REP October 2020 by BOC design Inc

vol.28 no.10 • October 2020

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CH R O N I C D I SE A SE M A N AG E M EN T I N T H E AG E O F Now more than ever, patients with cardiovascular disease (CVD) and diabetes need to ensure these diseases are managed to mitigate the high risks associated with COVID-19.

to learn more about the Afinion™ 2 Analyzer and PAGE 31 to learn more about the Cholestech LDX™ System. SEE PAGE 11

COV I D-19 R I SK S

F O R P EO P L E W I T H P R EE X I S T I N G CO M O R B I D I T I E S Patients with preexisting comorbidities appear to have more severe courses and worse outcomes.1-5 According to the statistics below, patients with CVD and diabetes have a higher mortality rate should they contract COVID-19.6 Furthermore, patients with well-managed diabetes have a lower risk of severe outcomes compared to those with poorly managed diabetes.7

PAT I E N T S I N F E C T E D W I T H C O V I D -19 H AV E A H I G H E R M O R TA L I T Y R AT E W I T H P R E E X I S T I N G C O N D I T I O N S

10.5% HIGHER WITH

CVD

7.3%

HIGHER WITH

DIABETES

C O M PA R E D T O A N E S T I M AT E D G E N E R A L M O R TA L I T Y R AT E O F 2.3% 6 The Cholestech LDX™ System can help your customers identify those patients with CVD, while the Afinion™ 2 Analyzer can help your customers better manage their patients with diabetes.

CONTAC T YOUR ABBOT T CARDIOMETABOLIC ACCOUNT EXECUTIVE TODAY TO LE ARN MORE ABOUT CHOLESTEROL AND DIABETES M ANAGEMENT AT THE POINT OF CARE . YOU CAN ALSO VISIT US AT ABBOT T.COM/POC T. 1. World Health Organization. Clinical management of COVID-19. Interim guidance May 27, 2020. WHO/2019-nCoV/clinical/2020.5. https://www.who.int/publications/i/item/clinical-management-of-covid-19. Accessed June 5, 2020. 2. CDC COVID-19 Response Team. Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 — United States, February 12–March 28, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:382-6. 3. Bode B, Garrett V, Messler J, et al. Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States. J Diabetes Sci Technol. Published online May 9, 2020. 4. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323(20):2052-2059. 5. Lippi G, Wong J, Henry BM. Hypertension and its severity or mortality in Coronavirus Disease 2019: a pooled analysis. Pol Arch Intern Med. 2020;130:304-9. 6. Wu Z, McGoogan JM. Characteristics of and important lessons from the Coronavirus Disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA. Published online February 24, 2020. doi:10.1001/ jama.2020.2648. 7. Zhu L, She Z-G, Chen X, et al. Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes. Cell Metabolism. 2020;31:1068-1077. © 2020 Abbott. All rights reserved. All trademarks referenced are trademarks of either the Abbott group of companies or their respective owners. Any photos displayed are for illustrative purposes only. 10005895-01 08/20

vol.28 no.10 â&#x20AC;˘ October 2020

Selling Moderate Complexity Molecular testing could drive POL market

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OCTOBER 2020 • VOLUME 28 • ISSUE 10

PUBLISHER’S LETTER A Strong Finish...................................4

LEADERSHIP Facing Down Fear How to quiet fear and step into the boldest version of you........................ 6

PHYSICIAN OFFICE LAB Lab and Rx Examining the changing dynamics of test-and-treat programs........................ 8

SALES Keeping Sales Moving In order to keep the sales channel open, manufacturer and distributor reps have gotten creative in the ways they communicate and collaborate..................18

Back to School Five homework tips to make you a best-in-class salesperson.......................22

Customer Care Before and After the Sale

Selling Moderate Complexity

Molecular testing could drive POL market

Seven ways every customer touchpoint can increase company revenues...............28

IDN OPPORTUNITIES

Trends Marisa Farabaugh

Supply Chain Executive Profile Marisa Farabaugh, BS, MBA, senior vice president and chief supply chain officer, AdventHealth..........32

Don’t Delay As if combating a pandemic was not enough, healthcare providers were urging patients not to delay important medical procedures.

repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2020 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 2020 • VOLUME 28 • ISSUE 10

TRENDS Medical Distancing COVID-19 leads to a decline in screening and testing for cancer, diabetes and cardiovascular issues. What’s next?..........44

HIDA 90-Day PPE Stockpile Mandates Increase Shortages and Drive Up Costs....................... 54

Quick Bytes

Technology news

Rep Corner

New Territory for a Seasoned Rep Melody Hernandez, senior account manager with Owens & Minor, said this year has been unique in more ways than one.

Healthy Reps

Health news and notes

Automotive-related news

NEWS Industry news................................... 62 2

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PUBLISHER’S LETTER

A Strong Finish If 2020 was Halloween, it would certainly

be a trick verses a treat. The good news is, it’s October, and this crazy year is three months from being over! As I talk with reps around the country, I’m pleasantly surprised at how optimistic you all are and how you’ve learned to thrive in an environment that goes against how we’ve all grown up in the industry. I’ve always loved face-to-face sales calls and meetings. Attending your national sales meetings and events has been a staple in my career, not to mention the people I’ve been blessed to meet and call lifelong friends along the way. I have faith that live meetings and ride days will return some time in 2021, and I long for the day when we get to bump fists or elbows, or get really crazy and give each other a hug. In the meantime, we must keep moving forward and selling to the folks taking care of Americans. As I’ve stated in videos and Publisher’s Letters this year, your relationships with customers have never been more valuable to our industry’s future. These relationships will be the driving force to finish 2020 strong and launch 2021 in a positive direction.

Scott Adams

Watching our distribution sales professionals pivot over the last several months has been

a case study in how salespeople thrive in times of chaos. Here are a few stats for you: ʯ Repertoire’s website traffic is up 165% verses the same time last year ʯ Repertoire magazine being read online is up 180% and page views are up 225% ʯ Sessions viewed of our 2-Minute Drill videos have doubled over last year January - August. These are short conversation starts we build for manufacturers. You can find the entire library in the RepConnect app. I share this information with you for two reasons. First, it is evidence you want good content to help you sell more during the “New Norm.” Second, for those who may be struggling, look to your peers for guidance. They are consuming content, then using it to help them bring value to their customers. We will continue to work with best-inclass manufacturers to help bring you the latest content, videos, podcasts, and articles to keep you armed to sale more in this new virtual selling world. That said, put on your mask and go trick or treat!!! Dedicated to the industry, R. Scott Adams

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

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2020 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 Keith Boivin: IMCO Home Care

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LEADERSHIP

Facing Down Fear How to quiet fear and step into the boldest version of you By Lisa Earle McLeod

In the last several months, many have faced (and continue to face) an unprecedented level of ‘unknown.’

Ambiguity can give rise to our deepest insecurities, and left unchecked, has the potential to fill us with fear.

Being afraid is natural. But when you let fear take over, the world misses out on the bravest and brightest version of you. And that’s no good for anyone. Here are three tips to help you quell the fear and step into bold action:

No. 1: Disrupt negative thought cycles If you’re about to give a big presentation, pitch an idea, or do something courageous, the onslaught of “what ifs” will have no problem keeping you awake at night. Sure, we have to assess potential risk. The challenge is, we tend to default to the negative “what ifs” when it comes to being vulnerable and putting ourselves out there. The potential of shame is more initially jarring than the upside. If you find yourself starting to think “what if it goes terribly and they hate it,” interrupt that thought cycle, and challenge your brain to think “what if it goes awesome and everyone loves it?” Pointing your brain towards the payoff (instead of the risk) helps you be more confident and courageous before bold action.

No. 2: Understand your body When you’re afraid, your amygdala (aka lizard brain) goes into overdrive protection mode. You become hyper alert, your heart rate rises, your pupils dilate, and unfortunately, your critical thinking goes out the window. While your lizard brain does have your best interest of survival at

heart, it’s not always the most holistic, strategic counsel. The lizard brain has a hard time determining a threat to your life and a threat to your ego. When you understand why your body is reacting to fear the way it is, it’s easier to become objective in the face of it. When you recognize an oncoming wave of fear, ask yourself, is this my lizard brain thinking? Take a step back, inhale a big deep breath, and remove yourself from that fight or flight brain space by breathing, moving your body, and practicing mindfulness.

No. 3: Don’t take yourself too seriously Try to remember a time when you said or did something embarrassing. Is your skin crawling now? Ok, now, try to remember a time when someone else said or did something embarrassing … harder to recall? You likely can’t think of times that people misspoke during a meeting, made a crucial typo, or even spilled their coffee. High performers are their own toughest critics. When you start to feel anxious, remind yourself, you’re likely the only one looking at your words and actions through the microscope of judgement. People make mistakes, most other people don’t remember or even notice those mistake, and life moves on. Stepping into the murky waters of growth and vulnerability can be scary. It’s also incredibly courageous.

Lisa Earle McLeod is a leading authority on sales leadership and the author of four provocative books including the bestseller, “Selling with Noble Purpose.” Companies like Apple, Kimberly-Clark and Pfizer hire her to help them create passionate, purpose-driven sales organization. Her NSP is to help leaders drive revenue and do work that makes them proud. 6

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PHYSICIAN OFFICE LAB

Lab and Rx Examining the changing dynamics of test-and-treat programs.

By Jim Poggi

The conventional wisdom tells us that test-and-treat models improve healthcare, provide faster care, reduce cost

and reduce morbidities. But do new medicines lead to development of new lab tests, or do new lab tests drive the development or use of new drugs? In this month’s article, I will explore this issue reflecting on changes in test-and-treat programs in the past few decades. I will also shed light on some lab tests that simply soldier on, seemingly immune to changes in availability of new drugs or newer lab tests.

decreases in death rates for cancer, heart disease, stroke, and upper respiratory illness, all leading causes of death in the United States. So, we can conclude that testand treat-programs, in combination with Americans taking a more active role in their health (quitting smoking, eating better, and exercising more), are making a positive impact in health and wellness. But, how do these trends relate to availability of newer medicines since cancer, autoimmune and arthritis, in particular, have seen major new drug introductions in the past two decades? New more targeted lipid/cholesterol medications are now entering the market and are likely to improve outcomes for heart disease even further. In terms of morbidity and mortality, we are clearly seeing progress. Let’s quickly review the landscape. Most experts believe that lab tests factor into around 70% of all medical decisions. The data is clear. In 2016, Centers for Medicare and Medicaid Services reported $6.8 billion in lab spend, concentrated in the top 6 tests, which comprised 35% of all lab test spend. These tests were: 1. TSH 2. CBC 3. CMP 4. Lipids 5. Vitamin D 6. Hemoglobin A1C While total lab spending only accounted for 3% of CMS spend in 2016, lab tests are strongly associated with 8

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Let’s look at some examples of how the interaction of new drugs and new tests are improving healthcare. I’ve organized them into a few simple categories: ʯ Improvements in understanding of the underlying disease process that drive new lab test development; ʯ Changes in drugs and therapies reducing the use of specific tests; ʯ New medicines making established tests more relevant; ʯ And some tests that just continue to be immune to changes in drug development and our understanding of the disease they diagnose.

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PHYSICIAN OFFICE LAB When causes of disease become clearer, lab markers appear to diagnose and or monitor treatment Nowhere is this clearer than cancer. Understanding the disease at a molecular level, particularly underlying genetic mutations associated with cancer and how therapies can deal with these changes has dramatically improved the kinds of drugs and therapies being used and also the diagnostic methods to detect and monitor cancer. Better chemotherapy agents and new ways of stimulating the patient’s own immune system are making a difference. Cancer death rates in the U.S. have declined by 27% in the last 25 years, the largest reduction in mortality of any leading cause of death. On the lab front, sophisticated new liquid biopsy tests including detection and quantitation of cell free DNA and circulating tumor DNA are detecting cancer earlier and also being used to monitor response to therapy. On the imaging front, low dose CT scans are being used to find lung cancers earlier when they are more responsive to therapy.

The data is clear. In 2016, Centers for Medicare and Medicaid Services reported $6.8 billion in lab spend, concentrated in the top 6 tests, which comprised 35% of all lab test spend. Our awareness of sepsis and how it progresses has dramatically changed in the past few years from its characterization as a “blood infection” to our current understanding of sepsis as an infection that leads to an overwhelming and inappropriate immune system response. Sepsis is the number one cause of death in U.S. hospitals and costs the U.S. healthcare system $24 billion annually. Faster diagnosis coupled with aggressive antibiotic therapy is reducing the mortality rate and reducing post sepsis complications. Lactate, procalcitonin and monocyte distribution width have all helped diagnose sepsis earlier and more confidently. Heart disease is declining largely due to better health habits combined with lipid tests including cholesterol, HDL, LDL, and triglycerides. While statins have been the mainstay of prescription therapy for many decades, newer drugs target reduction in LDL cholesterol which has been problematic for statins alone. Use of newer lipid markers including Apo A1, Apo B and lipoprotein (a) are 10

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increasing, and I expect new markers to emerge in the coming years as we learn more about which lipid fractions are most associated with heart disease. Upper respiratory infection has been subject to dramatic reductions in deaths due to influenza and pneumonia before the current COVID-19 pandemic. This has largely been fueled by greater use of influenza vaccines and widespread use of specific tests for flu, strep and RSV. Multiple COVID-19 antigen and antibody tests are entering the market. New vaccines are being developed and there is evidence that established vaccines for MMR and flu may confer a level of immunity against COVID-19. Changes in drugs and therapies seem to be making some established lab tests disappear Cardiac therapy monitoring frequently involved testing digoxin levels when digoxin was front-line therapy to improve pumping efficiency of the heart. Newer therapies including ACE inhibitors, which reduce resistance in the vascular system, have largely replaced digoxin as front-line therapy. As a result, the use of digoxin testing has declined. The same is true on PT/INR where newer anticoagulant medications have begun replacing warfarin. As a result, PT/INR testing is declining.

Some new drugs are making established tests more relevant Improvements in drugs to treat arthritis, Lyme disease and autoimmune diseases have made established autoimmune tests including RF, CRP, and others more relevant. These diseases all share several patient signs and symptoms. But, until recently, treatments for both autoimmune and arthritis have been largely ineffective. Newer therapies have emerged and are showing significant improvement.

Finally, there are the tests that never seem to go away There are some time-honored tests that somehow seem to remain relevant no matter how much drug and diagnostic technology changes. Either they were well ahead of their time or advances in technology have not yet created newer, better solutions. While there have been some improvements in ESR speed, ESR continues as a wellestablished infection marker. RF, CRP and mono have also undergone some changes in how the tests are done, but the markers continue to be relevant. Test-and-treat models are making headway and continued advancements are forecasted to further reduce morbidity and mortality for the leading causes of death.

A C LO S E R LO O K AT A FI N I O N™ 2 A N A LY Z E R The Afinion™ 2 Analyzer enables fast and easy quantitative determinations of hemoglobin A1c (HbA1c) and albumin-creatinine ratio (ACR). With its compact size and short test times, the Afinion™ 2 System is ideal for any of your customers that are managing patients with diabetes.

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Recent studies comparing the Afinion™ HbA1c assay to routine and reference laboratory methods have consistently shown a bias close to zero and a coefficient of variation (CV) below 2% (NGSP units).1-5 Test results can be printed or transferred to electronic medical records. 1. Nathan DM, Griffin A, Perez FM, et al. Accuracy of a Point-of-Care Hemoglobin A1c Assay. J Diabetes Sci Technol. 2019;13(6):1149-1153. https://journals.sagepub.com/doi/abs/10.1177/1932296819836101. 2. Arnold WD, Kupfer K, Little RR, et al. Accuracy and Precision of a Point-of-Care HbA1c Test. J Diabetes Sci Technol. March 10, 2019. https://journals.sagepub.com/doi/pdf/10.1177/1932296819831292. 3. Arnold WD, Kupfer K, Swensen MH, et al. Fingerstick Precision and Total Error of a Point-of-Care HbA1c Test. J Diabetes Sci Technol. March 6, 2019. https://journals.sagepub.com/doi/ pdf/10.1177/1932296819831273. 4. Lenters-Westra E, English E. Evaluation of Four HbA1c Point-of-Care Devices Using International Quality Targets: Are They Fit for the Purpose? J Diabetes Sci Technol. 2018;12(4):762-770. https://journals.sagepub.com/doi/pdf/10.1177/1932296818785612. 5. Sobolesky PM, Smith BE, Saenger AK, et al. Multicenter assessment of a hemoglobin A1c point-of-care device for diagnosis of diabetes mellitus. Clin Biochem. 2018;61(4):18-22. https://www.sciencedirect.com/journal/clinical-biochemistry/vol/61/suppl/C. © 2020 Abbott. All rights reserved. All trademarks referenced are trademarks of either the Abbott group of companies or their respective owners. Any photos displayed are for illustrative purposes only. 10005910-01 08/20

Selling Moderate Complexity Molecular testing could drive POL market By Mark Thill Molecular testing may lead more physician office labs

to make the transition from CLIA-waived to moderate complexity, even as the percentage of POLs performing moderate complexity testing has been falling over the past several years. Government statistics show the trends. The Centers for Medicare & Medicaid Services reports that in 2019, approximately 13% of physician office labs performed moderate and/or high complexity testing procedures. But the percentage has been falling steadily since 2015, when 14.5% performed such tests. During the same timeframe, 12

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the number of POLs holding a certificate of waiver steadily increased, from almost 76,000 in 2015 to more than 81,000 in 2019. More waived options exist today than 10 years ago, and some of those waived options – including BMP and CMP – were previously considered to be moderate complexity, says Jim Poggi, principal, Tested Insights, and the physician office lab columnist for Repertoire. “On the other hand, there’s a cascade effect, where some tests that are high complexity today are likely to transition to moderate complexity in the future.”

Selling Moderate Complexity Meanwhile, some customers believe the cost of the moderate complexity license exceeds revenues, says Poggi. “There is an upfront investment, but the smart distributor sales rep and their supplier can tailor the right system for the right size customer.” In fact, most moderate complexity test systems have far higher daily throughput than waived platforms, resulting in a better use of labor for larger (5+ doctors) practices, he adds. What’s more: ʯ POLs can do many more tests of moderate complexity than waived only, such as CBC (with some exceptions); allergy testing; most cardiac markers; Vitamin D; Vitamin B-12; folate; TSH (though some waived tests exist); and PSA. ʯ Most moderate complexity tests systems are fairly easy to train and run. ʯ Current moderate complexity labs are ideal settings for menu expansion from hematology to chemistry to immunoassay.

electrolytes, are also very common in POLs, although some perform these tests via waived methods. Urine microscopic examinations are among the most frequently performed moderate complexity tests that we see in POLs as well. More often than not, the chemical analysis portion of the urinalysis test is performed via a waived method.”

The IDN effect The acquisition of physician practices by IDNs has affected the market, says Densford. “We have seen many POLs close their moderate complexity laboratories after acquisition by a health system. Testing is consolidated at the laboratory of the ‘parent’ system.” But that’s not always the case, she adds. “Depending on the location of the POL and the accessibility to laboratory testing, as well as the particular medical specialty of the practice, we have sometimes seen POLs expand testing after being acquired by a health system, [giving them] access to administrative support and capital.” Some IDNs and POLs have formed creative partnerships to provide testing where needed. For example, a urology practice performing a high volume of PSA testing could provide the test for other POLs in the system. Says Poggi, acquisition of POLs by IDNs is a “mixed bag” insofar as its impact on moderate complexity labs. “Some health systems have allowed their owned practices to continue to have autonomy over tests performed in their office, others have standardized methods while allowing testing to continue as before, and others have pulled higher volume tests into the core lab. Ultimately, it is up to management of the IDN and their physician practices to decide the ‘cost-vs.convenience’ question. “I persist in believing a test should be performed in the POL if it can be used to initiate or modify a patient treatment program.” Regarding the future of moderate complexity testing, Poggi expects drug panels and Vitamin D to decline or remain flat, while the following could grow: CBC, BNP, more sophisticated colorectal cancer tests, and a range of

‘Moderately complex testing is becoming more of an interest to POLs with the introduction of molecular testing and the patient’s need to have a diagnosis immediately,’ “Moderately complex testing is becoming more of an interest to POLs with the introduction of molecular testing and the patient’s need to have a diagnosis immediately,” says Kathy Mannone, manager, distribution sales, Sysmex America Inc. “There is also a potential revenue opportunity with reimbursements for flu and COVID molecular tests. Once molecular testing is implemented, physicians start to add more testing, like hematology and immunoassay, which gives reps additional opportunities to grow their lab business.” Susan Densford, director of accreditation for COLA, says that CBCs continue to be the most common moderate complexity tests COLA sees in POLs today. “Basic chemistry tests such as glucose, creatinine, BUN and 14

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Selling Moderate Complexity respiratory and other infectious agent tests, including GI infectious agents. Densford expects to see continued expansion of molecular testing. “The majority of these today are infectious disease molecular tests, but as personalized medicine gains traction, other molecular biomarkers could see growth in the POLs in the next five years.” That said, larger POLs will be more likely to adopt moderate complexity molecular tests than smaller ones, she adds.

COVID-19 The COVID-19 pandemic probably has complicated POLs’ interest in transitioning from CLIA-waived testing to moderate complexity testing, says Dr. David Grenache, chief scientific officer, TriCore Reference Laboratories in Albuquerque, New Mexico, and president of AACC. “On one hand, COVID-19 has made clear how having rapid access to test results affects clinical care,” he says. “On the other hand, medical practices have experienced revenue shortfalls, as patients have avoided seeking care and procedures have been postponed. Their enthusiasm to invest in the additional tests, personnel and oversight required to operate as a moderately complex lab could be diminished.” Says Mannone, “More customers are bringing on molecular/IVD COVID testing, which is increasing the interest in moderately complex licensing. I’ve seen increased interest from pediatric and cardiology offices. Some physicians are taking the approach of ‘one stop’ testing and diagnosis to eliminate an additional stop at a lab.” Poggi believes that following up with patients who have had COVID-19 could increase testing in the physician office. “Knowing whether there is any new, underlying organ damage or a worsening of a preexisting condition is important,” he says. “Organ panels, respiratory assessment (not always by lab tests) and CBC assays should grow as we learn more about the longer-term

‘ There is an upfront investment, but the smart distributor sales rep and their supplier can tailor the right system for the right size customer.’

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impact of a COVID-19 infection.” However, he does not see widespread testing for the COVID-19 antigen as a mainstay in the POL, primarily because most such tests are highly complex RT-PCR tests. Densford says that some practices that had CLIA certificates of waiver have converted to moderate complexity in order to perform COVID-19 diagnostic testing. “Early on in the pandemic, it was difficult for many POLs to obtain instrumentation and supplies for the testing, but that situation has improved, so we do continue to see this trend. “But more than CLIA-waived laboratories converting to moderate complexity testing, we have seen two other trends. First, new laboratories have started up just to do COVID-19 testing. And second, many high complexity molecular or otherwise specialty laboratories have added diagnostic COVID-19 testing to their test menu.”

SALES

Keeping Sales Moving In order to keep the sales channel open, manufacturer and distributor reps have gotten creative in the ways they communicate and collaborate The sales must go on, even amid a pandemic. Though collaboration between manufacturer and distributor reps

has been – understandably – much more difficult in recent months, reps are finding ways to stay in touch and stay in front of customers.

“Many distributor reps have been quite busy, in the first few months, trying to help customers with urgent needs – like PPE products – instead of being able to discuss and introduce differentiating, revenue-generating types of products,” said Albert Sands, vice president of sales for non-acute, MedPro. “This has eased some, as non-acute offices start to re-open, but again, re-opening in this pandemic world has created a demand for different types of products.” Sands said MedPro has gotten creative in its approach with the distribution teams – including some fun ideas like virtual “happy hours” to help MedPro reps stay in

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front of their distribution rep teams. “This more relaxed environment has allowed some reps to build better relationships around non-work topics, while still creating time for product-related discussions.”

Getting in front of the customer Getting in front of customers amid a pandemic and social distancing requirements is a new challenge to navigate for all companies and organizations. Sands said some MedPro reps have added multiple cameras to their home offices to allow them to do virtual demos and in-services. “I think our distribution partners appreciate this approach as we continue to try to keep sales moving, despite the challenges.” Tools and resources like Zoom and Microsoft Teams have been the most prominent used in the field. Also, the old-fashioned telephone and texting and social media platforms can be effective too. Sands said creativity and persistence are two of the skills most needed by field reps in today’s environment. “We must now be creative in our approach – as mentioned above with the virtual Happy Hour,” he said. “But I also think that we will now have the need to be persistent and effective over the phone. The idea of ‘stopping into’ customers is not going to be an option for quite some time, if ever again. So, we will all need to improve our skills over ‘selling’ and being consultative, over the phone, and scheduling out appointments for in-person meetings.”

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(ACS), the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), and the Association of Perioperative Registered Nurses (AORN). One thing appears certain – smoke evacuation is here to stay. This has been more apparent in the hospital operating room environment but is expected to carry over into ambulatory surgery centers, clinics, and physician’s offices. Smoke evacuation devices have been on the market for many years and are being produced by several manufacturers.

Smoke evacuation solutions Most shelf-mounted smoke evacuation devices on the market today are much larger than the high frequency desiccators they support. With shelf and/or table space at a premium, these facilities struggle to find room for them. With the increased need for a smaller, less costly smoke evacuation device, Symmetry Surgical has introduced the Bovie® Smoke Shark® III. At less than half the cost of existing smoke evacuation systems, the Smoke Shark® III’s size and design preserves valuable space in the examination room and saves significant cost. The Smoke Shark® III includes the Bovie® Smart Shark Remote Activation Switch, a wall mounting bracket, a SharkSkin smoke evacuation pencil adapter, and a four-stage ULPA filter. Smart Shark activates the Smoke Shark® III smoke evacuation device automatically when the electrosurgical pencil’s cut or coagulation button is pressed and deactivates it a few seconds after the button is released. This extends filter life by engaging the device only when smoke is being generated, making the filter more cost effective. The Bovie® SharkSkin smoke evacuation pencil adapter is a perfect accessory for the Smoke Shark® III. The SharkSkin works in tandem to transform an electrosurgical pencil into a device that captures smoke plume at the surgical site. With a more open design on the proximal end, SharkSkin better accommodates the reusable electrosurgical pencils found on high frequency desiccators like the Bovie® DERM and Bantam PRO ESUs. With more procedures shifting from the operating room to the outpatient clinic, the need for cost-effective smoke evacuation has never been greater. For specialties such as dermatology, physician’s offices, and any electrosurgical customer performing shorter procedures and seeking a more cost-conscious option, the Bovie® Smoke Shark® III provides a unique smoke evacuation solution to make the procedures safer for the surgeon, surgical staff, and the patient. When the electrosurgical market required safety and value, Symmetry Surgical delivered the Bovie® Smoke Shark® III.

“ At less than half the cost of existing smoke evacuation systems, the Smoke Shark® III’s size and design preserves valuable space in the examination room and saves significant cost.” For facilities seeking to incorporate smoke evacuation, the main issue impeding their adoption has been cost. While inexpensive wall-mounted devices consisting of an ULPA filter placed in-line to connect a suction instrument are available, these devices are not useful in clinics and physician’s offices without wall vacuums. The addition of this vacuum source could be more expensive than the electrosurgical unit that generates the smoke. Dermatologists, for example, employ a high frequency desiccator (lower-wattage electrosurgical unit) in each of their examination rooms. A typical practice may range from as few as six rooms to more than 50 rooms. The cost to outfit each of these rooms with a smoke evacuation device can be significant, up to twice the cost of the ESU itself, and persuade some facilities to delay or even forego such a purchase. This is not an option in locations where legislation mandates smoke evacuation.

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SALES

Back to School Five homework tips to make you a best-in-class salesperson By Brian Sullivan

Last week, my 14-year old daughter came running into the kitchen and yelled, “I am so excited! I just found out

about my freshman class schedule. I can’t wait to mask up and get back to class!” (Okay, I might have added that mask up part myself)

My first reaction was, “That sounds great!” And my second thought was, “Are you really excited to get back to school after being off since March?” Well, I wasn’t about to stifle her enthusiasm, but it made me think a bit more about it. What is it about this strange 2020 and the beginning of the school year that is making kids reenergized? Perhaps it’s the same thing that makes us old people pumped up to someday put COVID-19 behind us and get back in the sales groove. 22

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But like students, it’s important to realize that much of the success that will come from our own “school” year will be determined by how much homework we do. So while it’s important to show up for class and pay attention, we must realize that it is equally important to show up fully prepared to succeed come test time. Test time for us is that huge customer Zoom presentation, that live and in-person lunch meeting with a high-level executive, and that first prospecting call we make when the bell rings in the morning.

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SALES Below is your fall semester class schedule that your sales counselor has set up for you. And unfortunately, none of them are electives.

LinkedIn class For those salespeople who jumped all in on LinkedIn months and even years before the virus, you quickly learned you had a head start on those who didn’t. This is because you had already invested the time in connecting with people in your industry (and other rock stars). And because you had already developed a network, you quickly found out it became easier for you to search and find decision-makers that you never even met before – but needed to. LinkedIn is the single greatest tool to research existing prospects and to find new ones. Homework assignment: Over the next three months, dedicate 15 minutes a day to do nothing but connect with people within the organizations you’re hoping to serve, as well as other company associates who also may sell to that client. Once you connect with one person in that building, it’s a lot easier to connect with 10. If Jan. 1, 2021 rolls around and your network still only consists of two cousins and a stranger from another country, there’s a good chance you are getting an “F” in this class.

Cold prospecting class 101 Question: Why did we sign up for the LinkedIn class? Answer: So we have high-value prospects to target. There is no value in having a ton of great prospects on LinkedIn if you don’t actually try to reach out, build a relationship, and see if there is a way for you to add value to them (and them to you). So let’s say you got that big-time decision-maker to accept your connection on LinkedIn. Your first step is to not reach out and throw them some cheesy product sales pitch. Think about it. How much would you like somebody who you just met at a social event if they immediately started hitting you with a product presentation? The same rule applies to LinkedIn. It is appropriate, however, to send them a casual “Thanks for connecting, Sue.” Once connected with “Sue,” you now have access to her email in the Contact Info section of her Profile. Homework assignment: Wait a week and send her an email or phone call to see if there may be interest in your company or solutions. 24

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Cold prospecting class 202 When reaching out to your new connection via phone or email, you need to know exactly what you are going to say or write that will create one emotion – curiosity. How do you do that? With value, pain, and a name drop. You can use these alone or in any combination. Below is an example of value and a name drop combined: “The reason for my call is that we work with hospice organizations like Vitas and Kindred Healthcare to help them find ways to better care for their at home patients during and after this COVID-19 crisis.”

Over the next three months, dedicate 15 minutes a day to do nothing but connect with people within the organizations you’re hoping to serve, as well as other company associates who also may sell to that client. Once you connect with one person in that building, it’s a lot easier to connect with 10. The goal of this statement isn’t to tell them about my solution. It is merely to make them curious to want to learn more. If the person on the other end of the phone is not a decision-maker, he will often pass you off to somebody who may actually care about what you’re selling. When that person comes on the line, deliver the same value/name drop pitch. Homework assignment: Get with your manager or other teammates and develop value, pain and/or name drop pitches that you can use when reaching out to customers. Will they all work? No. But too many salespeople in our industry have no idea what is about to come out of their mouth when somebody picks up that phone. (If you need help building your scripts, reach out to us as bsullivan@preciseselling.com. We have a cool software program that can help you develop them)

Phone 877-828-9975 Email sales@macmedical.com

SALES Vendor class Whether you’re in distribution or manufacturing, your homework assignment starting this school season is to suck as much knowledge as possible out of the brains of industry vendors. Company A rep who calls on the same client base as Company B rep (non-competing products) can tell you a ton about how to best approach a prospect. But guess what? You have to be the one to initiate the contact. Homework assignment: Write down five vendor reps who are high performers. Then schedule a specific time to meet. But remember, you need to be specific in WHY you are meeting. Lunch or Zoom meetings for the sake of “networking” can be construed as a big waste of time. Tell them what you hope to accomplish and how you might be of service to them.

Virtual presenting class Zoom, Microsoft Teams and GoToMeeting are no longer new to you. I want to put your mind at ease as it relates to

virtual selling. While the vehicle to delivering your presentation may be different, it shouldn’t be that different. In short, if you show enthusiasm about your solution when meeting live, it should be just as easy when your computer camera is on. If you ask great questions when live, you should also ask great questions virtually. If you don’t normally use slides when presenting live, don’t use them when presenting remotely.

Get with your manager or other teammates and develop value, pain and/ or name drop pitches that you can use when reaching out to customers. Will they all work? No. But too many salespeople in our industry have no idea what is about to come out of their mouth when somebody picks up that phone. Homework assignment: In short, just be you, but be the best virtual version of you. Practice presenting virtually and you will realize that there really isn’t that big a difference. The technology just means you don’t have to jump on as many planes or sit in traffic nearly as long. The reality is, nobody knows if our kids’ schools will remain open. And who knows if/when our company offices are going to let everybody back. But so what? School is always open and class is always in session. Now is the time to do all you can to make the final months of 2020 the time in your career when you did what was necessary to become an A student and the teacher’s (or CEO’s) pet.

As president of PRECISE Selling, Brian Sullivan helps improve sales, customer service, negotiations, leadership, and presentation skills through seminars and Internet training programs. He is also the author of the book, 20 Days to the Top-How the PRECISE Selling Formula Will Make You Your Company’s Top Sales Performer in 20 Days or Less. To learn more, go to www.preciseselling.com. 26

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SALES

Customer Care Before and After the Sale Seven ways every customer touchpoint can increase company revenues By Sandler Systems There’s a hidden sales force within your company right now. They may already have great relationships built with

your customers. They speak to them regularly and help them each time. Most importantly, their relationships are built on trust. Where can you find this hidden sales force? It’s the customer service department! (It might also be the marketing department, or accounts receivable, or repairs.)

There’s only one problem: the staff outside of the sales team don’t think of themselves as salespeople and are often simply reactive, rather than proactive. Tapping into this unmined resource of knowledgeable, experienced, passionate supporting players can produce incremental topline revenue. Unfortunately, it’s not as easy as simply saying “Do it!” Guide your customer service and other high-touch teams to follow these best practices and lay the groundwork for growing your business without adding to your personnel or your overhead.

No. 1: Overcome the stigma of sales The reason many customer service-focused staff choose their roles over sales is that they see salespeople as pushy, 28

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sleazy or self-serving. When they accept that there’s another way to sell, a way that actually helps customers make smart buying decisions, they will move past this stereotypical view and be more comfortable in a sales role. Service providers are born to help. When they see sales through that lens, they’ll be open to adding some selling skills to their role.

No. 2: Have a customer service step-by-step process for selling Another reason customer service providers avoid sales is that they don’t know how to approach or avoid push back. They may be uncomfortable dealing with what they consider awkward “sales” conversations. Arm them with

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SALES a systematic process for taking a business development approach to service. A step-by-step process takes the pressure off them and off your customer.

No. 3: Engage on more than a surface level When you ask customers about their problems, thoughts, and challenges, you tap into their wants and needs. Ensure customer support providers are empowered to craft and deliver compelling questions and know how to actively listen to customers and potential customers.

Customer service providers must learn to dig deep and find out what’s underneath or behind the visible issue, then match the company’s products and services to those issues “beneath the surface.” No. 4: Check for icebergs The surface problem a customer brings you is rarely the real problem. Imagine it like this: 90% of an iceberg is below the surface and not visible to the naked eye. Customer service providers must learn to dig deep and find out what’s underneath or behind the visible issue, then match the company’s products and services to those issues “beneath the surface.”

No. 5: Make it easy to say “yes” “Anything else I can help you with today?” is easy to reply to with “no.” “I see you’ve bought widgets by the dozen in the past. We have them on special this week. Is that something you’d like to stock up on when we ship the rest of your order?” This question, however, is specific, tailored and helpful. If the customer has a need, it’s easy to say “yes.”

No. 6: Develop sales antennae When a technician hears, “I should really replace this unit you’re working on,” this is a buying signal. Unfortunately, service providers don’t always recognize the signals when they’re focused on the immediate task at hand. They may also believe it’s not part of their job to act on or follow up on a buying signal, or that they shouldn’t encroach on a salesperson’s area of expertise. But a potential buyer may take that as a sign of disinterest and shop elsewhere. Give these teams the tools to turn buying signals into revenue.

No. 7: Understand value rather than just price When they’re empowered and confident, they will stop assuming that buyers only want the lowest priced items, and start finding out their needs and will match those needs to the right product. Customers need a return on their investment, and a customer service provider’s product knowledge, experience, problem-solving abilities and industry knowledge have huge value. Remember, revenue left on the table is vulnerable to your competition. Ensure your hidden sales force is prepared to pick up that revenue and help bring it home! Through the Sandler Strategic Customer Care program, customer service providers are empowered with a communications and sales process that will help them create a sales “comfort level,” a “helping approach” to sales, and a structured behavior plan that will enable sales to become part of their normal, daily routine. How do you know if your organization needs to “tap into” this potential revenue center? And where would you even start? Act now to start a conversation about your team’s strengths and challenges and get some insight from a development expert. A complimentary Zoom or phone debrief session is yours at no charge when you request and complete a brief Strategic Customer Care Assessment Survey. To request an Assessment and your complimentary debrief, send your contact information with the subject line “Customer Care Debrief ” to SalesTips@repertoiremag.com.

About Sandler Training With over 250 local training centers around the globe, Sandler is the worldwide leader for sales, management, and customer service training. We help individuals and teams from Fortune 500 companies to independent producers dramatically improve sales, while reducing operational and leadership friction. ©Sandler Systems, Inc. All rights reserved. 30

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CHOLESTEROL M A N AG E M E N T I N T H E AG E O F COV I D -19 Protect Heart Health Preventative care and chronic disease management for diseases such as cardiovascular disease (CVD) are more important now than ever. High-quality point-of-care cholesterol and glucose testing enables practitioners to diagnose and manage cholesterol conditions at the time of consultations, providing comprehensive, immediate results that can improve patient care.

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Patients with preexisting comorbidities such as CVD and diabetes need to ensure diseases are managed to minimize the risks associated with COVID-19.6-8 Check out the inside cover of this issue to learn more and visit us at abbott.com/poct. *FDA approval since 1991. 1. Cholestech LDX™ Package Insert. 2. Frost & Sullivan. Global Point-of-Care Testing (POCT) Market. April 2013:71. 3. Jain A, Nair DR, et al. Evaluation of the point of care Afinion AS100 analyser in a community setting. Ann Clin Biochem. 2017;54(3):331-341. 4. Whitehead SJ, Ford C, Gama R. A combined laboratory and field evaluation of the Cholestech LDX and CardioChek PA point-of-care testing lipid and glucose analysers. Ann Clin Biochem. Published online July 23, 2013. http://journals.sagepub.com/doi/pdf/10.1177/0004563213482890. 5. Jain A, et al. Point of care testing is appropriate for National Health Service health check. Ann Clin Biochem. 2011;48:159-165. 6. WHO. Clinical management of COVID-19. Interim guidance May 27, 2020. WHO/2019-nCoV/clinical/2020.5. 7. Holman N, Knighton P, Kar P, et al. Type 1 and Type 2 diabetes and COVID-19 related mortality in England: a cohort study in people with diabetes. NHS England. Published May 19, 2020. Accessed June 8, 2020. https://www.england.nhs.uk/wp-content/uploads/2020/05/Valabhji-COVID-19-and-Diabetes-Paper-2-Full-Manuscript.pdf. 8. Bornstein S, Rubino F, Khunti K, et al. Practical recommendations for the management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol. 2020;8:546-50. © 2020 Abbott. All rights reserved. All trademarks referenced are trademarks of either the Abbott group of companies or their respective owners. Any photos displayed are for illustrative purposes only. 10005909-01 08/20

IDN OPPORTUNITIES

Supply Chain Executive Profile Marisa Farabaugh, BS, MBA, senior vice president and chief supply chain officer, AdventHealth

Marisa Farabaugh

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The Journal of Healthcare Contracting (JHC): What’s the most challenging or rewarding project that you’ve worked on the last 12 to 18 months? Marisa Farabaugh: COVID-19. How can you not call that both challenging and rewarding? From a challenge perspective, we’ve had to re-engineer all our processes around sourcing and even logistics – overnight. When your traditional resource streams are rocked, the need for supplies and keeping our clinical teams safe doesn’t change. The responsibility for ensuring our patient care and clinical care shifts in a more acute way for us as sourcing leaders to find new streams of resources, or whatever it would be that we’re trying to source. Going into that was a great unknown. We were used to working with vendors, partners and suppliers who we’ve had relationships with, and we’ve seen their faces and talked to them multiple times and worked through many opportunities and incremental changes over the years. Suddenly, we’re asked and required to reach out to unknown brokers, distributors and people who are friends of people and may know somebody through the hospital and put together purchase orders on new companies. We put new companies in our systems to be able to create a purchase order, then generate a purchase order with very limited information about that organization. We

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IDN OPPORTUNITIES had a vetting process we were using to make sure these organizations were legitimate and real. I’ve talked about challenges, but there was so much in terms of reward too. We’re in an industry where we believe in helping other people and being a part of something that’s bigger than just profit or margin. We picked healthcare because it connects us. We feel connected to the work that we do, because there are people on the other end of the work that we do. We’re helping people do their jobs to help people. JHC: What project or initiative do you look forward to working on? Farabaugh: This season is going to be a part of our world. There’s going to be many organizations that put a spotlight on COVID-19 for a temporary time and then naturally migrate back towards the traditional contracting, logistics way of supply chain that was pre-COVID-19. But I also think there’s going to be some organizations that say no, this has happened, and it has raised supply chain and the need to know where our resources are coming from, how we can de-risk the model, what we’re willing to do and not do as an organization to give capital or invest in this change, because we recognize that it’s a weak link or if it’s broken, we can’t do what we need to do. So, we’ve got to invest in it and make it stronger. When you ask about what are the projects in the future that I look forward to in the wake of this, it’s the ability to strategically think about healthcare supply chain in a new way. And I think I know parts of what that means today, but I promise you I don’t know all the parts yet, but I will as the months and weeks unfold and get more time to digest and think about it.

But in this moment, we’re going to think about derisking supply chain. Does everything come through single channels? How do we think about sole sourcing? How do we think about and know where products are being manufactured? How do we create a risk profile like an investment portfolio? JHC: What lesson or lessons do you think supply chain leaders will take from the COVID-19 pandemic? Farabaugh: There’s a silver lining to everything that has happened. It has catapulted healthcare supply chain to the forefront of discussion. Let’s seize this opportunity to make meaningful changes to our industry that have a sustained impact on a stronger supply chain. Is Just-In-Time the right model? It works in many other industries. But if you’re in food and beverage and you run out of supply, there is not a life at the other end. Whereas in healthcare, you’re taking care of patients. So, is Just-In-Time the right model? JHC: How do you think you’re better at practicing your profession than you were five to 10 years ago? Farabaugh: The people are the most important thing. Creating environments and teams that thrive is such a big focus of mine now. Maybe 10 years ago I was more focused on project execution. Today I’m much more focused on how the team is performing. Where are they at? Who’s in what role? How are we going to move forward post-COVID-19? How does our organizational structure change? Do we need additional support in areas that weren’t there before? My biggest focus has been around relationships with our team and then building a network of relationships both internally within AdventHealth, and externally.

About Marisa Farabaugh is senior vice president and chief supply chain officer for AdventHealth. In this role, she is responsible for all aspects of supply chain within the system, including contracting, field operations, data and analytics, value analysis, affiliates program, corporate pharmacy and RxPlus, and corporate construction management. Farabaugh joined AdventHealth in July 2019. Prior to this transition, Farabaugh held several roles within healthcare supply chain, most recently as the chief supply chain officer for Wake Forest Baptist Medical Center in WinstonSalem, North Carolina. During her time at Wake Forest, she also served as head of the M&A and led the organization through major corporate initiatives including an overhead study. Prior to joining the healthcare industry, Farabaugh worked as an industrial engineer at The Hershey Company in Hershey, Pennsylvania. Farabaugh received her bachelor’s degree in industrial and systems engineering from the University of Florida and her MBA from Pennsylvania State University.

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TRENDS

Don’t Delay As if combating a pandemic was not enough, healthcare providers were urging patients not to delay important medical procedures.

In early spring, as COVID cases rose and states shut down, many hospitals, if not all in Georgia, stopped doing

elective procedures, said Anna Adams, vice president of government relations at the Georgia Hospital Association (GHA).

Or, at least, that’s the term used for the procedures. Patients who had those procedures scheduled would probably phrase it differently, she said. “I don’t know that elective is really the best way to describe these types of procedures, because it doesn’t really feel that way for patients who needed hernia repairs, or perhaps a gallbladder removed – things that are truly causing discomfort.” For almost two months, those patients had to play the waiting game until hospitals were able to start their procedures back up with new rules in place. 36

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“For some patients, as soon as hospitals started to open back up and allow these elective procedures again, there was a flooding, if you will, of everyone trying to reschedule all at once.” As of midsummer, hospitals in Georgia were still working feverishly to get those done. Fortunately, most of those procedures were outpatient, so they weren’t contributing to the capacity issue the hospitals faced in July and August as COVID cases began to rise again. However, there’s no doubt that the pandemic has thrown a wrench into the regular pace of electives. Not

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TRENDS all patients who needed care rushed back to schedule their procedures. “I think for certain communities, these patients would love to have their procedures done, but either couldn’t because the hospital stopped elective procedures, or they were choosing not to because they were afraid that going into the hospital would put them at risk for COVID.” GHA has done a lot of work, both statewide and at the community level, to ensure the public understands that hospitals are safe and that the facilities are going through very extensive cleaning and sanitation measures to ensure patient safety. “Sanitation is not a new practice for hospitals,” said Adams. “Cleanliness is a priority. But we don’t want our patients to delay care because of the fear of COVID. It’s best for patients to get care as quickly as possible so that these issues don’t get worse or become chronic. We certainly don’t want people to delay if they don’t have to.”

and PSA called “Stop Medical Distancing.” Committed to helping Americans better understand the risks of not seeking medical attention for symptoms that would normally lead to visiting a healthcare provider or healthcare facility, the campaign draws a distinction between social distancing and medical distancing and underscores the preventive measures healthcare organizations now have in place to limit the spread of the virus, including the use of telemedicine. Recent research published by GoodRx reported that more than 75% of Americans have had some aspect of their healthcare disrupted due to COVID-19. “While people should continue to practice good hygiene, social distancing and mask wearing in public settings, it is critically important for people to continue talking to their healthcare professionals to get the care they need,” the organizations said in a joint release. Delaying care for a medical emergency, such as a heart attack or stroke, can be life-threatening or lead to serious complications. In children, delaying routine care, such as vaccinations or well-child visits that help to assess development and growth, can have negative consequences. “We are seeing a troubling pattern that people are avoiding medical visits in fear of contracting COVID-19,” said William Shrank, M.D. and chief medical officer of Humana. “While we understand the fears that many people have around contracting the virus, our country’s medical facilities have adopted CDC guidelines and best practices and even telemedicine options to make your visit as safe as possible to prevent the spread of the virus. The intent of the campaign is to let people know that protecting yourself against getting this virus does not need to come at the expense of your overall health.” The healthcare organizations that came together to create the “Stop Medical Distancing” campaign include: Baptist Health South Florida, Baylor Scott & White Health, Children’s Hospital of Philadelphia, Health Mart, Humana, Kindred Healthcare, LabCorp, McKesson Corporation, Providence and Walgreens.

Recent research published by GoodRx reported that more than 75% of Americans have had some aspect of their healthcare disrupted due to COVID-19. In late July, GHA announced #MaskUpGA, a campaign to encourage all Georgians to make the choice to wear face coverings when in public settings and to social distance when possible to slow or stop the spread of COVID-19 in the state. The purpose of the campaign is to encourage organizations, businesses, and individuals to post on social media pictures or videos of themselves wearing masks and to accompany these posts with #MaskUpGA and a message about why they “mask up.” “If the public doesn’t take personal responsibility for their own health and responsibility for not spreading COVID, our hospitals are not going to get a break,” Adams said. At the national level, in July, an alliance of healthcare organizations announced the launch of a campaign 38

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Financial impact Having to delay care hasn’t affected just patient health. Hospitals in Georgia and across the country are feeling the strain financially.

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TRENDS “It has put them in a bad spot financially, because these are the types of procedures where we do get some sort of revenue to help offset the losses that we see in other areas – emergency care and OB care, etc. When that revenue stream is lost, it impacts the hospital’s ability to maintain normal operations, and it impacts their cash flow,” Adams said. Adams said when some hospitals started canceling elective procedures, they also found themselves furloughing staff.

Wellstar Health System, announced in May it would furlough more than 1,000 employees.

Emergency care Delayed medical care wasn’t solely related to elective procedures. According to a Centers for Disease Control and Prevention (CDC) study, patients delayed emergency care at an alarming rate. As the United States declared a national emergency in response to the COVID-19 pandemic and states enacted stay-at-home orders to slow the spread and reduce the burden on the U.S. health care system, the CDC and the Centers for Medicare & Medicaid Services (CMS) recommended that health care systems prioritize urgent visits and delay elective care to mitigate the spread of COVID-19 in health care settings. By May 2020, national syndromic surveillance data found that emergency department (ED) visits had declined 42% during the early months of the pandemic. In the 10 weeks following the emergency declaration (March 15–May 23, 2020), ED visits declined 23% for myocardial infarction (MI), 20% for stroke, and 10% for hyperglycemic crisis, compared with the preceding 10-week period (Jan. 5–March 14, 2020). “EDs play a critical role in diagnosing and treating life-threatening conditions that might result in serious disability or death. Persons experiencing signs or symptoms of serious illness, such as severe chest pain, sudden or partial loss of motor function, altered mental state, signs of extreme hyperglycemia, or other life-threatening issues, should seek immediate emergency care, regardless of the pandemic,” the CDC said in a release. “Clear, frequent, highly visible communication from public health and health care professionals is needed to reinforce the importance of timely care for medical emergencies and to assure the public that EDs are implementing infection prevention and control guidelines that help ensure the safety of their patients and health care personnel.”

“Emergencies don’t stop, and neither do we,” Estes wrote. “We urge you, please don’t delay emergency care … for heart attacks, strokes, falls or any other urgent need.”

“In the middle of a pandemic, you don’t want to think about having to furlough your staff so that you can meet payroll,” she said. “This is something that’s more common in smaller hospitals and more rural areas, but it’s had a huge impact on the big system facilities as well.” Indeed, in May, Georgia’s largest healthcare system, Emory Healthcare, announced it would cut hours and furlough 1,500 employees as it faced a $660 million revenue shortfall due to the COVID-19 pandemic, the Atlanta Business Chronicle reported. Another major organization, 40

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TRENDS The CDC reported that, based off its study, at least one in five expected U.S. ED visits for MI or stroke and one in 10 ED visits for hyperglycemic crisis did not occur during the initial months of the COVID-19 pandemic. Patients might have delayed or avoided seeking care because of fear of COVID-19, unintended consequences of recommendations to stay at home, or other reasons. In an op-ed for USA Today, Dr. Melinda L. Estes, chair of the American Hospital Association board, and president and CEO of Saint Luke’s Health System in Kansas City, Missouri, urged readers not to delay emergency care.

A lot of surgeons and facilities have made it a point to do regular telehealth visits in the interim while they’re waiting to be able to reschedule their elective procedures to maintain a line of communication so that the patient doesn’t feel forgotten. “Patients should know that hospitals are still open and ready, we still want to get them the help that they need, and we’re making every effort to do it in a way that’s responsible.” Hospitals and providers have come a long way since the beginning of the pandemic. Georgia and other states are no strangers to disaster preparedness, but the majority of the disaster preparedness done in the past has been for things like hurricanes and tornadoes. “This has been a new animal because it’s not isolated to just one portion of the state,” Adams said. “COVID has had a profound effect on whole state and the entire United States of America.” One positive change has been the amount of communication that’s happening from hospital to hospital. Recently, hospitals have started sharing supplies because it’s still difficult to get PPE, some medications and even equipment. In some cases, they’re even sharing staff. Furloughed staffers at one hospital are finding work through a contract that GHA has with one of its vendor partners. “They’re using them in hospitals where they’re short staffed, so we can keep them employed,” Adams said. “I think that communication and that sharing between facilities has been incredibly helpful.” The supply chain continues to be a challenge. “From a from a PPE standpoint, I don’t think we ever realized that we were going to need this much PPE,” she said. “There were hospitals who went into this with PPE supplies that, under normal circumstances, would last a year, and instead they were burning through those in one to two months. That extra cushion on making sure that you have enough supplies is something I don’t think they’ll forget in the near future and will keep in mind moving forward. Once we have bounced back from COVID, I don’t think you’ll see hospitals who keep a low supply of PPE, maybe one or two months, on hand anymore.”

Many hospitals require presurgery COVID testing within a certain time period before the surgery occurs. “I think the screenings have given patients a little peace of mind as well as the providers and the facility itself,” Adams said. “Emergencies don’t stop, and neither do we,” Estes wrote. “We urge you, please don’t delay emergency care … for heart attacks, strokes, falls or any other urgent need. Right now, a hospital’s emergency department is among the safest places you can step into anywhere. If you need care, please don’t allow unwarranted fear of COVID-19 to prevent you from getting the medical attention you need and deserve.”

Making adjustments Adams said hospitals in Georgia have adjusted in several ways. Hospitals are performing extensive pre-surgical screenings that include asking patients a series of question to determine if they’ve had a fever or been around someone who has tested positive for COVID. Many hospitals require pre-surgery COVID testing within a certain time period before the surgery occurs. “I think the screenings have given patients a little peace of mind as well as the providers and the facility itself,” Adams said. 42

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TRENDS

Medical Distancing COVID-19 leads to a decline in screening and testing for cancer, diabetes and cardiovascular issues. What’s next? By Mark Thill

COVID-19 kept patients away from their doctor’s offices. When will they return?

Will they return? And how will all this affect Repertoire readers? In May, the Kaiser Foundation Family Poll found that 48% of adults surveyed said they or someone in their household had postponed or skipped medical care due to the coronavirus outbreak. Epic Health Research Network reported that appointments for screening for cervical cancer, colon cancer and breast cancer decreased by 86% to 94% in March 2020 compared to pre-COVID volumes.

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TRENDS Writing in The New York Times in early June, Tomislav Mihaljevic, chief executive and president of the Cleveland Clinic; and Gianrico Farrugia, chief executive and president of the Mayo Clinic, wrote, “In the case of cancer alone, our calculations show we can expect a quarter of a million additional preventable deaths annually if normal care does not resume. Outcomes will be similar for those who forgo treatment for heart attacks and strokes.”

Gastroenterology “In Colorado, we definitely hit our peak [of COVID-19] in March and early April,” says Christopher Lieu, M.D., associate professor, director of GI medical oncology, and associate director for clinical research at the University of Colorado Anschutz Medical Campus, Division of Medical Oncology. Lieu is a member of the Medical Scientific Advisory Committee of the Colorectal Cancer Alliance. Emerson Perin At the peak of the pandemic, Medical Campus providers saw about a 10% decline in in-person visits and a rapid migration to telehealth. “We did have a drop in our clinical trials volume, though we did continue to enroll people even at its peak,” says Lieu. But patients came “roaring back” in June and July. “Our state did a great job of flattening the curve and getting everybody back on track.”

Cardiology Seattle was the nation’s first COVID-19 hot spot in February and March, says Eugene Yang, M.D., chairelect of the American College of Cardiology Prevention of Cardiovascular Disease Council, a cardiologist and professor of medicine at the University of Washington, and medical director of a large multispecialty center at UW Medicine. Normally, his clinic has about 4,500 outpatient visits a month. During the month of April, that fell to 1,400. A state-mandated stoppage in hospital-based elective procedures had a major impact on cardiologyrelated procedures. “At the time, we projected we wouldn’t get back to 100% until fall, but our volumes were restored more quickly than we anticipated,” he says. In fact, the clinic reached that mark in July and was projected at press time to exceed last year’s average in August. Meanwhile, by the beginning of September, in-person visits to the Texas Heart Institute in Houston had climbed to about 70% of normal, says Emerson Perin, M.D., director of the Center for Clinical Research, director of THI’s Stem Cell Center and medical director of THI. “Patients have died at home because of reluctance to seek medical care,” he adds. “Those who do reach out for care will likely have some kind of resolution to their issues, although probably not as complete, depending on the severity. Unfortunately, the routine visit as part of preventative medicine probably has sustained the greater impact.” In fact, because the coronavirus is primarily a vascular, or endothelial, disease, it may have long-term consequences on cardiovascular health, says Perin. “In certain patients, small vessel clotting may cause damage similar to what is seen with heart attacks due to atherosclerosis, that is, the common form of heart disease related to known risk factors such as high cholesterol, high blood pressure, diabetes and smoking. In most cases, they will be treated similarly given the common resultant of damage from lack of blood flow.”

‘ Unfortunately, the routine visit as part of preventative medicine probably has sustained the greater impact.’ Consequently, damage to patients’ health was minimized. One- or two-month delays in routine labs or surveillance CT scans for patients with colorectal cancer and no evidence of disease present little risk to the patient, he points out. Stage migration – that is, migration of Stage 1 or 2 cancer to Stage 3 or 4 – is more likely to occur after delays of six months or more. 46

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TRENDS

Patients with diabetes

A boost for telemedicine

“For some patients, [delayed medical care due to the pandemic] may not make a big difference in the long term, but for others, we believe it will, and there’s growing data to support that,” says Debra Simmons, M.D., professor of medicine at University of Utah and director of clinical affairs at Utah Diabetes and Endocrinology Center. “It will take more time to fully understand.” Research was unavailable regarding the impact of stay-at-home mandates on people with diabetes, but “anecdotally, we really worry about it,” she says. Published data on COVID-19 and heart disease may offer some clues, as people with diabetes are more likely than others to develop heart disease. There’s another problem, says Simmons: “People may believe they’re doing fine despite skipping routine appointments with their physician. I think that will have a longterm effect on people with diabetes and other diseases.” She also worries about the mental health of the population as a whole, because of the coronavirus itself and its economic fallout. Healthcare disparities, racial unrest and other factors all contribute to the stress many people are experiencing. And their return to the doctor depends on more than just their medical condition. “I think it will have everything to do with the economy. Will people have health insurance, or will they have to pay for the visit out-of-pocket? And if they have a job, will they get paid if they take time off ?”

Physicians who spoke to Repertoire believe that COVID-19 has been a shot in the arm for telemedicine. Less certain is whether the boost will be short-lived or the new normal. Prior to COVID-19, few if any non-primary-care physicians used telemedicine at University of Washington, says Yang. “But after COVID, we put a huge number of resources into it.” Even though overall patient volumes had dipped, in April, more than 80% of the clinic’s visits were conducted via telehealth, either by phone or video. By July, that percentage had dropped to about 20%.

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‘ I think we’ve learned that even in the most challenging circumstances, we can provide oncology care safely.’ “There’s agreement on the national level that telemedicine will be embedded in cardiology practices for the long term,” he says. Between a quarter and a fifth of patient visits may ultimately be conducted that way. “In my own practice, I might see patients with stable chronic conditions once a year, and visit with them remotely in between.” Televisits will never replace face-to-face visits, says Perin. “In-person interactions are far superior to video visits. They seem to be preferred by patients as well.” Rather than relying on telemedicine to streamline physician office operations, clinics should focus on automating processes such as prescription refills, fielding simple questions and triage. “Visits to the cardiologist by patients with complex and life altering heart disease will continue as before.” Says Lieu, “I think we’ve learned that even in the most challenging circumstances, we can provide oncology care safely. We can continue to enroll people in clinical trials. And in this era of telehealth medicine, we can gather more data without in-person visits. “We’ve also learned our patients in the cancer community are extraordinarily good at avoiding infection. They have demonstrated they can avoid infection by acting smart.”

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TRENDS

Measuring COVID’s Impact Key findings of the Kaiser Family Foundation’s Family Poll (Conducted in May):

ʯ Amidst the coronavirus pandemic, Americans

are deferring medical care. Nearly half of adults (48%) say they or someone in their household have postponed or skipped medical care due to the coronavirus outbreak. However, as stay-athome restrictions ease, most (68% of those who delayed care, or 32% of all adults) expect to get the delayed care in the next three months.

ʯ About four in ten U.S. adults (39%) say worry or

stress related to coronavirus has had a negative impact on their mental health, including 12% who say it has had a “major” impact. This is down slightly from early April when 45% reported a negative mental health impact. Yet, women continue to be more likely than men to say it is has negatively impacted their mental health (46% vs 33%) and urban (46%) and suburban (38%) residents are more likely than those in rural

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areas (28%) to say coronavirus has had a negative impact on their mental health. Among adults in households that experienced income or job loss due to the coronavirus outbreak (who make up one-third of adults overall), 46% say the pandemic has had a negative impact on their mental health.

ʯ Three in ten adults (31%) say they have fallen

behind in paying bills or had problems affording household expenses like food or health insurance coverage since February due to the coronavirus outbreak. Additionally, one in four Americans (26%) say they or someone in their household have skipped meals or relied on charity or government food programs since February, including 16% who say this was due to the impact of coronavirus on their finances. The share who say they have skipped meals or relied on charity or government food programs due to coronavirus is higher

among those in households that have lost a job or income due to coronavirus (30%) and among Black adults (30%) and Latinos (26%).

ĘŻ As states consider spending cuts to address bud-

get shortfalls caused or exacerbated by the coronavirus pandemic, it appears that many potential cuts will be unpopular among the public. At least three-quarters of adults oppose decreasing spending on K-12 public education (80%), police and safety (75%), and Medicaid (74%). Moreover, majorities oppose cutting spending on social services (60%), higher education (55%), prisons and jails (54%), and environmental protection (53%). Transportation is the only area which garners majority support for state budget cuts. Majorities of Democrats (85%), independents (73%), and

Republicans (62%) oppose their state government decreasing spending on Medicaid.

ĘŻ At a time when many newly unemployed Americans

may turn to Medicaid for health insurance coverage, a majority of adults (55%) say the Medicaid program is personally important to them and their families and about one in four adults (23%) who are not currently on Medicaid say it is likely they or a family member will turn to Medicaid for health insurance in the next year. This share rises to 31% among those who lost income or whose spouse lost income due to the coronavirus outbreak. Two-thirds of adults in states that have not expanded Medicaid say their state should expand the program, including seven in ten adults (72%) in those states whose household experienced a job or income loss due to coronavirus.

Source: Kaiser Family Foundation, www.kff.org/report-section/kff-health-tracking-poll-may-2020-health-and-economic-impacts.

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.

27-inch iMac FaceTime

Technology news

We’re all Zoomed!

iMac gets an upgrade

America experienced a collective cry of sorts when Zoom reported widespread outages Monday, August 24. Classrooms and boardrooms that had come to rely on the videoconferencing platform were panicking as the company worked to address the issue. But it was a reminder of the perils created by a reliance on technology to facilitate conversations that used to be face to face only months before.

Apple recently announced a major update to its 27-inch iMac. It now features faster Intel processors up to 10 cores, double the memory capacity, next-generation AMD graphics, superfast SSDs across the line with four times the storage capacity, a new nano-texture glass option for an even more stunning Retina 5K display, a 1080p FaceTime HD camera, higher fidelity speakers, and studio-quality

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mics. Whether composing a new song with hundreds of tracks, compiling thousands of lines of code, or processing large photos with machine learning, the 27-inch iMac, with the latest 6- and 8-core 10th-generation Intel processors, has pro-level performance for a wide range of needs. For pros who need to push iMac even further, the 27-inch iMac has a 10-core processor option for the first time, with Turbo Boost speeds reaching 5.0GHz for up to 65 percent faster CPU performance. And when working with memory-intensive applications, iMac features double the memory capacity for up to 128GB.

The Hi-Print is the first instant digital product to be announced since Polaroid’s rebranding exercise back in March. It ditched the ‘Originals’ from its name in order to appeal to those familiar with the brand’s extensive heritage. For customers using their iMac more than ever to connect with friends, family, and colleagues, the FaceTime HD camera now features 1080p resolution, while the Image Signal Processor in the T2 Security Chip brings tone mapping, exposure control, and face detection for a much higher quality camera experience. To complement the improved camera, the T2 Security Chip also works with the speakers to enable variable EQ for better balance, higher fidelity, and deeper bass. In addition, a new studio-quality microphone array enables users to capture high-quality audio for improved FaceTime calls, podcast recordings, Voice Memos, and more, right on their iMac. Prices start at $1,799 (US)

Digital shopping gets a boost As the COVID-19 pandemic reshaped our world, more consumers have begun shopping online in greater numbers and frequency, according to Tech Crunch. According to new data from IBM’s U.S. Retail Index, the pandemic has accelerated the shift away from physical stores to digital shopping by roughly 5 years. Department stores, as a result, are seeing significant declines. In the first quarter of

2020, department store sales and those from other “nonessential” retailers declined by 25%. This grew to a 75% decline in the second quarter. The report indicates that department stores are expected to decline by over 60% for the full year. Meanwhile, e-commerce is projected to grow by nearly 20% in 2020.

BlackBerry hardware making a comeback OnwardMobility announced agreements with BlackBerry Limited and FIH Mobile Limited, a subsidiary of Foxconn Technology Group, to deliver a new BlackBerry® 5G smartphone, powered by Android™, with a physical keyboard, in the first half of 2021 in North America and Europe. “BlackBerry is thrilled OnwardMobility will deliver a BlackBerry 5G smartphone device with physical keyboard, leveraging our high standards of trust and security synonymous with our brand. We are excited that customers will experience the enterprise and government level security and mobile productivity the new BlackBerry 5G smartphone will offer,” said John Chen, Executive Chairman and CEO, BlackBerry. Under the terms of the agreement, BlackBerry grants OnwardMobility the right to develop, engineer, and bring to market a BlackBerry 5G mobile device. Working closely with BlackBerry and FIH Mobile, OnwardMobility will ensure the world-class design and manufacturing of these devices.

Say ‘Hi’ to Polaroid’s new pocket-sized printer

Polaroid has launched a new pocket-sized printer for printing snaps taken with your phone, according to Tech Radar. The Polaroid Hi-Print produces 2.1 x 3.4-inch prints (credit card-sized), with sticky backs for attaching your shots to a variety of surfaces, such as notebooks, lockers and scrapbooks. The Hi-Print is the first instant digital product to be announced since Polaroid’s rebranding exercise back in March. It ditched the ‘Originals’ from its name in order to appeal to those familiar with the brand’s extensive heritage. Retail price is $99. www.repertoiremag.com

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HIDA

Stockpiles Divert Critical Supplies from the Front Lines to the Back Shelf Long-term stockpiles present an unworkable mix of management, logistical, and financial challenges for healthcare providers Proposals requiring healthcare providers to maintain a 90-day stockpile of personal protective equipment (PPE)

and other critical supplies appear to be a simple way to avoid future equipment shortages. In reality, requiring every hospital and nursing home to maintain a sizable stockpile in the middle of global pandemic will exacerbate ongoing PPE shortages. Stockpiles of this size divert supplies from the front lines to the back shelf of a warehouse.

HIDA and fellow trade association a steep decline in revenue due to canceled or AdvaMed wrote to New York’s Health Departpostponed elective surgeries that can generate ment and Governor’s Office to share concerns up to 50% of a hospital’s operating revenue. about the state’s 90-day mandate. Together, A better approach is to leverage the we urged the state to utilize the private sector’s proven expertise of health industry disinnovation and experience with manufacturtributors. Distributors have the infrastrucing, storage, warehousing and technology to ture ready to provide storage, logistics supBy Linda Rouse O’Neill, help ensure New York’s public health goals. port and the expertise to manage the range HIDA VP of “Leveraging experienced supply chain of costs, operational, and logistics issues. Government Affairs experts will avoid the risk of product expiAll this can be done while building a new ration, theft, damage, and waste,” we wrote national pandemic response infrastructure in the letter. “Further, we are concerned that hospitals in capable of replenishing supplies. New York will not be able to meet the logistical challenge One component of that infrastructure would be forof this stockpiling requirement. A 90-day supply for a 350ward-deployed reserves of supplies to meet the first-call bed hospital requires 5,700 square feet of space, which needs of healthcare providers when a crisis strikes. Based at is the equivalent of approximately 15 tractor trailers.” the 500 commercial distribution centers across the country (See infographic on page 55) or government warehouse, the federal government would manage and control the stockpiles. Distributors would manage them to ensure the inventory is rotated and replenished. Distributors have the In addition to reserves, the pandemic response infrastructure ready to provide infrastructure would include expanded, diversified surge manufacturing capacity with a strong focus on domestic storage, logistics support and production and centralized federal stockpiles to meet the the expertise to manage the emergency needs of state and local governments. Relying range of costs, operational, on forward-deployed reserves would relieve providers of the expense and administrative burdens of maintaining and logistics issues. massive stockpiles of their own and enable hospitals to keep doing what they do best: care for patients. Efforts to create larger equipment reserves are one Lawmakers are considering language originally introreason why demand continues to outstrip supply. Imposduced in the Medical Supplies for Pandemics Act of 2020 ing a 90-day stockpile mandate on every hospital would that would implement this framework. It would authorize create even greater shortages. Stockpiling incurs additional funds to implement a supply chain flexibility manufacturcosts and complications happening when hospitals are reeling program creating incentives for U.S. manufacturers to ing from the impact of the pandemic. Many are suffering improve supply chain elasticity. 54

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90-Day PPE Stockpile Mandates Increase Shortages And Drive Up Costs

Policymakers are considering mandates for healthcare providers to maintain 90-day stockpiles of critical supplies such as personal protective equipment (PPE). These mandates are likely to increase supply shortages and drive up costs to hospitals. A better solution is to stockpile government controlled pandemic supplies at the country’s 500+ existing distributor warehouses across the U.S., positioning inventory close to healthcare providers for immediate surge needs during a crisis.

Large Stockpiles Create New Logistical Challenges A 90-day supply for a 350-bed hospital requires 5,700 sq. ft. of space — the equivalent of

13–15 tractor trailers.

A 90-day supply for a 5,000-bed system requires 81,400 sq. ft. of space — the equivalent of

1½ football

Supplies Needed On The Front Lines Get Moved To The Back Shelf... July 8, 2020

Grave Shortages of Protective Gear Flare Again as Covid Cases Surge

…And Drive Up Costs A 90-day supply of PPE for a 350-bed hospital would cost as much as

$2 million.

May 6, 2020

“…demand continues to outstrip supply because hospitals, states and the federal government are trying to stockpile supplies.”

Stockpiles need to be managed and the increased inventory rotated to avoid the risk of product expiration, theft, damage, and waste. © Health Industry Distributors Association

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August 2020

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 Car-buying tools Buying a vehicle has long required in-person communication, often followed by a request to fill out a customer survey a few miles long. Over the past few months, Volkswagen has tackled both of those challenges amid a pandemic with two new tools. Volkswagen of America and VW Credit have worked with CDK Global, Inc. to launch Sign Anywhere, a digital signature tool that’s among the first of its kind in the U.S. auto industry, according to the auto manufacturer, allowing vehicle buyers to finish their financial paperwork with a participating dealer without having to visit the dealership.

Sign Anywhere

The other step is a new system of customer surveys that ditches a long list of multiple-choice questions for a few open-ended questions that gives customers the power to give detailed feedback and post their review to VW.com and the dealer’s website. The Sign Anywhere tool developed by CDK Global allows customers to remotely and securely digitally sign financial documents with their own computer or mobile device. While digital signatures are common in many industries, many laws and state regulations governing financial documents in vehicle buying have usually required in-person or “wet” signatures. Volkswagen began planning to roll out this tool two years ago, but the COVID-19 pandemic sped up the 56

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deployment, and more than 400 Volkswagen dealers now have access in states where laws allow it. “Customers are asking for flexibility and looking for peace of mind especially during this time, and Sign Anywhere helps provide that.” said Anthony Bandmann, President and CEO of VW Credit, Inc. “Planning to implement this technology began two years ago but since this pandemic took hold, we’ve accelerated our plan to make this a permanent tool for our dealers.”

Mazda, Toyota partner in U.S. manufacturing technologies Mazda Toyota Manufacturing, (MTM), a new jointventure between Mazda Motor Corporation and Toyota Motor Corporation, recently announced an additional $830 million investment to incorporate more cuttingedge manufacturing technologies to its production lines and provide enhanced training to its workforce of up to 4,000 employees. Total funding contributed to the development of the state-of-the-art facility is now $2.311 billion, up from the $1.6 billion originally announced in 2018. The investment reaffirms Mazda and Toyota’s commitment to produce the highest-quality products at the facility, according to a release. It also accommodates production line enhancements made to improve manufacturing processes supporting the Mazda vehicle and design changes to the yet to be announced Toyota SUV that will both be produced at the plant. The new facility will have the capacity to

Mazda Toyota Manufacturing, (MTM) Alabama manufacturing plant.

produce up to 150,000 units of a future Mazda crossover vehicle and up to 150,000 units of the Toyota SUV each year. MTM continues to target up to 4,000 new jobs and has hired approximately 600 employees to date, with plans to resume accepting applications for production positions later in 2020. “Toyota’s presence in Alabama continues to build excitement about future opportunities that lie ahead, both for our economy and for the residents of our great state,” Alabama Governor Kay Ivey said. “Mazda and Toyota’s increased commitment to the development of this manufacturing plant reiterates their belief in the future of manufacturing in America and the potential for the state of Alabama to be an economic leader in the wake of unprecedented economic change.” “Mazda Toyota Manufacturing is proud to call Alabama home. Through strong support from our state and local partners, we have been able to further incorporate cutting-edge manufacturing technologies, provide worldclass training for team members and develop the highest quality production processes,” Mark Brazeal, VP of Administration at MTM said. “As we prepare for the start of production next year, we look forward to developing our future workforce and serving as a hometown company for many years to come.”

Hyundai launches new Elantra N Line sedan Hyundai Motor Company announced the launch of the new Elantra N Line in August. The new model is designed and engineered to deliver more enhanced driving fun to the bold new Elantra that launched in April. The N Line model, characterized by N specific design and performanceenhancing elements, offers an attractive entry point to the Hyundai’s high-performance N Brand lineup and will expand Elantra’s appeal to a broader range of customers. Elantra N Line delivers a spirited driving experience, powered by a 1.6-liter GDI turbocharged engine with six-speed manual or seven-speed Double Clutch Transmission (DCT) that produces up to 201 horsepower and 195 lb-ft torque. Hyundai engineers implemented several mechanical improvements to Elantra’s suspension to increase stiffness for a gripping performance, aided by 18-inch alloy wheels, multi-link independent rear suspension and larger front brake rotors. Driver-oriented features, such as paddle shifters and Drive Mode Selector system, enable a racing-inspired experience behind the wheel. Interior design elements, including a leather-wrapped perforated N steering wheel with metallic spokes, N sport seats with leather bolsters, gearshift with metal accents and leather inserts, and alloy pedals, complement Elantra’s sporty exterior styling.

Hyundai Elantra N Line

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October 2020

REP CORNER

New Territory for a Seasoned Rep Melody Hernandez, senior account manager with Owens & Minor, said this year has been unique in more ways than one. By Graham Garrison

October 2020

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www.repertoiremag.com

With 17 years of experience as an account manager for Owens & Minor, Melody Hernandez has seen her share of

market disruptions. New technology implementations. Health systems consolidating. Recessions and bounce backs and economic swings.

But 2020? Yeah, this year will take the cake. “The pandemic has made this year incredibly challenging,” she said. “COVID-19 has rattled the entire industry. This is new territory for us all as we navigate through the chaos in search of sustainable solutions.”

Fortunate to be in healthcare Born and raised in Southern California, Hernandez is a senior account manager with Owens & Minor, having just celebrated her 17th anniversary with the company in July. She has a Bachelor’s of Science degree in Business Management. She supports healthcare facilities in San Diego and Riverside County. Prior to joining O&M, she worked in a clinical role, for a hospital system in SoCal, and considers herself fortunate to play a part in healthcare for over 20 years. One of the things Hernandez finds most rewarding in her role as a distribution rep is being able to deliver solutions that create efficiencies for her customers. “This is one of the reasons I love working for O&M,” she said. “I enjoy working very closely with my customers. Every day brings forth a new set of challenges and opportunities to problem solve.” Particularly each day lately amid a pandemic. With the increased demand on product and the decreased availability, Hernandez said she spends the majority of her time searching for quality product sources. “We are so fortunate to have our Halyard-brand products as part of the O&M offering,” she said. “My O&M Global Products teammates have been incredibly supportive. Teamwork is critical. Current demands of the healthcare industry prompt dramatic scaling up in disaster readiness and my team has stepped up to support our customers in every way possible.” As any sales rep would say, Hernandez considers herself a people person and thrives on daily interactions with customers, “and really just people in general,”

she said. “To go from being onsite with my customers several days a week to mainly working from home was certainly an adjustment. It really makes you appreciate the face-to-face meetings so much more as you work to find creative ways to replace those interactions. Add quarantine and business closures and now I’m feeling completely cut off from the world. This year has been a true test of one’s strength.” Success today will take a collaborative environment, she said. “It is extremely important to see yourself in your customer’s shoes. Value that we provided in the past may not be relevant in this new day. Understanding the current priorities of your customer is essential – just as being able to adjust your role to provide the appropriate support in this changing environment.”

As any sales rep would say, Hernandez considers herself a people person and thrives on daily interactions with customers, “and really just people in general,” she said. “To go from being onsite with my customers several days a week to mainly working from home was certainly an adjustment. When not working to provide solutions for her customers, Hernandez puts most of her energy into her family. “My husband and I are a modern-day Brady Bunch. Between us we have six children from ages 14 to 24. We enjoy our family time. I love to cook and they love to eat! We sit together for dinner nightly. We enjoy being outdoors. Nothing beats the fresh air! We enjoy taking the trailer out for a quick weekend of camping and hiking.” www.repertoiremag.com

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October 2020

HEALTHY REPS

Health news and notes A golfer’s guide to low back pain Golf is often thought of as a low-impact sport, but it can be associated with several musculoskeletal injuries due to its repetitive nature, according to U.S. News and World Report. One of the most common complaints reported by golfers is low back pain, with reported rates varying from 26% to 52%. Low back pain is also a major health issue among adults in the general population. Given the high prevalence and high cost of low back pain care, it’s worthwhile to consider how to prevent golf-associated low back pain. 60

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While the golf swing seems like a relatively easy motion, it is actually an extremely complex series of motions that involve most of the muscles and joints in the body. As with all things, the golf swing’s frequent repetition – compounded over years of playing the sport – places significant stress on those muscles, joints, and tendons. Over time, this may result in injury. Understanding the mechanics of the golf swing, along with education and training, can help prevent golf injuries. It’s important to use proper posture and proper sequencing, and not to over-swing. Swinging

touches a contaminated mask and then touches their mouth or nose, they might also contract an infection. Like all medical devices and equipment, face masks need to be properly cared for in order to be safe and effective. But not all face masks are the same; different kinds of masks need to be sanitized in different ways depending on the type of material they’re made out of. Face masks It’s important to apply the correct method to each reduce the type of material, or else spread of you could wind up making COVID-19 the mask harder to breathe because they through and less effective! provide a Fortunately, Healthbarrier that line has created an easy-tocatches the follow list of the common virus-containing types of face masks, how respiratory to safely disinfect them for droplets that are reuse during the pandemic, released when and how to handle medicalpeople cough, grade masks that can’t easily sneeze, or talk. be cleaned properly outside of a medical setting. Check out the list at: www.healthline.com/health-news/ how-to-safely-sanitize-every-type-of-face-mask#Propercare-of-cloth-face-masks

Make these simple travel snacks to eat like a health pro on the road

too hard may increase the stress placed on the spine and surrounding structures… Read the full article at: https://health.usnews.com/healthcare/for-better/articles/a-golfers-guide-to-low-back-pain

How to safely sanitize every type of face mask Face masks reduce the spread of COVID-19 because they provide a barrier that catches the virus-containing respiratory droplets that are released when people cough, sneeze, or talk. Being a barrier between the virus and the wearer means that the mask becomes contaminated instead. While the greatest danger is from inhaling virus-filled respiratory droplets from those around us, if a person

Whether you’re planning to take a short, safe vacation; just “going for a drive” (who doesn’t need a brief change of scenery?); or on the road making sales calls, you should try to avoid fast food and C-store fare. A post from U.S. News and World Report has a few simple recipes for easy-to-make and easy-to-eat snacks to take along with you the next time you hit the road. The quick recipes include: ʯ Vegetable rice paper rolls. ʯ Yogurt parfait with wild blueberries. ʯ No-bake energy bites. ʯ Fruit with squeezable nut butter. ʯ Popcorn. ʯ Prepackaged portions of mixed nuts, jerky and dried fruits. Read the full post at: https://health.usnews.com/healthnews/blogs/eat-run/articles/healthy-travel-snacks-forcar-and-road-trips www.repertoiremag.com

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October 2020

NEWS

Industry News Midmark names Jon Wells as president Midmark Corp. announced Jon Wells as president, effective Sept. 15. He will continue to serve as Midmark’s chief commercial officer. As president, Wells will work with the Midmark executive team to further solidify its strategy and execution, ensuring the delivery of its brand promise to “design seamless solutions that simplify and enable better care, wherever clinician and patient interaction occur.” Wells has held numerous posiJon Wells tions in product management, sales and marketing leadership, where as VP, he led the recent corporate rebrand initiative while streamlining and unifying the marketing strategy to a single brand. He currently holds the position of chief commercial officer, leading corporate sales, marketing, customer experience, and hospitality services. Wells will report directly to Midmark CEO John Baumann. The company says that this management structure will allow Baumann, as CEO, to remain focused on Midmark’s transformation, strategic direction and organic and inorganic investments in Midmark’s capabilities and long-term strategic priorities. Baumann will continue to serve on Midmark’s board of directors.

Quidel to update packaging of POC Sofia SARS Antigen test for COVID-19 to include either nasal or nasopharyngeal swabs Quidel Corporation announced that labeling for Quidel’s Emergency Use Authorization (EUA) for the Sofia SARS Antigen FIA has been amended to include either nasal or nasopharyngeal swabs. The new kit labeling, with the addition of a nasopharyngeal swab, allows Quidel to offer a second kit configuration to support the nasopharyngeal sample commonly performed in hospitals and helps alleviate some of the supply chain constraints around nasal swab-based kits. Quidel’s Sofia SARS Antigen FIA has always been authorized for use with either nasal or nasopharyngeal 62

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swabs specimens. Due to customer preference, the Sofia SARS Antigen kit has been sold only with a nasal swab. The new kit configuration including nasopharyngeal swabs allows Quidel to increase its weekly delivery of the Sofia Antigen test. “In our quest to do the most good during the novel coronavirus pandemic, offering our hospital customers another kit configuration with an NP collection device option allows us to work through some of the near-term nasal swab shortages we face to be able to ship more Sofia SARS Antigen FIA kits and thereby enable more patients to be tested,” said Douglas Bryant, president and CEO of Quidel. “We strongly believe that frequent testing using an accurate point-of-care antigen test allows for more successful implementation of contact tracing and self-isolation programs, which are key to help reduce the spread of COVID-19.” Quidel currently sells the Sofia SARS Antigen FIA in the U.S. under Emergency Use Authorization (EUA) by the FDA.

Baptist Health installing 432 Amazon Echo devices Baptist Health (Little Rock, AR) is installing 432 Amazon Echo Show devices in potential COVID-19 patient rooms at nine of the healthcare system’s hospitals to offer a new and improved way that clinicians can visit with their patients through video communication. Echo Show devices and deployment support are being donated by Amazon as part of its $5 million global initiative to help healthcare workers, patients, students and communities impacted by COVID 19. Baptist Health will be deploying these to units across the system that have the potential to have COVID-19 patients, which includes ICU areas, medsurg floors, emergency departments and labor and delivery rooms. The devices feature a speaker for twoway communication plus an 8-inch touch-screen display. The “Drop In” feature allows physicians, nurses, therapists and other clinicians to visit a patient’s room virtually. This allows caregivers to see the patient more

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NEWS frequently without having to go through the process of putting on personal protective equipment each time, which in turn also preserves PPE and adds a layer of safety for the staff.

Roche gets emergency approval for combination COVID-19, flu A/B test Roche (Basel, Switzerland) announced that the cobas SARS-CoV-2 & Influenza A/B Test for use on the cobas 6800/8800 Systems received Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration (FDA). This test is intended for the simultaneous qualitative detection and differentiation of SARS-CoV-2, Influenza A, and Influenza B in patients suspected by their healthcare provider of having respiratory viral infection consistent with COVID-19.

Roche’s widely-available, fully automated cobas 6800/8800 Systems, which are used to perform the SARS-CoV-2 & Influenza A/B Test, offer the fastest time to results with the highest throughput and the longest walk-away time available among automated molecular platforms, the company says. The systems provide up to 96 results in about 3 hours and 384 results for the cobas 6800 System and 1,056 results for the cobas 8800 System in an 8-hour shift. It is also available in markets accepting the CE mark.

Walmart remains committed to health center expansion Walmart CEO Doug McMillon said recently that the company remains committed to its roll out of Walmart Health brand centers to expand low-cost healthcare services to its U.S. customers. Comments by McMillon and the head of Walmart’s U.S. operation came after the abrupt departure in August of Sean Slovenski who had been Walmart’s SVP 64

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of health and wellness for the last two years and oversaw the launch of what he called “super centers” for healthcare services. The retail giant currently has clinics in Georgia and Arkansas, and plans to enter the Florida market in 2021. Like the handful of healthcare services “super centers” Walmart has rolled out in the last year in Arkansas and Georgia, the Florida facilities will feature an array of primary medical services, dental care, and behavioral health services as part of a new model being replicated into other markets. The new, larger, clinics which are more than double the size of rival efforts by CVS Health and Walgreens are being launched in various sizes.

Clear link between heart disease and COVID-19; Long-term implications unknown Severe damage to the lungs is one of COVID-19’s most harrowing effects, making breathing hard or impossible for those who’re severely affected, Intermountain Healthcare said in a post on its website. However, evidence is mounting that COVID-19 also damages the heart, damage either caused by the virus itself, from inflammation triggered by the immune system’s response to the virus, or from increased clotting in heart vessels. There is now evidence that heart damage may persist even after the patient recovers and, in some cases, that damage may be long lasting. Experts just don’t know how often the heart damage will occur at this point or whether it might affect people with only mild symptoms. In a prospectus review published in the Journal of Molecular and Cellular Cardiology, Kirk U. Knowlton MD, from the Intermountain Healthcare Heart Institute in Salt Lake City, examined more than 100 published studies related to COVID-19 and its effects on the heart. While lung disease (severe acute respiratory distress syndrome, or ARDS) has been the most consistent problem with the virus, Dr. Knowlton found that many patients also suffer significant cardiovascular damage that might also persist after they have otherwise recovered. Dr. Knowlton points out that there is considerable evidence that the COVID-19 infection can damage the heart in hospitalized patients via several mechanisms, including myocarditis. However, less is known about the effects of the virus on the heart in patients that do not require hospitalization or in those that do not develop significant lung disease.

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