REP Nov 21

vol.29 no.11 • November 2021

repertoiremag.com

Culture as a Core Competency Midmark CEO Jon Wells on leading well in an age of disruption.

Jon Wells, CEO, Midmark

Virtualize Thyself.

There was a time when maybe you wished you could conduct business meetings in your pajamas but we never really thought it would happen.

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POINT-OF-CARE READER

RAPID DIAGNOSTICS

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

NOVEMBER 2021 • VOLUME 29 • ISSUE 11

PUBLISHER’S LETTER A Little Kindness Goes a Long Way.............................. 2

PHYSICIAN OFFICE LAB COVID Risk Factors and Co-morbidities Which tests make the most sense for diagnosis and follow-up for the COVID patient?............................ 4

LEADERSHIP The Initiative to Grow How McKesson is shaping future leaders with Employee Resource Groups............10

IDN OPPORTUNITIES Supply Chain Leader Spotlight Lorraine Lee, MHA, BSPharm, Senior Vice President, Clinical Operations, Yale New Haven Health System...............14

Culture as a Core Competency Midmark CEO Jon Wells on leading well in an age of disruption.

24

Lorraine Lee

TRENDS

HEALTHY REPS

ACOs: Still Standing Reducing ‘unnecessary care’ is key to their success.................................18

RNs in Primary Care Opportunities, barriers and hopes for a vital component of healthcare providers.....32

Equipment Selling Post-Pandemic Leverage technology, yes. But don’t forget it’s all about relationships.........................45

EQUIPMENT

3 Practical and Sustainable Processes to Improve Your Health..........................................54

MARKETING MINUTE The Benefits of Marketing Automation in Medical Manufacturing How your business can grow quickly and efficiently with the help of marketing automation.............................56

HIDA

What to Do with ‘Legacy’ Equipment How can you guarantee the cybersecurity of outdated equipment?.....50

The Nation’s Transportation Disruptions Are a Healthcare Issue.............................. 58

QUICK BYTES Technology news............................60

SALES Using Social Media as a Sales Rep....................................62

WINDSHIELD TIME Automotive-related news........68

INDUSTRY NEWS Industry news....................................70 Silver screen staffers...................72

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PUBLISHER’S LETTER

A Little Kindness Goes a Long Way I remember as a young man listening to older folks talk about how time speeds up as

you age. One conversation with an older woman on a plane comes to mind. My family and I were flying back from a wedding in North Carolina, and Scottie my oldest son was screaming his head off due to an ear infection. I was on edge because I knew the entire plane had to be thinking “can you shut that kid up?” Just before I lost my mind, a sweet little eldery woman said, “Son, days like these are long, but I promise you the years are short.”

I never forgot her words. In fact, almost every congratulation card for a new baby I’ve given since then has had that story inside. Over the past 24 months, I believe we’ve all faced some long days – and in many cases we still are – but we must step back and remember with those long days comes short years.

Scott Adams

This month’s cover story is with Jon Wells of Midmark. I also did a Road Warriors podcast with him that is worth listening to when you have a few minutes. In this Q&A with Jon, a few things repeatedly came to the surface: 1. Listen to your customer, and for that matter your parents, kids, co-workers, and friends. In all of life’s rush, take time to stop and listen. It’s an amazing way to let people know how much you care.

2. Be obsessed with your clients. After listening to them, you’ll learn everything you need to know about their needs, and that’s when you’ll have the opportunity to solve their biggest problems.

3. Care and kindness. At Midmark, it all starts with caring about your fellow colleague. Which then leads to a culture of success. People will never care how much you know until they know how much you care.

All three of these points have something in common – they tell us to stop and slow down so we can appreciate those around us. So, even with our long days, we must remember

the years are short. What we choose to do today could have a lifetime effect on someone else.

The day I interviewed Jon it was raining sideways.

When I drove home, I passed my mailman putting letters and packages in everyone’s box while it was pouring outside. Jon inspired me that day, because I rushed inside my house, heated up a cup of tomato soup, and took it to my mailman. The gentleman was so touched, he teared up and said: “You have no idea how much I needed that today.”

I don’t share this story to brag on my good deed; I only share it to say, Happy Thanksgiving to you and your family.

Thank you for all you do every day for our country and its caregivers. Hopefully this story will encourage you to show some of them your gratitude for all they do to take care of us.

Dedicated to the industry, R. Scott Adams

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

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Brent Cashman

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IT’S NOT TOO EARLY to test for heart disease.

Pediatric lipid testing is on the rise.

The epidemic of childhood obesity continues to grow. But with the identification of early indicators of high cholesterol, clinicians can help fight the epidemic by conducting more lipid testing.1 The Cholestech LDX™ System offers exactly what your pediatric customers need.

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CONTACT YOUR ABBOTT REPRESENTATIVE TO LEARN MORE. 1. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report.

Pediatrics. 2011;129(Suppl 5):S1-S44. pediatrics.aappublications.org/content/128/Supplement_5/S213.full. © 2020 Abbott. All rights reserved. All trademarks referenced are trademarks of either the Abbott group of companies or their respective owners.

Any photos displayed are for illustrative purposes only. Any person depicted in such photos is a model. 10004984-02 06/20

PHYSICIAN OFFICE LAB

COVID Risk Factors and Co-morbidities Which tests make the most sense for diagnosis and follow-up for the COVID patient?

As we approach what we have come to think of as respiratory infection season, and following

last season where the COVID pandemic raged and influenza didn’t show up, there are a lot of questions about what shape this respiratory season will take.

By Jim Poggi

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Who is at higher risk of contracting COVID? Is vaccination for COVID working?

And how exactly do we define “working”? Will the newest COVID variants, including Delta and Mu, drive higher infection rates? Will flu make its typical annual appearance? Finally, which tests make the most sense for diagnosis and followup for the COVID patient? In this column, I will provide information I’ve gathered in my www.repertoiremag.com

research to shed some light on these issues. At the same time, I will speculate about the respiratory season ahead.

Risk factors Let’s start with an overview of who is most likely to contract a severe enough COVID infection to require hospitalization, or who may risk becoming a “long hauler”. While

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PHYSICIAN OFFICE LAB I will address the classic risk factors a bit later, there’s now overwhelming evidence that vaccination reduces the chances of becoming seriously ill with COVID or requiring hospitalization. A study by the Virginia Department of Health uncovered some interesting facts. First, that vaccination is absolutely effective in preventing serious illness. In a study released in August, they reported approximately 170,000 COVID cases in the unvaccinated population compared to about 19,000 among those who were vaccinated. Vaccine effectiveness was considered as “effective” in 80% of adults in the 20-29 age group and rose to greater than 90% in those 60 years of age or older, demonstrating apparently increasing effectiveness with age.

A similar study conducted by the county of Los Angeles showed hospitalization rates seven times higher in unvaccinated persons compared to those who were vaccinated.

So, while breakthrough infections do take place among the vaccinated population, vaccine effectiveness is defined as its ability to reduce the incidence or severity of the disease and/or the rate of hospitalization. There is plenty of data out there, and all I have seen supports these conclusions.

Other than vaccination status, what are the other risk factors associated with severe cases of COVID? Classically, a compromised immune system is associated with higher risks of respiratory infection, and that is also true of COVID. In addition, co-morbidities including COPD and other lower respiratory conditions make serious COVID infections and complications from pneumonia more likely. Heart disease, obesity and

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diabetes are also higher risk factors for COVID and this association seems to hold up for other respiratory infections. Age is also a factor, but is more likely related to the incidence of co-morbidities mentioned earlier than to any other reason.

The experienced distributor account manager needs to be alert to the signs of respiratory season incidence in their community and prepared to assist their customers with flu vaccines and tests for flu, strep and RSV as well as COVID. The CDC reports that the Delta variant of COVID is twice as contagious as previous variants and more likely to cause serious illness. As of mid-September, it was the most common variant of COVID in the United States.

So, while vaccination rates have begun climbing again, the emergence of the Delta variant is likely to continue to drive the infection rate. It’s unlikely that infection rates will match those prior to availability of vaccines, but Delta presents a risk of infection particularly among the unvaccinated and those with other pre-existing health issues.

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BD Life Sciences, 7 Loveton Circle, Sparks, MD 21152-0999 USA 800-638-8663 BD, the BD Logo and Veritor are trademarks of Becton, Dickinson and Company or its affiliates. © 2021 BD. All rights reserved.

PHYSICIAN OFFICE LAB Forecasting respiratory season Now to speculate a bit on this year’s respiratory season.

Flu incidence remains the wild card. It was virtually absent last year, with few cases reported and the lowest rate of flu tests performed in many years. But, much of the country was in lock down for the typical respiratory season. With the country struggling to open up and return to some semblance of normal at present it seems reasonable to presume that increased social contact will result in more flu cases this year than last. Opinions vary and the season is not yet upon us, but the CDC also cautions that this flu season is likely to be more severe than last.

I believe strep and RSV will also be at higher levels than last year. As of press time, the CDC was reporting the weekly average of COVID cases at 146,182. During the last typical flu season (2018/19) there were more than 37.4 million cases of flu reported. Which respiratory

Other than vaccination status, what are the other risk factors associated with severe cases of COVID? Classically, a compromised immune system is associated with higher risks of respiratory infection, and that is also true of COVID.

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disease will top the headlines this season is still to be determined. The experienced distributor account manager needs to be alert to the signs of respiratory season incidence in their community and prepared to assist their customers with flu vaccines and tests for flu, strep and RSV as well as COVID. It will be an interesting respiratory season for sure.

How do you prepare?

So, where does testing fit in and how do you prepare?

At the top of the season, you need your armamentarium of diagnostic tests to include COVID-specific antigen and antibody tests, as well as RT-PCR for your more sophisticated customers. CBCs are also an important element of diagnosis and monitoring of all the typical respiratory conditions. Monocyte distribution width hematology parameters can signal the development of sepsis and complement IL-6, procalcitonin and lactate.

Some customers will choose CRP as an early screen for an infection and later use more specific tests to identify the infectious agent. Flu, strep and RSV test systems are also critical. Choose from reader based, molecular and traditional lateral flow test options wisely. Each offers differential advantages. Be sure to work closely with your key manufacturing partners to understand the test mix you need and availability of tests since the health care product supply chain has been negatively impacted

by COVID. As customers shift from diagnosis to patient management later in the flu season, the ratio of diagnostic to monitoring tests is likely to shift. It will also be dependent on the underlying co-morbidities of their recovering patients.

Diabetics and many obese patients will likely require A1C, glucose and lipid testing along with evaluation of renal function. Patients with underlying cardiac conditions may benefit from BNP and D-Dimer assays also. Those with underlying immune system issues will need monitoring of their specific condition including HIV, cancer and others.

Especially with “long haulers” (typically defined as those whose symptoms persist beyond three weeks), a range of organ tests is useful, again including renal function and general metabolic panels (CMP or BMP). Outside of the lab testing perspective, recovering patients are likely to need pulmonary function tests, cognitive assessments, adjustments of their medications, counseling for depression and other affective issues and in some cases more extensive rehabilitation.

Buckle down and be prepared to be especially busy in the months ahead.

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LEADERSHIP

The Initiative to Grow How McKesson is shaping future leaders with Employee Resource Groups

By Pete Mercer

Luke Moore is always on the hunt for ways to add to – and improve upon – his skillset. For instance, as a

diagnostic sales consultant for McKesson Medical-Surgical, while no one is answering to him, Moore still needs to find ways to engage sales reps who call on accounts. Specifically, Moore is interested in better understanding how to craft emails that speak directly to an individual’s motivations.

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LEADERSHIP Moore is spending time this fall developing those skills via a unique McKesson initiative called the Emerging Professionals Group.

The Emerging Professionals Group is equipping him with the skills and experience he needs to engage his sales representatives to achieve better outcomes for lab products and services.

“One rep may be motivated by commission dollars and gross profit percentages, and another may be motivated by serving the future needs of the customer,” Moore said.

“Using these resources, it helps me to communicate and influence to get the results I need for the lab. I can now tailor the right message to the right reps to get the right response.”

For Moore, the greatest value that the Emerging Professionals Group provides is professional and personal development. “This program understands that your professional and personal lives reflect each other, and each part of you requires development and growth,” he said.

“McKesson is not only trying to develop people professionally, but

Growing in the organization

Professional and personal development The Emerging Professionals Employee Resource Groups at McKesson are designed to provide education and empowerment opportunities

Luke Moore

“ McKesson uses this term, ‘build your brand.’

In other words, it’s a way to help you build your personal brand.”

– Luke Moore for individual professionals within the organization. McKesson has developed these groups of volunteers as a way to make the company feel like a smaller community, Moore said. “[It’s a] McKesson sponsored group that exists to connect and develop the next generation leader within McKesson.

Their vision is to produce top level leaders across the enterprise, so it’s not just geared for medical-surgical, or McKesson specialty,” Moore explained. “It’s looking at McKesson holistically, enterprise-wide.”

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and personal development at their own pace, Moore said McKesson is investing in its greatest resource: its people. “I want to be the best version of myself,” he said. “Using those resources and working through some of those courses is helping to create and train the best version of myself that I can be, not just within McKesson, but within all the other areas of my life.”

also personally, which is what really caught my attention. We all compartmentalize our lives. I have my work life here and my family life over here, but I think the reality is that the fabric of who we are kind of weaves through all of those areas.”

It’s that level of employee engagement that makes McKesson unique, Moore said. Without an employee engagement strategy, it can be hard to push any group of people to achieve business goals. By leveraging a group where employees can invest in their own professional

For Moore, the Emerging Professionals Group is giving him the perfect opportunity to advance his skills and grow within McKesson, at his own pace. “[Your managers] notice when they get notifications when we complete these courses. I want my managers to know that I take this seriously and I want to grow within the organization,” he said.

Not only are individuals voluntarily developing and training themselves through the group, but they are also establishing their own personal brand, Moore said. “Your personal brand is a huge aspect of what will set you apart from others in your field.”

Moore said he has a deep desire to be in the best position that most impacts the people he works with and the organization as a whole – no matter the title or role. He recognizes the value in branding and is using the personal brand approach to his advantage. “McKesson uses this term, ‘build your brand.’ In other words, it’s a way to help you build your personal brand,” Moore said.

“This approach helps you to craft what other people are saying about you when you leave the room. If I’m leaving the room, I want the vice president of the organization to say, ‘That’s what it looks like to take the initiative to grow.”

IDN OPPORTUNITIES

Supply Chain Leader Spotlight Lorraine Lee, MHA, BSPharm, Senior Vice President, Clinical Operations, Yale New Haven Health System Editor’s note: Lorraine Lee, MHA, BSPharm, Senior Vice President, Clinical Operations, Yale New Haven Health System, was one of this year’s Ten People to Watch in Healthcare Contracting. The Journal of Healthcare Contracting, a sister publication of Repertoire, interviewed her for the August 2021 issue.

The Journal of Healthcare Contracting: What’s the most challenging or rewarding project you have worked on in the last 12 to 18 months?

Lorraine Lee: I think from a supply chain perspective, we’re not unlike anyone else in the country. Literally overnight, we were forced to figure out how to find supplies for COVID-19 patients at 500 to 1000 times the amount that we normally would need. So, my supply chain team just changed course and we did whatever we had to.

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Lorraine Lee

We admitted up to 900 COVID patients very quickly because we’re right outside of New York City. It wasn’t like we had an opportunity to plan or wait even a week. We had to find PPE and supplies within days.

It was challenging. And my team did everything from driving to shipyards to see what came over in shipping containers to getting up in the middle of the night to talk to Asia.

We needed to know if things were coming or not, as it was all in flux at the time. A lot of our supplies did not come from the United States, it all came international. So, it was a stressful time.

It was challenging, but it was also really rewarding because we were able to successfully find what we needed to and supply our colleagues with all the PPE they needed.

We never ran out of PPE; we came close in a couple of categories, but we never ran out. We used to watch the news and see caregivers in garbage bags. And my team did everything they could to ensure we never were in that place. I think there was stress, but I do think our colleagues and leaders understood supply chain challenges. Luckily, we were successful and that was our collective reward.

The other rewarding thing was that we worked together as a system.

We’re a five-hospital system under the Yale New Haven Health banner.

During the pandemic, we all rowed in the same direction. Everyone knew what we needed to do. Nobody was off doing their own thing. It was amazing and humbling to watch what happened internally. It was something I will never forget, no matter what I do in my whole career. A lot of staff got redeployed because we didn’t have any outpatient services during that initial time. We shut down all our clinics and our physician offices. All

the staff needed somewhere to go, but we never furloughed. They all just got redeployed. Many helped my team in supply chain.

JHC: Have you changed anything in regards to storage or how products are distributed to your sites?

Lee: We’re not self-distribution. We had a distributor who distributed directly to the point of use for the most part, to the hospitals, and the clinics. Interestingly enough, we changed distributors in the middle of the peak of the pandemic. It was a little crazy. We had been with the same distributor for over 30 years.

And when I came into supply chain three years ago, the contract was coming up. Thirty years is a long time. So we did an extensive RFP, and we chose a new distributor.

for weeks and weeks and weeks. But what about all the other stuff, just the normal supplies that we need?

We were having a lot of outages in March, because of the impending switch. We decided to go ahead and switch in the middle of the pandemic. In the end, it was the right decision, because the new distributor had uploaded all our inventory into their warehouse. So, we didn’t have to worry about normal supplies, we were getting lots of material.

JHC: What project or initiative are you most looking forward to working on?

Lee: Especially for supply chain, I want to get back to the business of continuing to develop what we call our clinically integrated supply chain.

Before the pandemic, we worked

We never ran out of PPE; we came close in a couple of categories, but we never ran out. We used to watch the news and see caregivers in garbage bags. And my team did everything they could to ensure we never were in that place.

All of this happened in 2019, and our date to transition was April 1, 2020. On March 8, we had our first COVID patient. I think we hit 900 patients in the middle of April. We had many meetings about what to do. Should we switch? Should we just stick with the distributor that we have? The problem with that is the incumbent knows they’re out.

Your new distributor is ramping up all your inventory to normal levels, and your incumbent it is taking it down. My team was working on PPE sourcing, and we still worked on that

very hard on involving the clinical staff in supply chain decisions, doing what we call value analysis work. Is this medical device the right device for the right patient at the right time?

And is it the best price? So, it’s a little bit of everything, but we start with what we need for the patient. We have a physician leadership group that makes all the decisions about what we do bring in and what we don’t bring in. We have more work to do in that area. But now that we’re almost back to normal business, that will be our focus moving forward. www.repertoiremag.com

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TRENDS

ACOs: Still Standing Reducing ‘unnecessary care’ is key to their success Experts are convinced that to preserve our healthcare system, the U.S. must move away from fee-for-service to a

managed care model. They argue that doing things the old way – that is, rewarding healthcare providers for performing more procedures and shielding consumers from the full financial impact through insurance – leads to a bigger national healthcare bill. And they point to statistics indicating that despite all the money spent on healthcare, Americans aren’t all that much healthier – and in many cases, are less healthy – than people in countries that spend less.

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THE SOLUTION IS IN SIGHT Up to 24,000 Americans will go blind from diabetic retinopathy each year.1 But the solution is in sight.

With early detection, 95% of vision loss due to diabetic retinopathy can be prevented.2 On World Diabetes Day, join Hillrom in our mission to help the millions of people living with diabetes and make sure your customers are doing all they can to save their patients’ sight.

Visit retinavue.com to learn how the Welch Allyn® RetinaVue® care delivery model can help primary care organizations offer simple and affordable teleretinal exams to their patients during routine primary care visits.

Centers for Disease Control and Prevention. Vision Health Initiative (VHI) 2017. https://www.cdc.gov/ visionhealth/projects/economic_studies.htm. Accessed January 31, 2018

1

National Eye Institute. Diabetic Retinopathy. https://nei.nih.gov/health/diabetic/retinopathy.

Accessed March 9, 2017.

2

© 2020 Welch Allyn, Inc. ALL RIGHTS RESERVED. APR140406 Rev 1 01-OCT-2020 ENG-US

TRENDS Their solution is better care management, with an emphasis on wellness, prevention, coordination of services, and management/monitoring of people with chronic illnesses. And right now, accountable care organizations, or ACOs, are the leading model.

ACOs are part of the Medicare Shared Savings Program, which was established by the Affordable Care Act of 2010. ACOs are groups of doctors, hospitals and other healthcare providers who voluntarily join to give coordinated, high-quality care to Medicare beneficiaries and ensure that people receive the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

Centers for Medicare & Medicaid Services Innovation (CMMI) Center in 2012. The ACO model has since been adopted by Medicaid and even commercial payers. In fact, McKinsey & Company reports that of the roughly 33 million lives covered by ACOs in 2018, more than 50% were commercially insured and approximately 10 percent were Medicaid lives. CMS has been tweaking the ACO program ever since the Pioneer days by resetting benchmarks, quality goals and risk arrangements.

In January 2016, CMMI launched the Next Generation Accountable Care Organization (NGACO), designed to test whether

Despite the downturn in numbers, over 12.1 million Medicare fee-for-service beneficiaries receive care from a healthcare provider participating in a Medicare ACO. What’s more, 41% of ACOs are taking on two-sided risk, more than double the 17% doing so in 2018.

In an ACO, physicians and hospitals assume responsibility for the total cost of care for a given patient population. When an ACO succeeds in delivering high-quality care and spending health care dollars more wisely, its participants can share in the savings achieved on behalf of the Medicare program. Increasingly, ACOs are required to pay back some Medicare dollars if they fail to meet certain quality goals or financial benchmarks.

Program is tweaked The first ACO program – the Pioneer ACO – was launched by the 20

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stronger financial incentives, paired with tools to support patient engagement and care management, could improve health outcomes and lower expenditures for Medicare fee-forservice beneficiaries, according to McKinsey. A key attribute of the NGACO model was a higher level of shared financial risk and reward than what was available under other Medicare ACO models.

In 2018, ACO participation dipped when the Trump Administration launched “Pathways to Success,” whose intention was to push ACO participants to take on downside risk after just two years in the program.

(When the Medicare Shared Savings Program began in 2012, ACOs had six years of one-sided risk – that is, the potential to share savings without risking a loss for failure to meet certain goals.) Even three years later, at the start of 2021, only 477 ACOs participated in the Medicare Shared Savings Program, down from a high of 561 in 2018 and the lowest since 480 in 2017.

Despite the downturn in numbers, however, over 12.1 million Medicare fee-for-service beneficiaries receive care from a healthcare provider participating in a Medicare ACO. What’s more, 41% of ACOs are taking on two-sided risk, more than double the 17% doing so in 2018.

Up next: Direct Contracting CMS launched the Direct Contracting ACO model, set to replace the Next Generation ACO program, in April 2021. At the time, CMS said the program’s risk-sharing options “will appeal to a broad range of physician practices and other organizations because they are expected to reduce burden, support a focus on beneficiaries with complex, chronic conditions, and encourage participation from organizations that have not typically participated in Medicare FFS or CMS Innovation Center models.” These healthcare organizations may offer optional incentives and benefit enhancements to Medicare beneficiaries, who will retain all their benefits and who may continue to see any healthcare provider they choose.

CMS has called the Direct Contracting Model “the next evolution of risk-sharing arrangements to produce value and high-quality healthcare.” While Direct Contracting does provide a high-risk option for more advanced ACOs, David Pittman, senior policy advisor of the National

Association of ACOs, says the association’s take is more nuanced.

“Our biggest concern is that the model is overly friendly to new organizations, but not so favorable to organizations that have historically participated as ACOs in the Shared Savings Program,” he says. “The previous administration was not shy in saying they wanted new players in alternative payment models, so the rules are a little more favorable to attract them.”

NAACOS believes Direct Contracting’s full-risk option is “the opposite of what’s needed to get people into the ACO program,” adds Pittman. “Without an ‘on’ ramp, it’s highly unlikely providers will go from not participating at all, to forming a Direct Contracting Entity.” NAACOS will continue to press CMS to establish a more level playing field, he says.

Do they work?

There are many ways to define “savings” and “improvements” in the ACO program. Some studies compare the performance of participants in one ACO model to that of its CMSdefined benchmark or spending target. NAACOS believes a truer measure would compare the performance of ACO providers and beneficiaries to providers and beneficiaries in traditional fee-for-service programs.

CMS’s statistics indicate the agency believes ACOs are getting the job done. In 2020, ACOs earned performance payments (shared savings) totaling nearly $2.3 billion while saving Medicare approximately $1.9 billion, marking the fourth consecutive year of net savings for Medicare, according to CMS. Sixty-seven percent of ACOs shared savings with CMS in Participation Year 2020. Eighty-eight percent

of two-sided model (i.e., those with the potential for shared savings or losses) ACOs earned shared savings payments, and 55% of one-sided model (potential for shared savings only) ACOs earned shared savings payments.

Reduce unnecessary care “A core lever of success [of ACOs] involves reducing use of unnecessary care,” according to McKinsey. Care management costs for an ACO range from 0.5% to 2% of total cost of care for a given ACO population, the firm points out. These care management costs include ensuring patients with chronic conditions are continuously managing those conditions and coordinating with physician teams to improve efficacy and efficiency of care. ACOs at the lower end of that spending spectrum may struggle to expand care coordination for their

patients. But those that can do so will realize a return on their investment.

The transition to value-based payment is expected to take years, and it’s critical that there be careful evaluations on the effect of ACOs and other value-based payment programs on health outcomes, quality, utilization, cost, and overall savings/ losses to the Medicare program, says NAACOS in its Overview of Research on ACO Performance. However, there remain many unanswered questions, such as how to appropriately account for the significant investments ACOs make up front, and understanding the tension between short-term spending (to invest in things like quality and care coordination) and long-term savings. Further research is expected to help shed light on the impact of ACOs on Medicare, beneficiaries, and the healthcare industry. www.repertoiremag.com

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SPONSORED

B. BRAUN

B. Braun Launches CARESAFE™ IV Administration Sets With Optional AirStop First Robust Portfolio of IV Sets Not Made With PVC and DEHP B. Braun Medical Inc. (B. Braun), a leader in infusion therapy and pain management, announced the launch

of its new CARESAFE™ IV Administration Sets with Optional AirStop component. CARESAFE IV Sets are the first robust portfolio of IV administration sets in the US market that are not made with polyvinyl chloride (PVC) and diethylhexyl phthalate (DEHP).1 They provide an added level of protection for the environment and, most importantly, to patients from the potential health risks associated with exposure to these chemicals.

“More than four decades ago, B. Braun recognized the environmental and patient risks posed by products containing PVC and DEHP,” said Chad Laity, Director of Marketing, Vascular Access and IV Systems at B. Braun.

“B. Braun is the only supplier that offers a full line of IV solution containers not made with PVC and DEHP, and we are now pleased to introduce our robust portfolio of IV administration, secondary, extension, and specialty IV sets that eliminate the risk of patient exposure to these potentially dangerous toxic substances,” continued Laity.

Dioxin, a known human carcinogen, can be formed during the manufacture of PVC, and during the incineration or burning of PVC products.2 DEHP, a phthalate used to soften PVC, is an endocrine disrupting

compound (EDC) that has been shown to be harmful to certain patient populations including pregnant women, male neonates, and young children.3 The American Medical Association, among other healthcare and professional organizations, encourages hospitals and physicians to reduce and phase out the use of PVC medical device products, especially those containing DEHP, and urges the adoption of safe, cost-effective, alternative products where available.4

In addition to reducing patient exposure to toxic substances, CARESAFE IV Sets with Optional AirStop component also help to protect patients from the risks associated with air infusion and helps prevent the line from running dry.5 This is critical in IV therapy because any entry of air into the vascular system causes a risk for air embolism.6,7 Air embolism is on the Center for Medicare & Medicaid Services (CMS) list of Serious Reportable Events known as “never events”.8 While the frequency of air embolisms is low, the mortality rate is high (21%).9 The innovative AirStop filter is designed to only allow fluid to pass through and thereby helps to prevent the line from running dry, providing peace of mind for the clinician and increasing safety for the patient.5

B. Braun Data on File PVC and Phthalates. Health Care Without Harm. https://noharm-uscanada.org/issues/us-canada/pvc-and-phthalates 3 Schettler, T. Polyvinyl chloride in health care. Health Care Without Harm. January 2020.

4 Encouraging Alternatives to PVC/DEHP Products in Health. American Medical Association. 2016.

5 B. Braun Engineering Test Report: PVC-Free IV Set Project, JMLY-BXWRDT, April 8, 2021.

6 Cook, Lynda S. Infusion-Related Air Embolism. Journal of Infusion Nursing. February 2013. Volume 36 Number 1: 25-34.

7 Infusion Therapy Standards of Practice 2021. January/February 2021. Volume 44 Number 1S. 8 State Medicaid Director Letter SMDL #08-004. Centers for Medicare & Medicaid Services. July 2008.

9 McCarthy, C., Behravesh, S., Naidu, S., Oklu, R., Air Embolism: Diagnosis, Clinical Management and Outcomes. US National Library of Medicine. March 2017.

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Jon Wells, CEO, Midmark

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Culture as a Core Competency Midmark CEO Jon Wells on leading well in an age of disruption.

In any business, people and culture are critical, said Jon Wells, president and CEO of Midmark. “I think Midmark

is unique in that we consider culture one of our core competencies,” he said. “Culture enables us to unlock value, create new solutions through new ways of thinking that we otherwise wouldn’t be able to.”

Never has that been more apparent than the last yearplus for the manufacturer, which their employees (known as teammates at Midmark) worked tirelessly through the pandemic to meet the needs of their healthcare customer base while establishing itself as a clinical environmental design company in a changing marketplace.

In a wide-ranging interview with Repertoire Publisher Scott Adams, Wells discussed Midmark’s COVID-19 response, how the organization leveraged its core values amid the pandemic, and how it is looking beyond to anticipate customer needs through a digital transformation.

Scott Adams: This last year, really the last two years, have been tough for everybody. What’s the one thing that makes you most proud of your organization over that period of time?

Jon Wells: I have to start with Midmark’s teammates.

They are the most dedicated, innovative group of people I’ve ever worked with. This was on display during the challenges of the past year with COVID. Obviously, the pandemic has put an unprecedented amount of pressure on our healthcare customers. Our teammates and management team across all our locations really stepped up and made it a priority to be there for our customers, and offer any support needed.

We’re still not through it. We’re still working 24/7, late nights – we call it four-wheel drive. But I can tell you the great thing was that this didn’t go unnoticed by our healthcare customers. They trusted us and knew we had their back. A number of them have even expressed gratitude for us helping them through the pandemic. This is

across medical, dental, and animal health businesses. All three were impacted in different ways. It’s fantastic how our teammates responded.

Adams: Throughout my career watching Midmark, I’ve noticed how your organization is seemingly always ahead of the curve on the manufacturing side. Talk a little bit about how Midmark has adapted in this changing marketplace. What are some of the changes you’ve made?

Wells: The pace of change in healthcare was accelerating even before the pandemic. Our customers need us now more than ever to enhance the quality of care provided to their patients.

COVID has impacted the inventory space and the point of care. That’s challenged healthcare organizations and providers to think differently about these spaces in ways that are both effective and safe. And it put a spotlight on how important it is to share new ideas to help meet these existing and new challenges.

At Midmark, we are adapting by listening, responding, and doing everything we can to support them. At the same time, we’re thinking one, three, and five years down the road. The impact of COVID is no longer a variable that we think of separately. It’s really built into our day-today business. It’s built into our long-term planning.

COVID has changed the business and changed Midmark in many ways, whether it’s working remotely or in the office. I’m sure Repertoire readers are experiencing those things as well. We’re adapting at the same pace, or maybe a little quicker, than our customers are to www.repertoiremag.com

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Midmark’s Jon Wells

stay ahead of this. As healthcare systems are looking for empathetic approaches that bring workflows and technologies to engage with patients, we’ve accelerated our transformation into a clinical design company. We are the only clinical environmental design company to provide medical, dental, and animal health solutions that creates new, innovative caregiver experiences at the point of care.

Adams: How have your core values at Midmark helped you adapt and overcome challenges in the last year or so?

Wells: In any business, people and culture are critical. I think Midmark is unique in that we consider culture one of our core competencies. Culture enables us to unlock value, new solutions, and new ways of thinking that we otherwise wouldn’t be able to.

Jon Wells (top left) with the Midmark Medical Sales team at HIDA circa 2006. The theme of Midmark’s booth was “There’s no promotion like the 75.” The late Jerry Maren of the Wizard of Oz spoke to the team on adversity and being a part of something special.

People ask us, what’s Midmark’s culture like? I respond with this … we care for each other, we care for our customers, and we care for our communities. When we care for each other, we encourage collaboration, the honest sharing of ideas, and feedback assessments. We’re very honest with each other. We give unvarnished views with respect. And it leads to the best decisions.

We think of culture not just as an edict or grand PowerPoint. It’s really all those decisions day in and day out that our teams make. It’s how they respond to something positive, or a challenge. THAT’S your culture.

This carried us through the pandemic. We had a level of trust shared amongst our teammates and the company that allowed us to talk through these things.

We shared good news as well as challenging news. We 26

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were as transparent as we could possibly be, and empathetic. I feel it further strengthened our culture.

Adams: How do you as an organization stay in the forefront of what customers need despite the rapid change that’s going on in our industry?

Wells: First, you need to listen. Listen to your customers, understand their challenges, the concerns they have and offer any solutions and ideas that are not just innovative, but strategically fit what they need.

It sounds very simple, but a lot of companies fall into the trap of telling customers what they need or what they should do, and try to oversell some view of where they should go. And frankly, it’s listening and responding to their needs. With this, the pull of the customer becomes very strong. This takes a deep understanding of the environments or equipment technologies and solutions that are used, and how they’re experienced by the patients and providers on the front lines.

So, we take a lot of steps. We do a lot of designthinking research, which is an empathetic approach and a user experience approach in everything we do.

In fact, we just hired a new director of design and human factors, and it’s a new position for us. It will ensure that design and user experiences across the organization continue as we become more complex in multiple businesses. It’s something that was built into all our work, but now we have a focused role that will lead us into the future.

Adams: I don’t think there’s ever been a time in the history of our industry calling on caregivers where listening is more important.

Sometimes it’s not even listening to what they need, but just listening to their frustrations and the things that they’ve gone through.

Wells: Empathy and EQ are truly not just secondary requirements in execution. They’re essential in executing.

Part of winning in markets is being able to understand, and utilize, those soft skills and empathy wherever you can.

People need to be listened to. They really do, especially in these times.

Adams: How are you forecasting and mapping out the future, not just the disruption in supply chain that affects Midmark products, but disruption in supply chain as a whole?

The new Midmark Experience Center and Technology Center in Versailles, Ohio is the epicenter for Midmark’s efforts to change how care is delivered, to enable a better care experience for both caregivers and patients.

Wells: That’s a good question. We’re fortunate to have some strong suppliers. That being said, through this whole process, it’s not just our suppliers, it’s their suppliers, and then their supplier’s suppliers. I feel for our operations team, purchasing teams, supply chain teams who are pulling this all together and ensuring we’re delivering products and staying in front of this.

It is unprecedented with not only the supply chain challenges, but also the spike in demand that has happened at the same time. But we’re doing everything we possibly can. We search for supply, different parts and pieces … we’ll call it “raw materials” for some suppliers.

We’ll stop and search for a particular part for a supplier’s supplier, something that we don’t even source, but we have the ability to find things for them to ensure that we can keep these parts and pieces in our operations.

This is part of the culture – not accepting no. Let’s dig in and see what we can do. And usually two or three days later, it’s solved, and we’re on to the next crisis. But this is across all three businesses and all our locations.

I am hearing that it’s probably going to get worse before it gets better, which is not the greatest news. But I’d say from Midmark’s perspective, we’re feeling confident in how we’re managing this into the future.

Adams: How important is it to collaborate with your customer when you’re working with them on their biggest problems and solving it through medical device technology?

Wells: Well, certainly listening to your customers is number one. Listen to their challenges, listen to their goals and then provide solutions. Becoming a trusted partner is key.

You have to earn that. It’s not something you just say, “I’m listening and here’s a solution.” You have to be a trusted partner over a period of time. That collaborative approach does take time. It takes a concerted effort, but that collaboration is how we’re delivering seamless solutions that improve care.

Back to the trusted partner piece, we think of ourselves as an external asset for a lot of our customers, where they can trust that we’re going to pull this through for them just like an internal asset would.

And if we can help them improve that patient caregiver experience, improve that quality of care, they’re going to come back to us time and time again, because that better-designed experience is truly what they’re moving forward to deliver.

You’re not designing a new exam room, or a new procedure room, or a new dental office every day. You’re doing that once every five, seven, or 10 years. So, providers want to know what’s the latest in layouts and configurations and types of equipment to make modifications. For instance, now they’re asking about what’s the latest in infection prevention. We don’t do it a few times a week – we do it 10 to hundreds of times per week. We see it across the industry, truly what’s happening in these buying habits, and then what works and what doesn’t. We advise and help them through these challenges. So, collaboration is key. It’s listening and becoming that trusted partner. www.repertoiremag.com

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Midmark’s Jon Wells

Adams: I want to switch the conversation back to you a little bit. How do you continue to grow and develop as a leader?

Wells: In the CEO role, one thing you learn is you have to be aware of the fact that you’re not all knowing. Be honest with yourself that you don’t have all the answers and that’s OK. You need to have a strong work ethic, and a high level of dedication, confidence, and abilities. Really, I think what goes back to this winning attitude is a burning desire to build something. You must listen and have a thirst for knowledge.

HIDA Washington Summit 2016 L to R: Sean McNally, Cardinal Health; Larry Lollis, Grove Medical; U.S. Senator Tim Scott; Brad Connett, Henry Schein; Jon Wells, Midmark

So, I’m learning. This is seven to eight months in now. I’m finding that success means surrounding myself with talented teams and talented executives that make great decisions day in and day out, setting their own goals, setting goals of the team, and aligning strategy.

I’m very fortunate. We have an incredible team here at Midmark, and I see my job as empowering them and helping them execute, and really supporting them. Part of it is that I feel like I’m working for them. I say that with all respect because they’re moving a lot of these things forward and winning in the marketplace. And I’m very fortunate.

Adams: I got to know you at some of the organizations where you volunteered your time. How important is it to you to give back to the industry?

Wells: Today, I’m on the board of the Health Industry Distributors Association’s education foundation. I’m a former board member for the Healthcare Manufacturers Management Council (HMMC), and was president of HMMC for a while, and have held roles on several industry trade councils. This is about learning and staying engaged. Giving back and caring for communities – just like I spoke about our culture – these things are all intertwined.

Before I came to Midmark, I started in architecture.

That degree has helped me so much in my roles at Midmark, especially in my current CEO role, because that architectural background brings clarity and focus to how we design better healthcare experiences, and building this out, and sharing across industries. So being engaged with industry associations is very important for me and for Midmark.

Mentors Jon Wells has a long list of people he considers leadership mentors. Internally at Midmark, there is Dick Moorman, Joe Rothstein, Don Kitzmiller, Anne Eiting Klamar, and John Baumann more recently. “All of them have had a significant impact on my leadership style.”

Industry staples such as Rob Saron, Cindy Juhas, Gary Corless,

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Brad Connett and Joan Eliasek are individuals Wells said he’s looked up to during his entire career. “There are so many who have given me breaks, showed me the way through a difficult decision, and challenged me when I needed to be challenged.”

Wells credits his father with instilling in him a mentality that you can’t

expect someone to buy your product or give you a dollar – you have to earn it.

“I’ve always carried that with me,” Wells said. “Everything I do and everything Midmark does is about earning that. And we earn it. It takes work. You have to be obsessed with your customers, be with them in their execution and then build trust.”

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Americans masked up, socially distanced, and washed their hands to slow the transmission of the SARS-CoV-2 virus last year. One of the unexpected results was the almost non-existence of flu during last year’s respiratory season.

That’s unlikely to be the case this year.

Between September 2020 and April 2021, there were slightly more than 2,000 lab-confirmed cases of influenza in the U.S., according to the CDC.1 The U.S. sees more than 200,000 lab-confirmed flu cases in a typical respiratory season. This is a small portion of the total number of cases, which chart into the millions.2 But as more people head back to work and school, the flu will likely

return. And the lack of exposure to the flu last year could make people more susceptible to it, along with co-infections between flu, COVID-19, and RSV. Children’s hospitals activated surge plans in response to an increase of children presenting with RSV, which usually hits during the winter.

RSV presents like many other respiratory illnesses as a fever, cough, and runny nose and can cause respiratory

distress like other respiratory illnesses. Public health experts say the increase in RSV is an indirect result of the pandemic as pediatricians didn’t see typical instances of RSV last respiratory season.3 “We anticipated there would be a significant respiratory season and coinfections this year,” said Cisco Merrill, National Sales Director, Alternate Site for Sunnyvale, Calif.-based Cepheid, www.repertoiremag.com

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a molecular diagnostics company.

“We had to find a way to test for all those illnesses at the same time.

We increased production to get our tests to more clinics to help filter out patients who weren’t acute and to help unburden the health systems.”

Respiratory tract infections require an accurate diagnosis to ensure that patients receive appropriate treatment. Cepheid’s Xpert® Xpress CoV-2/Flu/RSV plus (4-plex plus) – a PCR test – provides actionable, rapid respiratory results to meet the challenges of the pandemic and other respiratory illnesses. It rapidly detects SARS-CoV-2, Flu A, Flu B, and RSV and identifies potential cases of co-infections.

The test provides actionable detection of SARS-CoV-2 in 25 minutes with results for all four pathogens in 36 minutes. It also tests for three distinct gene targets for SARSCoV-2: N2, E, and RdRP, offering broad coverage for detecting the virus, inclusive of variants.4 Cepheid’s 4-plex plus provides a rapid result that aids physicians in determining appropriate treatment in a single-cartridge, easy-to-use workflow, helping hospitals, clinics, and physician offices to manage limited resources.

PCR tests like Cepheid’s 4-plex plus take more time to deliver results than antigen tests do but, according to the FDA, antigen tests may not detect all active infections as they do not work the same way as PCR tests. They are not as sensitive as molecular PCR

Cisco Merrill

emphasized. “Meet and treat in one visit. One swab. One test.”

Not only does Cepheid’s 4-plex plus check for three distinct respiratory illnesses with four targets, it also uses one swab to test for all four.4 “That helps unburden the health system from a supply constraint perspective,” Merrill added. “There was a significant swab shortage last year.

Even if there were enough assays, there weren’t enough swabs to test.

The 4-plex plus design provides one swab for four tests and helps aid swab supply.”

Not only does Cepheid’s 4-plex plus check for three distinct respiratory illnesses with four targets, it also uses one swab to test for all four.4 tests, which leads to a higher chance of false negatives; negative results from an antigen test may need to be confirmed with a PCR test prior to making treatment decisions.5 “Getting it right the first time and not infecting others is significantly important,” Merrill said. “Our test makes it much more likely you’ll get the right result.”

“We position that to our distribution partners and our physicians.

We’re a little bit longer in time than antigen tests, but it’s still under an hour and you’re much more likely to get the right result,” Merrill

Using only one swab and one test along with diagnosing in one encounter can be a competitive differential.

The specificity for Cepheid’s 4-plex plus is over 99%.4 “Having that confidence to tell patients what they definitively have and what treatment plan can be started is an advantage for physicians and non-acute facilities,” Merrill said. “PCR testing is the ultimate in quality and people are asking for it by name. They might not know what PCR stands for but, like an MRI, they know they need to get one.”

CDC: Weekly U.S. Influenza Surveillance Report (FluView) CDC. Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States — 2019–2020 Influenza Season.

Reviewed June 2, 2021. Accessed September 29, 2021. https://www.cdc.gov/flu/about/burden/2019-2020.html?web=1&wdLOR=c8E88FEDA-013B400E-B982-42900B491873 3 The Washington Post: Children’s hospitals seeing early increase in seasonal respiratory illness. September 15, 2021.

4 Xpert® Xpress CoV-2/Flu/RSV plus Package Insert 302-6991, Rev. A. September 2021.

5 FDA. Coronavirus Update: FDA Authorizes First Antigen Test to Help in the Rapid Detection of the Virus that Causes COVID-19 in Patients. Press Release.

May 9, 2020. Accessed September 29, 2021. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizesfirst-antigen-test-help-rapid-detection-virus-causes 1 2

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TRENDS

RNs in Primary Care Opportunities, barriers and hopes for a vital component of healthcare providers.

Nurses in hospitals are experiencing physical and emotional stress due to COVID. But RNs in the primary care

environment aren’t immune.

“They work in a different work environment, but nurses in ambulatory care are facing stress and pressure just like those in acute care,” says Deena Gilland, DNP, RN, NEA-BC, FAAN, vice president and chief nursing officer of Emory Ambulatory Patient Services Operations at Emory Healthcare in Atlanta. “With COVID has come a wave of patients who need care outside the acute care setting. Instead of seeking care in emergency departments, they are coming to our practices.”

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Celebrating 30 Years of Enhancing Family and Community Health For the past three decades, Dukal has evolved with the ever-changing healthcare industry.

We’ve transformed from a single product company operating from founder Gerry LoDuca’s basement, to a leader in the development and manufacturing of medical products.

Working collaboratively with healthcare professionals, Dukal aims to create a resilient and innovative healthcare industry. Our 30th anniversary is a celebration of our journey and a tribute to our employees and partners.

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professionals to launch innovative solutions to unmet clinical needs.

TRENDS With COVID came an overnight boom in telemedicine and telehealth, adds Gilland, who is president-elect of the American Academy of Ambulatory Care Nursing.

“That’s a positive thing, but it happened so quickly, we didn’t have the necessary structure and processes in place.

That meant additional stress.” Meanwhile, nurses in the ambulatory care setting face the same domestic pressures as their counterparts in the hospital, such as finding child care and monitoring their kids who are doing remote learning.

But the challenges – and opportunities – facing the nursing profession, and all those who rely on nursing, precede COVID and will outlast it. In a report published this spring, “The Future of Nursing:2020-2030,” the National Academy of Medicine made the following points: ʯ As the U.S. population ages, patients will include increasing percentages of older people, many of whom will have multiple comorbid conditions, which will increase the complexity and intensity of the nursing care they require. Increases can also be expected in the number of frail older adults – those who need assistance with multiple activities of daily living, are weak and losing body mass, and have an increased risk of dying within the next 2–3 years.

‘Nurses operating at their full scope of practice are skilled at communicating with patients and the healthcare team – a very, very vital role in the practice.’ ʯ Nurses will have to expand their roles to supplement a shrinking primary care workforce, provide care to rural populations, help improve maternal health outcomes, and deliver more health and preventive care in community-based settings. A 2020 report prepared for the American Association of Medical Colleges estimated that by 2033, current physician shortages could increase, ranging between 21,400 and 55,200 for primary care physicians, and between 33,700 and 86,700 for specialty physicians. These projections, made prior to the COVID-19 pandemic, take into account decreasing 34

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hours worked by physicians, accelerating retirements, and increasing demands for medical care among aging baby boomers.

ʯ As the population diversifies in race, ethnicity and other factors, nurses will need to be wellversed in providing care that is culturally respectful and appropriate. Nurses also will be called on to address the persistent and widening disparities in health tied to poverty, structural racism, and discrimination.

ʯ Nurses may be called upon to aid in providing mental health care among the general population, stemming from high rates of depression, suicide, anxiety, trauma, and stress due to such challenges as substance abuse, gun violence, and now the lingering effects of the pandemic.

New and broader roles for RNs and advanced-practice RNs (e.g., nurse practitioners) can enhance patient care and access to care, says Gilland. “Nurses can perform care coordination, true population health management and chronic disease management to enhance the work of physicians, who lack the bandwidth to perform all these functions.”

“Care is and will continue to occur more frequently outside of acute care sites,” says Joan Stanley, PhD, RN, FAAN, CRNP, CNL, who is chief academic officer for the American Association of Colleges of Nursing. “It is important that [nurses] are prepared to provide care across the continuum of care. If the U.S. is going to improve outcomes of care and address the inequities in health care, a greater emphasis must be made in prevention and chronic disease management. These are areas of care in which nursing both at the entry-level and advanced levels of practice can make significant contributions to care.”

Team care The potential role of RNs in the primary care setting has been a topic of discussion for years. According to the Institute of Medicine’s 2011 report “Future of Nursing: Leading Change, Advancing Health, “traditional nursing competencies, such as care management and coordination, patient education, public health intervention, and transitional care, are likely to dominate in a reformed healthcare system as it inevitably moves toward an emphasis on prevention and management rather than acute [hospital] care.”

TRENDS Some have used the term “team care” to describe a physician practice that makes full use of the talents and skills of all staff members, including RNs. In 2008, Peter Anderson, M.D., a family physician in Newport News, Virginia, described in Family Practice Management his practice’s “family team care” system, which, he said, improved professional satisfaction, quality of care and financial performance. Most patient visits can be broken down into four distinct components, he wrote: ʯ Part 1: Data-gathering. ʯ Part 2: Analysis of data and pertinent physical exam. ʯ Part 3: Decision-making and development of a plan. ʯ Part 4: Implementation of the plan and patient education.

“During a traditional office visit, the physician completes the majority of all four components. But in the team care model, the clinical assistant [typically an RN or LPN, or a capable medical assistant] gathers data according to specific protocols and communicates that information to the physician, in the presence of the patient, when the physician enters the exam room (Part 1). The physician then analyzes the data, conducts the exam, determines the diagnosis and develops the treatment plan (Parts 2 and 3).

“The clinical assistant documents the findings and additional information elicited by the doctor during the exam. The physician discusses the treatment plan with the patient and the clinical assistant and exits the room. The clinical assistant closes the visit with the patient, reiterating the physician’s instructions and providing prescriptions, referral information and patient education materials as directed by the physician (Part 4).”

Beyond the physician office In June 2016, the Josiah Macy Jr. Foundation convened a group of national experts to address the need to transform primary care and promptly identified the need to change the culture of healthcare and transform the practice environment. The outcome of those proceedings were published under the title “Registered Nurses: Partners in Transforming Primary Care.”

The report emphasizes the need to overcome the limited ways in which many primary care practices currently use RNs, e.g., telephoning prescriptions to pharmacies or performing administrative duties.

“Primary care practices should evaluate the skill mix of current team members to ensure that their contributions 36

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are optimized, and either hire RNs into enhanced roles or reconfigure the roles of those already on the team,” the experts concluded. “The RN roles should include care management and coordination for aging and chronically ill patients and those with increasingly complex health needs; promoting health and improving patients’ selfmanagement of prevention and behavioral health issues; and placing greater emphasis on transitional care, prevention, and wellness. Practices should optimize the potential of RNs, allowing them to spend ample face-to-face time with patients.”

RNs also can help improve transitional care, as patients move between hospitals, other care facilities, and home. Further, they can help improve patient engagement, quality scores, and team collaboration using health assessments, patient education, motivational interviewing, medication reconciliation, care planning, and more.

‘Primary care practices should evaluate the skill mix of current team members to ensure that their contributions are optimized, and either hire RNs into enhanced roles or reconfigure the roles of those already on the team.’

The human element Because of their clinical knowledge, experience, and hands-on work with patients, nurses are uniquely qualified to step up their role in the outpatient clinic, says Sean DeGarmo, PhD, RN, ACNS-BC, FNP-BC, ENPBC, director of Advanced Practice Initiatives and Certification Outreach at the American Nurses Credentialing Center. “Nurses operating at their full scope of practice are skilled at communicating with patients and the healthcare team – a very, very vital role in the practice.” Using that skill, they keep in touch with patients between visits, answer questions, and – because they understand diagnostic tests and procedures –help make sure patients are scheduled appropriately and understand the plan of care, he says.

“Nurses are skilled in dealing with the human responses to the disease process, not just the disease itself.”

“We need to make sure the public – and even nurses themselves – see nurses as capable of providing care at all ends of the spectrum, not just as comforters or as the ones to carry out doctors’ orders,” says Katie Boston-Leary, PhD, MBA, MHA, RN, NEA-BC, who is the director of nursing programs and co-lead for Project Firstline in the Department of Nursing Practice & Work Environment at the American Nurses Association. “If nurses are to feel valued, they must be allowed to practice at the top of their license.” Nurses can address the primary care supply and demand gap starting with increasing and optimizing roles as nurse practitioners. As case managers, for example, they help patients and the community understand steps they can take to remain well, a process that takes place largely outside the doctor’s office, including on the phone or video, she says.

“We have an increasing number of advanced practice nurses who can help provide care in the office, but room has to be made for them to enter that space.”

Nursing stats

ʯ An estimated 600,000 baby boom RNs are

expected to leave the workforce by 2030, per the National Academy of Medicine’s “Future of Nursing: 2020-2030” report. “The exit from the workforce by so many experienced RNs (about 70,000 per year) means that health care delivery organizations that depend on RNs will face a significant loss of nursing knowledge, clinical expertise, leadership, and institutional history.”

ʯ Forty-two percent of RNs in private medical practice are older than age 50.

ʯ Just 5% of RNs work in a private medical practice (clinic, physician), while 27% work in an inpatient unit (not a critical access hospital), 11% in a critical access hospital, and 9% in a hospital-sponsored ambulatory care setting, per the NAM report.

ʯ Based on findings from the American

Association of Colleges of Nursing’s annual survey conducted in Fall 2020, nursing programs offered at the entry-level baccalaureate, master’s and Doctor of Nursing Practice have seen more than 15 years of continuous enrollment growth.

Barriers Proponents argue convincingly that RNs can and should be allowed to manage patient care across the continuum of care. But are they?

“It has been happening around the country for the past five to 10 years,” says Gilland. While not universally adopted, “it’s an evolution,” she says. With changing payment and reimbursement models, telehealth and today’s emphasis on population health, the transformation will speed up. “The time is now. The spotlight is on.”

Authors of a September 2018 article in Nursing Outlook magazine, “The American Academy of Nursing on policy: Emerging role of baccalaureate registered nurses in primary care,” wrote that high-performing teams, including RNs, who participated in the Robert Wood Johnson Primary Care Teams’ “Learning from Effective Ambulatory Practices (PCT-LEAP)” program played a pivotal role in preventive health and chronic care management and practiced autonomously in many of these domains. “BSN-RN responsibilities in high-performing primary care organizations have been found to increase access to healthcare services, decrease hospital re-admission, ER use, and overall costs of care, and improve quality of care, patient outcomes, and staff satisfaction,” they said.

Nurse-led clinics have proven to reduce lengthy backlogs of care, says Boston-Leary. “Data shows they are successful and, over time, many in the community are seeing the benefits.”

DeGarmo says that studies have demonstrated that practices with strong working teams, in which everyone works to their highest level, function better and yield better patient outcomes. “In a shared-decision-making environment, everyone has a voice. Instead of someone telling staff, ‘I want you to do this,’ you find people speaking up with, ‘Is this the best treatment option and has it taken into account what matters most to the patient?’ It leads to a more functional and productive work environment.”

But barriers still exist. The Macy Foundation identified four of them: ʯ Many RNs in primary care still spend much of their time on patient triage, sorting out who needs to be seen immediately and who can wait – important functions, but functions that take away time that could be spent on chronic care management, care coordination and preventive care. www.repertoiremag.com

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TRENDS

ʯ Some state laws inhibit RNs from exercising the full extent of their education and training. Even when state law supports full practice authority, healthcare organizations sometimes restrict RNs from practicing to the full extent of their licensure.

ʯ Much of the work that RNs and other primary care team members currently perform is not directly reimbursable under the fee-for-service payment model, meaning that new payment models are needed to facilitate the growth of primary care teams that include RNs.

ʯ Perhaps most important, many RNs are not exposed consistently to the full range of primary care content in the classroom or through instructional clinical experiences, which overwhelmingly focus on inpatient and acute care. As a result, RNs may lack skills and competencies essential to functioning effectively in primary care.

Educating tomorrow’s nurses Changes such as these call not only for enlightened, capable leadership among non-acute providers, but for new emphases in nursing education.

“Nursing education programs have historically emphasized preparing students for inpatient acute care and medical and surgical nursing,” wrote the authors of the National Academy of Science report on the future of nursing 2020-2030.

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“Consequently, too few nurses today are adequately prepared to practice in non–acute care settings. To address the growing need for primary care providers, educators will have to increase coursework and student clinical experiences in primary care settings, which in turn could lead to more graduates choosing careers in primary care and ambulatory and community-based settings.”

In fact, more nursing schools are adding primary care content at the undergraduate level, says Joan Stanley of the American Association of Colleges of Nursing.

In addition, nursing schools are providing nursing students with practical experience in non-acute care settings, including primary care.

“AACN has strongly endorsed the need to strengthen academic-practice partnerships in our ongoing work with the American Organization for Nursing Leadership and in our 2016 publication, ‘Advancing Healthcare Transformation: A New Era for Academic Nursing,’” she says. “We also have encouraged schools to develop diverse partnerships, which include primary care, public health, and other nonacute care partnerships.”

The result – it is hoped – will be growing enthusiasm on the part of nursing graduates to work in nonacute-care settings.

“Over the past five years or so, we had seen a great interest among nursing graduates who want to practice in ambulatory care,” says Gilland. “They understand that tackling our healthcare crisis starts in the non-acutecare setting.”

Retaining the Workforce Health systems explore ways to recruit, retain staff amid variant surge; prepare for long-term changes

Twenty two percent of nurses providing direct patient

elective surgeries. According to The Atlanta Journal-

care indicated that they may leave their current position

Constitution, experienced nurses are quitting in Georgia,

within the next year in a recent McKinsey survey.1 A signifi-

changing jobs or just hanging on. The Delta variant struck

cant strain exists in the healthcare workforce due to the

the South harder than other areas of the country and hos-

COVID-19 pandemic. Health systems recognize the unique

pital staff are exhausted battling COVID-19’s fourth wave.

challenge and are responding with wage increases, recruitment increases and one-time bonuses. These are the top tactics used during the past three months to maintain and retain a strong nursing workforce.2 Nursing turnover and vacancy rates have increased four to five percentage points in the past 12 months. This is all during a time when health systems are trying to catch up to meet increased demand as patient volumes return and exceed 2019 levels in the U.S. Expanded clinic hours, increased physician productivity expectations, optimized operating room scheduling and expanded operating room hours are all critical challenges hospitals cite3 and to meet them lies on the capacity and well-being of their healthcare workforces.

Operations impacted Health systems have had to change their care model, reduce inpatient capacity, report reductions in operating room and

Because of healthcare staffing shortages in Missis-

ambulatory clinic capacity, increase emergency department

sippi, 771 medical-surgical and 235 ICU beds were reported

diversion and increase length of stay as more than 80% of

unused in August. More than 70 Mississippi hospitals had

respondents reported continued challenges with nursing

collectively asked the state for about 1,450 healthcare

workforce coverage. Challenges with broader clinical sup-

workers to make use of the available beds during the Delta

port staff coverage was reported by 60% of respondents.

variant surge. A recent health order certified Mississippi’s

The McKinsey survey represented 100 respondent hospitals

Emergency Medical Services workers to provide care for

across the U.S. with more than 200 beds, collectively repre-

patients in state-licensed hospitals as Mississippi saw its

senting about 10% of all hospital beds in the country.

highest number of coronavirus-related hospitalizations since the virus entered the state in March 2020.

Hard hit South

According to McKinsey, healthcare systems are man-

Hospitals are making do with available resources and staff

aging short-term, pandemic-era workforce challenges

in the hard hit states in the South. Hospitals in Georgia had

and preparing for long-term changes to enhance the

to scale back services due to lack of staff and some halted

workforce and patient experience.

References 1

2021 McKinsey Future of Work in Nursing Survey, 2 McKinsey COVID-19 Hospital Insights Survey (July 2021), 3 McKinsey COVID-19 Hospital Insights Survey (July 2021)

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It’s Time to End the HIV Epidemic On June 5, 1981, the first five cases of what later became known as HIV/ AIDS were officially reported. For years, HIV/AIDS has been politicized,

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Great advancements to ending the HIV epidemic have been made in the last 40 years. We have more knowledge about the virus now than we did in the early 1980s, testing has progressed, and not only do we have treatment to help HIV-positive people stay healthy, but there is also treatment to help an HIV-negative person stay negative.

Despite all of this, there’s still work to do.

MSM, Black/African Americans, Hispanics/Latinos, transgender women who have sex with men, and people who inject drugs are the populations most affected by HIV.2 Approximately 1.2 million people in the U.S. have HIV and 13% of them don’t know it. They need testing.3 To cross the finish line, the federal government in 2019 created Ending the HIV Epidemic, a plan to end HIV by 2030. To achieve this goal, four key strategies were developed: Diagnose, Treat, Prevent, and Respond. The plan is dependent on diagnosis and when people get tested they can make informed health decisions. The CDC recommends everyone between the ages of 13 and 64 be tested at least once for HIV in their lifetime. For those at higher risk, CDC recommends getting tested at least once a year.4 42

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At OraSure, we are proud to say we are doing our part to end the epidemic by 2030. We currently offer two rapid HIV tests that use oral fluid, OraQuick ADVANCE®HIV-1/2 Rapid Antibody Test and OraQuick® In-Home HIV Test.

The OraQuick ADVANCE® HIV-1/2 Rapid Antibody Test is an FDA-approved professional pointof-care HIV test that detects antibodies to HIV-1 and HIV-2. It is also approved for use with oral fluid, plasma, fingerstick and venipuncture whole blood. The professional test can be used for batch testing and help reduce in-direct costs.

The OraQuick®In-Home HIV Test is the first and only FDA-approved over-the-counter HIV test that detects antibodies to HIV-1 and HIV-2. The In-Home test can be sent to patients, which is quarantine/self-isolation friendly, helping facilitate telehealth healthcare. It can also be purchased at retail pharmacies across the country.

One of the advantages of using the OraQuick platform is the ability of the tests to be used with oral fluid. Testing with oral fluid means enables more people to get screened.

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reach people who would otherwise not get tested, because of fear of blood or fear of going to a doctor’s office.

It is empowering – whether you are a manufacturer like OraSure Technologies or a distributor – to support someone’s health journey and link them to the care that they need, whether preventative measures or treatment. Our tests provide patients with life- changing results and help them take charge of their health.

It has been 40 years since the first official HIV/AIDS cases were reported. During that time, we have made progress, but there is more work to do. It is our job to do what we can to help end the epidemic. It is time to end HIV.

Did you know that we recently launched an implementation manual called HIV Testing Through Telehealth? Written by renowned HIV subject matter experts Rob Stephenson, PHD, and Stephen Sullivan, MPH, in this manual you will learn how to set up a telehealth session, guide the patient through taking an HIV test remotely with the OraQuick In-Home HIV Test and provide counseling, all in under an hour. Download for free at oraquick.com/telehealth.

Rapid Point-of-Care HIV Tests OraSure offers two rapid HIV tests that use oral fluid, OraQuick ADVANCE®HIV-1/2 Rapid Antibody Test and OraQuick® In-Home HIV Test.

The OraQuick ADVANCE® HIV-1/2 Rapid Antibody Test: ʯ Is an FDA-approved professional point-of-care HIV test that detects antibodies to HIV-1 and HIV-2. ʯ It’s also approved for use with oral fluid, plasma, fingerstick and venipuncture whole blood. ʯ The professional test is a simple three-step process with less than one minute hands on time, making it suitable for batch testing.

The OraQuick®In-Home HIV Test: ʯ IsthefirstandonlyFDA-approvedover-the-counter HIV test that detects antibodies to HIV-1 and HIV-2. ʯ The In-Home test can be sent to patients, which is quarantine/self-isolation friendly, helping facilitate telehealth healthcare. ʯ It can also be purchased at retail pharmacies across the country.

For more information about OraSure products and how you can help end the epidemics, please reach out to us at endtheepidemics@orasure.com.

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TRENDS

Equipment Selling Post-Pandemic Leverage technology, yes. But don’t forget it’s all about relationships With limited access to customers and transportation/logistics disruptions, sales professionals face all kinds of

challenges these days. The challenges become more formidable for those selling healthcare equipment, because more dollars are involved. Repertoire asked equipment sales experts how they meet these challenges, and how they plan to keep doing so in the future. Their message? Leverage technology, but don’t forget, it’s still all about relationships. The experts are: ʯ Cindy Juhas, chief strategy officer, CME Corp., supplier of healthcare equipment, logistics and services. ʯ Jack Moran, managing partner, MTMC, an outsourced sales firm. ʯ Ben Powers, director of distribution sales, Sysmex America, diagnostics manufacturer. www.repertoiremag.com

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TRENDS Repertoire: What’s the latest on access to equipment customers?

Cindy Juhas: Customers have become very accommodating when it comes to scheduling virtual calls. It is harder to read people on these calls, but we have found that customers include more people on the calls, as do we, since no travel is involved ... and that makes for higher quality calls.

More and more customers are asking our installers, biomed technicians and account managers to comply with their mandated vaccinations policy. Anyone entering their buildings needs to be vaccinated by a certain date.

Most of the hospital systems on the West Coast, in the Northeast and in the middle of the country have sent out notices to us.

Because of COVID, raw materials that are needed in the manufacturing of most healthcare equipment are scarce.

Ben Powers: During the pandemic, access initially disappeared as everyone raced to get their immediate needs (i.e., PPE, testing) met. Access eventually migrated toward virtual meetings and sales calls. Typical in-person meetings with distributors became [Microsoft] Teams calls. As an organization that sells to labs via distributors, we faced a significant challenge with forecasting and funnel development.

Repertoire: What are customers’ expectations of their suppliers in terms of equipment demos, installation and inservicing?

Cindy Juhas: CME has invested in making videos of some demos on strategic products. More and more manufacturers have demo videos available as well. We have also sent equipment to customers for them to try. All of these tactics have been effective.

Our direct-to-site delivery and installation services are very popular. There was a brief time early in the pandemic when we were asked to just drop things off at the dock, but all of our installers are equipped with PPE, and they comply with CDC or customer guidelines, so very little has changed. If anything, hospital customers are using these services even more due to lack of resources on their 46

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part. Our biomed technicians’ group has been very busy, again, due to lack of resources at the hospitals.

We also use videos for inservicing. Many of our manufacturer partners do so as well.

We face continuing issues with equipment manufacturing and shipments. Because of COVID, raw materials that are needed in the manufacturing of most healthcare equipment are scarce. Some come from out of the country and are affected by the back-up of vessels in major harbors and the shortage of containers. You also need to take into account the shortage of truck drivers domestically. Because all we sell is equipment, these issues have affected delivery timelines to the customer. Add to that the fact that most manufacturers had major price increases mid-year, and shipping costs went through the roof. We expect more price increases in January. How this will ultimately affect our customers’ purchasing patterns has not been realized yet.

Jack Moran: Access for sales reps remains limited, and we are doing more demo-ing virtually. Inservicing is the one area where access is much less limited. Customers still rely heavily on in-person inservicing of equipment.

Ben Powers: We created virtual demos for distributors and customers, which give them an opportunity to experience our analyzers. The live events give viewers an interactive experience where they can ask questions.

We leverage our “Center for Learning” – our customer training facility and production studios – as much as possible to create customer and/or distributor interactions. (Editor’s note: Sysmex opened its 98,000-square-foot Center for Learning in August 2018.)

Many of our installations require that support staff fly to the customer’s site. The changes in travel have affected the lives of the installation and service engineers.

Repertoire: What are some of the most effective ways you and your reps have been meeting these challenges?

Cindy Juhas: Our account managers and internal staff have had to increase communications between us and manufacturers, and us and customers. Customers used to order equipment four weeks before they needed it, but now they order 12 or more weeks ahead. Manufacturers often cannot give us accurate ship dates, so we have to pass that bad news along to customers. They are mostly understanding but their patience is running thin, for sure.

Most experts think the raw materials and logistics issues will continue well into next year.

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TRENDS We make sure to connect with customers regularly with emails and calls. We also post pertinent blogs and timely content on social media – just one more way we connect with customers routinely.

Ben Powers: Teams, Teams and Teams. We are fortunate to have great relationships with our distributor partners. Their long-lasting relationships with customers have created a true teamwork environment for learning and adapting.

Repertoire: What lasting effects will the pandemic have on the way equipment is sold?

Cindy Juhas: Quite a few of our customers have said they appreciate the virtual meeting format. I think it is here to stay, even after we get back to some kind of normalcy.

Jack Moran: I think there will be fewer in-person opportunities to demo equipment. Customers expect the sales rep to be in and out for a specific purpose. I am not sure this will change after the health emergency ends. Also, while our team has traditionally been able to create new leads when inservicing, this is very difficult to do in the current market.

Our team will need to continue to master virtual selling skills. In addition, making good use of data and strategically creating leads will be very important. The lack of access makes it difficult to create leads transactionally.

We need to be data-driven on how we target customers for lead generation and develop messaging that engages them, so they want an in-person or virtual demo.

Ben Powers: Moving forward, I can see customers requiring proof of vaccination to avoid complications for immunocompromised patients.

Silver lining Limited customer contact due to COVID-19 has tested inside sales reps as well as their counterparts in the field, says Joanne Wills, partner, MTMC Inside Sales, which develops and creates custom call campaigns for the outsourced sales firm MTMC and other medical device and healthcare clients. But the pandemic has strengthened the sales skills of both.

Inside reps who have traditionally contacted customers by phone to present product features and benefits before passing the lead to a field rep may find themselves becoming more adept at “soupto-nuts” sales, particularly among lower-to-medium-revenue customers and markets, she says. Meanwhile, field reps who traditionally have avoided using the phone or other digital media to sell products, have become savvier at doing so, leading to more creative ways to reach customers. In fact, the development of more and better sales skills by inside reps and field reps “is probably the only silver lining” of COVID19, she says.

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“Given the obstacles we’re trying to overcome with the pandemic, we can never lose sight of the importance of the customer relationship. We need to keep in mind the importance of staying in touch, whether it’s through social media or simply checking in every once in a while.”

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EQUIPMENT

What to Do with ‘Legacy’ Equipment How can you guarantee the cybersecurity of outdated equipment?

Editor’s note: Last month Repertoire shared some experts’ perspectives on selling the cybersecurity-related merits of new equipment and devices. This month, we look at a nagging problem – ensuring the cybersecurity of “legacy” devices and equipment, that is, devices that keep on working beyond the point when their operating systems and software can be updated or patched.

How long will distributors and manufacturers be on

the hook for ensuring the safety – from a cybersecurity perspective – of the equipment they sell? One year?

Five? Ten? In a letter written in May 2018 to the U.S. House of Representatives Energy and Commerce Committee, the American Hospital Association took a strong stance: “The FDA must make clear that security measures to protect legacy devices are required, not optional. Unfortunately, the health care sector, including the device sector, continues to be confused as to whether FDA guidance on post-market cybersecurity is binding.”

‘Certain legacy applications simply will not work on more recent versions of Windows due to lack of support, compatibility, or license schema issues.’

In the letter, former AHA Executive Vice President Thomas Nickels wrote, “It would be useful for manufacturers to provide guidance to end-users at the time of purchase about the expected supported lifetime. This would allow for better planning and risk management activities.

Chad Waters, senior cybersecurity engineer, Device Evaluation Group at ECRI, told Repertoire in an email, “Going forward, the strategy should focus on producing devices that don’t become ‘legacy’ before their useful lifespan. It’s also reasonable that a device [be] easily patchable. These devices should have security support throughout their expected lifespan. In some cases, this 50

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includes one or more upgrades of the operating system platform. Manufacturers should be transparent with the lifecycle plans of their devices.”

Even the AHA’s Nickels doesn’t believe it will be easy.

“There is a significant contrast between the ease and efficiency of updating network and PC software for security, and updating software embedded in medical devices,” he wrote. “Software companies have generally prioritized creating a systematic approach for sharing timely updates and providing guidance on how to complete them. Similar approaches have yet to be deployed by medical device manufacturers.”

At some point, healthcare providers must decide, Will they disconnect their equipment from the Internet of Things, or will they simply replace it?

A 2019 analysis by cybersecurity firm Forescout Research Labs put it this way: “Networks will most likely continue to have medical devices running legacy operating systems, since updates are costly. The downtime associated with an operating system update might not be acceptable for critical-care systems. In addition, certain legacy applications simply will not work on more recent versions of Windows due to lack of support, compatibility, or license schema issues.

“The business need to run legacy operating systems on medical devices isn’t going away any time soon, so these devices must be segmented appropriately to protect access to critical information and services.”

CME Corporation CIO Peter Wyner told Repertoire, “Legacy equipment is definitely a challenge, especially once it has reached an end-of-support status. When connected equipment is no longer being supported and patched by the manufacturer, we typically work with customers to provide options for replacement or recommend deactivating the connected functionality of the equipment when feasible.”

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1. Nathan DM, Griffin A, Perez FM, et al. Accuracy of a Point-of-Care Hemoglobin A1c Assay. J Diabetes Sci Technol. 2019;13(6):1149-1153. https://journals.sagepub.com/doi/abs/10.1177/1932296819836101.

2. Arnold WD, Kupfer K, Little RR, et al. Accuracy and Precision of a Point-of-Care HbA1c Test. J Diabetes Sci Technol. March 10, 2019. https://journals.sagepub.com/doi/pdf/10.1177/1932296819831292.

3. Arnold WD, Kupfer K, Swensen MH, et al. Fingerstick Precision and Total Error of a Point-of-Care HbA1c Test. J Diabetes Sci Technol. March 6, 2019. https://journals.sagepub.com/doi/ pdf/10.1177/1932296819831273.

4. Lenters-Westra E, English E. Evaluation of Four HbA1c Point-of-Care Devices Using International Quality Targets: Are They Fit for the Purpose? J Diabetes Sci Technol. 2018;12(4):762-770. https://journals.sagepub.com/doi/pdf/10.1177/1932296818785612.

5. Sobolesky PM, Smith BE, Saenger AK, et al. Multicenter assessment of a hemoglobin A1c point-of-care device for diagnosis of diabetes mellitus. Clin Biochem. 2018;61(4):18-22. https://www.sciencedirect.com/journal/clinical-biochemistry/vol/61/suppl/C. © 2020 Abbott. All rights reserved. All trademarks referenced are trademarks of either the Abbott group of companies or their respective owners. Any photos displayed are for illustrative purposes only.

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Prevention of device-related skin injury is a top concern of healthcare professionals and the facilities where they provide care. This is

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The Dale Tracheostomy Tube Holder supports bariatric care in two ways. Patients who have a high degree of adiposity between the skin surface and the tracheal area require a deep surgical incision to locate the trachea.

The Dale Tracheotomy Tube Holder is designed to provide secure positioning and minimize movement of the tracheostomy tube. This is an important factor in the presence of a deep surgical incision because unnecessary movement of the tracheostomy tube can result in not only trauma to the tracheostomy wound, but also accidental dislodgement or displacement of the tube, tracheal fistula, tracheal stenosis, or airway granuloma.

The Dale Tracheostomy Tube Holder is also instrumental in preventing device-related injury that occurs when gauze or twill tracheostomy tube ties burrow into the soft tissue around

the neck, especially in the presence of deep skin folds. The exclusive moisture-wicking neck band lining serves to reduce the risk of skin injury due to moisture associated skin damage (MASD) within deep skin folds.

Understanding the relationship between the skin, obesity and respiratory issues has become a principal concern in the presence of the COVID-19 pandemic, and a lesson learned. Researchers have learned that morbid obesity is an independent risk factor for severe COVID-19 infection.

The Centers for Disease Control (CDC) reported that individuals who have obesity are at an increased risk of severe illness from COVID-19, and may have triple the rate of hos-

pitalization due to the infection. For instance, a study of COVID-19 cases suggested that risks of hospitalization, intensive care unit admission, invasive mechanical ventilation, and death were higher with increasing BMI. Simmonet and others reported that 30% of adult COVID-19 hospitalizations that occurred in the United States between the beginning of the pandemic and November 18, 2020 were attributed to obesity. From a respiratory perspective, obesity decreases lung capacity and reserve and can make ventilation more difficult. The increased risk for hospitalization or death was particularly pronounced in those under age 65. To that end, a keen understanding of respiratory care is essential when caring for the plus sized patient anytime, but especially in the presence of the current pandemic.

The issues associated with improperly securing a tracheostomy tube can lead to a device-related skin injury, dislodgment of the tube and more. Each of these may lead to adverse clinical, economic and humanistic outcomes for the patient.

Demeulemeester, F., de Punder, K., van Heijningen, M., & van Doesburg, F. (2021). Obesity as a Risk Factor for Severe COVID-19 and Complications: A Review. Cells, 10(4), 933. https://doi.org/10.3390/cells10040933 Kompaniyets L, Goodman AB, Belay B, et al. Body Mass Index and Risk for COVID-19–Related Hospitalization, Intensive Care Unit Admission, Invasive Mechanical Ventilation, and Death — United States, March–December 2020. (2021). MMWR Morb Mortal Wkly Rep 2021;70:355–361. DOI: http://dx.doi. org/10.15585/mmwr.mm7010e4.

O’Hearn M, Liu J, Cudhea F, Micha R, Mozaffarian D. (2021). Coronavirus Disease 2019 Hospitalizations Attributable to Cardiometabolic Conditions in the United States: A Comparative Risk Assessment Analysis. Journal of the American Heart Association. 2021 Feb;10(5):e019259. doi:10.1161/JAHA.120.019259.

Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, Labreuche J, Mathieu D, Pattou F, Jourdain M; LICORN and the Lille COVID-19 and Obesity study group. High Prevalence of Obesity in Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) Requiring Invasive Mechanical Ventilation. Obesity (Silver Spring). 2020 Jul;28(7):1195-1199. doi: 10.1002/oby.22831.

The Joint Commission. (2017). Quick Safety #43: Managing Medical Device Related Pressure Injuries. Accessed at: https://www.jointcommission.org/ resources/news-and-multimedia/newsletters/newsletters/quick-safety/quick-safety-43-managing-medical-devicerelated-pressure-injuries

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How can you help distribution reps sell more while improving outcomes and taking care of the caregivers?

Share Moving Media is committed to providing the med/surg community with timely, important content to help reps thrive during a crucial point in the industry’s history.

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Contact Amy Cochran to learn how Share Moving Media can be your content resource for 2021.

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Share Moving Media is dedicated to providing our customers with the tools to increase their market-share through our publications, educational services and associations for providers, manufacturers and distributors in the business of healthcare.

HEALTHY REPS

3 Practical and Sustainable Processes to Improve Your Health Maintaining a lifestyle of health

and wellness is hard enough without a pandemic. When you look at the last year and a half, are you happy with how you have treated your physical and mental well-being? Jen Widerstrom, entrepreneur and founder of GetUP CBD, was recently a guest on Parcels of Info, An NDC Podcast to discuss how to establish and maintain a healthy lifestyle that will benefit your personal and professional life. In this podcast, she describes a process that she calls “Three Factor Wellness” that breaks down how to navigate the “pathway to wellness.”

Logistics When it comes to the logistics factor of Widerstrom’s Three Factor Wellness plan, she said it involves learning how to take better care of yourself. She explains, “Everyone asks me ‘what workout should I do?’ When I look at logistics, the last thing on my mind when I hear about you wanting to think about your wellness, your weight loss, your excitement towards just making this healthier shift in your life, I look at baseline health.”

She breaks it down into four categories: consumption, sleep, movement, and body talk. With these four areas in check, you can begin to course correct on any bad habits you might have settled into the past few months.

Jen Widerstrom

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Longevity Forming a plan is only the first step in the right direction, but it needs be a practical and sustainable journey for you. Widerstrom said, “I want you to look at yourself from a standpoint of being a student, using the metric of reps versus rules. When it comes to mental and physical health, it takes practice to get good at this.”

It’s important to remember that you are doing this for yourself, she said. When you approach your new lifestyle with the mindset of a student, you can allow yourself the grace to fail.

Describing the student mentality, she said, “I have a lot of people get really hard on themselves for not getting it

right away. Just because you failed the first time, doesn’t mean you failed and you should give up. You are taking reps and getting valuable insight on your ability to say what’s working.”

Loving the process Maintaining a healthy lifestyle, whether you are focused on mental or physical health, takes a multi-step process that requires constant work. Widerstrom’s third factor of wellness is all about loving the process and taking joy in the journey. It’s as much about self-healing as it is about self-care. She said “Learn about when you’re selling yourself short, learn when you’re cutting corners, and when you’re aligned.

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At the end of the day, it’s all about seeing the bigger picture for yourself. Widerstrom said, “I love being a coach and I love being a trainer. I know you guys enjoy what you do. You’re in a field where you get by with what you are selling and what you are doing, and those connection points are really helping people. But what’s the bigger picture? What’s the bigger message? You are the only one that can answer that for yourself.”

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MARKETING MINUTE

The Benefits of Marketing Automation in Medical Manufacturing How your business can grow quickly and efficiently with the help of marketing automation.

Marketing automation software is

taking over the medical industry. Medical manufacturing has been behind in adopting marketing automation, but that is starting to change. With medical manufacturing a $176.7 billion industry with an expected compound annual growth rate (CAGR) of 5.0%, marketing automation in medical manufacturing has never been more critical.

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What is marketing automation?

Marketing automation is the process of automating essential marketing tasks to save employees time and increase efficiency. This includes creating marketing campaigns, scheduling content, and nurturing current and potential leads.

To effectively use marking automation, your business needs to have a defined strategy for marketing. This strategy should provide your employees with specific objectives and KPI’s, and ensure that the automation aligns with your overall marketing strategy.

How is marketing automation used in medical manufacturing?

Marketing automation is used throughout the entire medical manufacturing process, including: › Pre-filling of order forms/documents › Document and PDF follow-ups › Pre-sending of automated emails › Email campaigns › Email follow-ups › Lead nurturing via automated emails/phone calls › Sales follow-ups There are also many other ways marketing automation can be used in the medical manufacturing industry. When done correctly, there are multiple significant benefits to using this process in medical manufacturing.

Benefits of marketing automation in medical manufacturing Your medical manufacturing business can grow quickly and efficiently with the help of marketing automation. If you have yet to implement marketing automation in your manufacturing business, then you’ll be interested in the following benefits:

1. Saves you time One of the most significant benefits of marketing automation for any industry is the amount of time it saves your team. Research shows that at least 30% of business owners, executives, and marketers say that the most significant benefit of marketing automation is saving time.

In the medical manufacturing industry, this translates into the ability to respond to leads faster, which in turn increases your sales and revenue. With sales being one of the most critical factors in any business, it is essential to have the ability to scale and manage sales quicker and with higher efficiency.

2. Increases efficiency Another benefit of marketing automation is that it will increase the efficiency of your employees. This will improve both your workplace productivity and the quality of your products.

This is especially true in medical manufacturing, as employees have to spend a lot of time filling out manual forms and templates.

With marketing automation, your employees can spend most of their time creating new content and following up with leads and customers.

3. Helps you scale your business One of the main reasons medical manufacturing businesses are slow to adopt marketing automation is that they don’t see this software as valuable.

Their biggest concern is not the technology, but the time spent and the amount of money it takes to implement.

However, the time and effort saved from utilizing marketing automation software can significantly increase the growth of your medical manufacturing business.

To read about three more benefits of marketing automation, visit: https://sharemovingmedia.com/6-huge-benefits-of-marketingautomation-in-medical-manufacturing.

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HIDA

The Nation’s Transportation Disruptions Are a Healthcare Issue Transportation challenges affecting ports, roads, and railways are hobbling the U.S. supply chain’s pandemic

response and adversely affecting the nation’s healthcare. Prioritizing critical medical products throughout the country’s transportation system would help doctors, nurses and other providers get much-needed supplies for patient care.

HIDA and its members offer solutions Finding solutions to shipping challenges are a top priority for HIDA and its members. In a letter to the White House Supply Chain Disruptions Task Force, Health Industry Distributors Association President & CEO Matthew J. Rowan discussed solutions to transportation delays hampering the supply chain’s COVID-19 response.

“It is critical that a process to prioritize important medical supplies be identified,” he wrote, adding that rising COVID-19 cases combined with the upcoming flu season could further strain the transportation system.

transportation industry is struggling to keep up with a big spike in online commerce, while addressing worker shortages and higher costs. Two years ago, a 40-foot shipping container cost less than $2,000 to transport goods from Asia to the U.S., according to Bloomberg Businessweek. Today, it can cost as much as $25,000. In September, there were a record 73 cargo ships waiting to unload off California.

This is partly due to the shortage of chassis – the trailers that transport shipping containers. Volume at the Port of L.A. – nation’s busiest gateway for trade with Asia – is up more than 30% since last year.

… lead to uncertainty in U.S. medical supply chain

HIDA also has discussed the issue with leadership and staff of the U.S. Federal Maritime Commission, sharing HIDA’s Critical Cargo Position Statement. HIDA supports prioritizing container access and sea freight space for essential medical products. The process should address the entire U.S. transportation system from ports to rail to trucks to small parcel carriers so products are moved efficiently. To read the full statement, visit HIDA.org.

HIDA’s Shipping Workgroup, comprised of membercompany transportation and logistics leaders, has been meeting regularly to identify pain points and share best practices with each other as well as with HIDA’s federal partners.

Challenges in U.S. transportation…

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Along with the holiday shopping season, the fourth quarter of the year brings “cough and cold season.”

Georgia and New Mexico in August already were experiencing “high” flu activity, according to the Centers for Disease Control and Prevention. That means increasing demand for PPE and ancillary flu vaccine products, as well as for medical supplies essential for healthcare. The nation’s current transportation woes are intensifying the supply and demand strain. Healthcare providers need to know how much product they are receiving and when to ensure appropriate, clinical patient care. Snarled ports, delayed deliveries, the surging COVID Delta variant, and uncertainty over when products will arrive is stressing the system.

The nation’s shipping challenges will not be solved in the very near future. Healthcare distributors are taking action to ameliorate this difficult situation. They are diversifying sources, expanding domestic manufacturing, recommending alternative products, and working on building a bigger cushion of medical supplies by increasing inventories and supporting public-private partnerships.

For more on efforts by the Health Industry Distributors Association to educate the healthcare continuum and others about shipping challenges and possible solutions, visit HIDA.org.

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QUICK BYTES Editor’s note: Technology is playing an increasing role in the day-to-day business of sales reps. In this department, Repertoire will profile the latest developments in software and gadgets that reps can use for work and play.

Technology news Development of Instagram Kids paused Instagram is pausing the development of Instagram Kids, a dedicated service it’s building for children, in order to spend time focusing on developing parental supervision tools, according to CNET. The news that Instagram was working on a dedicated app for kids was first reported by Buzzfeed back in March. Instagram confirmed the service was in development, and was met with outrage from rights organizations, as well as

bullying and mental health groups, which were all concerned about the impact of giving younger children access to social media. Recent reporting by The Wall Street Journal raised concerns that Facebook’s internal research showed Instagram to be bad for teens, which added to the pressure on the company, CNET reported.

Light up your spaces The Philips Hue line of smart bulbs is growing with the addition of new

lights, strips, and lamps. According to The Verge, the list includes new filament bulbs that can change color temperature (plus a new candle shape for filament bulbs); brighter options (75 watt and 100 watt equivalent) for color-temperature changing and full color versions of the standard Hue bulbs; a “light tube” for illuminating around your TV (it’s meant to sync the colors to what’s on screen); and A new ceiling light called Infuse that can change colors and throws a bit of light up onto the ceiling.

Apple unveils its most advanced pro camera system Apple recently introduced the iPhone 13 Pro and iPhone 13 Pro Max. Both models introduce an all-new Super Retina XDR display with ProMotion featuring an adaptive refresh rate up to 120Hz, making the touch experience faster and more responsive.

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Apple says the pro camera system gets its biggest advancement ever with new Ultra Wide, Wide, and Telephoto cameras that capture stunning photos and video, powered by the performance of A15 Bionic. New computational photography features like Photographic Styles personalize the look of images in the Camera app, and both models now include Night mode on all cameras. Video capabilities include a Cinematic mode for depth-of-field transitions, macro video, Time-lapse and Slo-mo, and even better low-light performance.

Both models also offer end-to-end pro workflows in Dolby Vision, and for the first time, ProRes, only available on iPhone. iPhone 13 Pro and iPhone 13 Pro Max also include 5G with more bands for better coverage, big improvements to battery life for the best battery life ever on iPhone with iPhone 13 Pro Max, new storage capacity of 1TB, and the Ceramic Shield front cover, tougher than any smartphone glass.

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SALES

Using Social Media as a Sales Rep

By Alan Cherry

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If you aren’t using social media

platforms as part of your sales strategy, you’re losing easy business, missing out on big opportunities for new business, and failing to get a full picture of your customer.

In the competitive world of sales and in an industry that spans the globe, simply being more accessible and more available than your competition is going to give you an edge. Having a presence on the web and social media in particular means that you’re always accessible when you can’t be immediately available.

Nick Merritt

Repertoire recently talked to a couple of IMCO members who’ve seen great success in a time when the marketplace is experiencing disruption – thanks in large part to their savvy use of social media to help grow their network and their business.

“Typically, when you hear about a company, the first thing you do is run to your computer and Google reviews or check out content on their website.

You’re almost judged by that more than you were previously judged on your face-to-face appearance,” says Scott Wicks, sales manager at C&S www.repertoiremag.com

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SALES Medical Supply. “The content that you put on there is your salesmen.

You’re using these platforms to really sell yourself. Then it’s your job to go in and create that relationship.”

Relationships The key to success in healthcare supply chain is maintaining good relationships. Social media allows you to develop and maintain real, personal connections. If it builds your relationships with your friends, why would it be any different for your business relationships?

“People think that social media, email, and text are ruining personal relationships, but I think it’s strengthening them,” says Nick Merritt, sales rep with Grove Medical.

Wicks says that social media has been a great avenue for him to show his passion for the industry and show his customers that he truly cares about their patients.

“I’m constantly researching and trying to find products that are going to help my customers better care for their patients, provide better resources for them, and for them to see the relationships I have with my manufacturers and with my other facilities.

I really just use it to stay in front of them and let them know that I’m in the marketplace and I’m there for them,” says Merritt.

Building and leveraging your network When it comes to networking, both Wicks and Merritt have found great success using LinkedIn due to the way that the platform connects users to one another. But when it comes to social media, it’s important not to forget the social and personal connections that those platforms are trying to foster.

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your contacts? Or is your network truly a connected one that is bringing value to the table?

“I’ve got a great network where we all tag each other on social media.

We all do different things, but we bring everybody into our network,” says Merritt. “As you help them out, then your views grow, and as your views grow, your network grows.

People realize that you’re a valueadded service rather than just somebody posting motivational quotes on social media.”

“And that’s where I think people improperly use social media – they try to pump themselves up and try to make themselves look great, but they’re not helping their network, so their network’s not helping them,” Merritt adds.

Eyes on the prize Connecting on a personal level with your customers is only one objective

of your overall reason for using social media as a sales rep.

“Your social media presence is basically a 24/7 sales rep that works rain and shine to spread the message of what you do. The ultimate goal is to direct viewers to the website where there’s a lot more in-depth content and things like that,” says Wicks. “For any sales rep or business trying to get into it, it’s a very inexpensive way to kind of get your message and to make it a little more human. It’s been an invaluable tool.

And it’s very simple because you can do it really at any time of the day, any hour of the day and then let the technology do the work for you.”

Return When wielding social media as a tool for sales, keep in mind that the returns and payoffs are different from other tools and that the success needs to be measured in its own ways. All

Best Practices

ʯ Always be genuine and personal. ʯ Be active and responsive. ʯ Be consistent and constant. ʯ Be patient – your goals are long term, not quick success. ʯ Don’t just throw random things out there because you’re thinking about it in that moment.

ʯ Be strategic with your posts and posting times. Having great con-

tent isn’t going to do much unless you post it when people are most likely to see it. ʯ Be aware of what the purpose of the platform is and tailor your posts to match it. ʯ Before you hit send on anything, double check that your message is coming across the way you intend it to. ʯ Make sure the things you post or share are true and come from credible sources that have good data and documentation to back up their claims. ʯ If you truly believe in a product, then talk about it. But don’t put something out there that you’re not willing to stand behind. ʯ Levity and humor are great – but don’t say or share something you wouldn’t be comfortable saying face-to-face. ʯ Don’t use social media platforms and messaging as a direct selling tool.

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SALES of the experts we talked to agreed that you shouldn’t expect to measure the returns in dollars. Success often takes the form of new opportunities and relationships. Realize that success takes time and patience.

The good news is, especially in the current market climate, you probably won’t have to be waiting for that long.

Wicks says that, even though he and his company have only been active on social media for a few months, the effort has already paid for itself, with new leads that they never would have had if not for people discovering them on the web and then seeking them out.

Merritt adds that one of the biggest keys to success is consistency and paying attention to what works, what doesn’t and why.

“You just have to really figure out what you’re posting, what the content is and the best time to post that content. If you utilize it properly and provide good content and don’t vomit at the keyboard, then people want to come to your profile because they want to see what you’ve posted,” Merritt says. “It’s a big snowball effect.”

“ As you help them out, then your views grow, and as your views grow, your network grows.

People realize that you’re a value-added service rather than just somebody posting motivational quotes on social media.”

– Nick Merritt, sales rep with Grove Medical

What NOT to do Doing the right things is all well and good, but on the internet, it’s crucial that you also avoid doing the wrong things. One misinterpreted comment can hinder, alter, or just ruin a relationship that was previously fine.

“One of the most important things is just being very cognizant of how you say things,” says Merritt.

“When you’re on social media, you’ve got to make sure you say things in a way that the audience understands your meaning and where you’re coming from.”

Just like in real life, using any social media channel effectively means you need to read the room.

While all social media platforms have the same basic function of facilitating personal connections, the

types of content and expectations for those interactions varies greatly from platform to platform. Bringing the wrong type of content to a platform is going to be a waste of your time and could ultimately work against you if people don’t like what you’re posting.

“If you utilize social media the way that most people think it’s intended to be utilized, you’ll fail.

If you utilize it in a way that’s strategic, and if you are genuine, put yourself out there and are making a point to show people who you are in the business world, in your family world, and in your relationships and in your network and you support your network, then that is the ultimate way to utilize social media,” says Merritt.

Where to Start Here are tips on how to use some of the larger social media platforms:

ʯ Facebook is not a great platform for business net-

working or selling. People are on Facebook to keep up with their friends and relatives and share stories and pictures of their social lives. ʯ Instagram is really only helpful if what you have to post has a visually compelling component. ʯ Twitter is more of a mixed bag when it comes to the personal/professional breakdown, but it’s conversational nature makes it very easy to get lost or buried under other content. ʯ LinkedIn is the clear winner when it comes to using social media for professional relationships. For starters,

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people expect to find professional and businessrelated content when they look at LinkedIn. On top of that, the way the platform shows and shares content to users makes it a great place to network.

That said – our experts all agreed that, even though LinkedIn is more professionally geared, it is still a place for social connections. Don’t automate your interactions or go straight into “sales mode.” You’re there to form business relationships, not just to advertise your product or engage in “guerilla marketing.” Tactics like that are more likely to burn bridges than they are to create opportunities.

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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 Volkswagen launches Car-Net® Carrier of Choice relationship with Verizon and T-Mobile Volkswagen of America, Inc. announced its offering through wireless providers Verizon and T-Mobile in launching Carrier of Choice in late September. Volkswagen is the first automaker working with Verizon and T-Mobile to offer its U.S. customers the flexibility to choose from multiple wireless providers to enable Car-Net’s in-vehicle Wi-Fi hotspot through embedded technology.

VW owners and passengers can currently purchase unlimited data through Verizon or T-Mobile for their car via Car-Net Hotspot. Customers can visit carnet. vw.com or download the Car-Net mobile app to select their mobile wireless provider, verify their account and pair it with their existing Volkswagen Car-Net subscription in a matter of minutes.

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“Carrier of Choice breaks down the barriers for connecting to Wi-Fi and meets customers where they are in their digital lifestyles,” said Frank Weith, director of Connected Services at Volkswagen of America. “As consumers start driving more in a post-pandemic world, it creates a window of opportunity for drivers to customize their content and stream reliably.”

Since its debut for the 2014 model year, Volkswagen Car-Net has allowed Volkswagen owners to get connected to their vehicles. For the 2020 model year, Car-Net moved into the next generation of integration, with an updated mobile app, a long list of no-charge services for five years available on most models, and new subscription options.

The suite of connected car features – remote access, parking information, and more – is all at their fingertips via their iPhone or Android smartphone.

With the introduction of Carrier of Choice, drivers have increased flexibility to customize their own digital content through VW Car-Net and stream directly through phones, tablets and other personal devices.

Car-Net Hotspot allows passengers to access the internet with up to four connected devices simultaneously, including compatible tablets, smartphones, laptops, gaming devices, and more – at 4G LTE-enabled speed.

Verizon Wireless or T-Mobile customers with an existing mobile data plan can simply add their Volkswagen vehicle as a new line item to their existing monthly bill; non-Verizon or T-Mobile customers can set up an unlimited plan for $20/month, plus any applicable taxes and fees.

Lincoln to debut electric vehicle in 2022 Lincoln announced it will debut its first global fully electric vehicle in 2022, the first step toward electrifying its entire portfolio of vehicles by the end of the decade. The new electric vehicle will debut as the brand celebrates its 100th anniversary next year.

By mid-decade, Lincoln said it expects half of its global volume will be zero-emissions vehicles and plans to electrify its portfolio of vehicles by 2030. This is part of the company’s Ford+ plan and Ford Motor Company’s planned investment of more than $30 billion in electrification by 2025.

The company’s new rear-wheel-drive and all-wheeldrive battery electric flexible architecture will enable Lincoln to deliver four new and distinct fully electric vehicles. The first fully electric Lincoln will join the plug-in hybrid Aviator and Corsair SUVs, as the brand shifts toward electrification.

Lincoln also plans to expand its portfolio of effortless and personalized experiences, using the Lincoln Way app to deliver an enhanced suite of connected services as it prepares for an electrified future.

GM outlines plan to address Chevy Bolt issues General Motors outlined a comprehensive action plan in September “to ensure that customers can safely and confidently drive, charge, and park the Chevy Bolt EV and EUV.” The action plan includes both hardware and software remedies, some of which are in place with immediate effect.

“We’re grateful for the patience of owners and dealers as we work to advance solutions to this recall,” said Doug Parks, GM executive vice president, Global Product Development, Purchasing and Supply Chain.

“Resuming battery module production is a first step and

we’ll continue to work aggressively with LG to obtain additional battery supply. In addition, we’re optimistic a new advanced diagnostic software will provide more convenience for our customers.”

LG battery plants in Holland and Hazel Park, Michigan, have resumed production. In addition, LG is adding capacity to provide more cells to GM. As a result, replacement battery modules will begin shipping to dealers as soon as mid-October.

The root cause of the “rare circumstances” that could cause a battery fire is two manufacturing defects known as a torn anode and a folded separator, both of which need to be present in the same battery cell, the auto maker said in a release.

“Resuming battery module production is a first step and we’ll continue to work aggressively with LG to obtain additional battery supply.

In addition, we’re optimistic a new advanced diagnostic software will provide more convenience for our customers.”

– Doug Parks, GM executive vice president, Global Product Development, Purchasing and Supply Chain

LG has implemented new manufacturing processes and has worked with GM to review and enhance its quality assurance programs to provide confidence in its batteries moving forward. LG will institute these new processes in other facilities that will provide cells to GM in the future.

GM said it will continue to prioritize Chevy Bolt EV and EUV customers whose batteries were manufactured during specific build timeframes where GM believes battery defects appear to be clustered. The company has established a notification process that will inform affected customers when their replacement modules will be available.

The new batteries will include an extended battery 8-year/100,000-mile limited warranty (or 8-year/160,000 km limited warranty in Canada). www.repertoiremag.com

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NEWS

Industry News

Midmark hires Chris Collins as director of design and human factors

organization and setting user experience standards for Midmark products and solutions. He will help keep the end-user experience top of mind throughout the entire design process to ensure Midmark offerings are designed for how patients and caregivers can best interact and use the products and technologies.

Ships line up in Savannah, Georgia, as shipping backups reach the East Coast

Chris Collins

Midmark Corp., announced the hiring of Chris Collins as director of design and human factors. In the newly-created position, Collins will lead design and user experience across the organization, enabling Midmark’s solution development for the medical, dental, and animal health markets. Collins will be tasked with creating a common design language for products and digital solutions aligned to Midmark’s brand, elevating the understanding of design and human factors across the 70

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Shipping delays and logjams are rampant across the country, on both the West and East coasts. The port in Savannah, Georgia recently had a queue of 22 ships waiting to unload.

On the one hand, the backup is a positive, as it signals strong demand for good as retailers scramble to stock up as holiday season approaches. But the nautical backlog – virtually nonexistent a few months ago – was also a warning that consumers could see shortages and higher prices, according to supply chain experts.

About 65% of containers passing the port are imports bound for American companies and consumers. Much of the demand now is pegged to the approaching holidays.

In August, the Port of Savannah had its second-busiest month on

record, handling 485,595 containers.

That was 10% higher than the same month a year ago, which at the time, was a record for August.

Even just a few months ago, the port was busy, but there were often no ships waiting, said Griff Lynch, executive director of the Georgia Ports Authority told the Atlanta-Journal Constitution. “In the spring, it was nothing like this.”

Cardinal Health launches Reimbursement Solution for hospital claims remittance Cardinal Health (Dublin, OH) launched the Reimbursement Solution, a comprehensive approach designed to help hospitals and health systems minimize their number of claim rejections and denials by up to 80%. The company says that the Cardinal Health Reimbursement Solution uses a three-pronged approach – proactive coverage verification, patient financial assistance support, and ongoing analysis and action – to identify and correct potential claims issues before treatment begins. The Cardinal Health Reimbursement Solution provides patients with support from third-party payers and offers screening for individual insurance program requirements.

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NEWS

Silver screen staffers Gericare Medical Supply in August

recognized 18 employees who have been with the company 10 years or longer by giving them an “Oscar” engraved with the year they joined the company, and a poster of the AcademyAward-winning picture of that year – with their faces superimposed on it.

The event was concocted by Monroeville, Alabama-based Gericare’s “fun team” and was intended to recognize six employees with 15 or more years of service, seven with more than 20 years, and five over 30 years, says Bob Miller, executive vice president of sales.

Earlier, the fun team photographed each of the veterans using the ruse that the photos were needed for “the files.” Their head shots were superimposed onto the Oscar-winning poster from the year they joined the firm. “We got “Oscar” trophies and presented them in our warehouse over lunch and cake,” says Miller. “The pictures are still up on the walls of Gericare, and the employees see them every day. They absolutely love them.

“Those three hours between 11:30 and 2:30 were a great relief from the stressful time we live in.”

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