REP Oct 18

vol.26 no.10 • October 2018

Selling

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OCTOBER 2018 • VOLUME 26 • ISSUE 10

PUBLISHER’S LETTER

Selling

Gaining Insights..............................................................6

into the POL

PHYSICIAN OFFICE LAB The Tests Every Practice Should Have..............8

LEADERSHIP Exceeding Expectations

Start well, end well

A reflection of the First PWH Leadership Summit..................................................... 14

IDN OPPORTUNITIES

22 POST-ACUTE

Fall Prevention As the population ages, the risk for falls rises

Speak Up!

As multistate systems become more commonplace, supply chain leaders need to speak with a louder voice...................... 16

CHRONIC CARE MANAGEMENT

32

MVPs: Most Vulnerable Patients

Home visits are key to DaVita Health Solutions’ patient-centered approach to chronic care management......................... 38

repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2018 by Share Moving Media. All rights reserved.

Subscriptions: $49.00 per year for individuals; issues are sent free of charge to dealer representatives. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address.

POSTMASTER: Send address changes to Repertoire, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors. Periodicals Postage Paid at Lawrenceville, GA and at additional mailing offices.

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OCTOBER 2018 • VOLUME 26 • ISSUE 10

HIDA POST-ACUTE INSIGHTS

QUICKBYTES

Technology news

ASCs Plan Investment as Patient Volumes Rise.......................................... 46

HIDA GOVERNMENT AFFAIRS UPDATE CMS Seeks to Ease Provider Burdens with New Payment Rules................ 48

TRENDS

63 HEALTHY REPS

‘Why Not Us?’

Health systems increasingly look to initiate innovation, instead of being on the receiving end........ 50

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

REP CORNER

Health news and notes

72

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Day and Night John Kenny: Cool head by day, cool hair by night..... 76

INDUSTRY NEWS News........................................................................................... 82

Commitment to Service B. Braun Medical Inc. and Marathon Medical

“By teaming with B. Braun, we are able to supply an excellent product line to the Veteran Administration’s Veteran patients, providing for their health and welfare.”

John St. Leger

Vietnam veteran, Marathon Medical Founder

B. Braun Medical Inc., manufacturer of innovative medical products and services, and Marathon Medical, a Service Disabled Veteran Owned Small Business (SDVOSB) and national distributor of medical supplies, share a commitment to serving those who serve us. Through our combined efforts, we provide products and services for those who care for our nation’s heroes.

We are proud to employ our military veterans and are grateful to them for their contributions to our companies and country. ©2018 B. Braun Medical Inc., Bethlehem PA. All rights reserved.

PUBLISHER’S LETTER

Gaining Insights Share Moving Media, Repertoire’s parent company, recently held our IDN Insights West meet-

ing, hosted by Amazon. Most of the meeting was about best practices when calling on IDNs, but a portion of it included an Amazon presentation. Below are a few pearls I took from the meeting.

Insights from IDN supply chain leaders: •T hink logistically on ways to save each other dollars. It’s not always about the price of the product.

• Stop bundling and stop selling around their formulary.

• Culture and integrity are key – always tell the truth, even if it’s unpopular.

• If you’re not spending 50 percent of your R&D on ensuring your product is EHR friendly, you’re wasting your time on new products.

Scott Adams

Takeaways from Amazon: • Price-Selection-Convenience is Amazon’s moto. Candidly, it should be our moto in traditional distribution as well, just maybe not in that order.

•A mazon as an organization has an “Customer Obsession.”

They don’t do anything without asking their customers what they want first. This is the reason they are successful in my opinion.

• Personalization is where everything is headed, not just at Amazon. For example, think of how personalized your phone is compared to your spouse or kid’s phone. We need to be personalizing the way we work with customers.

• Amazon is a marketplace. They are not here to eliminate distribution. They are here to work with distribution in a way that is convenient for the end-user.

Last week, my business partner ordered laundry detergent from Amazon, and it came to his house from Costco. We have to keep in mind the difference between distribution and a marketplace.

Regardless of your opinion on Amazon, it’s 100 percent about the customer. Now more than ever in our history, your relationship with your clients is of upmost importance!

Dedicated to the industry, R. Scott Adams PS: I am launching a new podcast series this month called “Road Warriors and Their Untold Stories.” This podcast focuses on salespeople and their days in the field. I have already recorded several episodes, and let me tell you these stories will make you laugh, cry, and be a better rep. Be watching the dail-eNews for the launch of this series. If you have an interesting story, or you want me to interview a fellow rep on this series, please send me an e-mail with a short description. I will forward it to our editors for approval. sadams@sharemovingmedia.com repertoire is published monthly by Share Moving Media 1735 N. Brown Rd., Suite 140, Lawrenceville, GA 30043 Phone: (800) 536-5312, FAX: (770) 709-5432; e-mail: info@sharemovingmedia; www.sharemovingmedia.com

editorial staff editor

Mark Thill lthill@sharemovingmedia.com managing editor

Graham Garrison ggarrison@sharemovingmedia.com editor-in-chief, Dail-eNews

Alan Cherry acherry@sharemovingmedia.com art director

Brent Cashman bcashman@sharemovingmedia.com

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vice president of sales

Jessica McKeever

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

Alicia O’Donnell

aodonnell@sharemovingmedia.com (800) 536.5312 x5261 sales executive

Tyler Moss

tmoss@sharemovingmedia.com (800) 536.5312 x5279 sales executive

Lizette Anthonijs Lizette@sharemovingmedia.com (800) 536.5312 x5266

publisher

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

Brian Taylor btaylor@ sharemovingmedia.com circulation

Laura Gantert lgantert@ sharemovingmedia.com

Subscriptions

www.repertoiremag.com/ subscribe.asp or (800) 536-5312 x5259

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

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PHYSICIAN OFFICE LAB

The Tests Every Practice Should Have When I began thinking about

how to write the most pertinent and useful article on the topic of tests every physician practice should have, I obsessed over how to introduce the test menu. There are just so many good choices.

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By Jim Poggi

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PHYSICIAN OFFICE LAB patient treatment program. I am so confident this is true, that I’m thinking of getting a tattoo of it.

If the clinical need of the practice was the sole decision criterion, life would be very simple. Every practice type would use the same tests every day, patients would be treated quickly and effectively on a timely basis, and we would all live happily ever after. But, life is quite a bit grittier than that.

The other classic parameters that come into play in determining the tests likely to be performed in the physician practice include overall practice objectives, skills and attitude of the staff, CLIA license, practice work flow and efficiency needs, training and experience of the physicians and staff with lab tests and available space.

Finally, we can’t forget MACRA, which aims to improve patient outcomes, reduce costs to the healthcare system and improve patient satisfaction. While MACRA presents a daunting challenge, we can all agree that testing and treating during the patient visit meets the general requirements of improving patient care and satisfaction. One visit, rather than several, also saves both the healthcare system and the patient time and money. So, you see, MACRA is our friend.

In order to simplify a useful guide to tests needed every day, I have based my testing suggestions on a model of a fairly typical independent suburban physician practice: 10 physicians, 3 PA/NP personnel, an office manager and typical nursing and support staff. Their patient mix includes children and adults, and spans a range of chronic and light acuity conditions, such as flu, strep, sprains and minor orthopedic injuries. They have a Medicare and private insurance payer mix. They have a CLIA moderate lab license.

While MACRA presents a daunting challenge, we can all agree that testing and treating during the patient visit meets the general requirements of improving patient care and satisfaction.

Then the light bulb went on. Trying to decide the list of tests every practice should have is like trying to determine who is the best doctor in town. It all depends on who the patient is, and what the clinical conditions that need to be treated are. In the end, practice specialties will be different since the types of patients and the typical healthcare needs of different patient populations they see will differ.

This will determine the test mix to a large extent.

But, the constant is always the same. The tests each practice needs are the tests needed to initiate or modify a

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PHYSICIAN OFFICE LAB What are the core tests this typical middle of the road mixed specialty practice needs?

12

What’s the test?

Why?

CLIA Category

Comments

Hemoglobin

Quick check for anemia

Waived

Fast, easy, accurate

hCG

Pregnancy can happen at any time

Waived

Important for nutritional needs, pre-natal care and before imaging studies

Urinalysis

Fast, easy, non invasive health screen

Waived

Should be part of every annual physical

Mono

Adolescent health

Waived/Moderate

The new waived tests are easy and accurate

Glucose

Diabetes, especially type 2, is on the rise worldwide

Waived

Treatment can’t begin without a good diagnosis; use an accurate quantitative test

CBC

Infection, anemia, general health

Waived/Moderate

Next to glucose, UA and hCG, the best tool in the general use lab tool belt

CMP

General metabolic assessment

Waived/Moderate

Tells the story of overall patient status in health and disease

BMP

Limited general health assessment

Waived/Moderate

Less data; typically, no liver function tests

Lipid profile

Lipid disorders lead to serious complications and are often related to diabetes

Waived/Moderate

Use of statins has made lipid tests fundamental in adult medicine

A1C

Knowing average glucose level over time

Waived/Moderate

Are Ward and June sticking to their diet? How well controlled is their diabetes?

Flu

Know what you are treating

Waived/Moderate

Only about 30 percent of all flu tests are positive; ever wonder what the other causes are?

Strep

Prevent very dangerous complications

Waived/Moderate

Before antibiotics, strep was a serious cause of illness and death

RSV

Some practices love it; others want it done in a more sophisticated lab

Waived/Moderate

This test has arguments for and against in-house testing; new, molecular tests make it a better in office test choice than ever

FIT/FOBT

Colorectal cancer is highly curable if detected early

Waived

Colonoscopy has left these tests “behind” to a large extent; they are still important

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Additional useful tests based on patient population What’s the test

Practice type/ patient type

CLIA category

Comments

Lead

Pediatric

Waived

Can prevent serious neurological damage via early detection

TSH

GP/IM/OBG

Waived/Moderate Useful at annual physical

Free T4

GP/IM/OBG

Moderate

Reflex with abnormal TSH

PSA

GP/IM/URO

Moderate

New, multiple assay tests including PSA are better than ever

PT/INR

GP/IM/Cardio

Waived/Moderate Important follow up for clotting disorders

BNP

GP/IM/Cardio

Waived/Moderate Detect/follow up on heart failure

B12/Folate

GP/IM/OBG

Moderate

CRP

Rheumatology

Waived/Moderate One test in a tricky differential diagnosis panel

ANA

Rheumatology

Moderate

Typically done with or after CRP; autoimmune diseases are among the toughest disorders to diagnose and treat

Vitamin D

GP/IM/OBG/Etc. Moderate

Depending on who you believe, either everyone or no one has a Vitamin D deficiency

So, what’s the bottom line? Essentially, it’s to know your customer and their needs, and understand their practice in every detail. What are their objectives? Does their staff love or fear lab tests? What patients and clinical conditions do they see every day? What pressures is the practice under?

Differential diagnosis of anemia

Seventy percent of all medical decisions involve a lab test, but only if it’s ordered and used to initiate or modify a patient treatment program. There is no better place to perform lab tests than the physician practice, and no better time to perform them than during the patient visit.

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October 2018

13

LEADERSHIP

Exceeding Expectations A reflection of the First PWH Leadership Summit

By Julee Prefer, PWH Chair 2017-2018 What an unprecedented time for Professional Women

in Healthcare. The Inaugural PWH Leadership Summit, held in Minneapolis in June, was truly an event to remember. This educational event combined impactful leadership development with enjoyable networking for all 175 attendees, whether aspiring leaders, managers or executives.

During the two-day event, the medical distribution industry came together for the first time to focus on creating and developing strong leaders for the industry. Attendees were able to begin new relationships and build upon current ones during receptions and networking sessions.

The carefully curated program provided a variety of ways to learn and engage. Based upon the evaluations PWH has already conducted, and testimonials received, attendees left as better leaders, ready to challenge themselves … refocused on professional development. Some of the feedback we received included: “ The speakers were excellent, and the topics were extremely relevant.” “ I was amazed at the level of enthusiasm and the extent of engagement from all of the attendees.” “ The summit was a success and exceeded my expectations.”

The Summit kicked off with the PWH version of TED Talks called Leadership Insights. Respected leaders within the healthcare industry shared their vision on current topics, such as John Baumann, President and CEO of Midmark Corporation; Dr. Dannellia Green, Director of Supplier Diversity of Owens & Minor; Joan Eliasek, President Extended Care Sales of McKesson and more. Topics included the leader’s role in establishing a thriving organization, building and fostering diverse and inclusive corporate cultures, and understanding the process and skills needed when transitioning to new roles.

After in-depth breakout sessions, interactive networking opportunities, and a lot of great food, the PWH Leadership Summit concluded with high energy and enthusiasm. A panel of four successful executives shared their personal leadership journeys including challenges, disruptions and wisdom they encountered along the way. The day ended with a presentation by nationally recognized speaker, Valorie Burton. It was inspiring to watch as many attendees stepped outside of their comfort zone aiming to reach new heights of fulfillment and accomplishment as they took it all in.

For more detailed takeaways from this year’s Leadership Summit, or information about next year’s Leadership Summit, please visit the PWH website at www.mypwh.org.

Joan Eliasek Honored as Leader of Distinction PWH was honored to present Joan Eliasek with the inaugural Anne Eiting Klamar Leadership Award of Distinction at the PWH Leadership Summit. This award recognizes a woman who has experienced significant growth to become an accomplished leader in our industry. Joan leads by example and is dedicated to making sure the path that she leaves is clear for others to follow.

She has worked tirelessly with honor over the years, to build her reputation and overcome obstacles. She is a woman of clear vision who always leads with strength, integrity, dignity and grace. She is a strong supporter of women both within her own company and in our industry as a whole, and is committed to developing those around her.

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SAVE THE DATES: June 5–7, 2019

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IDN OPPORTUNITIES

Speak Up! As multistate systems become more commonplace, supply chain leaders need to speak with a louder voice The bigger the organization, the bigger the challenge

of effecting change. Unlike standalone facilities or small IDNs, multistate healthcare systems bring more voices to the table, each with their own opinions, preferences and interpretation of facts. To be heard, one needs to speak forcefully, clearly, simply and reasonably. A skilled, respected leader is needed to bring those many voices together.

Why shouldn’t that person be a supply chain executive?

“There used to be a saying among supply chain personnel that if we were doing a good job, clinicians

wouldn’t even know we were there,” says Kathryn Carpenter, vice president of clinical strategy for Catholic Health Initiatives Supply Chain, based in Denver, Colorado. “As long as everyone got what they wanted, there would be no controversy.

“Now, case margins have become extremely tight, and hospital systems are struggling. Supply chain has a responsibility to be front and center in discussions of quality, patient outcomes and financial margin.” That’s exactly where Carpenter finds herself – front and center.

With more than 100 hospitals in 18 states, CHI is a diverse system, comprising large academic medical centers

“Supply chain has a responsibility to be front and center in discussions of quality, patient outcomes and financial margin.” in large urban areas, as well as dozens of critical access facilities, each with different stressors and patient needs.

Street cred

Kathryn Carpenter

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Carpenter was a practicing RN for more than 30 years, most of them in the “heart of the hospital,” that is, the OR. She also worked in the cardiac ICU, “so I certainly have an appreciation for how important product availability is for intense practice areas.”

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IDN OPPORTUNITIES During her years on the front lines, supply chain was not what she woke up thinking about. “As a clinician I had very little pricing knowledge. Savings was always an idea, but not a priority.

“I never gave a thought to how products got on the shelf, but I experienced the disruption that occurs when any product change was not communicated to me. Even a change in packaging for commodity products felt like a safety issue. Was this the same product I used yesterday or not?

“To that end, I was quite dissatisfied as a nurse when a product change would occur and I had no knowledge of the rationale for it, nor had I been asked to be part of the decision.”

In 2010, Carpenter left OR nursing to join the materials management team at St. Agnes Hospital in Baltimore. It was

manager, one sees the cost of each product, and that can be sobering. Together with managing inventory, cost and savings became the paramount concern. It was a priority for me to educate the clinicians on just how much these products were costing the institution. It was a powerful tool that allowed me to start to change behavior.”

Critical products manager In 2012, Carpenter became a critical products manager at Ascension. In that position, she and her peers were engaged in product selection and utilization for high-cost, high-utilization products. The position proved instrumental in driving change across a system as large as Ascension, which today spans 22 states.

“All new product introductions would come through the critical products manager, who as a clinical person would be able to communicate with the nurses and physicians on a peer level rather than having inventory managers without clinical backgrounds make supply changes,” she says.

“The conception of this idea – that nurses would relay change management messages to physicians and nurses – bridged a gap that had not been addressed before. The fact that I had worked in their shoes was an instant source of trust, which allowed change to go forward a bit more easily.”

“ I was quite dissatisfied as a nurse when a product change would occur and I had no knowledge of the rationale for it, nor had I been asked to be part of the decision.” a leap of faith, she says. She learned quickly what it meant to be on what physicians sometimes call “the dark side.”

“It was a grave responsibility to make sure that every single product – and there were thousands – was on the shelf and available if a patient needed it,” she says. “In addition, it was important to have exactly the right quantity there – enough, but not too much.

“It sounds simple now, but without much direction or data infrastructure, it was a daunting task. The most immediate difference was that product descriptions made no difference. It was the product code language that mattered. There was very little oversight of my work, and the ERP system was complicated.”

From her new vantage point in supply chain, Carpenter got a different perspective on sales reps. “As a clinician, the reps were quite helpful during procedures, but as a materials manager, they were salesmen.”

She also got a close-up look at pricing, something she had had very little to do with as a clinician. “As a materials

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The link In 2017, Carpenter became vice president of clinical strategy for Catholic Health Initiatives, reporting to the senior vice president of operations for supply chain, Dan DeLay. “The vision and mission of this role is to provide the link at a national level between cost savings change and clinical practice change,” she says.

“Each healthcare facility has a comprehensive view that exists in a small space. Each facility will say that their patients have special needs, that they have special financial and reimbursement needs, that they have staffing constraints that are unique.” In her role as vice president of clinical strategy, Carpenter brings the perspective of the entire system “to illustrate that we are not all that different, and that behaving in different ways costs us a great deal.”

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IDN OPPORTUNITIES

Walk a mile in their shoes

Without clinical experience, supply chain executives may have difficulty anticipating the potential repercussions of product changes, whether that product is a glove, sterile gauze or monitoring equipment, says Kathryn Carpenter, vice president of clinical strategy for Catholic Health Initiatives Supply Chain.

As an OR nurse, “even the change in packaging for commodity products felt like a safety issue,” she recalls. “In surgery, predictability is everything. You want everything to work perfectly, just as it did before. You get into a routine; you open products, they look the same. If something has been pulled for you, or you have to replace something in the middle of a case, it makes you pause. If it’s a marking pen, no harm, no foul. But if it’s a biliary catheter, wow.

“Any change in capital equipment or the addition of a new procedure certainly impacted my practice, and the quality of the vendor community in instructing the staff was a major factor in successful deployment or not.”

“It’s not change itself that people dislike; it’s being forced to change that is disagreeable.”

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Local committees had succeeded in making local clinicians aware of cost, which continues to be the No. 1 thing physicians ask for when engaging supply chain, she says.

But regional leaders don’t always control costs well because they are rightly concerned about revenue and volume, and they sign contracts that ultimately tie them to marginnegative cases, she says. “Local facilities are often saddled with limitations in analytics to support that work. They are also subject to marketing campaigns, and they may leap to be the first in the market with a product that may or may not actually help patients at a cost premium. The national supply chain perspective and national data analytic capability can help in these decisions.”

“ The vision and mission of this role is to provide the link at a national level between cost savings change and clinical practice change.”

For the future

Every system will need to address how communication with practitioners occurs in a more sophisticated way, says Carpenter.

“I happen to think this clinical strategy model is here to stay for this reason: Many executives and supply chain people are afraid to talk with physicians about products, margin and cost. Often physicians are hesitant to address their colleague’s product choice, even if it is more expensive. If the supply chain can create that conversation by bringing data, clinical evidence and the authenticity that nurses provide in this role, we will be able to create change on a large scale.

“Physicians read the Wall Street Journal too, and they are becoming increasingly interested in the business side of medicine,” she continues. “They are stakeholders in the decisions around the practice of medicine, and they need to be invited to the conversation. As the practice of medicine becomes more technical and less invasive, supply chain will need to offer a strategy for financial success that involves the total picture of an episode of care. The cost, the revenue, the correct utilization and the applications of criteria for the correct patient become the pieces of our decision-making. The more complex administering healthcare becomes, the more collaborative supply chain will need to be with our physicians.”

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Selling

into the POL Start well, end well I

f you want to catch your lab customers’ attention, downplay using the word “lab” and instead focus on “patient care” or, better yet, “treatment plan.”

“When you focus on how tests will influence treatment plans, you’ll always have their interest,” says lab expert Jim Poggi, Tested Insights, LLC. Poggi made his comments during the first of a series of podcasts on selling to the physician office lab. The first podcast is titled “The knowledge and skills you need to walk into any POL customer with confidence,” and is posted – along with the other podcasts – online at repertoiremag.com. Poggi was interviewed by Repertoire Publisher Scott Adams.

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Lab/Diagnostics Red flags Confidence begins with correctly identifying the correct person in the office with whom to broach the topic of the POL. In most cases, that will be the financial decisionmaker, probably the medical director. If that person is interested, the rep will probably be referred to the office manager or practice manager.

That may be good news, but the rep must watch for red flags, says Poggi. “We always get excited when the customer is interested. But we might miss the fact that he or she is excited for the wrong reasons, or is only interested in certain outcomes.”

Be wary of the customer who puts excessive emphasis on revenue or return on investment, he advises. “They typically want high-reimbursement products; they don’t always have clinical outcomes in mind. This can be dangerous if the ROI isn’t there.

“You find a lot of buyer’s remorse with these customers.”

Another red flag: The head physician who shrugs his or her shoulders and says, “Work it out with the lab manager or practice manager.”

“That shows a disconnect in the practice,” says Poggi.

“You really want to encourage active engagement,” particularly on the part of the head physician.

Watch out for the manager who avoids discussing the details of implementing a POL. The practice whose attitude is “Let’s start testing now; we can figure out the details later,” often ends up having difficulty with regulatory issues downstream.

But the biggest warning signal is foot-dragging or lip service on the part of the staff, says Poggi.

Early grumbling can grow into allout rebellion further down the line.

It’s a situation the rep should be prepared for, and one that should be addressed promptly with the medical director or office manager. “Ask him or her, ‘Do you know of any reservations the staff might have about testing?’ You’re asking the person to think about the impact of testing on the staff. Things will go much more smoothly downstream if you do this.

“Staff who don’t want to do testing will find a hundred reasons why not to,” he continues. If the sales rep detects any signs of a footdragging, he or she should let the decision-maker know the staff has yet to buy into the concept. “But don’t ‘out’ anybody,” he advises.

Instead, focus on working with the

One of the most powerful questions to ask the customer is this: “How do you believe testing can fit into your overall practice?”

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Lab/Diagnostics Calling on the CPP

practice to find ways to motivate and inspire the staff to embrace in-office testing.

Key questions to ask One of the most powerful questions to ask the customer is this: “How do you believe testing can fit into your overall practice?” says Poggi. “You’ll learn a lot from that.

“I often follow up with this: ‘What tests do you want to perform to shape patients’ treatment plans?’”

Avoid spending too much time on matters of cost and potential revenue, he advises. “It’s always important to think about business issues, but excessive focus on this area leads to problems downstream. You might find your customer thinking about tests that might not be necessary, but that may yield good reimbursement.

Repertoire readers might notice some new initials appearing after their lab customers’ names.

The American Association of Clinical Chemistry launched a new credential for point-of-care testing professionals this summer. The program, created and overseen by AACC’s Board of Certification, will document that certified healthcare professionals working at the point of care have proven expertise in this area.

Those passing the certification will be known as a Certified Point-of-Care Testing Professional, or CPP. This means that the certified expert has demonstrated knowledge in U.S. point-of-care regulations and compliance, quality management, education and training, instrument selection and validation/verification, connectivity and information technology, leadership and communication, sample types, policies and procedures, clinical applications, and technology and methodology.

For more information, go to https://www. aacc.org/education-and-career/point-of-caretesting-professional-certification

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“ What starts well, ends well. What starts badly, ends worse.”

“Spending too much time on money diverts attention from the clinical side of things.”

No rep is an expert on Day 1, says Poggi. But don’t let that stop you from exploring opportunities in the physician office lab. “Don’t be afraid to expose yourself to an experience that’s new.”

He advises reps to learn from colleagues who have been successful selling into the lab, and to talk to customers with successful office lab programs. “Ask them, ‘What value do you get from your lab?’ ‘How do you suggest I talk to prospects in my territory?’

“They will help you. And don’t give up. The key to ‘yes’ is getting a few ‘no’s and learning from them.”

One final word of advice: If you come across a customer who is really not ready, willing or able to create and manage an office lab program, and who is just interested in doing it for the money, “hand him the business card of your competitor and leave the room,” says Poggi.

“What starts well, ends well. What starts badly, ends worse.”

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Lab/Diagnostics

And the Winner is …

The lab field is exploding with promise … and promises.

Which of these technologies will stand the test of time?

Technology

I

n the September issue of Repertoire, lab expert Jim Poggi wrote about exciting developments in tumor markers, including new, more specific molecular markers for a wide variety of cancers. The range of diagnostic benefits of newer markers is expanding quickly, as are the number of new tumor markers being brought to market, he said.

What about some of the other lab-related developments in the news today? They sound cool, but will they fly? We asked Poggi to give us his take.

What is it?

Poggi says…

Next-generation The ability to look at millions On the market sequencing of DNA changes in a single test to help determine the cause of disease

Dramatically changing what we know about causes of cancer and how it progresses. A big deal.

Liquid biopsy/ blood markers

This is where the future of colorectal cancer screening is going. Applicable to other cancers also.

Blood tests for detection of On the market colon cancer, lung cancer, etc.

HPV tests for Researchers are cervical cancer investigating substituting Pap smear with HPV test, which is less invasive, with longer-lasting results

Under study

More objective and consistent than human-read slides. But, do we really know that cervical CA is always related to HPV? At this point, I believe both techniques still have value.

Nanopore sensors

Research phase

My first impression is that there are better ways to achieve this outcome.

I would prefer to use LC/MS (Liquid chromatography–mass spectrometry), since it uses two different technologies to get a highly specific answer. The nanopore technology uses only one technology – pore size.

Research phase

Hello, 1984! Risk prediction uses clinical data to correlate personal and environmental factors to development, progression and treatment of disease.

I believe it is every bit as important as next generation sequencing to future prevention and treatment programs, and maybe your insurance premiums.

Microchip can analyze one molecule at a time

Risk prediction Use of algorithm/artificial models intelligence to identify patients at highest risk of a certain diseases (e.g., lung cancer), to improve screening guidelines

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Market status

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Technology

What is it?

Market status

Poggi says…

Routine DNA sequencing

Effort by some health systems to conduct DNA sequencing of entire patient population

Underway (Geisinger, for one)

What’s in YOUR genome? Privacy issues and percent yield of actionable data remain questions. BUT data indicates this technique can identify individuals with predisposition to certain cancers and heart disease. Privacy versus progress…

Voice-based technology

Machine intelligence helps Research phase detect changes in a user’s (Sonde Health) voice, which could signal a variety of health conditions

Your mom always had this. But, outside of detecting anxiety, untruthfulness and relating vocal timber to pain, I don’t see enough specificity to care about. Get a CBC and a CMP instead.

Blood test for concussion

Proteins in the blood are measured to help predict which patients may have intracranial lesions visible by CT scan

FDA clearance granted February 2018 (Banyan Biomarkers Inc.)

Already proving to be useful. I believe it is useful ALONG WITH careful followup post-cranial injury/impact. Routine follow-up to staff meetings?

Wearable and point-of-care microscopes

Devices use on-chip illumination and sensing to non-invasively aid in diagnosis and monitoring health conditions

Research phase

If issues can be diagnosed on the fly with wearables, the infrastructure to send the results to the clinician, make appointments for further work, etc., is already in place. I believe there is a future.

Retinal examination

Uses correlation between retinal vessels and the risk of cardiovascular episodes to predict major CV events

Research phase (Google)

Retinal changes are already used to evaluate progression of diabetes. The specificity needs to be demonstrated for me to buy in.

Cell markers

Indicate a DNA mutation Research phase that changes protein synthesis, either promoting a disease process or inhibiting typical treatments from working

Cell markers are the outcomes of changes in protein synthesis. They are the future of lab tests for cancer and other diseases. Think of them as metabolic end products. We already test for many metabolic end products, including bilirubin and creatinine.

Wearable Uses a combination of three Research phase glasses to optical sensors and a three- (Microsoft) measure blood axis accelerometer pressure

Worried well(thy), this dud’s for you!

Unless you already know you have seriously uncontrolled hypertension (51 percent of diagnosed U.S. hypertensives are uncontrolled), save your dough.

Exercise, eat right, stop smoking, have an annual physical and look forward to better drugs in the future.

Jim Poggi’s wild card!!

“Genes on, genes off!” As we learn which switches control which genes to create which proteins, we can control metabolism and alter the incidence of diseases. This could change everything.

DNA/protein switch regulation

Research phase

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POST-ACUTE CARE

Fall Prevention As the population ages, the risk for falls rises

Falls are the leading cause of injury-related deaths

among persons aged 65 and over, and the age-adjusted rate of deaths from falls is increasing. The Centers for Disease Control and Prevention released its most recent statistics this spring.

Advanced age is an independent risk factor for falls.

But so are related factors such as reduced activity; chronic conditions, including arthritis, neurologic disease, and

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incontinence; increased use of prescription medications, which might act synergistically on the central nervous system; and age-related changes in gait and balance.

Approximately one in four U.S. residents aged 65 years or older report falling each year, and fall-related emergency department visits are estimated at approximately 3 million per year, according to the CDC. In 2016, a total of 29,668 U.S. residents aged 65 and over died

Number of deaths from falls and age-adjusted rates* among adults aged ≥65 years — United States, 2007–2016

* Age-adjusted death rates were calculated by applying age-specific death rates to the 2000 U.S standard population age distribution.

The figure above is a combination bar chart and line graph indicating the number of deaths from falls and ageadjusted death rates from falls per 100,000 population among U.S. adults aged ≥65 years during 2007–2016.

Source: Centers for Disease Control and Prevention, May 2018

Although the rate of deaths from falls is increasing among all persons aged ≥65 years, it is increasing fastest among those aged 85 and over.

as the result of a fall (age-adjusted rate of 61.6 per 100,000), compared with 18,334 deaths (47 per 100,000) in 2007.

The rate of deaths from falls among persons aged ≥65 years increased 31 percent from 2007 to 2016, increasing in 30 states and the District of Columbia, and among men and women. Among states in 2016, rates ranged from 24.4 per 100,000 (Alabama) to 142.7 (Wisconsin). The fastest-growing rate was among persons aged ≥85 years (3.9 percent per year).

In 2016, there was a higher rate of fatal falls among older men, in contrast to the rate of nonfatal falls, which is higher among older women. This might have resulted from differences in the circumstance of a fall (e.g., from a ladder or while drinking), leading to more serious

injuries, including head trauma, or higher rates of postfall complications in men.

Adults aged ≥85 years are the fastest-growing age group among U.S. residents and will reach approximately 8.9 million in 2030. Although the rate of deaths from falls is increasing among all persons aged ≥65 years, it is increasing fastest among those aged 85 and over (3.9 percent per year). Nationally, the rate of deaths from falls might be increasing because of longer survival after the onset of common diseases such as heart disease, cancer and stroke.

If the current rate remains stable, an estimated 43,000 U.S. residents aged ≥65 years will die because of a fall in 2030, and if the rate continues to increase, 59,000 fallrelated deaths could result.

For more information: https://www.cdc.gov/mmwr/volumes/67/wr/mm6718a1.htm?s_cid=mm6718a1

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POST-ACUTE CARE Exercise can help prevent falls Exercise can have a moderate impact on preventing falls in older adults at increased risk for falls, according to the United States Preventive Services Task Force in its final recommendations issued this spring. In many respects, its findings echo those that USPSTF – which is independent of the U.S. government – made in 2012.

USPSTF bases its recommendations on the evidence of both the benefits and harms of specific preventive care services. It does not consider the costs of providing a service in this assessment.

Falls are the leading cause of injury-related morbidity and mortality among older adults in the United States, says USPSTF. In 2014, 28.7 percent of community-dwelling adults 65 years or older

The 2008 U.S. Department of Health and Human Services guidelines recommended that older adults get at least 150 minutes per week of moderate-intensity or 75 minutes per week of vigorous-intensity aerobic physical activity, as well as muscle-strengthening activities twice per week. It also recommended performing balance training on three or more days per week for older adults at risk for falls because of a recent fall or difficulty walking.

In its findings, the USPSTF notes that the National Institute on Aging outlines four interventions for the prevention of falls: exercise for strength and balance, monitoring for environmental hazards, regular medical care to ensure optimized hearing and vision, and medication management. According to the AGS, detecting a history of falls is fundamental to a falls Unfortunately, no instrument has been clearly reduction program, and it recommends identified as accurate and feasible for identifying that all older adults be asked about falls older adults at increased risk for falls. once a year. reported falling, resulting in 29 million falls (37.5 percent of which needed medical treatment or The AGS further recommends that older persons restricted activity for a day or longer) and an estiwho have experienced a fall should have their gait mated 33,000 deaths in 2015. and balance assessed using one of the available Unfortunately, no instrument has been clearly evaluations; those who cannot perform or peridentified as accurate and feasible for identifying form poorly should be given a falls risk assessment older adults at increased risk for falls. According that includes a focused medical history, physical to USPSTF, a patient’s history of falls is the most examination, functional assessment, and an envicommonly used factor that consistently identifies ronmental assessment. The AGS also recommends persons at high risk for falls. the following interventions for falls prevention: •A daptation or modification of home enviExercise interventions ronment (e.g., elimination of clutter and Effective exercise interventions include supervised throw rugs, adequate lighting, etc.). individual and group classes and physical therapy.

• Withdrawal or minimization of psychoactive The most common exercise component in proor other medications. grams reviewed by USPSTF was gait, balance, and • Management of postural hypotension (low functional training (17 trials), followed by resistance blood pressure occurring when standing up training (13 trials), flexibility (eight trials), and endurfrom a sitting or lying-down position). ance training (five trials). Three studies included • Management of foot problems and footwear. tai chi, and five studies included general physical • E xercise (particularly balance), strength, activity. The most common frequency and duration and gait training. for exercise interventions was three sessions per • Vitamin D supplementation of at least 800 week for 12 months, although duration of exercise IU per day for persons with vitamin D defiinterventions ranged from two to 42 months. ciency or who are at increased risk for falls.

Source: U.S. Preventive Services Task Force, https://www.uspreventiveservicestaskforce.org/Page/ Document/RecommendationStatementFinal/falls-prevention-in-older-adults-interventions1

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POST-ACUTE CARE Deaths from falls among persons aged ≥65 years — United States, 2007–2016 2007 Characteristic

2016

2007–2016

No. of deaths

Deaths per 100,000

No. of deaths

Deaths per 100,000

Annual percentage change

18,334

47

29,668

61.6

3.0

Men

8,408

57.9 (56.7–59.2)

13,721

72.3 (71.1–73.5)

2.4

Women

9,926

40.2 (39.4–41.0)

15,947

54.0 (53.1–54.8)

3.8

65–74

2,594

13.2 (12.7–13.7)

4,479

15.6 (15.2–16.1)

1.8

75–85

6,552

50.1 (48.9–51.3)

8,735

61.4 (60.1–62.7)

2.3

≥85

9,188

182.3 16,454 (178.6–186.0)

257.9 (253.9–261.8)

3.9

Total Sex

Age group (yrs)

Source: Centers for Disease Control and Prevention, May 2018

Home care and safety: A difficult match

Institute for Healthcare Improvement report lists risks, solutions The safety of care provided in the home has not yet received nearly as much attention as patient safety in hospitals and other clinical settings, despite the fact that the home has become the site of care for many people, says the Institute for Healthcare Improvement (IHI) in its report, “No Place Like Home: Advancing the Safety of Care in the Home.”

In 2016, more than 2 million personal care attendants provided care in the home, according to the U.S. Department of Labor. Across the country, workers from home health agencies provide home health care services to more than 3 million Medicare beneficiaries. The Department of Labor predicts that by 2026, the number of personal care attendants will rise by 40 percent.

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IHI convened an expert panel in November 2017 to consider the challenges to safety in the home setting and to offer recommendations for improvement. Its report identifies nine risks and their potential harms: •A dverse events related to medication and other forms of treatment.

• I njuries due to physical hazards in the home (e.g., falls).

• Injuries related to equipment and technology.

•P ressure injuries.

• Infections.

•C onditions related to poor nutrition.

•A dverse effects on family caregivers.

•A dverse effects on home care workers.

•P otential neglect and abuse of care recipients.

To read more, visit ihi.org/no-place-like-home.

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CHRONIC CARE MANAGEMENT

MVPs: Most Vulnerable Patients Home visits are key to DaVita Health Solutions’ patient-centered approach to chronic care management

Editor’s note: Demographics are changing. Venues of care are changing. Reps’ call points and the products in their bags are changing too. In this issue, Repertoire continues its series of articles on chronic care management.

Chronic diseases and conditions – such as heart disease,

stroke, cancer, type 2 diabetes, chronic obstructive pulmonary disease, obesity and arthritis – are among the most common, costly, and preventable of all health problems. As of 2012, about half of all adults – 117 million people – had one or more chronic health conditions. One in four adults had two or more chronic health conditions. Seven of the top 10 causes of death in 2014 were chronic diseases.

DaVita has a term for patients with multiple chronic conditions who are heavy utilizers of our healthcare system – MVPs, or most vulnerable patients.

Known for its renal care services, the Denver-based company has a long history of partnering with payers and risk-bearing entities to manage the total cost of care for patients with kidney disease. Since 2016, with the creation of its DaVita Health Solutions division, the company has broadened its approach by working with payers to provide care for high-risk patients with multiple chronic conditions, such as heart failure, COPD, diabetes, etc. To do so, it is leveraging its long history of running house

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call programs (since 2007) and post-acute care programs (since 2001) in several markets through its medical group, DaVita Medical Group.

(In December 2017, DaVita Inc. announced that its DaVita Medical Group subsidiary will combine with health services company Optum.)

MVPs are the highest-risk (and often, the highest-cost) patients in the healthcare system today, says DHS President Hank Schlissberg. Forty-one percent of U.S. healthcare spending is driven by 12 percent of the population with five or more chronic conditions, he points out. This is also one of the fastest-growing segments of the U.S. patient population, expected to grow by more than 20 percent over the next decade.

“If we can’t figure out how to better treat our nation’s MVP population, we will continue to fail them as care providers, and our healthcare costs will continue to spiral,” says Schlissberg.

One out of every three of the most vulnerable patients visits the ER at least one time per year, he says. One out

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CHRONIC CARE MANAGEMENT of every four patients has at least one hospital stay per year; and one out of every five Medicare patients is readmitted within 30 days. On average, MVPs visit 20 doctors and take 51 medications per year. “They need a high-touch, highly personalized care model that can complement their current care/providers and meet them when and where they need care most – within the home or skilled nursing facility – while providing 24x7 care coordination and a support network.

Hank Schlissberg “That is exactly what DHS does, and we believe it is the future of healthcare for this highly vulnerable and costly population,” says Schlissberg. “It will require health plans working together with providers to implement new care models and innovative programs (such as house calls) that can improve the quality and cost of care for these members.”

DHS recently completed its first partnership with a large regional health plan, says Schlissberg. The company built a physician-led, home-centered care model for the plan’s most vulnerable members, and then smoothly transitioned those capabilities after successfully demonstrating positive health trends and operational efficiencies.

launching and running its house calls and post-acute care programs. “We took best practices from those programs, combined with our integrated kidney care program expertise, and formed DHS,” says Schlissberg.

“The traditional care model for those with multiple chronic conditions does not work. These patients often cannot easily manage the 51 medications (on average) they take per year or visit the 20 doctors (on average) they see per year. And they often cannot properly coordinate their care across their specialists and primary care physician.”

Each of these patients’ chronic conditions requires complex management, he points out. “A onesize-fits-all care model that relies on traditional office visits that often last 15 minutes will never work for this population. Their needs require comprehensive care teams working together to ensure coordinated and convenient care.”

When DHS partners with a health plan, the company builds out a care team and works within the community to partner with the plan’s primary care physicians. Community-based care teams include MDs, NPs, RNs, behavioral health specialists, palliative care specialists, social workers, pharmacists and dietitians.

“We work with the health plan to announce the program to its highest-risk members as a complimentary benefit program to which they have the gift to receive,” says Schlissberg. The initial communication usually comes from the plan to its members and is supported by communication from primary care physicians. “We also work with local SNFs to ensure health plan members are seen by our skilled nursing facility specialists (SNFists), so their care can be coordinated.”

Partnering with local primary care physicians and specialists is an important part of DHS’s clinical and business strategy, says Schlissberg. Although DHS provides primary-care-type services, it is not the primary care physician of record, he says. “We provide an incremental layer of service; and we intentionally partner with local physicians.”

“You can’t learn everything you need to know unless you are in the home, meeting caregivers, looking at the home environment and all the determinants of health.”

Over nearly two years, DHS served approximately 7,000 patients in the partnership with over 600 local primary care physicians, specialists and extended care teams, including family members, caregivers, hospitals, SNFs and home care agencies. Among the results: • 1 0-15 percent fewer emergency room visits.

• 3 5-40 percent fewer hospitalizations.

• 15-20 percent lower cost of care.

• 4 6 percent lower SNF length of stay.

• 64 percent lower SNF-to-acute 30-day readmission rate.

• 9 1 percent patient satisfaction rating.

How it works DaVita Health Solutions leadership includes executives from DaVita Medical Group who were responsible for

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CHRONIC CARE MANAGEMENT Local caregivers typically welcome the assistance they receive from DHS, he adds. “They want to do the right thing by their patients, and they know that they can’t possibly address the needs of most MVPs in a 15-minute office visit. You can’t learn everything you need to know unless you are in the home, meeting caregivers, looking at the home environment and all the determinants of health.”

That’s the role the DHS team plays.

house calls care team. These SNFists round within the skilled nursing facility when a DHS/health plan member is admitted. “They work to ensure expedited dismissals and smooth transitions, and also coordinate care with the house calls care team and member primary care physicians. And we staff a 24x7 member support center to provide after-hours care and regular coordination.”

The payoff Care plan Every engagement begins with a comprehensive health assessment of the patient in his or her home or the skilled nursing facility. “This is most critical for establishing a care plan, which we then coordinate with existing doctors,” says Schlissberg. It is also important from a coding and documentation standpoint.

“Our biggest challenge is getting in the door, as some patients are reluctant to have a doctor or nurse visit them at home,” he says. “But once we gain their trust and establish a relationship so they are comfortable setting up an initial house calls visit, we have found the first visit – which is usually one and a half to two hours – highly valuable. The patients are comfortable in their home setting and reveal more about their care needs than when they are in an office setting.

“In that initial visit, we are able to build out a comprehensive care plan that includes both their personal and health goals. We also identify care needs that can only be found within the home – like tripping risks and other health hazards, medication management issues, social care needs, dietary needs, transportation needs, etc. We can then incorporate those broader care needs with actionable next steps into each member’s comprehensive plan.

“People welcome this. We hear things like, ‘I just didn’t know healthcare could be like this.’”

Palliative care can also be an important part of the plan.

“There is little more powerful than having a patient tell clinicians, ‘my daughter is getting married in November and I want to be able to walk her down the aisle,’” says Schlissberg. “The ability to help them achieve that goal is among the most beautiful things we do.”

DHS also operates post-acute care programs that involve employed SNFists who work in concert with the

Schlissberg admits that the DHS program is labor-intensive and requires comprehensive care teams supported by care coordinators, call centers and operations teams.

It also requires the right population of members within a market to justify the program costs.

But DHS leads to fewer ER visits, fewer hospitalizations and lower healthcare costs, so the investment pays off.

“Today’s healthcare system is just not built for MVPs, who are frequent utilizers of the ER and hospital, heavy users of prescription drugs, who have significant social and behavioral health challenges, and require more attention than a traditional office setting can typically offer.

“A different care model is required, and incumbent payers and providers are just not positioned to solve it. Payers are too far from the point of care and are trying their best to do telephonic care management on massive scale. Providers, who are inherently local, don’t have the scale to build capabilities and interventions for the 5 percent of patients – the MVPs – when they have to focus on the 95 percent.

“We believe at the core of this new care model are good old fashioned house calls, like the old Marcus Welby TV show. Doctors with black bags coming to you, like our parents and grandparents remember. Except now the house-calls ‘doctor’ is an entire care team with social workers, nurse practitioners, behavioral health specialists, care coordinators, etc.

“We feel a moral imperative to make a difference for these patients, the ones who are most in need of a different care model,” he says. “Caring for these members is a critical next step in creating a sustainable ecosystem for patients, payers and employers, and in their evolution to value-based care.”

“These patients often cannot easily manage the 51 medications (on average) they take per year or visit the 20 doctors (on average) they see per year.”

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Multiple choice Clorox Healthcare offers three right answers for quick, effective surface disinfection Your customers are on a mission: To provide high-quality

medical care as efficiently as possible, and to keep patients and staff safe and free from harmful infections. Today, they are increasingly delivering that care in the physician office.

In fact, patients visited doctors in their offices 990.8 million times in 2015, according to the Centers for Disease Control and Prevention. Fifty-two percent of those visits required an examination or screening with lab tests, with procedures being a common outcome. Two and a half percent resulted in a diagnosis of upper respiratory infection.1 When you consider their busy schedules, the number of touches on the same surfaces in the office, and the fact that cold, flu and other viruses can survive on surfaces for days and weeks, it’s clear that your customers need easy-to-use, fast-acting surface disinfectants to prevent the spread of pathogens. The innovators at Clorox Healthcare have developed a family of products to help them do just that.

Although the name “Clorox” is often associated with bleach and products used in the home, Clorox Healthcare offers a complete line of both bleach and non-bleach, ready-to-use healthcare disinfectants designed to meet the needs of a fast-paced healthcare environment. And the products are compatible with medical equipment and surfaces commonly used in healthcare settings.

• Clorox Healthcare® VersaSure™ Cleaner Disinfectant Wipes are the newest addition to the Clorox Healthcare portfolio. Ideal for general patient care areas and waiting rooms, as well as for odor-sensitive staff, these non-bleach, alcohol-free wipes are Environmental Protection Agency (EPA) registered to kill 44 pathogens, including bacteria, viruses and fungi, in two minutes or less.

•R eformulated Clorox Healthcare® Hydrogen Peroxide Cleaner Disinfectants offer broad spectrum disinfection efficacy, but with improved compatibility with plastic surfaces and visibly less residue. Hydrogen peroxide disinfectant wipes and sprays are EPA-registered to kill over 40 microorganisms in as little as 30 seconds. Their fast cleaning power makes them ideal for procedural areas.

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• Clorox Healthcare® Fuzion™ Cleaner Disinfectant is the first product of its kind to combine trusted bleach efficacy against tough-to-kill pathogens with low odor and low residue profiles required for broad use throughout healthcare facilities. Fuzion is EPA-registered to kill Clostridium difficile (C. difficile) spores in two minutes – the fastest kill time available (as of August 2018) – and 52 other pathogens in one minute. Fuzion can be used in conjunction with Clorox Healthcare® Bleach Germicidal Wipes and is ideal for high-risk areas including exam rooms where patients with gastrointestinal illness are seen, where the risk for C. difficile transmission can be higher.

“Clorox Healthcare understands that healthcare facilities have various infection control needs for different surfaces,” says Mike Harrington, Director of Sales-Clorox Non-Acute Healthcare. “We realize there is not a onesize-fits-all approach to selecting surface disinfectants for infection control.” That’s why Clorox Healthcare recommends the following tiered approach when walking customers through the disinfectant selection process: •B leach disinfectants: For high-risk areas or unknown infection control threats.

•H ydrogen peroxide disinfectants: For procedural areas, where there are more invasive procedures and more medical equipment.

•A lcohol-free quat disinfectants: For general patient care settings and waiting areas.

To help you and your customers make the right choice, refer to the Clorox Healthcare Compatible™ program. Clorox Healthcare continually works with medical equipment manufacturers to evaluate and test its disinfectants for compatibility on medical equipment and common surfaces. The results are easily viewed online.

To learn more about Clorox Healthcare innovations, including Clorox Healthcare Compatible™, contact a Clorox Healthcare regional sales manager or visit http://www.cloroxhealthcare.com.

Centers for Disease Control and Prevention, https://www.cdc.gov/nchs/data/ahcd/namcs_summary/2015_namcs_web_tables.pdf

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POST-ACUTE HIDA INSIGHTS

ASCs Plan Investment as Patient Volumes Rise

By Ann Peters, Manager, Research & Analytics, Health Industry Distributors Association, HIDA The majority of ambulatory surgery center (ASC) ad-

The leading types of surgeries ASCs plan to add in the next two years include plastic and podiatric.

In addition to expanding the range of surgeries they perform, many ASCs have already expanded the types of services they offer. These include physical therapy (54 percent), diagnostic imaging (54 percent), and clinical laboratory testing (41 percent).

ministrators and physicians expect surgical volumes to increase this year, according to HIDA’s 2018 Provider Survey: Technology Drives ASC Expansion. This survey of ASC administrators, doctors, and office managers looks at the factors driving this growth, and the steps ASCs plan to take in response.

Improved surgical capabilities are the More than leading factor behind rising patient volone-third umes, although respondents also identified (36 percent) of the aging population and increased capacity at their facilities as key drivers. To cope ASCs are planning with the influx of patients, ASCs are planto expand their ning to make a number of investments. physical facilities.

Here is a look at some of these:

ASCs look to reduce costs

Lowering costs is a key priority for ASCs, although many are not willing to let this aim compromise their ability to meet patient needs. Even though ASC supply chain decision makers are looking to reduce costs, they identified demonstrated clinical results Of these, more as the most important attribute when makthan half plan to ing purchasing decisions.

SCs plan physical expansion expand or remodel The vast majority (88 percent) of ASCs More than one-third (36 percent) of ASCs their current purchase their medical-surgical supplies are planning to expand their physical fafacilities, while through distribution. When purchasing, cilities. Of these, more than half plan to 43 percent plan these providers tend to exhibit a high degree expand or remodel their current faciliof independence, and even those affiliated ties, while 43 percent plan to build new to build new facilities altogether. facilities altogether. with large health systems still have a strong measure of influence in this area. Another Despite plans to physically expand, important fact for distributor reps to know is that medicalthe majority of ASCs have no plans for mergers and surgical supply purchasing makes up a large part of ASCs’ acquisitions. Only 5 percent of independent ASCs say budgets – second only to labor costs. they are in the market for acquisition, and 64 percent say ASCs are a rapidly growing segment in the healththey are not affiliated with a health system nor considercare industry, performing a growing range of surgeries ing this option. and drawing patients away from traditional settings. As the report details, these providers are making numerous ASCs plan to expand strategic investments as they plan for growth. Distriburange of surgeries at facilities tors are in a unique position to help address the pains that Advances in operating room technology, microscopes, and accompany rapid growth by providing customized stratepatient recovery have been key in allowing many procegies for holding down costs. dures to shift from the hospital to the outpatient setting.

For more information, and to see additional research reports in HIDA’s Provider Survey series, visit www.HIDA.org/ProviderSurveys.

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HIDA GOVERNMENT AFFAIRS UPDATE

CMS Seeks to Ease Provider Burdens with New Payment Rules The Centers for Medicare and Medicaid Services (CMS) has released a host of final

payment rules, increasing payments to hospitals, skilled nursing facilities (SNFs), and other providers in 2019. The rules also contain a number of provisions designed to ease administrative burdens and lower providers’ cost of complying with regulations.

To assist healthcare distributors, HIDA Government Affairs has prepared several resources that outline the changes contained in CMS’s new payment rules. Here are some key insights from these resources.

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

Acute and long-term care hospitals CMS announced it will increase payment rates for acute care hospitals by 1.85 percent and those of long-term acute care facilities by 1.35 percent. As part of the new payment rules, CMS will remove and de-duplicate a number of measures across the four quality and value-based purchasing programs.

The rules also contain a number of key changes and requirements for these providers. For example, acute care hospitals will now be required to list their standard prices online. The rule also changes the electronic health record program for these hospitals so that it has a smaller set of objectives. This move aims to give providers a more flexible, less-burdensome structure.

Skilled nursing facilities CMS will increase payments for SNFs by 2.4 percent, according to its new payment rules. The agency will also implement the new Patient-Driven Payment Model, which focuses on the patient’s condition and care needs to determine reimbursement levels.

Other key changes in the SNF payment rule include updates to the SNF Value-based Purchasing program.

These updates change the scoring methodology for lowvolume SNFs, and also includes an exemption policy for extraordinary circumstances.

Inpatient rehabilitation facilities and hospices CMS will increase payments to inpatient rehabilitation facilities (IRFs) by 1.35 percent and payments to hospices

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by 1.8 percent. The agency also announced that it will remove certain documentation requirements for IRFs and will reduce the number of quality measures each must report. These steps aim to achieve goals set out in the agency’s Meaningful Measures initiative, which seeks to improve patient outcomes while reducing the administrative burden on providers.

A common theme across these payment rules, in addition to the slight payment increase, is the agency’s efforts to reduce the reporting and administrative requirements on providers in different healthcare market segments.

“We’re excited to make these changes to ensure care will focus on the patient, not on needless paperwork,” CMS Administrator Seema Verma comments on the agency’s website. “We’ve listened to patients and their doctors who urged us to remove the obstacles getting in the way of quality care and positive health outcomes.”

The agency continues to gather feedback on its regulations, so it is possible CMS will take further action to reduce the impact of existing requirements. If you have any questions, or would like to access HIDA’s resources on CMS’s payment rules, please contact HIDAGovAffairs@HIDA.org.

3 Reasons GPOs Are Good for Distributors’ Business

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TRENDS

‘Why Not Us?’ Health systems increasingly look to initiate innovation, instead of being on the receiving end Where will the next great medical technologies come

from? A Fortune 500 company? A mom-and-pop start-up?

Silicon Valley?

How about one of your customers?

If it feels like you’ve been reading more news about health-system-operated technology incubators, accelerators and venture funds, you probably have.

“Yes, there has been an increase in their involvement in medical device innovation,” says Henry Soch, vice president, Sg2, a Vizient company.

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The reason is simple: Health systems realize they have a significant amount of intellectual capital within their organizations, and they can leverage it to create new devices and clinical pathways, which they can then commercialize to create new revenue streams, he says.

Soch leads Sg2’s intelligence work surrounding technology adoption and innovation. He looks at the technology landscape and informs member organizations when it is appropriate to adopt new technologies, and how they can incorporate those technologies in clinical care.

It is difficult to specify exactly how many healthcare systems operate accelerators or venture funds, because they often reside in different parts of the organizational structure, says Soch. Some fall under the strategy team (usually under the chief strategy officer), others may be included in the innovation office (under the direction of the chief innovation officer), and some may be stand-alone organizations or separate businesses that report directly to the board of directors.

Examples of active health systems include the Texas Medical Center, Cleveland Clinic, Kaiser Permanente, Intermountain Healthcare, Geisinger, Ascension, UPMC, Cedars-Sinai, Partners HealthCare System, Mayo Clinic, and many others.

Why health systems?

Henry Soch

business model, says Soch. That said, “an operational commercialization or technology transfer infrastructure” is the foundation for building a high-innovation environment.

An effective technology transfer infrastructure includes a formal process for soliciting ideas from people – clinicians or ancillary personnel – in the organization about projects they believe may have a major impact on healthcare delivery, he says. Perhaps it lowers the cost of delivery, shortens the

“ Health systems realize they have a significant amount of intellectual capital within their organizations, and they can leverage it to create new devices and clinical pathways, which they can then commercialize to create new revenue streams.”

– Henry Soch

Health systems are no longer content with waiting for innovation. Instead, they want to create it.

The “accelerator” concept has been around for decades, but its adoption within the healthcare industry is only about 10 or 15 years old, says Soch. “It is now being applied more frequently because of the move to value-based care and the increasing need to rapidly respond to changes in the healthcare environment,” he says. “The other major driver is to try and accelerate the ‘bench to bedside’ cycle of innovation and speed up the adoption of new advances to benefit the most patients in the shortest timeframe.”

Obtaining FDA clearance for a new device requires serious clinical validation across a wide range of patients, he points out. “In a world that is moving to value-based payment, unless you can demonstrate REAL clinical value in either the diagnosis, treatment or cost implications, you miss the mark in terms of market effectiveness in new product development.”

How does it work?

Today’s venture groups and innovation institutes have departed from the traditional “technology transfer”

time-to-diagnosis, reduces the workload burden on the clinical staff, or is truly transformative.

The healthy infrastructure allows people to discuss the project from a clinical and business perspective, says Soch. “If it passes that threshold, a certain amount of money will be allocated to the project for a prototype and proof of concept. Then the decision is made whether to provide additional funding or whether to seek outside help.”

But for many health systems, making the leap from technology transfer to true innovation can be challenging.

“Probably the biggest challenge is to eliminate the ‘silos’ in clinical innovation efforts that exist in most organizations,” says Soch. “It is critically important to understand how broadly a device or medical invention can be applied across disciplines when determining which proposals make the cut in terms of additional investment and prioritization.

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TRENDS “And health systems have limitations, not only in capital, but in knowledge of the business aspects of medical technology, such as manufacturing, marketing and distribution. In those cases, the health system would need a business partner with that kind of experience.”

If the healthcare system is heavily invested in the technology, it may be very involved in its development and commercialization. But many relationships are more “arm’s length,” meaning the system may cede these functions to others.

Either way, the stakes can be high. And they seem to be getting higher all the time.

The payback time to generate a positive ROI is shrinking considerably, says Soch. “In our conversations with healthcare innovation centers, we find they are beginning to

Five years ago, the leadership of the Texas Medical Center and its major institutions set out to create an environment that would nurture the next generation of therapies, medical devices and digital health applications.

The umbrella is the TMC Innovation Institute, which comprises about 200,000 square feet and several programs: • TMCx+ co-working space • TMCx accelerator • J&J JLABS@TMC • J&J Center for Device Innovation • AT&T Foundry for Healthcare, with a focus on digital health technologies • TMC Biodesign Fellowship Program • TMC Venture Fund The TMCx+ incubator is a coworking space in which roughly 30 young companies – ranging in size from just a couple of people to 20 or more – house their offices and research efforts.

Another facet of the Institute – the TMCx accelerator – provides start-up companies with a variety of services without charge, including business plan refinement, legal advice to establish or protect intellectual property, prototype design and development, regulatory guidance, and introductions to both medical center partnerships and venture capital. The accelerator runs two cohorts of 20-25 start-ups per year – one for medical devices, one for digital health, explains Halvorsen. The most recent medical device cohort drew more than 200 applicants from 18 countries. At the end of six months, the participants present their plan to potential investors and strategic partners.

A third component of the program is J&J Innovation’s JLABS@TMC, a 34,000-square-foot facility of common, wet lab and office space, as well as a 1,000-square-foot prototyping space, which includes specialized software, electronics testing and assembly equipment, rapid fabrication and 3D printing capabilities. At press time, JLABS@TMC had 51 resident

An effective technology transfer infrastructure includes a formal process for soliciting ideas from people – clinicians or ancillary personnel – in the organization about projects they believe may have a major impact on healthcare delivery, he says. Perhaps it lowers the cost of delivery, shortens the time-to-diagnosis, reduces the workload burden on the clinical staff, or is truly transformative. look at an ROI of between 18 and 24 months, as opposed to the more typical five to seven years.”

TMC The Texas Medical Center in Houston is a relative newcomer to the business of innovation, says Erik Halvorsen, Ph.D., director of the TMC Innovation Institute. But what it lacks in years, it has made up in terms of the number of early-stage healthcare companies under which it has lit a fire.

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TRENDS

companies – 49 percent therapeutics, 31 percent med/surg and diagnostics, 10 percent technology and 10 percent consumer.

The Center for Device Innovation (CDI@TMC) is collaboration between Johnson & Johnson Medical Devices Companies, Johnson & Johnson Innovation LLC, and the Texas Medical Center designed to enable rapid prototyping and pre-clinical/clinical testing. The 25,000-square-foot Center includes a full machine shop with advanced prototyping equipment; 60 work benches; facilities for electronics lab, wet lab and mechanical testing; 12 private offices and 24 open workstations; virtual reality system and visualization space; and conference rooms.

In November 2017, the Innovation Institute launched the $25 million TMC Venture Fund, dedicated to investing in early stage technologies that can advance human health.

The fund has invested $2.5 million across seven companies to date.

Finally, the TMC Biodesign Fellowship Program is a one-year paid fellowship for a handful of fellows specializing in digital health and medical devices, says Halvorsen.

They are embedded in TMC hospitals, participate in clinical rotations

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Nine questions Who better than health systems to address nine key questions that need to be answered to properly evaluate the potential of a new device or innovation, says Henry Soch, vice president, Sg2, a Vizient company: • Does this provide an improvement over existing practice?

• Is it technically feasible?

• Does it fulfill a REAL NEED? • Are there any barriers to commercialization?

• How easily can it be implemented?

• Is it evidence-based and does it provide real merit?

• Is there a competitive market advantage if the healthcare system were to develop it?

• What is the likelihood of peer adoption?

• Is it at an actionable stage of development?

and observational work, and identify unmet needs. They often come up with hundreds of ideas, which they ultimately narrow down to three, based on technical, market and other business criteria. The fellows then present their plans to the Innovation Institute team, who select one for the fellows to develop into a company.

They have approximately six months to build prototypes, test them, and form a company.

“It’s a ground-up build, a very exciting program, and great experience for the fellows who participate,” says Halvorsen. “We have been doing this three years, and we’ve launched four companies.”

Corporate help Academic medical centers and universities are strong at basic research, but have a tougher time working through prototyping, iterative design testing, IT, financing, gaining regulatory approval and carrying a product to market, says Halvorsen. “The further they go in the process, the less experience, knowledge and capabilities they usually have. You’re talking about taking a device from concept to regulatory approval and market entry. That can be several years and millions of dollars.” And that’s why they need help.

800-431-2123 info@polymedco.com

.

TRENDS

What’s an incubator?

Accelerator?

Both incubators and accelerators help firms grow by providing guidance and mentorship, but in slightly different ways and, more importantly, at different stages in the life of the business, explains Fernando Sepulveda, managing director, Impulsa Business Accelerator, in a 2012 Inc. magazine article.

“Like a father to a child, an incubator provides shelter, where the child can feel safe and learn how to walk and talk by offering office space, business skills training, and access to financing and professional networks,” he writes. “The incubator nurtures the business throughout the startup phase (childhood) and provides all the necessary tools and advice for the business to stand on its own feet.

“However, while learning to stand on its own is a great entrepreneurial achievement, the walk through adolescence is often wobbly and filled with challenges, and the need for guidance is far from over. Often it becomes necessary to receive advice and guidance from a business accelerator.”

Business accelerators “help companies get through adolescence and prepare them to enter adulthood, providing them with strong arms and legs, sound values and a clear mindset (strategy) for the future. In other words, while incubators help companies stand and walk, accelerators teach companies to run.”

Incubator programs nurture the business for the time it takes for it to get on its feet, sometimes many years, writes Sepulveda. On the other hand, a business acceleration program usually lasts between three and six months.

Source: “The Difference Between a Business Accelerator and a Business Incubator?”

Inc. magazine, July 31, 2012

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The TMC Innovation Institute draws on scores of corporate partners – law firms, venture capital groups, medical device companies, digital health companies – to mentor, advise or even partner with the start-ups in residence, he says. With 21 hospitals, collectively more than 800,000 surgeries, and 10 million patient encounters per year, TMC offers plenty of clinician involvement as well.

“If you can’t get traction [for your medical product] here, you probably won’t get it anywhere,” he says.

Future The activities of the Innovation Institute benefit TMC, its institutions and its patients, says Halvorsen.

“We find the best technologies from around the world that address unmet needs in healthcare, bring them to Houston and work to introduce them into clinical practice,

“Probably the biggest challenge is to eliminate the ‘silos’in clinical innovation efforts that exist in most organizations.”

– Henry Soch

to benefit patients and improve the entire healthcare process and experience.

“Our member institutions love it, because they want to be early adopters; they want to deliver the best for their patients. The Institute gives them a competitive advantage. People look at TMC as a destination where they get the best care with cutting-edge devices and procedures. That helps our hospitals recruit the best doctors, researchers and innovators, nurses, medical students and others, who want to be where new technology is being developed and deployed.”

Says Soch, as healthcare makes the transition from feefor-service to value-based purchasing, health systems will have more of an impact on innovation. “They hold the keys to clinical care pathways, and they can determine whether the proper use of a new device will improve clinical outcomes of time-to-diagnose.”

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SPONSORED HEALTH O METER

Why Calibration Matters: Medical Scales, Accuracy, and Safety

Scales are a necessary piece of equipment for all medi-

cal facilities. A patient’s weight provides vital information for detecting fluid retention, calculating proper medication dosages, and screening for malnutrition.

Properly maintaining a patient scale ensures accurate and consistent patient weight readings, which are critical to consistent, effective patient outcomes. Conversely, miscalibrated or inaccurate scales can cause inconsistencies that can lead to improper treatment.

This is especially relevant in environments where multiple scales are used with patients, as miscalibrated scales will record results differently than properly calibrated scales.

A study of nearly 8,000 patient scales in 200 hospitals showed more than a third of all scales tested were inaccurate.1 Another study found that more than 15 percent of tested scales showed an average inaccuracy greater than 6 pounds.2 In one state alone, 479 medication errors in a single year were attributed to inaccurate patient weights.3 The only way to guard against inaccuracies in patient scales is regular inspection and calibration.

Calibration helps ensure that scales are accurate and consistent – essential when using weight to track patient health or determine medication dosing.

Why do professional grade scales need calibration?

Healthcare providers utilize professional grade scales because of their accuracy and durability. But professional grade scales are still precision measuring instruments and, like many other medical instruments, they require calibration. Professional grade scales use meticulously manufactured mechanical and electronic components to ensure consistent and accurate weighing results. These components are subject to wear caused by both normal usage and abuse. While this wear may be small at first, over time it can lead to significant changes in a scale’s accuracy if not checked regularly. Calibration is simply the process of checking to see if any change has occurred and correcting it before the scale’s 1 results are impacted.

A study of nearly 8,000 patient scales in 200 hospitals showed more than a third of all scales tested were inaccurate.

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SPONSORED HEALTH O METER

How Scale Accuracy Affects Patient Safety Inaccurate scales can cause more than frustration. Some medications, particularly for renal disease and some cancers, are dosed by weight.

An inaccurate weight can lead to a patient getting too little – or too much – medication, resulting in a non-therapeutic or potentially harmful dose.

Such errors can lead to potentially dangerous, expensive complications. Establishing and managing a controlled process to ensure your scales are calibrated accurately and consistently can help better manage risk by reducing the potential for weighing errors, which in turn can improve patient outcomes and safety.

How and when should I calibrate my scales?

The FDA and The Joint Commission do not have specific standards or recommendations regarding calibration of medical scales. To ensure scale accuracy, they do require that facilities and providers engage in a regular and appropriate maintenance program that adheres to the manufacturers’ specifications and / or other procedural components known to be appropriate to ensure scale accuracy.

The National Institute of Standards and Technology (NIST), ISO, and ASTM, along with similar agencies around the world, have developed extensive, scientifically-based standards for calibrating weight scales. In the absence of specific guidelines from the FDA and The Joint Commission, institutions often rely on the standards developed and published by the NIST, ISO, and ASTM. Many facilities calibrate their scales annually – unless someone requests an earlier calibration after noticing discrepancies or potential errors.

Establishing a Reliable Calibration Process Step 1. Determine responsibility and governance Decide who should ensure that scales (and other instruments, as needed) are calibrated.

This may be an internal team, such as biomedical services, facilities, or a standards department. Your facility may also decide to outsource calibration to a contracted service provider.

Step 2. Establish frequency Set a regular, predictable schedule for calibration. While the medical profession in the United States has not officially adopted the NIST and U.S. Department of Commerce Calibration regulations, many standards agencies recommend annual testing. Investigate whether you can align calibration with other mandates or maintenance schedules.

Be sure to also implement a process for reporting anomalies and testing scales that may require calibration outside the typical schedule.

Step 3. Follow a consistent process Look to the NIST, The Joint Commission, the Food and Drug Administration, and other organizations to establish a consistent process that optimizes your calibration efforts. Document your process and maintain records of when the scales were last calibrated, including any needed traceability certificates.

Once you establish a process, educate your team on the importance of calibration and how inaccuracy can harm patients. A team effort can keep your scales calibrated, accurate, and safe.

For more information on scales and calibration, visit the Technical Documents page on Health o meter Professional Scales’ website: www.homscales.com/company/technical-documents.

Evans L., C. Best C “Accurate Assessment of Patient Weight.” Nursing Times, 2014. 110:12, p 12-14.

Stein, Risa, PhD; C. Keith Haddock, PhD; Walker S.C. Poston, PhD, MPH; Dana Catanese; John A. Spertus, MD. “Precision in Weighting: A Comparison of Scales Found in Physician Offices, Fitness Centers, and Weight Loss Centers.” Public Health Reports; May-June 2005, p 266-270.

3 “Medication Errors: Significance of Accurate Patient Weights.” Pennsylvania Patient Safety Advisory, March 2009.

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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

Drone delivery done right Indianapolis-based DroneDek has been awarded a U.S. Patent for last-mile drone delivery. Here’s how the company says its system will work: Users will receive alerts when their packages ship or arrive. They will also be notified of what item has arrived and from whom. A heated and cooled cargo area will pave the way for pharmaceutical, food and beverage delivery, according to the company.

DroneDek will operate off of solar or a 110v power supply, feature a heated door to operate in any climate and will host a charging station for delivery drones.

Passwordmania A password manager makes you less vulnerable online by generating strong random passwords, syncing them securely across your browsers and devices, and filling them in automatically, according to The Wirecutter, a New York Times company. The editors of The Wirecutter believe that LastPass is the best password manager for most people. It has all the essential features, it works with virtually any browser on any device, and most of its features

are free. (A Premium version, which costs $24 per year, adds advanced security features, better sharing, and other tools.) Once you create a master password for LastPass, you’ve made the only password you’ll need to unlock all your other secure data – usernames and passwords, credit card numbers, secure notes (including attachments, such as images and PDFs), contact information, software licenses, and so on, according to the editors. LastPass stores all this data safely encrypted in the cloud, letting you access it via browser extensions.

For the beginning investor SprinkleBrokerage is an investing app built with the beginning investor in mind, according to the company. Through its partnerships, SprinkleBrokerage says it can provide a social experience, allowing clients to share information and collaborate on their next investment ideas. For $15 per month, users can select the premium version of SprinkleBrokerage, which includes commission-free trades, no minimum investment, instant deposit from a U.S. bank account and 5.5 percent interest in their margin account.

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QUICK BYTES Standard margin accounts are $5 per month and includes some of the features with the premium membership.

Alexa on campus Saint Louis University says it is the first college or university in the country to bring Amazon Alexa-enabled devices, managed by Alexa for Business, into every student residence hall room and student apartment on campus.

Thanks to a custom SLU skill deployed on each device, students will get instant answers to more than 100 questions specific to the University – from “What time does the library close tonight?” to “Where is the registrar’s office?”

The university in St. Louis intended to deploy more than 2,300 Echo Dot smart devices by the start of the 20182019 school year.

It’s about time Apple announced new tools this summer built into iOS 12 to help customers understand and take control of the time they spend interacting with their iOS devices.

• Do not disturb. There is a new Do Not Disturb during Bedtime mode to help people get a better night’s sleep by dimming the display and hiding all notifications on the lock screen until prompted in the morning. Do Not Disturb has new options from Control Center, where it can be set to automatically end based on a specified time or location.

•N otifications. To help reduce interruptions, iOS 12 gives customers more options for controlling how notifications are delivered. Instantly manage notifications to be turned off completely or delivered directly to Notification Center. Siri can also make suggestions for notifications settings, such as to quietly deliver or turn alerts off, based on which alerts are acted upon. iOS 12 also introduces Grouped Notifications, making it easier to view and manage multiple notifications at once.

•S creen Time. Screen Time creates detailed daily and weekly Activity Reports that show the total time a person spends in each app they use, their usage across categories of apps, how many notifications they receive and how often they pick up their iPhone or iPad. The App Limits feature allows people to set a specific amount of time to be in an app, and a notification will display when a time limit is about to expire. Parents can access their child’s Activity Report from their own iOS devices to see where their child spends their time and to manage and set App Limits for them. Screen Time also

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gives parents the ability to schedule a block of time to limit when their child’s iOS device can’t be used.

During Downtime, notifications from apps won’t be displayed, and a badge will appear on apps to indicate they may not be used. Parents can choose specific apps like Phone or Books that will always be available, even during downtime or after a limit is spent.

Best mic for podcasts After 75 hours of research, interviews, and making audio professionals and regular humans listen to the same phrases spoken into 25 different USB microphones, editors at The Wirecutter, a New York Times company, remain conScreen Time creates vinced that the Yeti by Blue detailed daily and makes your voice sound the best with the least hassle. weekly Activity It makes a wider spectrum Reports that show of voices sound better than the total time a the other microphones person spends tested, which tend to favor certain tones. The editors’ in each app they pick since 2013, the Yeti is use, their usage solidly built and easier to set across categories up on your desk than most of apps, how many of the competition. It does best at capturing a single notifications they voice, but you can use it in receive and how a pinch for two-person sesoften they pick up sions or even music recordtheir iPhone or iPad. ing. The mute, gain, and volume controls are easy to manipulate while recording. If you’re an enthusiast, you might be able to get better results by putting time into a different, likely more expensive microphone, and more elaborate equipment, but the Yeti puts the fewest hurdles between you and an ear-pleasing sound.

Smartphone case OtterBox – the smartphone case company – announced a lineup of protective cases for Galaxy Note9. The Symmetry Series is available in clear, graphic and solid color options. The Defender Series features port covers that keep dirt out of ports, and two-layer construction, which keeps the Note9 safe from drops and bumps.

And the Commuter Series offers two layers of protection with a shock-absorbing slipcover that helps keep dust out of ports.

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Plan Ahead for the Flu How physician practices can plan ahead to avoid shortfalls

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A record-breaking season! The perfect storm! No, we’re not talking about

the movie that garners a mediocre 47% Rotten Tomatoes rating. If you recall, last month we discussed the perfect storm of a flu season that the U.S. experienced in 2017-2018. A particularly vicious strain, combined with other factors such as a flu test shortage and a less effective vaccine, which resulted in 30,429 laboratory-confirmed flu-associated hospitalizations in the U.S. Other parts of the world saw staggering numbers as well: North Korea reported more than 80,000 confirmed cases of the influenza strain H1N1 between December 1, 2017 and January 16, 2018; Japan saw almost three million cases by January 2018; and Britain experienced a severe season with a sharp increase in hospitalizations.

We all breathed a sigh of relief when the flu season ended. In just a few short months, the flu and the need for a vaccination will begin to creep back into the public’s thoughts. All those who were adversely affected last season,

physicians who experienced shortages and an overload of patients, will surely want to avoid those same pitfalls. So what can we all do to prepare now?

Keep Your Eye on the Land Down Under Fun fact: because Earth’s axis is titled, Australia experiences winter while those of us in the U.S. experience summer. Their flu season typically wraps up, just as ours is getting started. Meaning it can serve as a gauge for how severe our season here may be. If Australia sees a particularly rough flu season, you may want to prepare for an intense season here as well.

have elicited eye rolls when your mom or grandfather spouted it off, it is good advice. Consider the following to avoid some of the problems you may have experienced last year: • Do a business assessment of last flu season to try to plan or forecast the coming season, to ensure enough product is procured. Avoid the Tamiflu shortages that were seen last year!

• I nventory space is at a premium. However, when shelf life is not an issue, don’t return stock! Maintain preparedness and entertain options to create space for extra inventory of flu tests.

Watch the Trends Flu season will begin in the Fall for 2018/2019, but that doesn’t mean you should stick your head in the sand! In fact, the upcoming season represents the 100-year anniversary of the 1918– 1919 influenza pandemic, which was the most severe pandemic ever recorded!

A lot has changed in 100 years. It’s important to keep abreast of the news, guidelines, and trends.

The FDA has already recommended which strains should be included in the 2018/2019 flu vaccine. In addition, health officials are researching alternatives to egg-based flu vaccine production, which have reportedly been linked to the low effectiveness of the flu shot. Earlier in 2018, FDA commissioner Scott Gottlieb said that a cell-based flu vaccine may be more effective than an egg-based vaccine. However, most manufacturers continue to produce egg-based vaccines.

The CDC maintains an entire website devoted to the flu, no matter what time of year. It offers domestic and international news, resources, and information for providers.

• Research the best methods for picking a flu test. We’ll discuss this in-depth next month, but

The CDC maintains an entire website devoted to the flu, no matter what time of year.

Don’t Put It Off Until Tomorrow!

I’m sure you’re familiar with the saying—“don’t put off until tomorrow what you can do today!” While it may

consider priorities such as cost, time to result, and waived vs. moderate. Sekisui Diagnostics for instance offers the OSOM® Ultra Flu A&B Test and the Silaris™ Influenza A&B Test.

With the fear of changing strains, new technologies are more important than ever. You have options, but it’s important to educate yourself ! Manufacturers like Sekisui Diagnostics are trying to provide new options to keep up with flu diagnostic challenges— learn all you can to prepare now for the upcoming flu season!

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

Automotive-related news

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Take it slow

Who’s going electric?

Teenage drivers are eight times more likely to be involved in a collision or near miss during the first three months after getting a driver’s license, compared to the previous three months on a learner’s permit, suggests a study led by the National Institutes of Health. Teens are also four times more likely to engage in risky behaviors, such as rapid acceleration, sudden braking and hard turns, during this period. In contrast, teens on a learner’s permit drove more safely, with their crash/near crash and risky driving rates similar to those of adults. The study appears in the Journal of Adolescent Health. “Given the abrupt increase in driving risks when teenagers start to drive independently, our findings suggest that they may benefit from a more gradual decrease in adult supervision during the first few months of driving alone,” said Bruce Simons-Morton, Ed.D., M.P.H., senior investigator at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and one of the authors of the study.

While consumer adoption of electric vehicles (EVs) continues to disappoint, with only 2 percent of all vehicles shipping in 2018 expected to be electric, city governments are climbing aboard, according to a new report by ABI Research. The introduction of urban emission zones, initially aimed at banning older diesel vehicles, will culminate in zero emission zones and city centers restricted to EVs only, according to the report. The state of California was preparing a bill at press time that would mandate 20 percent of miles traveled via ride-hailing services to be in EVs by 2023, rising to 50 percent by 2026.

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Creepy in St. Louis Sitting in the back of a cab or ride-share can have a confessional allure, notes the author of an article this summer in The New York Times. “Sealed off to the world, you can take a private moment for yourself or have a conversation – casual or deeply intimate – with a driver you’ll

never see again. Now imagine finding out days later that those moments were being streamed live on the Internet to thousands of people. What’s more, some of those people paid to watch you, commenting on your appearance, sometimes explicitly, or musing about your livelihood. This was the reality for potentially hundreds of passengers of a ride-hailing service driver in St. Louis, according to a lengthy article published in The St. Louis Post-Dispatch this weekend. In it, Jason Gargac, 32, a driver for Uber and Lyft from Florissant, Mo., described an elaborate $3,000 rig of cameras that he used to record and live-stream passengers’ rides to the video platform Twitch. Sometimes passengers’ homes and names were revealed.”

Putting the reins on ride-hail services New York became the first major American city in August to halt new vehicle licenses for ride-hail services, dealing a significant setback to Uber in its largest market in the United States, according to a report in The New York Times.

The legislation passed by the City Council will cap the number of for-hire vehicles for a year while the city studies the booming industry. The bills also allow New York

The introduction of urban emission zones, initially aimed at banning older diesel vehicles, will culminate in zero emission zones and city centers restricted to EVs only.

to set a minimum pay rate for drivers.

Cars for rent

Getaround, the car-sharing platform that allows users to rent and drive cars shared by people in their city, was launched in Philadelphia this summer.

Every car on the platform can be booked hourly or daily and is equipped with Getaround Connect™, a technology that enables users to remotely locate and unlock cars using the Getaround iPhone or Android app. Philadelphians can car-share with people near them, without coordinating a key pickup or dropoff. This is said to put a wide variety of cars at the fingertips of consumers while allowing car owners to earn thousands in extra income that helps offset the cost of their vehicle.

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Squirreling away flu tests?

Quidel has you covered.

Does the past flu season, or the fear of another one like it, make you feel like you should be squirreling away flu tests? Good idea! Being prepared for an unpredictable flu season is always your best course.

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HEALTHY REPS

Health news and notes Screening for urinary incontinence Women of all ages may benefit from annual screening for urinary incontinence, according to a new guideline adopted by the Women’s Preventive Services Initiative (WPSI). The guideline recommends doctors screen women beginning in adolescence to find whether they experience urinary incontinence and how it affects their activities and quality of life, says an August article published in the Annals of Internal Medicine.

Urinary incontinence affects an estimated 51 percent of women and increases in prevalence with age, ranging

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from 13 percent in young women who have never been pregnant, to 47 percent in middle-age women, to 75 percent in older women, according to the article. These rates are twice those reported in men.

The WPSI maintains that screening has the potential to detect urinary incontinence in many women who fail to report it due to factors like embarrassment or stigma. Screenings, which can be clinician- or selfadministered, should include questions about whether a woman has symptoms of urinary incontinence; the type and degree of incontinence; and how symptoms

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HEALTHY REPS

affect her health, funcThrough a tion and quality of life, randomized trial the article says. with 41 people, The American College of Obstetricians and the researchers Gynecologists (ACOG) found that launched the WPSI in participants, who 2016. Through a five-year were overweight cooperative agreement with the U.S. Department of or obese, lost Health and Human Serweight when vices, Health Resources they ate a and Services AdministraMediterranean tion (HRSA), ACOG is engaging a coalition of Pattern diet with national health profeslean unprocessed sional organizations and red meats. consumer and patient advocates with expertise in women’s health across the lifespan to develop, review, and update recommendations for women’s preventive healthcare services

You’ve got the meats!

If you’ve abandoned red meat in an attempt to stay healthy, you may be able to enjoy it again. A June study

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in The American Journal of Clinical Nutrition shows a Mediterranean-style diet that includes some lean unprocessed red meat could help adults manage their weight.

The Mediterranean Pattern diet – which includes components such as eating plant-based foods, substituting olive oil for butter, and using herbs and spices rather than salt for flavor – has been in style for some time. But researchers at Purdue University and the University of Texas noticed that even though health agencies encourage Americans to lower their red meat intake, past studies indicated that the Mediterranean diet might still lead to benefits – like decreased risk for type 2 diabetes – even in people who eat red meats.

So they decided to test those findings. Through a randomized trial with 41 people, the researchers found that participants, who were overweight or obese, lost weight when they ate a Mediterranean Pattern diet with lean unprocessed red meats.

“No one’s arguing for fat-marbled meats, processed meats or meats chargrilled to a crisp in the barbecue,” Amby Burfoot writes in a Washington Post article on the study. “But modest amounts of lean, unprocessed red meat don’t appear to have major health risks. At least not if consumed within a Mediterranean diet framework that includes lots of fruit, vegetables, whole grains, fish and olive oil.”

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Day and Night John Kenny: Cool head by day, cool hair by night

Photography by Gregg Gannon

The three and a half years John Kenny toured and made

records with his Dallas-based band, The Spin, were some of the most amazing – though poorest (from a dollar perspective) – days of his life. He wasn’t happy when The Spin disbanded, because he thought they still had some good things left to accomplish.

But Kenny, who is vice president of sales for physician office corporate accounts for Medline Industries, doesn’t waste time on nostalgia. He’s too busy playing guitar and

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singing regularly with two new groups – the Graceland Ninjaz and Epic Unplugged.

“Many of my peers hunt, play golf, or watch movies or television,” he says. “I choose to play music with my free time instead.”

He ran into Brian Setzer [of Stray Cats fame] in an airport after Graceland Ninjaz played a show at the House of Blues in Las Vegas. “He asked me, ‘Do you tour?’ I said, ‘No, just these power weekends. We all have careers.’ He

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looked at me and said, ‘You have the perfect setup – you’ve got your career, you’re stable, you don’t rely on music for your income.’” Kenny knew Setzer was right.

But that wasn’t what made the biggest impact on him that day. It was when Setzer told him he had cool hair.

Kenny was born in Omaha, Nebraska, and raised in Houston. Today, he lives with his wife, Cristina, and their five children, in Dallas.

His father was an engineer and entrepreneur, who owned several small businesses. “My father would just get things done,” he recalls. “He would calmly face issues and look for solutions.”

When Kenny and his siblings were young, his mother was a homemaker. But after her husband’s death in 1992, she took over his commercial real estate business.

such as the Beatles, Led Zeppelin, The Who, and The Rolling Stones, and newer, lesser-known artists at the time, like U2, REM, Elvis Costello and The Police.

In high school, he began to pick up drums, singing and guitar, learning by ear. His first band was called SCSC, a new wave/punk group.

“We ended up headlining our school talent show my senior year, which to this day is still one of the favorite moments in my life,” he recalls. “The crowd was crazy, and during our first song, they were quickly getting out of hand. The principal pulled me aside and asked me to calm them down. I said I would … if they let us play an extra song. And he did. Everything changed for me after that night.”

He had learned how much he loved being on stage.

“When the spotlight is on, you have to find a way to calm your nerves and perform,” he says. “That experience also taught me that I was limited only by my own

“When the spotlight is on, you have to find a way to calm your nerves and perform.”

Exposure Although his family was not particularly musical, he was lucky to have friends with older siblings who liked groups

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corner fear and insecurity. I learned to set lofty goals that almost seem impossible.

“If you are passionate about achieving those goals and put in the hard work needed, you can accomplish almost anything.”

At Baylor University, he and some friends – bandmates – built a following. After graduation, they started playing in Dallas and Houston, put out a record, played the South by Southwest music festival, and signed a deal for three more records.

“A ton of musicians would kill to play music full time.

At the time, I probably took it for granted. But looking back, it was a special opportunity.”

It was also challenging.

“The lifestyle of touring the country and making records – it’s incredibly difficult. The fun part is playing the shows. But it is an exhausting life.”

“ The fun part is playing the shows. But it is an exhausting life.”

The Spin had a bright future. They were in serious talks with a major record label, and were offered an opportunity to tour Eastern Europe and Japan. Then, one of the members decided he had had enough.

“We had made a pact that if one of us ever wanted to leave, we would disband,” says Kenny. So they did.

“I wasn’t happy. I thought we had great things ahead of us. But in retrospect, it was probably a good time to start pursuing a career.”

His older cousin, Patrick Kenny, had joined Medline in 2002, and thought John would do well there. He applied for an acute-care sales role in the Dallas area, and got the job.

“Medline has been a great company to work for, and they have provided me opportunities to grow and learn in a variety of roles,” he says. After working for the company for nine years, he was offered a corporate sales opportunity in Medline’s relatively new physician office division. “I was intrigued by the potential for growth and the challenge of helping build out a new division,” he says.

He is still intrigued today.

The King of Party Bands Music remains a key part of Kenny’s life. In 2010, he became a founding member and guitarist for a group called Graceland Ninjaz.

“It is difficult to describe the band, and I often ask people who have just seen us how they would describe us the next day to a friend. The most common response is that we are ‘really entertaining.’ We describe ourselves as the King of Party Bands, and our audience is a wide mix of ages. We play many mash-ups with rock, hip hop, and just about anything. The goal is to put on a unique concert experience that all ages can enjoy.”

Indeed, their playlist includes AC/DC, Michael Jackson, Dr. Dre and Tupac Shakur, Jimi Hendrix, Beck, Devo, Eminem and, of course, Elvis.

This past April, Kenny co-founded a second group with a much different approach to music – Epic Unplugged. He describes it as “an MTV Unplugged experience with vocals, a full band and a string quartet,” playing epic rock by such groups as Pink Floyd, Foo Fighters, Led Zeppelin, Oasis, Jack White and Queen.

“It is very unique because we have the featured string quartet, having written unique parts for all of these songs.

There does not appear to be a band like it anywhere. The feedback has been positive so far, and we have ten shows lined up for the fall already.”

The members of Graceland Ninjaz and Epic Unplugged manage to keep their rehearsals to a minimum, says Kenny. “The players are all seasoned musicians. Everyone simply learns what they need to on their own, as it is difficult with everyone’s schedules, family and work, to arrange rehearsals. However, I pick up my guitar every day when I’m not on the road.

“I have an amazing wife, Cristina, and five children – Emma, Harper, Vivian, Ewan and Theo,” he says. “Without such an incredible wife, I would not be able to take the time to pursue these music projects, so I am thankful for her every day.”

The kids are all into music to some degree, he says, “and I hope they enjoy those skills in their future as I have.” And who knows, they might pick up some selling skills too. His oldest daughter, Emma, who is studying international business and Chinese, recently completed an internship at Medline.

Visit Graceland Ninjaz and Epic Unplugged at www.gracelandninjaz.com and www.epicunplugged.com

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Industry news Democrasales Inc acquires Grogan’s Inc Democrasales Inc (Philadelphia, PA) acquired Grogan’s Inc (Lexington, KY), a distributor of medical and surgical supplies and equipment. Customers of the combined company will have access to a broader array of products and services together with proprietary sales technology that adds convenience for customers while significantly reducing the combined company’s cost of sales, according to the company. The combined company is led by Gregg Rivkind. Alan Grogan will remain with the company as EVP of the combined business. Paul Kaliner, former CEO and president of Delaware Valley Surgical Supply, will be on the company’s board of directors.

Midmark announces new brand identity Midmark Corp (Dayton, OH) launched a new corporate brand identity “that captures the company’s commitment to a better care experience and the growing value Midmark offers customers as they focus on improving clinical outcomes.” According to the company, the new brand identity, which includes a new website, logo, tagline, and more, mirrors the transformation of Midmark from an equipment manufacturer into a clinical environmental design company that enables a better care experience for caregivers and patients in medical, dental, and animal health industries.

Amazon to open health clinics for Seattle employees Amazon (Seattle, WA) is considering opening primary care clinics for employees at its headquarters in Seattle,

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two sources familiar with the matter told CNBC. The sources said the tentative plan is to hire a small number of physicians to start a pilot clinic later this year for a select group of employees, and to expand access in early 2019.

Amazon was previously looking to outsource the clinics and brought in vendors to pitch their services. However, one source told CNBC that after numerous discussions, the company decided to develop the clinics internally and began hiring for its health initiatives last year. It is unclear if Amazon will make the health clinics available to its thousands of warehouse employees, who have separate health needs from its engineering and sales staff.

Best Buy to move into health space with $800M acquisition of GreatCall Inc Best Buy has agreed to acquire GreatCall Inc (San Francisco, CA) for $800 million. The deal will expand Best Buy’s reach in the health space. Founded in 2006, GreatCall makes Jitterbug mobile phones and Lively wearable devices that provide easy, one-touch access to U.S.-based agents who can connect the user to family caregivers, provide concierge services or dispatch emergency personnel Moving forward, GreatCall will continue to operate separately, with CEO David Inns staying on in his role. The company’s headquarters will remain in San Diego and its caring centers will remain at their current locations in Carlsbad, California, and Reno, Nevada. This is the largest acquisition in Best Buy’s history. Best Buy’s acquisition of GreatCall is subject to regulatory approvals and other customary closing conditions. It’s expected to close by the end of Best Buy’s fiscal 2019 third quarter.

Same people.

Same company.

Now, with a renewed focus.

Better care doesn’t happen by chance—it happens by design. Design that takes into account not just the space, but the people working in it. Because at Midmark, we believe that who’s using our technology is every bit as important as how and why it’s being used. It’s this attention to our customers and design that has enabled us to transform the clinical care environment—and our brand.

midmark.com/medicalREPoct

© 2018 Midmark Corporation, Dayton, OH

Rad-97 Pulse CO-Oximeter With NomoLine Capnography ™

®

™

NomoLine No-Moisture Sampling Lines Cost-effective, hassle-free sidestream capnography and gas monitoring

A More Complete Picture of a Patient's Respiratory Status

Upgradeable rainbow SET™ Pulse CO-Oximetry

Continuous Supplemental Remote Monitoring

For more information, visit www.masimo.com Rad-97 with NomoLine Capnography is not licensed for sale in Canada.

Caution: Federal (USA) law restricts this device to sale by or on the order of a physician. See instructions for use for full prescribing information, including indications, contraindications, warnings, and precautions. © 2018 Masimo. All rights reserved.

Advanced Connectivity and Electronic Charting Solutions

PLCO-001933/PLMM-10856A-0518 PLLT-10587B

Continuous Pulse Oximetry and Capnography Monitoring