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vol.26 no.11 â&#x20AC;˘ November 2018

Continuous Glucose Monitoring Why CGMs may help patients and caretakers better manage diabetes

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NOVEMBER 2018 • VOLUME 26 • ISSUE 11

PUBLISHER’S LETTER Saying Thanks...................................................................6

PHYSICIAN OFFICE LAB Diabetes Screening and Monitoring.................8

TELEMEDICINE ‘Broadband Everywhere’: FCC goal................. 24

TRENDS Improving Diagnoses A healthcare coalition aims to improve the quality of medical diagnoses...................................... 26

Continuous Glucose Monitoring A new technology may help patients and caretakers better manage diabetes

Hospital-acquired conditions are down........................................................... 28

IDN OPPORTUNITIES Cybersecurity Concerns................................................. 30

WINDSHIELD TIME

Paul Tirjan AllSpire Health GPO: Bending cultures

Five mid-Atlantic health systems....................................... 36

repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2018 by Share Moving Media. All rights reserved. Subscriptions: $49.00 per year for individuals; issues are sent free of charge to dealer representatives. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address. POSTMASTER: Send address changes to Repertoire, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors. Periodicals Postage Paid at Lawrenceville, GA and at additional mailing offices.

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NOVEMBER 2018 • VOLUME 26 • ISSUE 11

HEALTHY REPS

SMART SELLING To Grow Sales, Cultivate Empathy.................. 46

HIDA GOVERNMENT AFFAIRS UPDATE Insights for the 2018-19 Flu Season............ 52

Health news and notes

REP CORNER

SARNOVA

Serve First, Together Sarnova’s 2018 National Sales Meeting

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Tough Enough Selling copiers wasn’t a bad way for Dan Walsh to learn about sales................................ 54

INDUSTRY NEWS The Goal: Error-proofing Rooms.......................... 58 News........................................................................................... 60 Classified ad......................................................................... 62

OnGuard® CSTD (Closed System Transfer Device) meets the NIOSH1,2, ASHP 3, and ONS 4 definitions of a CSTD. Plus, it has FDA clearance under the ONB Product Code5 and will help healthcare institutions meet USP <800>6 requirements. Today, OnGuard remains the only CSTD that has been tested with commonly used chemotherapy drugs.7 1. The NIOSH definition is a performance standard, and does not prescribe how to meet the definition. 2. NIOSH Definition of Closed-System Drug-Transfer Devices, Ann Occup Hyg. 2009 Jul; 53(5): 549. Published online 2009 May 27. doi: 10.1093/annhygmep030\; 3. ASHP Guidelines on Handling Hazardous Drugs; 4. ONS Safe Handling of Hazardous Drugs; second edition 2011, M. Polovich; 5. FDA cleared with ONB product code: K141448 http://www.accessdata.fda.gov/cdrh_docs/pdf14/K141448.pdf 6. General Chapter <800> Hazardous Drugs—Handling of Drugs in Healthcare Settings Published February 1, 2016.; 7. Prevention of Hazardous Drug Vapor Release by the Tevadaptor® Vial Adaptor, Third-party lab testing performed at Analyst Research Laboratories, Ltd. Rehovot, Israel, Reference reports 2007-001 Et001C and Nextar Chempharma Solutions, Ltd. Rx only. ©2017 B. Braun Medical Inc., Bethlehem, PA. All rights reserved. 8/17

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PUBLISHER’S LETTER

Saying Thanks November is one of my favorite months of the year. College football is in full swing, the

leaves are changing color, and crisp cool nights are a welcome evening treat in greater Atlanta. November also brings my favorite holiday, Thanksgiving. Whether it’s the four-day weekend of gluttony, or just having some time with family, this is a great time to hit the pause button to reflect on the year. As 2018 unfolded, it has been encouraging to see the manufacturing community come full circle to focus as much on working with distribution reps as they do health systems. Indeed, the work that distributor reps do is vital to providers, and the manufacturers you sell daily. I would like to say thank you to every rep out there that picks up a bag and works to grow your business, as well as the business of the manufacturers you represent. And, to the manufacturers that support distribution – thank you for all you do for the channel. The past five years in healthcare have certainly had challenges, but we’ve found a way to solve our customers’ biggest problems, thanks to working together and bringing solutions to providers. Starting in January 2019, Repertoire Magazine will be launching a new podcast series dedicated to the manufacturing and distribution representatives in the field. This is our way of showing you appreciation, while allowing you to tell your story. The series will be called “Road Warriors and Their Untold Stories.” It will consist of interviews with sales reps and sales leaders from distribution and manufacturers covering topics from great sales stories, classic ride days, personal success stories, and sales lessons from top performers. We will announce these in the Dail-eNews, and host them on Repertoiremag.com.

Scott Adams

Happy Thanksgiving folks, we are incredibly grateful for you. Dedicated to the industry, R. Scott Adams

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

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Jessica McKeever jmckeever@sharemovingmedia.com (800) 536.5312 x5271 director of business development

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2018 editorial board Richard Bigham: IMCO Eddie Dienes: McKesson Medical-Surgical Joan Eliasek: McKesson Medical-Surgical Ty Ford: Henry Schein Doug Harper: NDC Homecare Mark Kline: NDC Bob Ortiz: Medline Pam Wedow: Independent consultant Keith Boivin: IMCO Home Care

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PHYSICIAN OFFICE LAB

Diabetes Screening and Monitoring

By Jim Poggi A word of caution regarding this month’s lab article:

it’s about diabetes, and the statistics are not pretty. So, if you’re squeamish, or you think we are doing a great job diagnosing and monitoring diabetes, or just believe “it can’t happen here”, turn the page. But, if you believe we have all the right tools to diagnose and monitor diabetes, believe we need to do better work with the healthcare community and think your personal involvement can make a difference, read on. There is plenty of work to do.

What are we up against? With some of the biggest lab companies in the world offering multiple testing methods to screen for and monitor diabetes – not to mention the abundance of diabetes meters available – you’d think diabetes in the United States would be well on its way to eradication. In addition, there are a growing number of new diabetes medications for both type 1 and type 2 diabetes. At the same time, you would expect that every primary care practice in the United States would have an effective diabetes screening and management program in place and a high patient compliance rate. So, there would be nothing to see here, right? While the death rate for diabetes is decreasing, the total number of diagnosed and undiagnosed diabetics is increasing. It is currently estimated that there are 23

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million diagnosed diabetics and over 7 million remaining to be diagnosed. In 2015, 1.5 million new diabetics were diagnosed. The picture for pre-diabetes (defined as A1c of 5.7 to 6.4 percent or fasting glucose in the 100-125 mg/dL range) is worse. The incidence is over 84 million Americans, or more than 33 percent of the U.S. population. If you total the number of diabetics and prediabetics, the number is over 115 million, nearly one of two Americans. Diabetes is most prevalent in the south and Appalachian states, among people with less than a high school education and among people in their middle years (45-64). A last sobering statistic: diabetes is the seventh leading cause of death in the United States, taking more than 76,000 lives in 2014, but it is implicated in over 250,000 deaths or more than 9.6 percent of all deaths in 2014.

What are the risk factors for diabetes? Among adults over 18, the key risk factors are listed below. While we can’t control our genetics, we can choose healthy habits. In many ways, the risk factors are related to personal health habits and lifestyle choices. • Smoking • Overweight and obesity • Physical inactivity • High blood pressure • High cholesterol • High blood glucose or A1c

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PHYSICIAN OFFICE LAB We have the tools to do the job For diagnosis of diabetes or pre-diabetes, we have an excellent combination of vital signs metrics and lab diagnostic tools. For monitoring, we also have the right tools for the job. While A1c tests have been cleared for monitoring for several years, recently a waived A1c test has been cleared for diagnosis also, and joins several large chemistry system assays cleared for diagnosis of diabetes. Risk Factor Smoking Overweight/obesity Physical activity High blood pressure High cholesterol High blood glucose or A1c Kidney co-morbidity

Diagnostic tool(s) History, cotinine test Office scale, waist measurements History, patient dialogue Blood pressure cuff Cholesterol, HDL and triglycerides tests Glucose and A1c tests Albumin, creatinine, A/C ratio

MACRA wants to help There are a large number of advocacy groups dedicated to diagnosis and effective treatment of diabetes, including the American Diabetes Association. Most communities also have support groups and most primary care physician practices have a list of local resources to assist their diabetic patients with life style changes, smoking cessation and peer support. With the advent of MACRA, Medicare has also added important “Quality” and “Improvement Activities” that are tracked as part of the Merit-based Incentive Payment System (MIPS). Quality measures include tracking A1c over 9 percent, eye exams for known diabetics and foot exams and care to prevent diabetic foot ulceration. Improvement Activities include glycemic screening, implementation of a glycemic management program and chronic conditions plans. MACRA broadly supports diabetic diagnosis and management initiatives for Medicare patients. Your key diabetic vital signs and lab diagnosis partners have all the details and can provide you with even more information.

How can we help? First of all, let me acknowledge two things. Number one, this article is a bit more of a call to action than my typical “hey, I have a few lab nuggets to share” article. Number

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two, I am not asking you to drop everything you are doing and devote your time to becoming a diabetes care advocate full time. From a strictly practical viewpoint, there will always be potential diabetics with little or no access to healthcare and/or no motivation to participate in managing their condition. So, we can’t save the world. But, you can do a few things that I believe make sense. Think about diabetes diagnosis and management Diagnosis/monitoring/both Both Both Both Both Both Both Monitoring

as more than a lab problem. Vital signs and lab both play a role and you have outstanding suppliers of both product categories to help. From my perspective, it’s worth assessing your customer and prospect base to look for practices with the right patient mix, mind set and personnel to consider initiating or improving their glycemic management program. I would then link up with my best vital signs and lab suppliers and put together a simple story and easy-toimplement program locally. Most distributor home office category teams may have already put together a template to use. It’s worth your time to make sure your best prospects also know about the MACRA implications and best practices regarding glycemic management and control. A list of CMS Core Quality Measures can be found by following the link in this article. https://www.cms.gov/ Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Downloads/ACO-and-PCMHPrimary-Care-Measures.pdf Every big job is really just a collection of smaller activities that are thoughtfully implemented to create a strong solution. Can we solve the challenge of diabetes incidence and health care impact over night? No, but we can take a series of small but meaningful steps to make an impact. Working hand in hand with the supplier community and your key physician practices, you can make a difference.

DEDICATION makes all the difference. With Terumo SurGuard®3, we make some great points. Partner with us to start delivering them to your customers. As specialists in alternate care, Terumo offers you and your customers a high-value partnership. With best-in-class products, innovative support solutions and a proven track record of identifying customer needs, we help you create better sales – and better relationships. Start by experiencing the benefits of our SurGuard®3 safety hypodermic needle. Sharper – Patients benefit from a more comfortable injection, as our needles are 10%* sharper than the market leader Safer – Safety mechanism includes a lock for both the needle and the hub, and is designed to minimize the ability to be removed Smarter – Clinicians can choose how they activate the safety mechanism using their finger, thumb or hard surface as dictated by the clinical situation

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Continuous Glucose Monitoring Why CGMs may help patients and caretakers better manage diabetes

h, the fingerstick. People with diabetes know it well. One fingerstick and a blood glucose meter, and they know their blood glucose concentrations, at least at that moment in time, and whether they need to address it, e.g., with sugar or insulin. But fingersticks hurt. They take time. Theyâ&#x20AC;&#x2122;re a little cumbersome. And really, how many times a day is a person with type 1 or type 2 diabetes going to stick his or her finger? And what about nighttime â&#x20AC;&#x201C; probably the scariest time of day for people with diabetes? Well, the fingerstick may never go away entirely. But it may have to take its place next to a newer technology: continuous glucose monitoring.

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What it is Continuous glucose monitoring automatically tracks blood glucose levels – also called blood sugar – throughout the day and night. Since March 2018, the U.S. Food and Drug Administration has approved at least three CGM systems for marketing in the United States. Most people who use CGMs have type 1 diabetes, though use of CGMs by people with type 2 diabetes is expected to grow, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. Traditional blood glucose meters allow the person to see his or her level at a glance. They can also trend their glucose concentrations over a few hours or days. But seeing continual glucose levels throughout the day with a

“Because the devices show trends, CGMs can alert the patient even before hypoglycemia occurs.” CGM can help people make more informed, timely decisions about how to balance their food, physical activity and medicines, according to NIDDK. A CGM works through a tiny sensor inserted under the skin, usually on the belly or arm. The sensor measures interstitial glucose level, which is the glucose found in the fluid between the cells. The sensor tests glucose every few minutes. A transmitter wirelessly sends the information to a monitor. The monitor may be part of an insulin pump or a separate device, which might be carried in a pocket or purse. Some CGMs send information directly to a smartphone or tablet. So, if you’re talking about a child with diabetes, his or her parents can view what’s going on at all times and advise the child on what to do next.

280 readings a day Blood glucose testing is the common way to test response to therapy, whether to intensify or de-intensify treatment, and to avoid the risk of low blood sugar, says

What is an artificial pancreas? The “artificial pancreas” you may be hearing about is not necessarily what you think. It does NOT involve biomaterial, synthetic or artificial tissue or organs. But it does replace reliance on 1) fingerstick testing or 2) continuous glucose monitoring systems and 3) separate, non-integrated delivery of insulin by shots or pump. An artificial pancreas monitors blood glucose levels around the clock (continuous glucose monitoring), and automatically adjusts the delivery of insulin to reduce high blood glucose levels and minimize the incidence of low blood glucose. Little or no input is required from the patient. The system can be monitored remotely, for example, by parents or medical staff. In September 2016, the U.S. Food and Drug Administration approved the first “hybrid closed-loop system” – the Medtronic MiniMed 670G System – for people with type 1 diabetes. The system tests the glucose level every 5 minutes throughout the day and night through a CGM, and automatically gives the person the right amount of basil insulin – a longacting insulin – through a separate insulin pump. The person still needs to test his or her blood with a glucose meter a few times a day. And they will manually adjust the amount of insulin the pump delivers at mealtimes and when a correction dose is needed. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has funded – and continues to fund – several studies on different types of artificial pancreas devices to better help people with type 1 diabetes manage their disease.

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Diabetes HbA1c testing: A must Even as continuous glucose monitoring systems gain in popularity, the need for HbA1c testing remains strong, says Guillermo Umpierrez, M.D., CDE, chair of the American Association of Clinical Endocrinologists’ Diabetes Disease State Network, and professor of medicine, Emory University. That’s because continuous glucose monitoring shows blood glucose levels on a daily basis, whereas HbA1c looks at average blood glucose control over the past 90 to 120 days. The American Diabetes Association puts it this way: “In some ways, the A1C test is like a baseball player’s season batting average; it tells you about a person’s overall success. Neither a single day’s blood test results nor a single game’s batting record gives the same big picture.” “HbA1c is the best tool we have to measure the effects of therapy,” says Umpierrez. Patients with high HbA1c levels are at increased risk of retinopathy, kidney disease and neuropathy, he adds.

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Guillermo Umpierrez, M.D., CDE, chair of the American Association of Clinical Endocrinologists’ Diabetes Disease State Network, and professor of medicine, Emory University. People with type 1 diabetes may need to test as frequently as four to eight times daily; those with type 2 who take insulin perhaps two to four times; and those with type 2 who do not take insulin, perhaps one to two times per week. While very effective, blood glucose testing can be expensive, with the cost of the strips representing a significant cost to the overall care of the patient, he says. “But perhaps its biggest shortcoming is that glucose meters tell you how your blood sugar is doing at the time of testing, which may not represent the average glucose concentration during the day. CGM has been shown in clinical studies to be a better way of controlling diabetes in patients with type 1 and type 2 diabetes than point-of-care testing, says Umpierrez. It can significantly reduce the risk of hypoglycemia and may decrease the risk of diabetic emergencies. “Most of these devices check blood glucose every 5 to 15 minutes, so you have about 280 blood sugar readings a day, instead of just a few times per day,” he says. “Because of that, the CGM devices are able to provide a better glucose assessment throughout the day.” Some CGM systems have alarms, which sound when blood glucose is too low or too high. “For those treated with insulin, our main concern is hypoglycemia,” he says. “Because the devices show trends, CGMs can alert the patient even before hypoglycemia occurs. “The hazards of hypoglycemia at night are recognized; but nocturnal hypoglycemia is less recognized during the day, because the body doesn’t respond the same at night as during the day. Alarms are very, very helpful, not only for patients, but for caretakers, spouses or parents.” Some CGMs – referred to as professional CGMs – are sold directly to physicians. The patient wears one for 10-14 days, then brings it back to the office for review by the physician. The other type of CGM is the personal CGM, which patients own and with which they conduct their own monitoring. (They may share data with their physician via a Bluetooth connection.) “The other area where our group is investigating CGMs is in the hospital,” says Umpierrez. In the hospital, most patients with diabetes are being treated with insulin, so hypoglycemia is common. Testing with CGM in the hospital can help improve the overall care of diabetes.

Fewer than 20 percent of primary care providers are familiar with continuous glucose monitoring.

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Diabetes

The downside of CGM systems? They are expensive, and, while frequently covered by insurance for people with type 1 diabetes and insulin pumps, not so much for those with type 2, he says. “Also, there is a lack of education on continuous glucose monitoring and its benefits,” he adds. “Unfortunately, primary care providers have not used CGM as frequently as they should. In fact, fewer than 20 percent of primary care providers are familiar with it. So we still have a lot of education to do.”

“If I’m in a meeting or something, I don’t have to be thinking about my blood glucose level all the time.”

Peace of mind CGMs can help a lot of people who have a hard time keeping their glucose levels in a safe range, says Matt Petersen, vice president of medical information, American Diabetes Association. That’s particularly true for those who take insulin. “Early on, people with diabetes generally have a fairly good sense of when their blood glucose is too low,” he says. “They may become sweaty, ill-tempered, confused. And they recognize these symptoms for what they are – low blood glucose. So they’ll do a check and see if they need to have something with sugar to raise blood glucose levels back up. “But that ability to detect approaching hypoglycemia tends to diminish over time. It’s called hypoglycemia

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unawareness. And it’s a problem, because you may think you’re doing fine, but you’re actually in a dangerous situation. Continuous glucose monitors can help with that.” The need for CGM is less obvious for people who are managing their type 2 diabetes with oral medications rather than insulin, he continues. That’s because they rarely experience the acute changes in blood glucose levels as those taking insulin. Many people with diabetes consider the most valuable asset of CGMs to be the alarms that alert them when their glucose levels are trending downward, says Petersen. That’s a bonus during the day. “If I’m in a meeting or something, I don’t have to be thinking about my blood glucose level all the time,” he says. And it’s especially reassuring at night, when people with diabetes can’t check their glucose levels with regularity. In short, CGMs can give people with diabetes some guidance and peace of mind. The ADA encourages primary care physicians to get the education they need in order to work with their patients on using continuous glucose monitors, says Petersen. “We know of many primary care providers who want CGMs to be more widely used,” he says. “As CGMs become easier to use, which is happening, providers will feel more comfortable prescribing their patients to use them.”

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Diabetes CGM: The players

Most oft-mentioned players in the continuous glucose monitoring market: • Dexcom Inc. (San Diego, California). The Dexcom G6® CGM System was cleared for marketing by the FDA in March 2018 for use as both a standalone CGM and for integration into automated insulin dosing systems. The system eliminates the need for fingersticks for calibration or diabetes treatment decisions. In June 2018, Dexcom announced that the U.S. Centers for Medicare & Medicaid Services updated its policy on mobile device compatibility for the Dexcom G5® CGM System , making it the first mobile-enabled CGM system for Medicare patients with diabetes that works to display and share real-time glucose activity. • Abbott (Abbott Park, Illinois). The Abbott FreeStyle® Libre system is a continuous glucose monitoring system consisting of a handheld reader and a sensor worn on the back of the upper arm. The FreeStyle Libre Flash Glucose Monitoring was approved for marketing by the FDA in September 2017, and was the first CGM system that could be used by adult patients to make diabetes treatment decisions without calibration using a blood sample from the fingertip. (That said, fingersticks are required for treatment decisions when the person sees the “Check Blood Glucose” symbol, when symptoms do not match system readings, when readings are suspected to be inaccurate, or when the person experiences symptoms that may be due to high or low blood glucose.) • Medtronic (Dublin, Ireland). The Guardian™ Connect was approved for marketing by the FDA in March 2018 for people with diabetes ages 14 to 75 years. The Guardian Sensor glucose levels are not intended to be used directly for making therapy adjustments, but rather to provide an indication of when a fingerstick may be required to measure glucose levels. All therapy adjustments should be based on measurements obtained using a home glucose monitor and not on glucose levels provided by the Guardian Sensor. •S enseonics Holdings Inc. (Germantown, Maryland). In June 2018, the Senseonics Eversense® became the first FDA-approved continuous glucose monitoring system to include a fully implantable sensor to detect glucose, which can be worn for up to 90 days. A sensor is implanted just below the patient’s skin by a physician. A fluorescent chemical coating on the outside of the sensor generates a small amount of light in response to the amount of sugar that is present in fluid under the skin (interstitial glucose). This light signal is converted into a glucose reading and transmitted wirelessly every five minutes to a compatible mobile device.

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Diabetes

Diabetes costs • The total estimated cost of diagnosed diabetes in 2017 is $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity. • For the cost categories analyzed, care for people with diagnosed diabetes accounts for one in four healthcare dollars in the U.S., and more than half of that expenditure is directly attributable to diabetes. • People with diagnosed diabetes incur average medical expenditures of $16,750 per year, of which approximately $9,600 is attributed to diabetes. • People with diagnosed diabetes, on average, have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes.

• Indirect costs of diabetes include increased absenteeism ($3.3 billion) and reduced productivity while at work ($26.9 billion) for the employed population; reduced productivity for those not in the labor force ($2.3 billion); inability to work because of disease-related disability ($37.5 billion); and lost productivity due to 277,000 premature deaths attributed to diabetes ($19.9 billion). • After adjusting for inflation, economic costs of diabetes increased by 26 percent from 2012 to 2017 due to the increased prevalence of diabetes and the increased cost per person with diabetes. • The growth in diabetes prevalence and medical costs is primarily among the population aged 65 years and older.

Source: Economic Costs of Diabetes in the U.S. in 2017, American Diabetes Association, https://doi.org/10.2337/dci18-0007

Basics on diabetes As we eat, the body breaks down the carbohydrates into blood glucose (also called blood sugar), which it uses for energy. Insulin is a hormone that the body needs to get glucose from the bloodstream into the cells of the body. In type 1 diabetes (affecting about 5 percent of people with diabetes), the pancreas does not produce insulin. With the help of insulin therapy and other treatments, even young children can learn to manage their condition and live long, healthy lives. In type 2 diabetes (about 95 percent of people with diabetes), the body does not use insulin properly. This is called insulin resistance. At first, the pancreas makes extra insulin to make up for it. But, over time it isn’t able to keep up and can’t make enough insulin to keep blood glucose at normal levels. Hypoglycemia is a condition that occurs when one’s blood glucose is lower than normal, usually less than 70 mg/dL. Signs include hunger, nervousness, shakiness, perspiration, dizziness or light-headedness, sleepiness, and confusion. If left untreated, hypoglycemia may lead to uncon-

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sciousness. Hypoglycemia (also called an insulin reaction) is treated by consuming a carbohydraterich food such as a glucose tablet or juice. It may also be treated with an injection of glucagon if the person is unconscious or unable to swallow. Hyperglycemia refers to excessive blood glucose. Fasting hyperglycemia is blood glucose above a desirable level after a person has fasted for at least eight hours. Postprandial hyperglycemia is blood glucose above a desirable level one to two hours after a person has eaten. Hyperglycemia can be a serious problem if left untreated, as it can lead to ketoacidosis (diabetic coma). Ketoacidosis develops when the body doesn’t have enough insulin. Without insulin, the body can’t use glucose for fuel, so the body breaks down fats to use for energy. Ketoacidosis is life-threatening and needs immediate treatment. Symptoms include shortness of breath, breath that smells fruity, nausea and vomiting, and very dry mouth. Source: American Diabetes Association

Diabetes apps: How effective are they? Of the hundreds of commercially available mobile phone applications for diabetes patients, just 11 have been researched, and just five have been associated with clinically significant improvements in levels of blood sugar control as measured by hemoglobin A1c (HbA1c) tests. They are: Glucose Buddy and Diabeo Telesage (for Type 1 diabetes), and Blue Star, WellTang and Gather Health (for Type 2 diabetes). That said, the study period was short – less than a year – so it’s difficult to determine the long-term impact of even those five apps. Researchers funded by the Agency for Healthcare Research and Quality (AHRQ) sought to understand the effectiveness of roughly 280 apps that may be used to support patient self-management of type 1 and type 2 diabetes. Common features of apps include the ability to measure HbA1c, as well capabilities to track shortterm blood glucose levels, medications, physical activity and weight. In addition to the five shown to improve levels of HbA1c, other apps studied were shown either to reduce episodes of blood sugar levels being too high or too low; reduce low blood sugar episodes while reducing triglyceride levels and improving treatment satisfaction; or

Common features of apps include the ability to measure HbA1c, as well capabilities to track short-term blood glucose levels, medications, physical activity and weight.

improve blood glucose levels, diabetes knowledge and self-care behaviors. However, evidence is lacking on the ability of apps for diabetes self-management to improve patients’ quality of life, weight, blood pressure or body mass index, the report concluded. AHRQ is a research agency of the U.S. Department of Health and Human Services. Its report on diabetes apps was developed through the agency’s Evidence-based Practice Center (EPC) Program. An article based on the evidence review was published in May in the Journal of General Internal Medicine.

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November 2018

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TELEMEDICINE

‘Broadband Everywhere’: FCC goal The American Hospital Association and the National

Association of ACOs were among the organizations voicing their support this summer for a proposed $100 million program to promote telehealth among low-income families and veterans, with a focus on services and applications delivered directly to patients outside healthcare facilities. Announced in August, the Federal Communications “Whether through Commission’s Connected Care remote patient Pilot Program would provide monitoring up to $5 million in funding to technologies or selected pilot projects that supmobile health port broadband connectivity applications that among patients and providers. can be accessed The agency accepted public on smartphones, comments on its proposal tablets, or other through Sept. 10. connected devices, “Whether through remote patient monitoring technolopatients are seeing gies or mobile health applicaimproved outcomes tions that can be accessed on and significant cost smartphones, tablets, or other savings through connected devices, patients high-tech care that are seeing improved outcomes can be delivered and significant cost savings directly to them through high-tech care that regardless of can be delivered directly to where they are them regardless of where they physically located.” are physically located,” the – FCC FCC wrote in its “Notice of Inquiry” on Aug. 3. “It is critical that all Americans have access to these connected care services – whether enabled by existing broadband technologies or next-generation technologies, such as 5G. However, many low-income Americans, particularly those living in rural areas, lack access to affordable or adequate broadband and thus might not have

the same opportunity to benefit from these and other advanced telehealth services.” In its proposal, the agency cited several telehealth-related success stories: • The University of Mississippi Medical Center (UMMC) partnered with a mobile broadband provider to remotely monitor diabetes patients in rural Mississippi via tablet computers. The pilot reportedly resulted in a marked decrease in blood glucose levels, early recognition of diabetes-related eye disease, and no diabetes-related hospitalizations or emergency room visits. • The Veterans Health Administration conducted a three-year remote patient monitoring program involving more than 43,000 veterans with conditions including hypertension, congestive heart failure, chronic obstructive pulmonary disease, depression, and PTSD. The program reportedly resulted in a 25 percent reduction in days of inpatient care and a 19 percent reduction in hospital admissions. • Louisiana-based Ochsner Health System launched a remote monitoring pilot program in 2015 that enabled patients to manage their hypertension via a smart watch. Program participants were more than twice as successful as non-participants in achieving their target blood pressure levels and showed improvement in patient engagement levels. While voicing its support for the pilot program, the American Hospital Association also encouraged the FCC to incentivize community-focused projects, rather than “oneoff ” projects driven by healthcare providers or telehealth companies. “By allowing rural healthcare providers to participate as a group, the Commission will encourage projects that have a wider geographic reach and thus are more likely to provide community-wide services,” said the AHA.

To learn more about the FCC’s proposed Connected Care Pilot Program, go to https://www.fcc.gov/document/fcc-seeks-comment-launching-connected-care-pilot-program

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New CPT Codes for Telemedicine Changes in Medicare reimbursement codes reflect the

government’s growing acknowledgement of the role that telehealth and remote patient monitoring are playing in patient care. Effective Jan. 1, 2018, the Centers for Medicare & Medicaid Services authorized separate payment for CPT 99091. (Prior to that time, it had been bundled with other CPT codes.) CMS defines CPT 99091 as: “Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/ or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time.”

Beginning in January 2019, the addition of three new CPT codes will expand physicians’ ability to bill Medicare for remote-patient-monitoring services. They are: CPT 99453: Remote monitoring of physiologic parameter(s), (for example, weight, blood pressure, pulse oximetry, respiratory flow rate) initial; setup and patient education on equipment use. CPT 99454: Device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days. CPT 99457: Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.

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November 2018

TRENDS

Improving Diagnoses A healthcare coalition aims to improve the quality of medical diagnoses A coalition of more than 40 healthcare and patient ad-

vocacy organizations have launched an effort to improve the quality of medical diagnoses, especially those that can result in patient harm. Researchers estimate that up to 80,000 deaths a year in U.S. hospitals can be attributed to inaccurate or delayed diagnoses, and that diagnostic errors affect 12 million adults in outpatient settings. ACT for Better Diagnosis™, an initiative of the Society to Improve Diagnosis in Medicine (SIDM), aims to improve the diagnostic process by calling on organizations to identify and spread practical steps to better ensure diagnoses are Accurate, Communicated and Timely. “Nearly everyone will receive an inaccurate diagnosis at some point in their life and for some, the consequences will be grave,” Paul L. Epner, chief executive officer and co-founder of SIDM, was quoted as saying. “Major improvement is needed to systematically identify how to improve diagnostic quality and reduce harm to patients.”

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Working in collaboration over several months, members of the SIDM-led Coalition to Improve Diagnosis – made up of national healthcare and patient advocacy organizations – identified initial obstacles they believe impede diagnostic accuracy, including: • Incomplete communication during care transitions. When patients are transferred between facilities, physicians or departments, important information can slip through the cracks. • Lack of measures and feedback. Unlike many other patient safety issues, there are no standardized measures for hospitals, health systems, or physicians to understand their performance in the diagnostic process, to guide improvement efforts or to report diagnostic errors. Providers rarely get feedback if a diagnosis was incorrect or changed. • Limited support to help with clinical reasoning. With hundreds of potential explanations for any

one particular symptom, clinicians need timely, efficient access to tools and resources to assist in making diagnoses. • Limited time. Patients and their care providers overwhelmingly report feeling rushed by limited appointment times. This poses real risks to gathering a complete history, which is essential to formulating a working diagnosis, and allows scant opportunity to thoroughly discuss any further steps in the diagnostic process and set appropriate expectations. • The diagnostic process is complicated. Limited information is available to patients about the questions to ask, or whom to notify when changes in their condition occur, or what constitutes serious symptoms. It’s also unclear who is responsible

for closing the loop on test results and referrals, and how to communicate follow-up. • Lack of funding for research. The impact of inaccurate or delayed diagnoses on healthcare costs and patient harm has not been clearly articulated, and there is a limited amount of published evidence to identify what improves the diagnostic process. Members of the coalition are taking action to improve the accuracy and timeliness of diagnoses, naming tactics like providing online tools that help physicians recognize and avoid diagnostic pitfalls and improving medical education for new practitioners, as well as tools to support patients as they seek to get a diagnosis. They will also develop tools that empower doctors, patients and caregivers to communicate test results in plain language.

Coalition members include: • ABIM Foundation • American Society for Health Care Risk Management •M edical Professional Liability Association •A lliance for Academic Internal Medicine • Association of American Medical Colleges •M edStar Health •A merican Academy of Family Physicians •A ssociation of Clinical Scientists •M idwest Alliance for Patient Safety •A merican Academy of Pediatrics •C hildren’s Hospital of Philadelphia •N ational Association of EMS Physicians • American Association for Clinical Chemistry •C onsumers Advancing Patient Safety •N ational Association of Pediatric Nurse Practitioners • American Association of Nurse Practitioners •C ouncil of Medical Specialty Societies •N ational Quality Forum •A merican Board of Internal Medicine • E CRI Institute • Patient-Centered Primary Care Collaborative

• American Board of Medical Specialties • Geisinger • Penn State Health (Hershey Medical Center) • American Cancer Society Cancer Action Network • Institute for Healthcare Improvement • Pennsylvania Patient Safety Authority • American College of Emergency Physicians • Intermountain Healthcare • The Permanente Federation, Kaiser Permanente • American College of Physicians • Johns Hopkins Medicine • Society of Bedside Medicine • American Health Quality Association • The Leapfrog Group • Society of Hospital Medicine • American Heart Association • Maryland Patient Safety Center • Society to Improve Diagnosis in Medicine • Massachusetts Coalition for the Prevention of Medical Errors • WomenHeart

Also participating in the coalition are federal liaisons, including the Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, and Veterans Health Administration.

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November 2018

TRENDS

Hospital-acquired conditions are down National efforts to reduce hospital-acquired conditions,

such as adverse drug events and injuries from falls, helped prevent an estimated 8,000 deaths and save $2.9 billion between 2014 and 2016, according to a report released this summer by the Agency for Healthcare Research and Quality. AHRQ estimates that 350,000 hospital-acquired conditions were avoided and the rate was reduced by 8 percent from 2014 to 2016. Federal experts note that the gains in safety among hospital patients echoed earlier successes, including 2.1 million hospital-acquired conditions avoided between 2010 and 2014. Examples of hospital-acquired conditions include adverse drug events, catheter-associated urinary tract infections, central-line-associated bloodstream infections, pressure injuries, and surgical site infections, among others. The Centers for Medicare & Medicaid Services has set a goal of reducing hospital-acquired conditions by

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20 percent from 2014 through 2019. Through the work of the Hospital Improvement Innovation Networks (HIINs), CMS provides quality improvement assistance to more than 4,000 of the nation’s 5,000 hospitals in the form of best practices in harm reduction. Once the 20 percent reduction goal is met, AHRQ projects that during 2015 through 2019, there will be 1.8 million fewer patients with hospital-acquired conditions, resulting in 53,000 fewer deaths and saving $19.1 billion in hospital costs from 2015 through 2019. Data in the new “AHRQ National Scorecard on Hospital-Acquired Conditions” shows that overall harms decreased in several categories, such as infections and adverse drug events, which dropped 15 percent from 2014 to 2016. Opportunities for further improvement exist for reducing some harms, such as pressure ulcers, which increased from 2014 to 2016.

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IDN OPPORTUNITIES

Cybersecurity Concerns Price, terms, service, warranties and fill rates have

long been the stuff of contract negotiations. Now, contracting professionals are adding “cybersecurity” to the list. “Cybersecurity concerns have heightened the importance of evaluating medical device vendors and service providers on their current and future cybersecurity management practices across the expected life of devices,” says Kent Petty, chief information officer, HealthTrust. “The avoidance of unexpected downtime, loss of functionality, or worse, harm to patients because of a cybersecurity event, makes the evaluation and negotiation of cybersecurity terms in purchasing agreements a top-of-mind focus.” Ross Carevic, director, technology sourcing operations for Vizient Inc., says, “A recent report from Symantec indicates some threat actors appear to be fine-tuning their attack tactics to more specifically target medical devices. While the exact intent is still unknown, it shows the changing tactics of threat actors and their

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willingness to probe deeper into medical systems to look for potential vulnerabilities.”

What’s the problem? It turns out that the strength of modern medical devices is also their weakness. “The interconnected medical device is critical in today’s diagnostic and patient treatment ecosystem, as it brings automation, accuracy and improved outcomes for patients and providers,” says Petty. “Unfortunately, many of these devices lack the basic security protections we have grown to expect from other systems connected to the hospital network. This puts interconnected medical devices increasingly at risk of cyberattacks that could affect patient care, safety, or data. “Additionally, these devices can be used as easy targets to gain a foothold into the hospital’s network to attack other non-medical systems,” he continues. “While

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IDN OPPORTUNITIES these indirect attacks may not directly harm a patient, the disruption to operations could affect the speed, accuracy, and overall delivery of patient care.” Examples of common cybersecurity-related risks include lack of support and/or timely release of security patches, the continued selling or use of unsupported operating systems (e.g., Microsoft Windows XP), and the overall lack of basic security controls within the device, including open services and ports that can be easily exploited by cyberattacks, says Petty. Historically, the U.S. Food and Drug Administration has been charged with providing reasonable assurance that the benefits of a medical device or technology to patients outweigh the risks, he says. With today’s net-

Patches “To date, medical devices haven’t been specifically attacked that we are aware of, but they have been impacted indirectly by exploits targeting the off-the-shelf software that the devices often utilize,” says Carevic. “As an example, the WannaCry virus quickly spread across unpatched Microsoft XP operating systems. This attack highlights a big debate in the industry about the frequency of regular software patches for medical devices.” Patching a medical device always carries some degree of risk because of its unintended impacts to device functionality, he says. “However, unpatched devices with offthe-shelf software are more vulnerable when a large virus outbreak occurs, so there needs to be a balance where patches can be tested and released on a defined schedule.”

“ The avoidance of unexpected downtime, loss of functionality, or worse, harm to patients because of a cybersecurity event, makes the evaluation and negotiation of cybersecurity terms in purchasing agreements a top-of-mind focus.” worked devices, that’s not so easy. “A medical device’s network connectivity and other cybersecurity risks adds to the device’s risk profile and complexity, and the responsibility falls to the manufacturers and providers to work together to remediate or mitigate these risks.” Given the number of medical devices that are networked and/or contain patient data, and the potential impact on patient health and safety, cybersecurity poses a big risk to providers, says Carevic. Common risks include default login credentials and unencrypted data storage and transfers, he says. The greater risks involve the failure to understand the medical device profile information, or the failure to identify the systems with which devices exchange information. Another risk is the failure to compile detailed device profile information of the deployed devices in advance of the next major cybersecurity exploit.

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Contracting implications

Healthcare providers can reduce their risks of cyberattack through attentive and informed contracting, according to those with whom the Journal of Healthcare Contracting (sister publication of Repertoire) spoke. But they’ll need help doing so. “Contract negotiators, along with IT and security teams, need to coordinate their efforts during the contract review and negotiation pro– Kent Petty cess to better identify the supportability and longevity of the underlying operating system and third party applications that are necessary for these devices to function,” says Petty. “During the sourcing and procurement process, they need to identify those medical devices that may run unsupported or with end-of-life operating systems, such as Windows XP. Doing so will call for collaboration with vendors, clinicians, IT and cybersecurity representatives.”

Manufacturers’ role Manufacturers can play a role in minimizing cyberattacks, says Carevic. “Suppliers can immediately help healthcare providers by acknowledging the issues and providing more information about their device designs and the proper controls that should be put in place when deploying and using their products in a safe and secure manner. Vizient is taking steps to request this type of information in new contracts

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IDN OPPORTUNITIES partnership and lead to discussions and RFPs going forward, but a lot of on mitigating associated risks well this information can be made availbefore they become an issue.” able from suppliers today.” Says Garrison Gomez, senior Manufacturers themselves are director of vitals and cardiology, prepared to work with providers. Welch Allyn, “IT has a more promi“Concerns about cybersecunent seat at the table than ever before rity are nothing new in the medical – and for good reason: No one wants industry,” says Chad Darling, senior to make front-page news with a data product manager, EMR business breach. They are engaging with vendevelopment, Midmark. “Our cusdors earlier and more often to make tomers primarily use various Security sure the technology selected aligns Risk Assessment questionnaires to with their security policies. Of course, understand the impact of software this means the CIO must partner to their organization. With cyberse– Ross Carevic closely with the CNO, informatics curity being an increasingly promiand other medical teams to make sure nent topic in the industry, we’re clinical needs and workflows remain prioritized. seeing those questionnaires becoming longer and more “At a minimum, [contracting professionals should] detailed. And, more organizations are using them than ask vendors about their methods for encryption, device what we’ve seen in the past. access control and cybersecurity patch release policies. “Using a Security Risk Assessment questionnaire early Understanding the opportunities and options for soluin the contracting process has been helpful for organizations that are both secure and offer high clinical usability tions to understand how the software functions and where should be an important aspect of the technology evaluapatient health information is stored and transferred. This tion process for connected medical devices.” can help identify potential security concerns early on in a

“Unpatched devices with off-the-shelf software are more vulnerable when a large virus outbreak occurs.”

Cybersecurity checklist Providers and manufacturers can work together to address current and future cybersecurityrelated issues for the life of the device, says Kent Petty, chief information officer, HealthTrust. Some points for contracting professionals to consider: • Require the vendor to disclose and discuss security-related features or vulnerabilities associated with the product or service the vendor seeks to sell into the healthcare system. • Clearly define a set of cybersecurity requirements within the contract that must be met before the device or technology is introduced in the facility, and independently validate that the vendor has met the requirements.

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• Ensure contract language requires manufacturers to maintain the cybersecurity of the device (e.g., timely patching, supported operating system version, etc.) over its expected lifespan. • Clearly define roles and responsibilities for addressing cybersecurity risks identified during the systems lifespan within the contract.

• When evaluating new products and/or vendors, include cybersecurity requirements in the scorecard to ensure they are a part of the purchase decision. • Encourage participation in vulnerability-sharing organizations (e.g., National Health Information Sharing and Analysis Center, or NH-ISAC) to bring added visibility and crowdsourcing to cybersecurity issues in a timely manner.

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IDN OPPORTUNITIES

AllSpire Health GPO: Bending cultures Five mid-Atlantic health systems Bringing about profound change within one organiza-

tion calls for time, deliberation and ultimately, hard decisions. Now multiply that by five organizations. Five years ago, a group of mid-Atlantic health systems began exploring a virtual network to accomplish things they couldn’t do independently, including group purchasing. In October 2016, AllSpire Health GPO was launched. The GPO is a spinPaul Tirjan out company from AllSpire

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Health Partners, and comprises five equity partners: Atlantic Health, Hackensack Meridian, Lehigh Valley Health, Tower Health and WellSpan Health. “In any collaborative venture involving health systems with a hundred years of entrenched culture, profound change in operations will have myriad issues and challenges,” says President Paul Tirjan. Building an organizational structure to enable large-scale, long-term collaboration was the first step.

Exclusive management agreement For group purchasing, the health systems decided to pursue a business partnership with an existing GPO, and after issuing multiple bids, signed an exclusive

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IDN OPPORTUNITIES management agreement with HealthTrust Purchasing Group. That in itself required some doing, as four of the five members at the time had to switch from their current GPO to HealthTrust. “While there were many contributing factors, the primary driver of the decision to contract with HealthTrust collectively was leveraging the aggregated purchasing power of their 1,600 hospital clients enhanced by the committed model and further enhanced by our regional consolidated purchasing,” says Tirjan. “Some of the longer-term benefits of this approach are the integration of supply chain decision-making into both

be it cardiology, surgery, nursing, etc. Each collaborative meets regularly, either in person or via conference call, and makes its recommendations to the AllSpire Health GPO Operating Committee, which is comprised of health system heads of supply chain, as well as the national advisory groups at HealthTrust. In its first year of operation, AllSpire Health GPO achieved $57 million in savings and distributed $13 million back to its members in excess administration fees, says Tirjan. That $70 million in first-year annual value, returned on an aggregate investment of $7.5 million in both AllSpire Health Partners and AllSpire Health GPO, equates to an internal rate of return of 91 percent, he points out. “By the end of our second contract year, the annual benefit will exceed $100 million, and the IRR will exceed 110 percent.” One of the GPO’s biggest successes thus far has been a pharmacy benefit management agreement. Four out of the five systems contracted with a national vendor, resulting in $27 million in savings – Paul Tirjan for CY 2018.

“ In any collaborative venture involving health systems with a hundred years of entrenched culture, profound change in operations will have myriad issues and challenges.” strategic and clinical initiatives at AllSpire, which would be impractical with disparate vendor selection in major spend categories.” The agreement with HealthTrust calls for AllSpire members to buy 80 percent of products and services (by value) in defined categories from GPO-contracted vendors. “This allows for some discretionary spending, but also implies a significant amount of conversion to new product and service vendors,” says Tirjan. “An in-depth analysis of the projected disruption and savings was conducted to ensure all members were comfortable with the cost-benefit trade-offs. “Some of the greatest complexities arose from synchronizing processes from legacy GPO vendors into standard formats and managing varied contract termination dates,” he adds. Value analysis teams from each of the health systems designate a delegate or delegates to serve on one of the AllSpire Health GPO Collaboratives, which are advisory councils of subject-matter experts who coordinate the acquisition of products and services within their specialty,

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Regional contracting Many categories of spend – particularly in purchased services – are not covered in the HealthTrust portfolio, Tirjan says. There are also new, emerging fields, for which traditional multi-bidder processes are not possible or where there is no spend history to evaluate. In some cases, the AllSpire staff and the collaborative teams directly evaluate the vendors and products, and in other cases, they retain an outside consulting firm to issue an RFP and conduct a larger scale process (as occurred with the pharmacy benefit management agreement). Over the next one to two years, Tirjan expects AllSpire Health GPO to build a broad portfolio of AllSpiregenerated contracts to complement those of HealthTrust, including new categories of spending. In addition, the GPO intends to expand its purchasing power by adding new equity members within its region, as well as nonequity members (called Joint Participants). “Our first two years has been about getting our operations running smoothly,” says Tirjan. “We have established a track record, and we think we will be attractive to a lot of folks.”

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WINDSHIELD TIME Chances are you spend a lot of time in your car. Here’s something that might help you appreciate your home-away-from-home a little more.

Automotive-related news

Hey, did you happen to see the most beautiful electric car in the world? The idea of a removing the “XK” inline-six engine from an early Jaguar E-type and replacing it with an electric motor might sound like sacrilege. Yet that’s exactly what Jaguar Classic did in creating what it calls the E-type Zero, reports Car and Driver. And it’s looking good. Jaguar Classic will offer the conversion for vintage E-types and will also sell restored E-types with batteries under the bonnet in the same way that it sells factory-restored “Reborn” E-types with their original powertrain. Says Car and Driver, “We’ve now driven the E-type Zero, and we must admit that, for an apostasy, it works surprisingly well.” Jaguar claims a range of 200 miles in optimum conditions and around 125 miles in regular use. Fast charging isn’t supported – it would have required active battery cooling, which would have added an unacceptable level of complexity and weight – but the Zero’s likely role as a sometime toy rather than everyday transport means that a 7.0-kW onboard charger capable of replenishing the battery pack in about five hours when connected to a 240-volt source is reckoned to be adequate; that will take longer from a standard 120-volt household outlet. “To our surprise, the lack of any combustion noise is not the deal-breaker we feared it might be,” according to Car and Driver. “The motor produces a characteristic

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electric whine under harder acceleration, but the nearly silent running actually well suits the car’s relaxed dynamic character at low speeds.”

Digital license plates Like phones, books and cars before them, license plates may soon go smart. Several companies, notably California-based Reviver Auto, are trying out digital license plates, a development that could save resources and even help police locate stolen vehicles, and may also turn cars into small-scale billboards. Reviver’s digital plate, currently being tested in a California pilot program, can be validated via cellular signal when drivers pay registration fees, meant to save states on postage and materials for paper renewals, according to The New York Times. Additionally, the plates can change to indicate if a vehicle is stolen, and they can also flash Amber Alerts. An RFID tag can be used to pay tolls, substituting for an E-ZPass. And when the car is parked, businesses can display advertisements on the plate, using GPS to target the ad to that specific geographic area. The RPlate, as Reviver’s model is known, uses the same E Ink technology that tablet book readers like Kindle and Nook use. The current RPlate model is out of most consumers’ price range – $699 for the plate itself, plus additional yearly fees to connect to Reviver’s cellular network – but the company aims to eventually lower the cost to $150.

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HEALTHY REPS

Health news and notes Some hope for MS Certain drugs could help repair nerve damage caused by multiple sclerosis. Researchers at Case Western Reserve University, the New York Stem Cell Foundation Research Institute and George Washington University collaborated on a study to find how the antifungal drug miconazole activates stem cells to repair damage to myelin, the lining that insulates nerves in the brain and spinal cord. Myelin damage causes interruptions to nerve cell communication, leading to muscle weakness, vision and coordination problems, and other MS symptoms. The research team found that miconazole and similar drugs block the enzyme CYP51. Doing so encourages stem cells to form new oligodendrocytes, cells that create myelin coatings. The findings were published in July in Nature Methods. Read about it in an article from the National Institutes of Health, which funded the study.

Gestational diabetes and blood tests Other NIH-supported research shows that early-pregnancy blood tests may help identify women at risk for gestational diabetes. The condition occurs during pregnancy when blood sugar levels rise too high, and it increases the mother’s chances of developing other health issues down the line, like high blood pressure disorders of pregnancy and type 2 diabetes later in life. Researchers used the HbA1c (or A1C) blood test, which is used to diagnose type 2 diabetes, for the study. They analyzed test records, taken from the National

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Institute of Child Health and Human Development Fetal Growth Study, of 107 women who later developed gestational diabetes and 214 women who didn’t. Women who went on to develop gestational diabetes had higher HbA1c levels (an average of 5.3 percent), compared to those without gestational diabetes (an average HbA1c level of 5.1 percent). Each .1 percent increase in HbA1c above 5.1 percent in early pregnancy was associated with a 22 percent higher risk for gestational diabetes. “Our results suggest that the HbA1c test potentially could help identify women at risk for gestational diabetes early in pregnancy, when lifestyle changes may be more effective in reducing their risk,” said Cuilin Zhang, the study’s senior author. The findings were published in Nature Scientific Reports. Read about it in this NIH article.

Nothing to hit but the heights Virtual reality may help people overcome their fear of heights. The findings, published in July in The Lancet, mean that with further research, virtual reality could be used as an affordable tool for mental health treatment. The research team at the University of Oxford studied a sample of 100 adults who scored more than 29 on the Heights Interpretation Questionnaire. Fortynine of those people then underwent the experimental treatment, a virtual reality program that had participants accompany a “virtual coach” (named Nic) through a 10-story office building where they completed a series of tasks. These tasks, which included things like rescuing a cat from a tree and playing a xylophone near the

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HEALTHY REPS edge of the floor, became more difficult as users progressed through the program. All of the virtual reality participants reported a reduction in fear of heights following the treatment, and by the time researchers followed up, 34 of those participants (69 percent of the group) fell below the entry criterion on the HIQ, compared with none in the control group.

Gym class memories Finally, the way you felt about gym class as a kid could affect the way you feel about exercise now. Researchers at Iowa State University surveyed 1,028 adults about their experiences with physical education during primary and secondary school and their exercise habits today. They found that survey participants who enjoyed gym class when they were younger were Random choosing more likely to exercise of teams, for now – and enjoy it – than participants who example, could didn’t like gym class. help decrease The reasons parembarrassment ticipants didn’t enjoy gym from being the last class most often had to do with embarrassment, one picked. And whether from being chononcompetitive sen last for sports teams physical activities, or from being made to like dance or yoga, feel incompetent by PE teachers or classmates. On might help students the flip side, the people learn to enjoy who enjoyed gym class exercise more than often enjoyed the activiteam sports can. ties and the opportunities to spend time with peers. While the results show correlation, not causation – it could be that nonathletic students didn’t enjoy gym class – the study authors believe PE teachers could learn from this. Random choosing of teams, for example, could help decrease embarrassment from being the last one picked. And noncompetitive physical activities, like dance or yoga, might help students learn to enjoy exercise more than team sports can. “It would be great if P.E. classes could teach kids that moving is fun,” lead study author Matthew Ladwig told The New York Times, which were published in the Translational Journal of the American College of Sports Medicine.

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Overloaded The Cheesecake Factory’s Breakfast Burrito was named the “Worst Way to Start the Day” in this year’s Xtreme Eating Awards by the Center for Science in the Public Interest. The tortilla is filled with scrambled eggs, bacon, chicken chorizo, cheese, crispy potatoes, and several additional ingredients. It features 2,730 calories—more than a day’s worth—and 73 grams of saturated fat. It’s like eating seven McDonald’s Sausage McMuffins, according to CSPI, and it’s served all day. Other notables this year include Chili’s Honey-Chipotle Crispers & Waffles; the Uno Pizzeria & Grill Deep Dish Buffalo Chicken Mac & Cheese; and Shake Shack’s Double SmokeShack. Jane E. Brody outlines the significance of the awards, including the epidemic proportions of obesity in America, in a New York Times article.

Maternal morbidity on the rise The rate of severe maternal morbidity at delivery increased 45 percent from 2006 through 2015, from 101.3 to 146.6 per 10,000 delivery hospitalizations, according to the Healthcare Cost and Utilization Project’s September report on “Trends and Disparities in Delivery Hospitalizations Involving Severe Maternal Morbidity” from 2006 through 2015. Severe maternal morbidity includes unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health, the report explains. These deliveries generally involve lifethreatening conditions such as acute myocardial infarction, pulmonary embolism or sepsis. Other findings highlighted in the report: • Severe maternal morbidity was highest among women 40+ years old and lowest for those 20-29 years old – 248 and 136 per 10,000 deliveries, respectively. • On average, Black mothers were younger than White mothers. Yet the rate of severe maternal morbidity was 112-115 percent higher for Blacks than for Whites in 2006 (164 vs. 76) and 2015 (241 vs. 114), with no change in the Black-White disparity. • Hispanics and Asian/Pacific Islanders also had higher rates of severe maternal morbidity than Whites in both years, but disparities decreased over time.

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SMART SELLING

DISTRIBUTOR SALES STRATEGIES FROM HIDA

To Grow Sales, Cultivate Empathy Some people are naturally empathetic – they easily sense and understand other people’s

perspectives. If you’re one of those people – congratulations! But if you’re not, no worries – you can cultivate your own ability to empathize.

Why is empathy so valuable in sales?

By Elizabeth Hilla, Senior Vice President, HIDA

Understanding your customer or prospect’s perspectives and reactions is the secret sauce for many successful sales reps. Empathy allows you to: •E motionally connect with your customers because they see that you “get them.” • Anticipate likely objections to your proposal, and either address them in advance, or be prepared to respond when the objections arise. • Know what’s likely to confuse your client, so that you can think about how to communicate concepts in a simpler way. • Understand how much detail the customer wants to hear, and avoid going too deep and/ or talking too much. • I dentify what’s really important to your customer.

How do I become more empathetic? As you prepare for your sales call, try to imagine what’s going on with your customer, and how he or she is likely to respond to your message. Start by stepping into their shoes, in your own mind. Imagine what it’s like to be that person. If you were a nursing home administrator, for example: •W hat would your average day be like? • What would your biggest concerns and problems be? •W hat kind of everyday aggravations might be stressing you out?

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Now, imagine being that administrator and listening to your sales pitch. Where does this solution stack up in terms of your other priorities as an administrator? By thinking through the customer’s perspective – stepping into their shoes – you will likely think of ways to make your solution more relevant, and to make sure you come across as a sales rep who is trying to help them solve a problem, not just sell something. Your sales call might begin with a question tailored by this thinking: “Amanda, you have a heck of a big job here – so many things to accomplish and never enough staff to get it all done, am I right?” If appropriate, that might lead into

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a conversation about your solution, for instance, a new time-saving distribution service. During the sales call itself, your eyes and your ears are your best tools for empathy. •A sk questions, and really listen to the answers rather than thinking about the next step of the call. •W atch the customer’s body language as well – does he or she appear interested? Confused? Resistant? The empathetic salesperson uses these clues to coursecorrect through the sales call.

Use your experiences Your experiences with other customers can also help you be more empathetic. What questions or objections have other similar customers raised? Let’s say you think a physician practice could really benefit from doing a particular diagnostic test on site, but that the product requires a

By thinking through the customer’s perspective – stepping into their shoes – you will likely think of ways to make your solution more relevant, and to make sure you come across as a sales rep who is trying to help them solve a problem, not just sell something. trained staff person to run it, and that often arises as an objection. An empathetic salesperson can anticipate the customer’s concerns, and even bring them up proactively. “Clare, I think your patients would really benefit from having EKG testing here on location rather than being sent to a specialist. However, if I were in your shoes, I’d be worried about the amount of staff time involved. Would you like to take a look at it together to see if it makes sense?” Empathy is particularly essential when you’re dealing with a service problem. For example, the customer calls to tell you that a delivery didn’t arrive, or wasn’t complete. An empathetic response like, “Juan, I don’t blame you for being frustrated. I’d be mad too if I didn’t get the product I ordered,” can help diffuse the anger while showing the customer you feel their pain as you move quickly to solve the problem. Work hard to cultivate empathy. Imagine yourself in the customer’s seat. It helps you connect, build relationships, and show customers that you understand them.

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November 2018

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What causes surgical smoke and what does a smoke evacuation system do? Electrosurgery generators are today’s standard of care for providing the energy needed to cut and coagulate tissue. Generators convert electricity into energy, which travels through a pencil/handpiece to the electrode at the surgical site. Surgical smoke, also known as a plume, occurs when electricity and tissue meet. A smoke evacuation system pulls smoke plumes from the surgical site, via tubing, into a filter, thus capturing particles that otherwise would be dispersed into the air and inhaled by the OR staff and patient.

What are the risks of surgical smoke? Surgical smoke contains multiple components that are known health hazards, such as benzene, toluene, hydrogen cyanide, formaldehyde, volatile organic compounds, viruses and bacteria. In fact, the inhalation of surgical smoke can lead to the passage of human disease to those who breathe it. AORN Journal, Back to Basics: Protection from Surgical Smoke, July 2018, Vol. 108, No. 1

Are smoke evacuation systems mandatory? The state of Rhode Island recently passed legislation mandating the use of smoke evacuation systems in operating rooms, which will be effective January 1, 2019. There are

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several other bills in various states of consideration in other states, and we anticipate other states joining Rhode Island and passing similar bills to regulate surgical smoke to protect surgeons, staff, and patients. Further, the National Institute for Occupational Safety and Health (NIOSH) has called attention to the dangers of surgical smoke and urges facilities to, “Evacuate all smoke, no matter how much is generated.”

Who currently uses smoke evacuation systems? Any surgeon who performs a procedure with an electrosurgical instrument would benefit from using a smoke evacuation system. Among the most frequent users of smoke evacuation systems are facilities and surgeons who perform OB-GYN procedures, such as the LEEP (Loop Electrical Excision Procedure. This procedure is performed by using a speculum to open the vaginal canal, using a colposcope to view the cervix, and then using a loop electrode to remove a thin layer of the cervix for testing in the lab. Without a smoke evacuation system, it would be nearly impossible for the surgeon to see the cervix through the smoke resulting from the loop electrode’s use. Perhaps more importantly, the plume from this procedure is typically laden with viral particles, so not only does it put the procedure’s efficacy at risk, but it also risks the surgeon’s health.

Other users of smoke evacuation systems include operating rooms in ambulatory surgery, acute facilities, surgery centers and physician offices/clinics.

Why should your customers be concerned about filter life? Replacing filters is one of the largest recurring expenses associated with smoke evacuation systems. That expense will lead your customers to insist on a filter that provides the greatest number of hours of use. Bovie’s filter is very effective in this respect, lasting 35 hours and providing a color-coded lifecycle countdown to help track replacement timing. The simple green, yellow, red signal ensures that staff is aware as a filter reaches the end of its life cycle so they can have additional filters ready. When the red light is showing, this means that the unit has depleted the filter life and it will no longer activate, so additional filters should always be on hand.

Using customized settings to enhance filter life: Some smoke evacuation systems allow users to select the proper setting for each procedure, such as High, Med and Low. These settings are helpful because they can ensure the proper power levels are utilized and filter life is extended. For example, if the clinician’s most common procedures produce a light amount of smoke plumes, they would choose a Low setting. However, if the most common procedure is a tummy tuck that would cause a greater amount of smoke plume, they would utilize a High setting. Each setting changes the life cycle of the filter. For example, the filters on the Bovie® Smoke Shark II will have varying life cycles depending on the setting used: • High - 18 hours • Med - 24 hours • Low - 35 hours

Using other methods to enhance the filter life: Using an accessory such as Bovie’s “Remote Switch Activator” will also help extend filter life by ensuring that the system is only utilized when needed, not constantly. Typically, the smoke evacuator may run during the entire procedure, or until it is manually turned off. If the procedure involves removing a mole or skin tag, the filter may need to run only a minute. But if the physician is performing a C-section, breast augmentation or other time-consuming procedure, it will require more smoke evacuation time.

The length of the procedure is one of the factors that determines the filter life. The Remote Switch Activator acts as the physician’s personal assistant. When he or she activates the generator’s pencil or handpiece to cut or coagulate, the activator starts the smoke evacuation system. When the physician releases the pencil/handpiece activation the smoke evacuation system is shut down – potentially extending the filter’s life.

Quiet please Many customers have complaints about the amount of noise generated by their current evacuation systems. Bovie’s system omits a low noise level, allowing the clinician to perform procedures with limited distraction and potentially a greater degree of focus on the patient.

When choosing a smoke evacuation system, your customers should check for these 4 things: •F ilter Life – This could be a costly mistake if the wrong system is purchased. Bovie® filters have a 35-hour filter life on Low setting, among the longest in the industry. • Customizable Settings – Customized settings allow users to engage the smoke evacuation system to operate based on intended procedures, using the right degree of power and potentially extending filter life. • Accessories that Enhance Filter Life – The Bovie® Remote Switch Activator accessory provides clinicians with the ability to activate the evacuation system only when cutting or coagulating – preventing the filter from running during the entire procedure and enhancing filter life. •N oise Reduction - Your customers should ask to listen to every unit prior to purchase. Preventing distraction during delicate procedures is imperative. For more information about smoke evacuation: • Download Smoke e-book www.boviemedical.com/ ebook-addressing-surgical-smoke •L earn more about Bovie® Smoke Shark visit: www.boviemedical.com/smoke-shark-ii/ •C ontact your local Bovie® sales rep @ info@symmetrysurgical.com

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Sofia 2 Lyme FIA: CLIA-waived Results in minutes, not days. Diagnosing Lyme disease is hard. Symptoms are broad and generic, mimicking many other conditions. Patients feel horrible and want answers. It doesn’t help that current testing methods may take hours or days for results. Not anymore! Sofia 2 Lyme FIA uses a fingerstick whole blood sample to provide accurate, objective and automated results in as few as 3 minutes, getting doctor and patient on a path to treatment much sooner. Sofia 2 Lyme FIA is the only rapid, near-patient testing solution that provides IgM and IgG differentiated results in a single test. It has demonstrated accuracy on par with current testing methods — all with less than 1 minute hands-on-time. And as you’ve come to expect from Sofia 2, our Lyme assay functions in WALK AWAY and READ NOW modes, providing flexible workflow options based on your needs.

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HIDA GOVERNMENT AFFAIRS UPDATE

Insights for the 2018-19 Flu Season The 2017-18 flu season was one of the worst in recent memory, with more than

By Linda Rouse O’Neill, Vice President, Government Affairs, HIDA

700,000 hospitalizations. The Centers for Disease Control and Prevention has warned the public to prepare for another potentially bad flu season this year. For the 2018-19 season, manufacturers are stepping up vaccine production. The Advisory Committee on Immunization Practices (ACIP) has also reversed its position held for the previous two seasons on the nasal spray vaccine and has endorsed its use for some cases. Physician offices remain the most popular location for consumers to receive vaccines, although more people are getting the flu shot at pharmacies or stores. HIDA just released its annual Influenza Vaccine Production & Distribution Market Brief. In addition to covering the above developments, the report contains projections for this year’s flu season, distributors’ perspectives, and a look at data from the 2017-18 season. Here are a few key insights from the report: Children were hit especially hard by last year’s flu. Only the 2003-04 and 2009-10 flu seasons were more severe for children, based on data review dating back to 2003. Last year’s flu season was also the first time all three age groups monitored for the disease were classified as “high severity.” The severity of the flu season surprised many experts, and even prompted Congress to examine the country’s readiness.

Influenza Season Severity Classification, By Age Group And Season Manufacturers predict increase in vaccine production. Manufacturers predict between 163 million and 168 million doses of flu vaccine will be produced for the 2018-19 flu season. They expected to produce between 151 million and 166 million last year. As of May 3 of this year, manufacturers report having shipped approximately 155.3 million doses of flu vaccine.

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Influenza Vaccine Doses Distributed In The United States, By Season Pharmacies and stores see uptick in flu vaccinations. The share of adults receiving the flu vaccine at pharmacies or stores was 28.2 percent in 2017, up from 24.3 percent in 2016. The doctor’s office remains the most popular location to receive the flu shot, with 64.6 percent of children and 34.7 percent of adults receiving the vaccine in this setting.

Place Of Flu Vaccination (%) For Children And Adults Changes to quality reporting offer an opportunity to suppliers. As part of its annual Medicare reimbursement update, the Centers for Medicare and Medicaid Services has included influenza immunization as a measure for several providers’ quality reporting programs. If providers fail to report on these measures, their Medicare payments may be cut. While this provides an opportunity for distributors who carry the flu vaccine and related supplies, the Trump Administration’s efforts to reduce regulatory burdens may remove immunization measures from some providers’ reporting in the future. The insights contained in the 2018 report cover demand trends and useful customer information. HIDA will continue to monitor vaccine and medical product demand as part of its efforts to strengthen the healthcare supply chain and foster effective responses to infectious disease.

To download your copy of the flu report, visit www.HIDA.org/FluBrief. Feel free to contact us at HIDAGovAffairs@HIDA.org if you have any questions or would like more information.

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corner

Tough Enough Selling copiers wasn’t a bad way for Dan Walsh to learn about sales

Playing college soccer was good training for a competi-

tive career in medical sales for young Dan Walsh, region account manager, Henry Schein. After all, a large part of sales is competition, particularly in the earliest stages of one’s career, he says. And if college athletics wasn’t enough, selling copiers for IKON Office Solutions was. “The copier world is tough,” he says. “At IKON, there were 20 other guys just like me. Young guys with the same mentality. You’re cold-calling, trying to set yourself apart. You’re hitting as many doors as you can, getting your card in as many people’s hands as possible. And if you do get to bid, there are seven other guys doing the same. “The longer you stay with it, though, the tougher you get. You don’t win every deal, but you learn all the time. It was a great experience right out of college.” Walsh was born and raised in Springfield, Missouri. His father, Denny Walsh, worked in sales and other aspects of the food and grocery industry. His mother, Lindsay, raised Dan and his brother, Michael. When he graduated with a business degree from Benedictine College in Atchison, Kansas, “I had no idea what was ahead,” he says. “Sales was a profession my dad knew I would enjoy,” he says. “Being a competitive person and playing sports all my life – it felt like a great fit.” “Hustle and learning to fail were two lasting impressions from my experience at IKON,” he says. “It was no

easy first job, but it instilled the values of learning how to sell, [thinking in terms of] processes, and creating value for customers.” After two years at IKON (which was acquired by Ricoh in 2008), he was an account manager for DHL Express, selling logistics services. “It was a different kind of sale,” he says. “There weren’t as many competitors,” but what competitors there were – i.e., UPS and FedEx – were big ones. “You have to set yourself apart, market yourself,” he says of the DHL experience. “And once you get the opportunity [to service an account], you have to show them everything you’re about – and not fail.” In 2008, after seven years at DHL, Walsh joined Cardinal Health’s ambulatory care division, which was acquired by Henry Schein in 2014. Throughout his years with Cardinal Health and now Henry Schein, his primary account has been Saint Luke’s Health System in Kansas City. When he first serviced Saint Luke’s, he had responsibility for between 15 and 20 ambulatory sites (the rest being serviced out of a central warehouse). Today, roughly 140 locations are set up in Henry Schein’s system, and more than 100 of them order regularly. Servicing IDN-owned sites calls for the representative to be mindful and supportive of group purchasing contracts, he says. “But my experience in areas of product knowledge, distribution, GPOs and contracts are all quite impactful on my servicing of Saint Luke’s.”

“At IKON, there were 20 other guys just like me. Young guys with the same mentality.”

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Calling all Manufacturers!!! Calling all Manufacturers!!! HMMC (Healthcare Manufacturers Management Council) is the organization for you as our membership is founded and focused on the Healthcare Manufacturer and the specific challenges and opportunities we face as a collective market.

HMMC is pleased to introduce our new “Education Excellence” conference being held at The University of Wisconsin School of Business Madison on May 21-23, 2019. Join us while we continue our commitment to provide for our members a platform focused on “Education for Ongoing Success.” During our meeting you will have the opportunity to improve your Business GPA = Goal attainment, Processes & Actionable takeaways.

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HEALTHCARE MANUFACTURERS MANAGEMENT COUNCIL

NEWS

Jeff Prestel, CEO, Sarnova

Serve First, Together Sarnova’s 2018 National Sales Meeting Sarnova and its family of companies – Bound Tree

Medical, Cardio Partners, Emergency Medical Products and Tri-anim Health Services – wrapped up their 2018 National Sales Meeting late this summer at the Hyatt Regency Columbus (Ohio). The four-day meeting brought together over 500 attendees from Sarnova, as well as 75 supplier partner companies. Sarnova’s senior leadership team – including Jeff Prestel, CEO; Tom Metcalf, president of acute care; and Brian LaDuke, president of emergency preparedness –

Sarnova Sales Awards, Award Winners from Tri-anim

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led breakouts and hands-on sessions to help drive home this year’s theme of “Serve First, Together.” Each presentation throughout the meeting revolved around the theme and emphasized working together, across all departments, hand-in-hand with strategic vendors, to deliver betterthan-expected service to customers, every time. More than 92 awards were presented to account managers and regional sales directors in recognition of their FY18 efforts. Awards included Account Manager of the Year, Regional Sales Director of the Year and Rookie of

the Year. Sarnova’s Servant Leadership Awards recognized one individual from the acute care team and one individual from the emergency preparedness team. Stories were shared about how they exceed their job duties with gusto and determination, sometimes up against personal struggles or hardships. Sarnova’s vendor partners were recognized at the Acute Care Vendor Awards Dinner and the Emergency Preparedness Vendor Awards Dinner. More than 50 awards were distributed in recognition of outstanding account managers and products. Two vendor fairs for the acute care and emergency preparedness teams drew more than 75 booths. Additionally, the product management teams designed and implemented dozens of sessions for the sales teams, all intended to help support them, to provide top-notch selling skills training, and to give cutting-edge product training. Lt. Col. Rob “Waldo” Waldman, a now-retired fighter pilot with 65 combat missions and 2,650 flight hours under his belt, was the special keynote speaker. Waldo spoke about how one should “Never Fly Solo,” and about building trusting relationships between coworkers, vendors and customers. “Our annual National Sales Meeting is one of the most important things we do all year,” CEO Jeff Prestel was quoted as saying. “It gives us a moment to reflect upon and celebrate our efforts in the previous year, to learn from our vendor partners and colleagues, and to connect with each other, to reinforce the importance of teamwork and working together for the good of our customers. We couldn’t operate without it.”

Lt. Col. Rob “Waldo” Waldman

Tom Metcalf, President, Acute Care

Brian LaDuke, President, Emergency Preparedness

Emergency Preparedness Vendor Fair

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NEWS

The Goal: Error-proofing Rooms

Midmark’s new brand identity – which includes a new

website, logo, tagline and more – signals the continuing transformation of the company from an equipment manufacturer into a clinical environmental design company. It is an extension of the company’s Midmark Clinical Solutions program, launched in 2012, which emphasizes how room design, equipment and electronics can improve the patient experience and the provider’s efficiency. A new tagline – “Designing better care ” – underscores Midmark’s strengthening role in the care experience through advanced technologies, acquisitions, new

emphasize patient satisfaction and the provider’s level of engagement with the patient. The need for patient comfort and safety remains unchanged, says Wells. But today’s healthcare environment also calls for a standardization of processes. Room design and flow can help. “We are talking about error-proofing rooms, so that exams and procedures can be easily repeated, without the staff thinking about 40 different things,” he says. “All of these elements together – the people, the technology, the space – free up caregivers to think about the most important piece of all, that is, connecting with the patient, rather than how to get the patient to the scale, or how to get data into the EMR.” Standardizing processes, including room turnover, also leads to greater efficiency on the part of the physician practice. “A room is an asset,” says Wells. “You want to make the most efficient use of it. That doesn’t mean pushing patients through as quickly as possible. But it does mean optimizing all the processes that surround caring for the patient.” Distributors can play a vital role in “Designing better care,” says Wells. Each component in a practice – including equipment, devices, software, storage, instrument processing – is complex on its own, “For us to make all those things work together – that’s where our distributor partners are key,” he says. With an understanding of MACRA and the pressures facing providers today, distributors can help their customers move ahead, says Wells. “We’re no longer just talking about supplies, equipment and getting contracts, but how to address the things that truly are keeping our mutual customers up at night.”

“ All of these elements together – the people, the technology, the space – free up caregivers to think about the most important piece of all, that is, connecting with the patient.” markets and expanded service offerings, says Vice President of Marketing Jon Wells. “It elevates the importance of design in the customer’s mind, helping them understand it’s not just about the space, but also how it is used and the people interacting within it.” It is often the “momentum of past decisions” that stands in the way of the harmonization of clinical space, technology, products and workflow, says Wells. “No longer can a provider buy an exam chair and place it in a room without understanding how it may impact the total workflow,” he says. That’s especially important given today’s payment systems, such as MACRA, which

November 2018

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Kathryn Carpenter Catholic Health Initiatives

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American Clinical Lab Association

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Industry news New collaborative to tackle end-to-end supply chain challenges Executives from 12 healthcare organizations formed the Healthcare Supply Chain Collaborative to address and solve longstanding supply chain issues. The new organization’s mission is to transform the healthcare supply chain through best practices for processes and data. To address these issues from an end-to-end supply chain perspective, the organization’s leadership includes manufacturers, distributors, providers, and group purchasing organizations. The organization will initially focus on two primary areas: Supply chain visibility and contract administration and pricing. The Health Industry Distributors Association (HIDA) will provide staffing for the Collaborative. Members of its steering committee include senior executives from: BD (Becton, Dickson & Company), Cardinal Health, Henry Schein, Johnson & Johnson, The Mayo Clinic, McKesson Medical-Surgical, Medline, Medtronic, Owens & Minor, Premier Inc, Quidel, UAB Medicine, and Vizient Inc. The Healthcare Supply Chain Collaborative will host a conference April 17-18, 2019, with sessions focusing on contract administration, e-commerce, and supply chain visibility. Industry organizations are invited to attend and to participate with the Collaborative. To join the Collaborative, or for more information, contact Jeff Girardi at Girardi@hida.org.

JV of Amazon, JPMorgan, Berkshire hires consulting firm The healthcare venture formed by Amazon, Berkshire Hathaway, and JPMorgan Chase has chosen Monitor

November 2018

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Group (Boston, MA), a global consulting firm based, to help develop its strategy for lowering healthcare spending by improving care of chronically ill patients, an unnamed a source familiar with the arrangement told STAT. Monitor Group, the business consulting division of Deloitte, helps companies identify services and technologies that will help them connect with their customers. In addition to working with Monitor Group, the healthcare venture recently hired Jack Stoddard to fill the COO position. Stoddard most recently served as Comcast’s general manager for digital health.

HCA makes $500,000 donation to hurricane relief HCA Healthcare (Nashville, TN) announced a donation of $500,000 to the American Red Cross to help people affected by Hurricane Florence. In South Carolina, HCA Healthcare has five hospital campuses, including Grand Strand Medical Center, the only Level 1 trauma center in the eastern part of the state, and 38 other sites of care.

47 Oklahoma hospitals meet 96% employee flu vaccination goal Forty-seven Oklahoma hospitals and specialty units reached the goal set by the Oklahoma Hospital Association to achieve an employee influenza vaccination rate of 96% or more in the 2017-18 flu season. OHA’s Council on Quality and Patient Safety started the employee vaccination challenge for hospitals during the 2012-13 flu season. For the 2016-17 flu season, 43 hospitals met this goal. The American Hospital Association (AHA), as well as other national professional organizations, endorse

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NEWS

mandatory flu vaccination policies for healthcare employees. Vaccinating healthcare employees has shown to prevent illness and death in patients and reduce influenza and absenteeism among healthcare providers.

CMS proposes to lift unnecessary regulations, ease burden on providers CMS announced a proposed rule to relieve burden on healthcare providers by removing unnecessary, obsolete, or excessively burdensome Medicare compliance requirements for healthcare facilities. Collectively, these updates would save healthcare providers an estimated $1.12 billion annually. Taking into account policies across rules finalized in 2017

and 2018, as well as this and other proposed rules, savings are estimated at $5.2 billion. Many of the proposals simplify and streamline Medicare’s conditions of participation, conditions for coverage, and other requirements for participation for facilities, so they can meet health and safety standards more efficiently. This proposal ensures continued protection for patient health and safety. A key provision would reduce burden and promote efficiency to support patients who need organ transplants. The rule would eliminate a duplicative requirement on transplant programs to submit data and other information more than once for “re-approval” by Medicare.

Cigna announces Cigna Ventures with $250M to fund transformative innovation, growth New Lenox, IL 60451

Territory Sales Managers Wanted Professional Medical, Inc. (ProMed), is seeking talented, motivated territory sales managers with years of experience. ProMed is a Midwest Leader and a Master Wholesale Distributor serving the LTC/Nursing Home industry and the HME-DME/Home Medical equipment and disposable supplies industry. We are a proud Family Owned & Operated company - 2018 marks our 50th anniversary. ProMed is a full-line Healthcare Wholesaler, (One Source Alliance) utilizing a unique & competitive pricing system which will save our valued customers substantially. We supply brand name and quality brand alternative products. Candidates must have a min. of 3 years of experience and an existing customer base of business specifically within the states of MO, IA, MN or OH. She/He should be able to maintain existing business as well as prospect new accounts in their territory within both industries. We can help you become more successful utilizing our many years of expertise. You will be able to differentiate ProMed from any of our competitors and become an ally to our valued customers throughout the Midwest and beyond. Aggressive compensation based on the candidate meeting requirements and performance goals. Additionally, quality BC/BS health insurance and 401K benefits with company match, etc.

Thank you, Terry

Direct all inquiries to Terry Barnes, President Submit your resume to tbarnes@promedsupply.com

November 2018

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Cigna announced it has committed $250 million of capital to Cigna Ventures to invest in companies across three areas: insight and analytics, digital health and retail, and care delivery/management. The fund builds on Cigna’s existing venture activity, including collaboration with five venture capital partners and an equal number of existing direct investments. Last November, Optum, the health services business of UnitedHealth Group, announced the creation of Optum Ventures, a $250 million venture fund focused on investing in digital health companies that use data to improve consumers’ access to healthcare services and how care is delivered and paid for.

AHA launches center for health innovation The American Hospital Association (AHA) introduced a center for health innovation to provide hospitals with resources and support as they respond to changes in the healthcare landscape. The center of health innovation will initially focus on developing market intelligence, innovation competitions, cybersecurity services, and “innovation boot camps.” Through the center, the AHA will offer hospitals insights into best practices to address emerging areas of healthcare, such as new payment, delivery and performance improvement models. The center will also test new ideas that improve outcomes and increase the affordability of healthcare services.

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