physicians in 12 states.

The Public Health Emergency Ends

What it means for patients and your provider customers

Editor’s note: COVID-19 might not be ending, but the Public Health Emergency is. And the impact on your physician office customers may be far-reaching. In Part 1, we look at potential implications on telehealth/digital health and the distribution and provision of COVID-19 vaccines. Next month we’ll look at the implications of potential Medicaid cuts and changes in enforcement of the physician-self-referral Stark Law.

The federal Public Health Emergency (PHE) for COVID-19 has expired. “We are in a better place in our response than we were three years ago, and we can transition away from the emergency phase,” declared the Department of Health and Human Services in February.

Two of the changes likely to affect physician practices are:

ʯ Telehealth/digital health: Although many telehealth flexibilities will be extended through December 31, 2024, some changes will become effective May 11. For example, clinicians once again will be required to have an established relationship with a patient prior to providing remotepatient-monitoring services. In addition, the ability of healthcare providers to dispense controlled substances via telemedicine without an in-person interaction will be affected.

ʯ COVID-19 vaccines: Distribution and provision of the vaccine will be taken out of the hands of the federal government and moved to traditional healthcare coverage.

Telemedicine

“Telehealth has caused the most angst among our members,” says Claire Ernst, director of government affairs, Medical Group Management Association.

During the PHE, individuals with Medicare had broad access to telehealth services, including in their homes, without the geographic or location limits that usually apply. The good news for the medical community is that Congress extended many PHE-related telehealth flexibilities through December 31, 2024, including:

ʯ People with Medicare can access telehealth services in any geographic area in the United States, not just rural areas.

ʯ People with Medicare can stay in their homes for telehealth visits rather than traveling to a healthcare facility.

ʯ Audio-only visits will be offered to those who are unable to use both audio and video (e.g. smartphone or computer).

“Telehealth services became a game changer in both rural and urban areas throughout the country,” says Kelly Ladd, CEO, Piedmont Internal Medicine, Atlanta. Prior to the PHE, only rural areas could provide and receive payment for these services. But that has changed, she says.

“Many of our senior citizens –including those in urban settings – do

Claire Ernst

Kelly Ladd

not feel comfortable going out in bad weather to go to the doctor. Telehealth allows them to engage with their provider for chronic care and even acute illnesses. It is especially helpful because it allows us to see the patient through video so we can make certain assessments. If the patient does not have video capabilities, we can still hear their voice, assess background noises, and have the personal engagement.”

president-elect, Rodney S. Alford, M.D. “The flexibilities that were instituted at the federal and state level created a pathway for physicians to incorporate telemedicine into their practices.”

Reimbursement an issue

Prior to the pandemic, among the most significant barriers to telemedicine was the fact that many payers, including Medicare, had

for practices. During the pandemic, HHS’s Office for Civil Rights relaxed enforcement of some HIPAArelated requirements, including the use of HIPAA-compliant telemedicine platforms, she says. That will probably change in May. Smaller practices may be more adversely affected than big ones, as they conduct fewer telehealth visits and are less likely to use HIPAA-compliant platforms, she says.

Another telehealth-related issue to watch is interstate licensure for Medicare patients, says Ernst. During the pandemic, qualified clinicians were allowed to provide telemedicine services to patients in states other than their own, provided the other state did not object. That could change.

Many practices have taken the time and expense to incorporate telehealth into their workflow, and they are hoping their investment won’t be cancelled with the expiration of COVID-era telehealth flexibilities, she says. “What CMS fails to realize is that providers must pay for the technology to provide these services and follow the same workflow as traditional office visits. We still must complete patient registration, review the patient chart, generate claims for payment and process those payments.” In addition, practices have had to adjust their IT networks to add additional cybersecurity and adhere to HIPAA policies and procedures to ensure patient health information laws are followed.

An Illinois State Medical Society survey found that of the 81% of its physician members who reported using telemedicine, three-quarters had not done so prior to the start of the pandemic, says the Society’s

restrictive reimbursement policies, says Dr. Alford. Illinois has already taken action to permanently retain many of the emergency flexibilities that applied to state-regulated health plans. Further, in-network healthcare professionals or facilities in the state must be reimbursed for telemedicine encounters at the same reimbursement rate that would apply to services delivered via an in-person encounter, at least through 2027.

Claire Ernst believes that eliminating payment parity for telemedicine and in-person visits, as CMS plans to do January 2024, could present challenges for MGMA’s physician-practice members. “There’s a large differential – as much as 30% – between tele visits and in-person visits, given the technology needed and workflow accommodations that must be made,” she says. “We’ll be looking at CMS’s proposed Physician Fee Schedule, probably in July, to see if they address that.”

Compliance with HIPAA rules presents another telemedicine challenge

In addition, questions have been raised about reimbursement for audio-only telemedicine services. The American College of Physicians is pleased that CMS is extending coverage of audio-only E/M services until at least December 2024, says Shari Erickson, chief advocacy officer and senior vice president of governmental affairs and public policy. Researchers have begun to identify the positive impact on health equity of audio-only E/M services, she says.

But regardless of what Medicare does, not all private payers will necessarily follow suit. “Many have stopped payment for these services altogether over the past year, if they covered them at all during the worst of the pandemic,” says Erickson. “And those that cover them may or may not be paying at the same rate as CMS. From a practice perspective, this makes for a very inconsistent experience and creates uncertainty as to if or how much physicians will be paid for offering audio-only services to their patients.”

‘A top priority is to ensure patients have continuous healthcare coverage and ongoing access to comprehensive care once the PHE ends.’

Remote patient monitoring

The end of the PHE also means changes for remote physiologic monitoring, or RPM. During the PHE, CMS permitted clinicians to bill for remote physiologic monitoring services furnished to both new and established patients, and to patients with both acute and chronic conditions. When the PHE ends, clinicians must once again have an established relationship with the patient prior to providing RPM services.

Piedmont Internal Medicine implemented remote patient monitoring and chronic care management services three years ago, says Kelly Ladd. “They have had a significant and positive impact on patient care” and have kept patients out of the Emergency Room, hospital admissions and readmissions. Blood pressure monitoring, pulse oximeter readings and glucometer-reading devices transmit information directly to software, which is monitored on a daily basis by nurses, she says. RPM facilitates patients’ engagement between the patient and the physician’s care RN/team on a regular basis, she adds.

COVID-19 vaccines

The end of the Public Health Emergency coincides with the U.S. government’s plan to transition the provision of COVID-19 vaccines and treatments to the traditional healthcare marketplace. In a statement, the Department of Health and Human Services said the transition is not tied to the ending of the COVID-19 PHE, but rather reflects the fact that the federal government has not received additional funds from Congress to continue to purchase more vaccines and treatments.

When this transition occurs, many Americans will continue

to get free COVID-19 vaccines, according to HHS. Vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) are a preventive health service for most private insurance plans and will be fully covered without a co-pay. Currently, COVID-19 vaccinations are covered under Medicare Part B without cost sharing, and this will continue. Medicaid will continue to cover all COVID-19 vaccinations without a co-pay or cost-sharing through September 30, 2024, and will cover ACIP-recommended vaccines for most beneficiaries thereafter.

“A top priority for family physicians and the AAFP [American Academy of Family Physicians] is to ensure patients have continuous healthcare coverage and ongoing access to comprehensive care once the PHE ends,” says Tochi Iroku-Malize, M.D., president of AAFP. “Transitioning COVID-19 vaccines to the commercial market

may create financial and operational challenges for physician practices and could negatively impact access to and utilization of COVID-19 vaccines for patients.

“If the price of the vaccines is too high, physician practices may struggle to make the upfront investment in COVID-19 vaccines,” she says. “Additionally, patients often prefer to receive vaccine counseling and administration from their usual source of primary care, such

as their family physician. As the PHE unwinds, the administration and Congress must work to ensure appropriate COVID-19 vaccine prices and payment rates to enable trusted physicians to offer vaccines, promote vaccine confidence, and bolster vaccination rates.”

Says Kelly Ladd, “Insurance carriers have not set their reimbursement fees, so we don’t know how much we are going to be paid yet for the vaccine.” And that amount will probably differ depending on the payer. What’s more, payers tend to update their fee schedule quarterly, she says. “The problem is, we typically don’t receive this information until the quarter is more than halfway through. We are not able to make an informed decision on which vaccine brand to choose.”

Next month: Impact of the end of the Public Health Emergency on the Medicaid population and on enforcement of the physician-self-referral Stark Law.

‘As the PHE unwinds, the administration and Congress must work to ensure appropriate COVID-19 vaccine prices and payment rates.’

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The Modern-Day House Call

Home-based primary care is more than a portable version of office-based care. But is it sustainable in a fee-for-service world?

Clinics were built to optimize the productivity of clinicians in a fee-forservice healthcare world, says Patina CEO Jack Stoddard in a recent article in Forbes. But the model doesn’t always hold up, particularly for people who are unable to go to a doctor’s office due to age or disability. And there are a lot of them. According to the American Academy of Home Care

Medicine (AAHCM), an estimated 2 million frail, seriously ill and vulnerable adults – many with two or more chronic conditions – are unable to visit physicians’ offices.

Launched in October 2021, Patina specializes in providing home-based care to people 65 years and older. “We decided to bypass the ‘drive-park-wait’ clinic model

and use technology and people to bring care to them, on their terms,” says Stoddard.

Home-based primary care represents a different approach to care than traditional office-based visits, say proponents. By staying in close touch with patients, homebased primary-care professionals can monitor and manage many

chronic conditions, such as heart and lung disease.

“We learn a great deal about people when we visit them in their homes,” says Stoddard. “Does the patient have enough social support? How do they manage their medicines? Their meals? Are they lonely? Often these factors determine outcomes even more than clinical interventions.”

But is home-based primary care sustainable in a fee-for-service environment? After all, the systems and logistics requirements are demanding. Proponents believe it might work only if value-based reimbursement takes hold.

“Home-based medicine, broadly speaking, which includes homebased primary care, is witnessing a cameo moment right now,” says Rebecca Ramsay, MPH, BSN, CEO of Housecall Providers, which has been providing home-based care in northwest Oregon since 1995. “There are still significant barriers to making this type of care accessible to all who need it, primarily around sustainable payment models and workforce education and capacity building,” she says. “It will take action at many levels to reach our access goals.” Ramsay is a board member of the Home Centered Care Institute (a national education and research organization) and a governing board member of Advanced Illness Partners, a nationwide accountable care organization, or ACO.

It’s not home care

Home-based primary care differs from care typically provided by home health agencies, e.g., part-time or intermittent skilled nursing care or care from home health aides (such as wound care or IVs), physical/occupational therapy, speech-language

pathology or medical social services, according to AAHCM. Rather, it provides comprehensive primary, urgent and in some cases, palliative care. For some patients, that can include the services of home health agencies.

Home-based primary care tends to focus on older, homebound or home-limited people with multiple chronic conditions, says Julie Sacks, president and COO of the Home Centered Care Institute. “Often, they have stopped seeing their primary care provider because it’s too difficult to get to the office. Home-based primary care steps in when there’s disconnection with primary care.”

such as wound care for pressure sores or surgical wounds, intravenous or nutrition therapy, lab draws, and patient and caregiver education. Skilled home health providers also offer physical therapy, occupational therapy and speech therapy for our homebound patients. We believe in this model to such a degree that we founded a new joint venture home health agency in 2021 to meet the needs of patients of VCU Health System and beyond.”

Independence at Home project

As part of the Affordable Care Act, the Centers for Medicare & Medicaid

In home-based primary care, physicians and advanced-practice providers (e.g., nurse practitioners) become the patient’s primary care providers, usually for life, says Jay Holdren, senior director of VCU Health at Home in Richmond, Virginia. VCU Health has been providing home-based primary care for adults since 1984. Clinical staff members make home visits every weekday during daylight hours to provide ongoing primary care as well as urgent care. Criteria for enrollment include living within 15 miles from the hospital and being unable to leave home to be seen in clinic without great effort.

Skilled home health agency nurses are a vital component of the program, helping monitor serious illness and/or unstable health status, says Holdren. “Home health nurses carry out critical functions,

Services enacted the Independence at Home (IAH) demonstration project in 2010 to test a payment and service delivery model for providing home-based primary care to chronically ill and functionally limited Medicare beneficiaries. In a January 2023 update, CMS reported that even though “no compelling evidence” exists that primary care delivered in the home reduces Medicare spending or hospital use, evidence suggests it may lead to better – or at least different – care.

In Year 7 of the project, IAH beneficiaries received twice as many primary care visits from primary care physicians and non-physician clinicians than comparison beneficiaries – and somewhat fewer specialty care visits. IAH beneficiaries had 10.9 primary care visits while comparison beneficiaries had 5.5 visits

‘ It means treating the whole person rather than the tiny slice of the person the doctor sees for 15 minutes in the office.’

on average, translating to approximately one primary care visit every five weeks for IAH beneficiaries and one every nine weeks for comparison beneficiaries. On the other hand, IAH beneficiaries averaged one specialty care visit every 17 weeks, while comparison beneficiaries had one every 10 weeks. In Year 7, specialty care accounted for about 50% of total visits for comparison beneficiaries, compared to about 22% for IAH beneficiaries.

The modern-day house call

“We often refer to ‘modern-day house calls’ because they’re so technology-enabled,” says Sacks. In addition to digital technology and remote monitoring, home-based care can offer blood and lab tests in the home, portable X-ray and pointof-care ultrasound. “A smartphone can function as an EKG and a portal to many medical references, such as drug databases. You can look up just about anything.”

dynamics, and we have a dedicated practice operations manager for home and community services, who manages the front- and back-office operations, as well as IT, supplies and equipment,” he says. VCU Health has also implemented a geographic software system called CareLink to help map efficient home-visit routes.

“Currently we don’t utilize remote patient monitoring to a large degree in the program, but we’ve recently established a transitional RPM program that monitors patients who have recently left one of our hospitals,” Holdren says. “By using that technology in tandem with nurse monitoring and telemed visits by an MD/APP [physician/advanced practice provider] team, we’ve shown significant progress in moving the needle on swifter hospital discharges and reduced readmissions for challenging diagnoses, such as sepsis, congestive heart failure and respiratory illness, including COVID.”

provider groups for support and growth. In the fall of 2020, Housecall Providers became a founding partner of the Advanced Illness Partners ACO [Accountable Care Organization], says Rebecca Ramsay. The ACO includes seven advanced illness providers around the country that provide primary care services, care coordination, community services and on-call support to patients and their caregivers.

As a network of practices, Advanced Illness Partners has been able to negotiate group pricing for various services and solutions, including remote patient monitoring, chart auditing, and education on documentation and coding, says Ramsay. “The ACO also provides data and analytics services to the participating providers in a way that is more meaningful and cheaper than what we would be able to purchase on our own.

“But the largest single benefit is the learning community that has evolved because of our joining forces to participate in [a CMS Innovation Center ACO demonstration project]. Our success in the demo hinges on our collective success, which incentivizes us to work together and learn together to improve our performance.”

Since VCU’s home-based primary care program began, both human capital and technological enhancements have advanced its capabilities, says Holdren. “An electronic medical record allows our providers to see notes from specialists, ER encounters, as well as laboratory results and other details. Portable laptops have replaced heavy, thick paper charts as well. Contracted mobile diagnostic imaging affords safe and timely access to X-rays and ultrasounds.

“We have added social workers to address often complex social

But is it affordable?

One of the biggest challenges facing primary care providers is delivering high-quality home-based care that is cost-efficient and sustainable, says Sacks. Small to mid-sized practices looking at providing such care will probably have to prepare themselves for value-based contracting, she says. HCCI can help them learn how to code their services correctly, identify and track quality metrics, and present that information to payers with whom they want to contract.

Some home-based primary care providers have partnered with other

New skills for in-office teams

No one knows how many practices will ultimately offer home-based primary care, but even those that don’t may benefit from colleagues’ experience in the field, says Sacks. For example, they can reframe questions to maximize the few minutes they have with their patients. “I don’t mean simply asking, ‘How are your kids?’” she says. “I mean digging deeper, so instead of asking, ‘How is your diet?’ they can ask specific questions like, ‘Tell me what’s in your refrigerator right now.’ If the answer is ‘frozen

‘ Home-based primary care steps in when there’s disconnection with primary care.’

Home-based services

Home-based primary care visits can include:

ʯ Routine medical care and management of chronic diseases.

ʯ Annual wellness visits.

ʯ Addressing urgent medical needs.

ʯ Management of cognitive and neurological disorders.

ʯ Advance care planning (e.g., goals of care conversations, endof-life preferences).

ʯ Vaccinations.

ʯ Wound care and other procedures.

ʯ Coordination of diagnostic testing (e.g., blood tests, EKGs, ultrasounds, X-rays).

ʯ Medical visits at assisted living facilities, group homes, foster care homes and similar settings.

ʯ Care coordination with community services and other healthcare providers, including specialists in psychiatry, podiatry, optometry, dentistry and more.

ʯ Caregiver support and guidance on managing patients’ complex medical and social needs.

Source: Home Centered Care Institute, www.hccinstitute.org/app/uploads/2023/03/HCCI-Home-Based-Primary-Care.pdf dinners,’ the doctor knows that patient is probably overdoing the sodium.

“It’s a very different way of asking questions. It means treating the whole person rather than the tiny slice of the person the doctor sees for 15 minutes in the office.”

The Home Centered Care Institute has trained approximately 3,000 providers since its founding and

hopes to double the home-based workforce in five years, she says. “When we started, we focused on providers who were currently practicing. Now we’re adapting our curriculum for physician and nurse practitioner training programs. We’ll be doing more to build the pipeline.

“One thing we know for sure: When students, media people –

anyone – goes on a house call, they suddenly ‘get it.’ When they see and experience the relationship, they fall in love with it.”

Says Rebecca Ramsay, “Things are aligning demographically, epidemiologically, and socially in a way we haven’t seen in a very long time, if ever. This is the time for investment in home-based medicine.”

Diabetes

Improved diagnostics mean earlier, more effective screening.

Diabetes continues to be a growing problem in the United States – and not just among aging boomers. Citing a study published in late December in Diabetes Care, the Centers for Disease Control and Prevention (CDC) reported that the number of people under 20 with diabetes in the United States is likely to increase in the coming decades. In fact, by 2060, the country may be home to as many as 220,000 young people with diabetes type 2 – a 700% increase in less than 40 years. Type 1 diabetes is also expected to increase, but only by as much as 65% during this period. Point-of-care testing will be critical in identifying the growing number of people who may be affected.

The diabetes epidemic is expected to impact races and ethnicities disproportionately, placing Black, Hispanic/Latino, Asian, Pacific Islander and American Indian/Alaska Native youth communities at greatest risk. Whether this trend is the result of an increasing prevalence of childhood obesity, maternal diabetes (which increases the risk of diabetes in children) or a combination of factors, the takeaway is clear: In just under four decades, a substantial number of middle-aged Americans could be diabetic, placing them at risk for a myriad of health complications, including death, and leading to escalating healthcare costs for the country.

Health complications

Although advances in diagnostics have enabled physicians to better screen their patients for diabetes –and thereby more effectively address the disease state – the potential for health complications remains. Common health problems associated with diabetes include heart disease, chronic kidney disease and nerve damage, as well as problems with

feet, oral health, vision and hearing, according to the CDC.

People with diabetes are twice as likely to have heart disease (considered to be the leading cause of death for both men and women in the United States) or stroke than those without diabetes, the CDC reports. The longer one has diabetes, the more likely they are to have heart disease, placing the growing number of diabetics at a much higher risk. Diabetic patients most commonly develop coronary artery disease, caused by the buildup of plaque in the coronary artery walls. As plaque builds, the arteries narrow and harden, decreasing blood flow. Decreased blood flow to the heart can cause a heart attack, while decreased blood flow to the brain may result in stroke. Arteries may harden in other parts of the body as well, such as the legs and feet. Referred to as peripheral artery disease (PAD), this is an early sign that a patient with diabetes has developed cardiovascular disease.

In addition, people with diabetes are at risk for other health problems that can lead to heart disease, including

high blood pressure, high LDL cholesterol and high triglycerides.

Another complication associated with diabetes – chronic kidney disease (CKD) – often doesn’t present itself until it’s very advanced and patients require dialysis. One in three adults with diabetes has CKD, which ultimately can lead to death, according to the CDC. Regular blood and urine tests are essential to monitor kidney health in diabetics.

High blood sugar also can lead to nerve damage – or diabetic neuropathy – that impacts different parts of the body. As with chronic kidney disease, symptoms of nerve damage often develop slowly. The four main types include peripheral nerve damage, which affects hands, feet, legs and arms; autonomic nerve

damage, which affects the heart, bladder, stomach, intestines, sex organs and/or eyes; proximal nerve damage, which targets the thighs, hips, buttocks and/or legs; and focal nerve damage, which can affect single nerves in the hands, head, torso or legs.

High blood sugar also weakens white blood cells, making it harder for the body to fight infections that may occur in the mouth. Patients with diabetes may develop dry mouth due to a lack of saliva, inflamed and bleeding gums, and infections in the mouth that take a long time to heal. In other cases, diabetes can lead to nerve damage associated with hearing loss. People with diabetes are also at higher risk of vision loss and blindness. As high blood sugar

damages blood vessels in the retina, diabetic retinopathy develops, leading to blurry vision, floaters, trouble seeing colors and vision loss.

Improved diagnostics

The earlier physicians can detect diseases, the easier it may be to treat them. Evolving diagnostic testing makes it possible for physicians to do just that. “More than 8.5 million people in the United States are living with diabetes and don’t know it,” according to Abbott, which is committed to removing barriers to care while providing greater access to the latest medical technologies and health resources for people with diabetes. “This problem has been exacerbated by the pandemic, which disrupted medical care and

annual health appointments for many people.”

Expanding access to testing can help people understand if they have diabetes or are at risk for developing it. “One of the benefits to rapid point-of-care testing for HbA1c is that it eliminates the need for people to fast beforehand, compared to a glucose test,” says Abbott. The company’s Afinion™ HbA1c Dx test provides a tool that physicians with a moderate complexity lab can use to screen for diabetes and prediabetes, enabling them to have a conversation with the patient in the same visit. (In addition to many office laboratories, hospitals, health systems, IDNs and even some community health centers have a moderate complexity lab.)

To screen a patient, a healthcare worker collects a small amount of blood from a fingerstick in the test cartridge, which is then placed into the analyzer. Within three minutes, the Afinion HbA1c Dx test measures HbA1c and delivers the result. In addition, the barcode on each test cartridge includes lotspecific calibration information, eliminating the need for any separate calibration steps.

When a patient’s HbA1c level indicates they have prediabetes or diabetes, their doctor can speak with them while the patient is still present. “As millions of people continue to live with diabetes or prediabetes and are unaware, the Afinion HbA1c Dx is a strong tool that can help more people be diagnosed early, counseled and linked to treatment to reverse this trend,” says Abbott.

delivery model has evolved, making diabetic retinal exams accessible across several point-of-care settings, including primary care clinics, payers, mobile healthcare providers and retail locations. “This growth is due in part to large organizations, like payers, driving compliance with providers for diabetic retinal exams – a key solution to achieving value-based care metrics,” says Baxter, which acquired the Welch Allyn brand as part of the Hillrom acquisition in late 2021.

The company’s newest addition to its care delivery model, the Welch Allyn RetinaVue 700 Imager, provides automated retina imaging, including auto-alignment, auto-focus and auto-capture. Image capture takes less than five minutes and generally does not require chemical dilation.

the first tele-ophthalmology provider to earn The Joint Commission’s Gold Seal of Approval, says Baxter. Alternatively, healthcare providers can send images to their preferred local eye specialists.

Distributor sales reps should educate their customers who provide primary care-based services that, with early diagnosis and treatment, vision loss from diabetic retinopathy is 95% preventable. Annual diabetic retinal exams are a key element of early detection. Timely and easier-to-access diabetic retinal exams help patients and their healthcare providers identify disease early so it can be managed and treated by eye care professionals to preserve vision. What’s needed is a turnkey solution to enable diabetic retinal exams at the point of care.

Preventing vision loss

When high blood sugar damages blood vessels in the retina, it can result in diabetic retinopathy. The Welch Allyn RetinaVue Care Delivery Model – designed specifically for point-of-care settings, such as primary care offices – allows physicians to provide increased access to diabetic retinopathy exams in a variety of care settings, across a broad patient population, and better treat the growing number of patients diagnosed with diabetes each year.

Welch Allyn’s first-generation retinal camera – the RetinaVue 100 Imager – was introduced in 2016. Since then, the imager and care

RetinaVue Network Software

is hosted on the secure Microsoft Azure platform and transmits encrypted retinal images to ophthalmologists for review and diagnosis, as well as for generating reports. HIPAA-compliant, SOC-2 Type II certified and FDA-cleared, the RetinaVue Network software manages image transmission, documentation and workflows with EMR systems. It also gives healthcare providers population health data on their tele-retinal program by clinic and patient. Image analysis and reporting is conducted by a nationwide team of state-licensed, board-certified ophthalmologists and retina specialists at RetinaVue, P.C.,

The importance of diabetic retinal exams cannot be overstated, which is why Medicare Advantage Star Ratings and CMS Quality Payment Program measures include the NCQA® HEDIS® quality measure (NQF #0055). Intercepting patients during routine primary care office visits with the RetinaVue care delivery model can help providers achieve up to 90% documented compliance with diabetic retinal exams in 12 months.

The RetinaVue Care Delivery Model is applicable across several segments, including retail, payers, mobile, large and small primary care practices, community health centers and non-profits and community organizations. Baxter reports it has seen adoption of the solution because its value proposition is multifaceted for commercial stakeholders who are focused on value-based care measures and financial performance and closing care gaps, as well as clinical stakeholders focused on patient outcomes, clinician satisfaction and lower overall cost of care.

By 2060, the country may be home to as many as 220,000 young people with diabetes type 2.

Physician Survey: Burnout Impacting the Future of Care in Massachusetts

About one in four physicians surveyed plan to leave medicine in the next two years.

By Jenna Hughes

Physician burnout is at an all-time high across the nation. The U.S. physician workforce has for many years been in short supply, and the stressors of the COVID-19 pandemic exacerbated the issue as the number of physicians leaving their career increases. Across the medical industry, organizations scramble to retain employees and fill open healthcare positions.

The Massachusetts Medical Society (MMS) conducted a survey to identify causes of stress that physicians experience in the workplace. The goal of the survey was to assess burnout and find ways to improve physician well-being in the state.

Massachusetts physicians are feeling the effects of burnout

Stressors in the workplace physicians experience include increased healthcare documentation requirements, lack of support staff for non-medical tasks, turnover of clinical staff, increased visit lengths/ elements, and prior authorization. These workplace stressors were not always an aspect of employment in healthcare, and have exponentially increased with the advent of technology in medicine, according to the MMS Physician WellBeing Report. These additional responsibilities overwhelm healthcare employees, and “overall, 55%

of respondents experience symptoms that reached the threshold for burnout,” the report said.

Burnout leads to concern for the future

Physicians are becoming so overwhelmed, they have started searching for new jobs, or have considered leaving the healthcare industry

entirely. In fact, “50% of physicians have already reduced their clinical effort or are ‘definitely’ or ‘likely’ to reduce their clinical hours before June of 2023. About one in four plan to leave medicine in the next two years,” according to the report.

The results are consistent with the national physician burnout crisis throughout the healthcare industry.

Also observed is a need to address the concerns of specific demographic groups in healthcare. Trends were observed in certain groups that responded differently to specific survey categories. For example, more attention is needed with respect to occupational well-being of particular groups, including women physicians, physicians of color, underrepresented physicians, and younger physicians, according to MMS.

Solutions

The survey data exemplifies that there are many areas in which healthcare organizations can make workplace improvements that contribute to physicians’ well-being. The MMS recommends that “stakeholders aim to reduce workplace stressors, address staffing issues in healthcare, support the viability of physician practices, confront excessive administrative burdens, and support the well-being of physicians,” to address the ongoing burnout crisis.

Some recommendations to actively address the issue of burnout include partnering with education programs to encourage new staff to enter the medical profession. There has also been a push to improve workplace support systems, access to mental health resources, and overall clinician office culture.

Stakeholders have recognized the urgency of the physician burnout crisis through system stressors brought on by the COVID-19 pandemic. They have made many efforts and great strides but “there is much work to be done,” and according to MMS, there is increasingly a need to address “the professional well-being of and recruitment and retention of physicians from underrepresented populations.”

Addressing Medical Debt

Unpaid medical debt after hospital visits has become of increasing concern for many Americans.

Healthy individuals and those with preexisting conditions are facing rising medical costs associated with care that can quickly turn into unpaid debt, according to The Robert Wood Johnson Foundation, which found that more than one in seven (15%) of adults in the United States report past-due medical debt.

Medical debt is any balance owed after receiving medical services. Overdue medical expenses have significant impacts on the patient. Often, patients with large sums of medical debt choose to forgo medical assistance in the future to avoid further fees. Impacts of debt also include struggling to afford expenses such as

food and rent, in addition to dealing with damaged credit.

Discounted care

Many hospitals in the United States are not-for-profit, which qualifies them for federal tax exemptions. These types of hospitals account for 60% of the hospitals in the nation. Nonprofit hospitals must provide charity care and community benefits to receive tax breaks.

Charity care is financial assistance or discounted medical services for individuals (under specific eligibility criteria) who are unable to pay for health services. Hospitals have flexibility when it comes to establishing eligibility criteria for discounted healthcare.

The immense flexibility hospitals have when determining eligibility criteria leads many patients who qualify for financial assistance to not receive it, with some even facing debt collection, according to The Robert Wood Johnson Foundation. “Though about onethird of adults with past-due hospital bills reported working out a payment plan, only about one-fifth received discounted care,” according to The Robert Wood Johnson Foundation.

Disproportionate debt

Medical debt is prevalent in the United States, especially debt related to hospital visits. Among adults who report owing past-due medical debt

to hospitals, 29.7% owe all their debt to hospitals, and 45.1% owe their debt to hospitals and other providers, according to The Robert Wood Johnson Foundation.

Medical debt is found to be higher for certain populations, especially adults with disabilities, minorities, and individuals with low income. “Adults with disabilities were more than twice as likely as those without disabilities to report past-due medical debt, and Black and Latino adults were more likely to report past-due medical debt than White adults,” according to the Robert Wood Johnson Foundation.

Solutions

Current federal policies in place have been in the process of change so those seeking care can afford the medical assistance they need. Standards also have been set in place to improve access to affordable care.

According to The Robert Wood Johnson Foundation, “Federal legislative and regulatory efforts could build on state-level protections by clarifying and strengthening community benefit standards for nonprofit hospitals, expanding consumer protections to other hospitals and health care providers, increasing standards and oversight of aggressive collection practices, and improving reporting of charity care and collection actions.”

The immense flexibility hospitals have when determining eligibility criteria leads many patients who qualify for financial assistance to not receive it, with some even facing debt collection, according to The Robert Wood Johnson Foundation.

The Power of Content

How healthcare sales teams can use content for supply chain success.

You need to stand out to your customers. Advertising campaigns and person-to-person sales strategies are excellent tools for bringing awareness to your company and your offering, but to really carve out mind share among your customers requires more – especially for sales in the health care supply chain.

Your messaging needs to go deeper than an advertising campaign, since marketing materials are often outright ignored by purchasing and value analysis leaders (Frustrating, but true!). They know that the goal of advertising is to showcase the best parts of your offering, they liked what they saw, and now they need to know more.

“Hard data” about your offering is a crucial asset, but to really get through and set yourself apart you need to tell your product’s story.

That’s where content saves the day.

Savvy, successful suppliers know that creating captivating, targeted content is the best way to close the deal. Never underestimate the power of success stories that clearly demonstrate how the value of your offering is multiplied by the added value of having you and your company as a supplier partner.

Know your customer better than they know themselves

We’ve asked supply chain leaders across the country what their top supplier partners have in common, and they all say the same thing: Good suppliers respond to problems, best-in-class suppliers are so

well-informed – so dialed in – that they can anticipate their supply chain partners’ needs and proactively collaborate on solutions.

When it comes to sales success in the health care supply chain, there’s nothing more critical than knowing everything there is to know about your customers and prospects. But how do you get those high-level insights? What’s the secret?

The best way to get relevant, actionable information for sales success is going to come from consuming content. Supply chain leaders want all the help they can get; they aren’t hiding what their needs and goals are. Whether its press releases, blogs, podcasts, or news articles, the content and media surrounding an

IDN can tell you exactly what they’re dealing with, what they’re planning to do, what their priorities are, and so much more.

Industry magazines and publications, like Repertoire, are treasure troves of details and nuance. Not to mention that there are countless podcasts and videos out there as well – a perfect way to stay in-the-know when you’re traveling or on-the-go.

Personal interviews and webinars with supply chain leaders are doubly helpful because you can get to know the supply chain leaders’ personalities and interests as well as clear information about exactly who you need to approach and what you need to do to get your foot in the door.

At Share Moving Media, we have a dedicated, captive audience of supply chain leaders across the biggest IDNs in the U.S. For over 30 years, we’ve been partnering with suppliers and distributors to create compelling content and messaging. We would love to work with you and help you tell your story. Visit www.sharemovingmedia.com for more information.

Navigating the End of the COVID-19 Public Health Emergency

With the expiration of the COVID-19 Public Health Emergency (PHE), now is a good opportunity to review what changes the end of the PHE mean for the healthcare industry. The termination of the PHE was announced at the end of January to give healthcare providers and distributors adequate time to navigate the numerous authorities, waivers, and flexibilities that are set to expire.

By Christina Lavoie, Director of Policy, Health Industry Distributors Association

Understanding the difference: PHE vs. EUA

The PHE is different from the Food and Drug Administration (FDA) Emergency Use Authorization (EUA) which allows FDA to fight threats by expediting the availability and use of medical countermeasures. The EUA authority allowed FDA to authorize diagnostic COVID tests, vaccines, and medical treatments to prevent serious illness in an efficient manner. Because EUAs are not dependent on a PHE, EUAs can

remain in effect after the termination of the PHE. However, the FDA must provide advance notice of the termination of a EUA declaration in the Federal Register.

Impact on patients and providers

For providers, certain Medicare and Medicaid waivers and broad flexibilities for healthcare providers are no longer necessary. Hospitals will no longer receive a 20% payment bump for the treatment of patients

diagnosed with COVID-19. Reporting of COVID-19 laboratory results and immunization data to the Centers for Disease Control and Prevention will change. At the end of the PHE, the Department of Health and Human Services will no longer have the express authority to require this data from labs. This may affect the reporting of negative test results and impact the ability to calculate the positivity rate for COVID-19 tests in some jurisdictions. However, EUAs issued by the FDA for COVID-19 products (including tests, vaccines, and treatments) will not be affected. Nor will telehealth flexibilities for both Medicare and Medicaid.

For patients, coverage for COVID-19 testing for Americans will change. Medicare beneficiaries will lose access to free over-thecounter (OTC) COVID-19 tests. However, for those enrolled in Part B, there will continue to be coverage without cost sharing for laboratory-conducted COVID-19 tests when ordered by a provider. The requirement for private insurance companies to cover COVID-19 tests without cost sharing, both for OTC and laboratory tests, will end. Access to COVID-19 vaccinations and certain treatments, such as Paxlovid and Lagevrio, will generally not be affected.

The formal end of the COVID-19 PHE is an opportunity to take stock of our nation’s commitment to public health preparedness. When COVID-19 was declared a pandemic more than three years ago, our industry faced a challenge of unprecedented scale and complexity. We rose to the occasion and answered the call of our country. Today, HIDA advocates for policies to strengthen the supply chain for the next health emergency.

Bone Health

Osteoporosis is a rising problem among the aging population.

By Jenna Hughes

Bones are the foundation of the body. Just as the foundation of a building holds a structure together, bones support the body throughout a lifetime. Bones hold all the body’s weight, allowing the ability to move. Good bone health is imperative to maintain overall health.

According to Claire Gill, CEO of The Bone Health and Osteoporosis Foundation, primary care physicians play a important role in a patient’s bone health by emphasizing a balanced diet rich in calcium and vitamin D and doing regular weight-bearing and musclestrengthening exercises.

The opposite of good bone health is osteoporosis, a bone disease that occurs when the body loses too much bone, too little bone, or both. This may cause bones to break from falls, injuries, or minor bumps.

The origin of the disease’s name “osteoporosis” means porous bone. According to the Foundation,

“healthy bone looks like honeycomb viewed under a microscope. When osteoporosis occurs, the holes and spaces in the honeycomb are much larger than healthy bone.” Less dense bones mean they are more likely to break.

Osteoporosis progressively weakens bones and can cause numerous

Prevention osteoporosis

The Bone Health and Osteoporosis Foundation aims to prevent osteoporosis and reduce human suffering with the disease through awareness. This includes bone health education throughout a lifespan, empowering individuals with osteoporosis, ensuring comprehensive post fracture care, and expanding resources and reach.

In 2022, BHOF worked on several projects that help osteoporosis patients learn more about disease management. The new online tool called “Your Path to Good Bone Health” provides information on how to prevent bone loss, maintain good bone health, and manage a diagno -

health complications if gone unnoticed. It is important to get tested for prevention. Gill said the key test to determine bone health is a tool known as the DXA scan (dualenergy X-ray absorptiometry). “This is also referred to as a bone density test,” Gill said. “It is very simple and only takes a few minutes. It’s noninvasive and you don’t even have to take off your clothes.”

According to Gill, osteoporosis is a rising problem among the aging population, “Each year, approximately 2 million people break a bone due to osteoporosis. Most remain unaware of their fracture risk until they break a bone. Fractures from osteoporosis are more prevalent in women than breast cancer, heart disease or diabetes. And the consequence to patients can be every bit as catastrophic.” About 54 million Americans have osteoporosis and low bone mass, which places them at higher risk for osteoporosis. For older patients, breaking a bone is a serious complication of the disease. Older patients are more likely to break bones in the hip and spine, which can cause serious complications and difficult surgeries.

sis. BHOF also launched a pilot program in Maryland and North Carolina that aims to improve the care received after a fracture to determine if a patient has osteoporosis called “Fracture Liaison Service (FLS),” according to Gill.

In 2023, the Foundation’s strategic goals, according to Gill, include working with a coalition of 30 organizations in the bone health field to persuade the Centers for Medicare and Medicaid (CMS) to include an FLS reimbursement model in its physician fee service proposed rule, so that bone care receives the same priority as cardiac care, diabetes care, and opioid usage disorder care.

Build healthy bones

You are never too young to improve bone health. According to Gill, “We build our strongest and most dense bones by the time we’re in our mid-20s. This is called peak bone mass. Our bones are living tissue, so throughout our lives, our bones break down and rebuild continuously. We build and maintain bone health and strength by eating a well-balanced diet that includes calcium and vitamin D (these nutrients are the essential building blocks of our bones) and getting plenty of weight-bearing exercise – this means walking, running, jumping, dancing – exercise that is on our feet. Swimming and cycling are great for our heart health,

but don’t help with maintaining strong bones.” Prevention of osteoporosis can begin as young as childhood. Taking steps to increase bone health early on can prevent pain and complications later in life.

Treatment for osteoporosis takes a whole-person approach. Patients diagnosed are encouraged to get enough dietary calcium, take vitamin D, participate in regular exercise, and avoid smoking and excess alcohol. Older individuals are encouraged to take steps to make their living spaces fall-proof. There are medications available for the treatment of osteoporosis, and healthcare providers can assist in finding one that works best for the individual.

“ Each year, approximately 2 million people break a bone due to osteoporosis. Most remain unaware of their fracture risk until they break a bone. Fractures from osteoporosis are more prevalent in women than breast cancer, heart disease or diabetes. And the consequence to patients can be every bit as catastrophic.”

Joint Health and Preventing Osteoarthritis

May is Arthritis Awareness Month, and the Osteoarthritis Action Alliance has steps you can take to maintain lifelong healthy joints.

By Jenna Hughes

Arthritis is one of the most common health conditions in the United States, and a leading cause of disability. According to the Centers for Disease Control and Prevention (CDC), one in four adults have arthritis that has been diagnosed by a doctor, and 26 million adults are unable to do daily activities because of arthritis.

May is Arthritis Awareness Month, when the focus is on arthritis intervention and prevention strategies. The month of awareness is recognized each year in May as an opportunity to learn about the different types of arthritis in addition to their

causes and treatment options. The month is also a chance for your physician customers to share resources and prevention strategies with patients.

Osteoarthritis (OA) is the most common form of arthritis, afflicting over 32.5 million U.S. adults, according

to the CDC. The Osteoarthritis Action Alliance is a national coalition of concerned organizations started as a partnership between the Arthritis Foundation and the CDC. Since 2011, the coalition has aimed to have osteoarthritis recognized as

a national health priority, and to promote policy solutions addressing the human impact of the disease.

OA can be managed through intervention, and steps can be taken to prevent it from developing. Communicating about the disease is critical for nationwide awareness. In 2023, the OA alliance’s overarching goal of “preventing and managing the disease to improve the quality of life for all Americans,” includes invoking policymakers, mobilizing health systems, and engaging individuals with OA.

In 2022, the alliance collaborated with industry stakeholders to expand and update a toolkit of resources for healthcare providers and the healthcare support community. Additionally, four new therapeutic interventions were added to the already growing list, and four new organizations were added to the alliance including Wake Forest School of Medicine, Paradigm Biopharmaceuticals, University of North Carolina Greensboro (EdD in Kinesiology), and Pain Free after 50.

So, why is osteoarthritis a national health priority, and how can it be treated and prevented?

Joint pain

OA is a type of arthritis that affects cartilage and causes moderate to severe joint pain, swelling, and a loss of motion in joints. OA is the most common type of arthritis, and generally afflicts older people. The disease has no cure and can get progressively worse over time if left untreated. Fortunately, education, intervention, and prevention can greatly improve the lives of those living with symptoms.

Evidence-based interventions

Arthritis-Appropriate, Evidence-Based Interventions (AAEBIs) can assist

individuals with managing their OA symptoms. There are treatments and therapies available for patients living with OA, and the CDC recognizes numerous AAEBIs, which are community-based programs shown to improve arthritis symptoms. These programs must meet criteria of scientific support, be shown to have previously addressed arthritis symptoms, and can be effectively carried out by community organizations. “Two specific AAEBIs include physical activity programs, designed to increase physical activity in a patient’s daily routine, and selfmanagement education programs, that teach individuals how to manage symptoms and maintain health and

risk of other chronic conditions like heart disease and obesity. The CDC recommends that adults get 150 minutes per week or more of moderate physical activity.

Prevention

Excess weight can exacerbate pain associated with OA. “One pound of weight gained can equal four pounds of pressure on your knees,” according to the OA Action Alliance. Maintaining a healthy weight reduces the risk of the disease, and makes it less likely that a patient will require major surgical procedures for treatment. Managing weight can be achieved through a healthy diet, physical activity, and daily movement.

activity level,” according to the OA Action Alliance. There are currently numerous approved therapies accessible on the OA Alliance website.

Improving quality of life

The OA Alliance recommends a variety of strategies to help manage the symptoms of OA. Physical activity has positive effects in arthritis management. Low-impact movement such as swimming, biking, and walking can not only improve OA symptoms, but also reduce the

Injury prevention is important to preventing the symptoms of OA. Individuals that are active in sports have a higher risk of knee-related injuries and ACL tears that make it more likely to develop OA down the road. Athletes and highly active individuals can take steps to prevent these injuries and decrease the risk of OA later in life. Participating in neuromuscular training exercises (specific targeted stretching), and warming up before physical activity can reduce the risk of injury.

One pound of weight gained can equal four pounds of pressure on your knees, according to the OA Action Alliance. Maintaining a healthy weight reduces the risk of osteoarthritis, and makes it less likely that a patient will require major surgical procedures for treatment. Managing weight can be achieved through a healthy diet, physical activity, and daily movement.

Finding Meaning in a Digital World

For Henry Schein’s Tami Cates, relationships with her customers are what matter most.

Early in her career, Tami Cates knew she would thrive in a fast-paced environment – one that revolved around continuous change and enabled her to help others. Healthcare distribution was the perfect fit, she says. She joined the distribution industry in 2009 as a field sales consultant, eventually making her way to Henry Schein in 2015, where she began as a group purchasing organization strategic account manager. The following year, she stepped into a new position at Henry Schein: strategic account manager, with a focus

on integrated delivery networks and large national accounts. She also had an opportunity to work with the company’s business development team, forging new relationships and familiarizing herself with the team’s goals and accomplishments. So, when she was promoted to Director of Business Development in the Eastern United States two years ago, once again, she found a perfect fit.

“The business development executive (BDE) team focuses on building meaningful relationships,” says Cates. “Our team is a trusted advisor that

healthcare customers can rely on for support. We are dedicated to helping our customers deliver the best quality patient care while enhancing their practice management efficiency.”

The non-acute customer

“The past two years turned health care upside down with supply chain challenges,” she says. “The COVID-19 pandemic disrupted hospitals in many areas. Recently, I listened to various supply chain leaders express their main supply chain goals. These goals included enhancing financial success,

resiliency and workforce optimization for the entire system, including non-acute settings.

“Non-acute financial success can be driven by looking at all options for a product,” she continues. “This means identifying the best price, reducing SKUs and utilizing smart sourcing by your distribution partner. [It calls for] maximizing processes and helping ensure clinics are doing what they do best – caring for their patients – instead of unpacking boxes and looking for missed items and alternatives.

“To enhance resiliency, all processes should be evaluated, and it is crucial to partner with an expert in the non-acute space. With patient visits returning and procedures moving outside of the hospital walls, understanding the needs of the nonacute setting is critical.”

Working with suppliers

Henry Schein has always worked closely with its supplier partners, says Cates. “Together with our more than 3,200 supplier partners, we provide over 1 million dental and medical customers globally with more than 300 solutions. We value our partnerships, and throughout COVID-19, these partnerships only strengthened, driving meaningful conversations with our customers.

“Because of our global sourcing capabilities and relationships, we are able to provide our customers with a comprehensive medical product portfolio that meets their unique needs,” says Cates. In fact, remaining aligned with manufacturers has led the business development team to strengthen – but not change –its goals. “These relationships have allowed us to serve our customers, providing them with the products and solutions they need to succeed.”

Always up for a challenge

Part of building strong customer relations involves accepting – and addressing – any challenges that may arise, notes Cates. “Regardless of what business our customers are in, there will always be challenges and concerns. It is important to be consistent and understand the environment within which our customers operate. I never look at a challenge as a negative, but as an opportunity to improve as a company, as a team and as people.”

she continues. While patients have been steadily moving from the acute care setting to the non-acute setting for some time, COVID-19 has left more patients wishing to be seen at home or at a location close to home, she points out. “Collaboration between corporate-owned entities and e-hospitals are on the rise in an effort to provide the best possible care for patients. At Henry Schein, we can provide the human touch in a digital world. By doing so for our customers and other constituencies in an increasingly digital world, we can continue to strengthen these connections.”

Understanding the value of a meaningful and human relationship with her customers is a critical part of Henry Schein’s business, she says. Doing so involves actively listening to others – a skill she has found beneficial both professionally and personally. “Only when you actively listen can you communicate in a mutual environment,” she explains.

For Cates, the future holds an opportunity to continue serving her

For Cates and her team, this has involved helping to expand the company’s portfolio of digital solutions. “The world is increasingly becoming more digital, and we must adapt and meet our customers where they are,” she says. “We continue to support their digital journey so that they, in turn, can deliver quality healthcare.”

It is an exciting time to be in distribution for the non-acute setting,

customers, as well to live a life filled with joy. “It’s important to figure out who you are and what makes you joyful,” she says. “I strive to live a positive life and surround myself with people who challenge me. I see myself continuing to focus on making a positive difference in the lives of others. If we each do this, together we can help create a world that’s better for all.”

‘It is important to be consistent and understand the environment within which our customers operate.’

Tami Cates

New report finds that 29% of patients receiving medical care from 2016 to 2022 did not visit a primary care provider

Nationally, from 2016 to 2022, 29% of patients receiving medical care did not visit a primary care provider, according to a new white paper from FAIR Health. This ranged from a high of 43% in Tennessee to a low of 16% in Massachusetts. These and other findings are detailed in the new report released, entitled A Window into Primary Care: An Analysis of Private Healthcare Claims.

Drawing on the nation’s largest private healthcare claims database, U.S. census data and National Plan and Provider Enumeration System (NPPES) data, this report provides an in-depth analysis of primary care with a focus on geography, physician versus nonphysician care and primary care specialties. In addition, the study reports on allowed amounts, telehealth utilization, diagnoses and behavioral health.

Some key findings:

ʯ Of the providers who performed primary care services in 2016-2022, 56% were physicians, while 44% were nonphysicians.

ʯ Nurse practitioners constituted the largest share of primary care providers by specialty (27%), followed by family medicine physicians (20%), internal medicine physicians (18%) and physician assistants (15%). Smaller percentages were accounted for by pediatricians, obstetricians/gynecologists and others.

ʯ The five states with the highest percentage of primary care patients receiving care from a nurse practitioner in 2016-2022 were largely states that permitted full scope of practice. Conversely, the states with the lowest percentage were generally those that reduced or restricted practice.

Physicians say that toll from prior authorization exceeds alleged benefits

The approval process health insurers impose on medical services or drugs is generating a toll that exceeds the purported benefits, according to a physician survey released by the American Medical Association and shared in a letter to federal health officials. While health insurers claim prior authorization requirements are used for cost and quality control, a vast majority of physicians say authorization controls lead to unnecessary waste and avoidable patient harm.

According to the AMA survey, more than four in five physicians (86%) reported that prior authorization requirements led to higher overall utilization of health care resources, resulting in unnecessary waste rather than cost-savings. More specifically, about twothirds of physicians reported resources were diverted to ineffective initial treatments (64%) or additional office visits (62%) due to prior authorization policies, while almost half of physicians (46%) reported prior authorization policies led to urgent or emergency care for patients.

The health insurance industry maintains prior authorization criteria reflect evidence-based medicine, but physician experiences call into question the clinical validity of insurer-created criteria that lack transparency. Only 15% of physicians reported that prior authorization criteria were often or always evidence-based.

QuidelOrtho announces formation of International QuidelOrtho Women’s Leadership Network

QuidelOrtho, a global provider of innovative in vitro diagnostic technologies designed for point-of-care settings, clinical labs and transfusion medicine, celebrated Women’s History Month by announcing that the QuidelOrtho Women’s Leadership Network (QWLN) has been formed, creating an enhanced network with 14 global leaders supporting 16 chapters around the world.

In 2022, Quidel Corporation and Ortho Clinical Diagnostics united as QuidelOrtho. Leaders from both companies’ women’s leadership networks came together to form QWLN, a global women-led organization amplifying the mentoring, empowerment, achievement and visibility of women. Because Women’s History Month was created to highlight the achievements women have made throughout history, it is the perfect time to share information about this expanding network. QWLN encourages and inspires members to stretch beyond their primary functions and learn about other areas of interest by serving on various committees.

“It is with great pleasure that we announce the launch of the QuidelOrtho Women’s Leadership Network, a global community built around the spirit of both professional and personal development and sharing insights on modern issues our leaders face every day,” said Douglas Bryant, President and Chief Executive Officer of QuidelOrtho. “At QuidelOrtho, we aspire to lead by

example in becoming a truly transformational global diagnostics company with a vibrant workplace.”

Setting the stage for many more company opportunities, the QWLN brings educational content, recognition, research and thought leadership in support of professional women at all levels of the organization. Today, QWLN has successfully launched 16 worldwide chapters representing employees from various regions within North America, Latin America, Asia Pacific, Europe, the Middle East and Africa.

Medline celebrates grand opening of $72M distribution center in Louisiana

Medline held a ribbon cutting ceremony recently for its new $72 million, high-tech facility in Hammond, Louisiana. The 650,000-sq-foot warehouse, located at the corner of Vinyard Road and Industrial Park Road, will be the biggest medical distribution facility in the state. The company expects the site to process more than $200 million in orders for healthcare providers every year and will deploy “thousands of individual products and devices […] across the continuum of care, such as hospitals, nursing homes, ambulatory surgery centers, hospices and physicians’ offices.”

CMS issues proposed rule on hospital payment rates

In April, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year 2024 Medicare hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) proposed rule.

The proposed rule would update Medicare fee-for-service payment rates and policies for inpatient hospitals and LTCHs. The proposed increase in operating payment rates is projected to be 2.8%. This would be for general acute care hospitals paid under the IPPS, that successfully participate in the Hospital Inpatient Quality Reporting (IQR) program and are meaningful electronic health record (EHR) users. This reflects a projected FY 2024 hospital market basket percentage increase of 3.0%, according to CMS, reduced by a 0.2 percentage point productivity adjustment.

Hospitals may be subject to other payment adjustments under the IPPS, including:

ʯ Payment reductions for excess readmissions under the HRRP.

ʯ Payment reduction (1%) for the worst-performing quartile under the Hospital Acquired Condition (HAC) Reduction Program.

ʯ Upward and downward adjustments under the Hospital Value-Based Purchasing (VBP) Program.

CMS said the proposed increase in operating and capital IPPS payment rates will generally increase hospital payments in FY 2024 by $3.3 billion. In addition, CMS projects Medicare disproportionate share hospital (DSH) payments and Medicare uncompensated care payments combined will decrease in FY 2024 by approximately $115 million.

OakWell to provide primary care to kidney patients in dialysis centers

Oak Street Health, a network of value-based primary care centers for adults on Medicare and the only primary care provider to carry the AARP name, and Interwell Health, a kidney care management company that partners with physicians on its mission to reimagine healthcare, today announced the launch of OakWell, a joint venture that will offer the highest-quality primary care to end-stage kidney disease (ESKD) patients directly in the dialysis center. This unique approach to primary care for ESKD patients aims to reduce hospitalizations, increase kidney transplantations, and improve outcomes to lower the total cost of care.

When a patient receives in-center dialysis treatment, they spend around 12 hours each week in a dialysis center, often making it difficult to attend primary care and other healthcare appointments. This is a significant challenge, as dialysis patients often have other complex chronic conditions and would benefit from high-quality, preventive primary care. OakWell enables patients to receive coordinated care from a primary care team and nephrologist.

OakWell will bring the type of coordinated primary care that dialysis patients need directly to them, offering appropriate interventions in the center while still working in close partnership with nephrologists. This will remove the significant barrier of attending additional, separate medical appointments and helping address important issues of health equity. These provider-led teams will coordinate with the dialysis care teams, and other specialists, ensuring the most comprehensive and coordinated concierge-level care.

Henry Schein Medical recently participated in the Ambulatory Surgery Center Association’s (ASCA) National Advocacy Day on Capitol Hill in Washington D.C. as part of Henry Schein’s commitment to amplify the value of ambulatory surgery centers (ASCs) and their role in helping to drive down heath care costs and deliver quality patient care.

In an effort to build relationships with the policymakers who make the decisions that directly impact the ambulatory surgery center community and its patients, Scott Jackson, vice president of surgical solutions at Henry Schein, along with 91 members of the ASC community representing 31 different states, met with representatives and their health staff to discuss the issues that are currently impacting ASCs and their patients. In particular, meetings addressed the Outpatient Surgery Quality and Access Act of 2023, which, if enacted, will ensure Medicare beneficiaries’ continued access to highquality outpatient surgery.

“Ambulatory surgery centers have such a positive impact on the health care ecosystem, and being able to stand alongside ASCs to advocate on behalf of the surgery center community in the United States was an incredible experience,” said Jackson. “It is important that ASCs

have their voices heard. By working together on the federal, state, and local levels, we can create change, and help make an impact on legislation that will elevate and advance the ASC industry.”

According to ASCA, approximately 6,100 Medicarecertified ASCs provide care to America’s patients across the country. ASCA’s 2023 National Advocacy Day event was the first in-person event of its kind since 2019.

Henry Schein Medical helps champion the advancement of ambulatory surgery centers

Mandy Hawkins and Scott Jackson, Advocacy Day 2023.

Congressman Joe Wilson, Advocacy Day 2023.

Rep. Nancy Mace, Advocacy Day 2023.

Understanding the 5-Step Instrument Processing Workflow

Why it’s Critical for Your Customers

As the number of outpatient clinics increase, instrument processing becomes a greater challenge for our customers. They may already understand the need for effective sterilization to reduce risk—but instrument processing is more than sterilization and it begins before they ever touch an instrument. Midmark instrument processing solutions were designed around CDC-recommended1 best practices to help make regulatory compliance to clinical standards as easy (and as automated) as possible.

Contact your Midmark Representative to start the conversation.

1 https://www.cdc.gov/infectioncontrol/guidelines/disinfection/sterilization/sterilizing-practices.html

© 2023 Midmark Corporation, Versailles, Ohio USA

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