REP Post-Acute April 19

vol.27 no.4 • April 2019

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The Sepsis Puzzle Sepsis disguises itself too well

ease of choice for you, ease of use for your customer (this is what we call a win-win proposition)

IMMUNOASSAY SYSTEM

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APRIL 2019 • VOLUME 27 • ISSUE 4

Excellence in Sales

18 POST-ACUTE

PUBLISHER’S LETTER In Search of Greatness................................................6

PHYSICIAN OFFICE LAB At the Press of a Button

The CBC: 3, 2, 1 … blast off!.................................................8

IDN OPPORTUNITIES

Dennis Mullins: Steering a vehicle for change at IU Health................................................. 12

DIABETES

The Sepsis Puzzle Sepsis disguises itself too well

32

Diabetes: In the News

40

repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2019 by Share Moving Media. All rights reserved.

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APRIL 2019 • VOLUME 27 • ISSUE 4

QUICK BYTES

Technology news

52 HEALTHY REPS

LEADERSHIP Why Nice People Start Turf Wars..................... 44

SMART SELLING Home Healthcare Providers to Face Worker Shortages..................................... 48

WINDSHIELD TIME

Automotive-related news...........................50

REP CORNER

Energizer Salesman

Health news and notes 4

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When Steve Amadio wants something, he goes after it – with vigor...............................57

54

INDUSTRY NEWS Urgent care industry experiencing growth boom................................... 60 News........................................................................................... 62

We go together like…

You play a vital role in B. Braun Medical’s success. And our success depends on each other. Thank you for supplying the products healthcare professionals critically need and making B. Braun a leading healthcare provider.

B. BRAUN AND YOU

Sales representatives in your area are ready to discuss how to further improve your customer experience.

B. Braun Medical | Bethlehem PA | 1-800-227-2862 | BBraunUSA.com ©2019 B. Braun Medical Inc., Bethlehem PA. All rights reserved.

PUBLISHER’S LETTER

In Search of Greatness Recently I watched the documentary “In Search of Greatness” about top athletes, includ-

ing Wayne Gretzky, Michael Jordan, Pele, and others. The filmmakers searched for common themes to determine what made these athletes so amazing. There were a few things that kept coming to the surface. The athletes were competitive on a different level, dedicated to their craft, and most importantly, creative.

The April edition of Repertoire is our annual Excellence in Sales issue. Each year our readers submit names and write a short note nominating the rep they think should be crowned the distribution or manufacturer sales rep of the year. This year, Stephen Raggio from Welch Allyn was named the manufacturer rep, and Jarrel Watkins from McKesson was named the distributor rep of the year.

Both of these reps have been able to train, learn, and adapt to the environment we live in today. They both realized you must be willing to face the challenge in front of you and adapt to the needs of today’s client.

I’ve been involved with this award for 10 years now. The salespeople who win year in year out are not unlike the athletes that perform above everyone else in their field. We also hear this in the Road Warriors podcast regularly. To be a superior rep, you must be competitive, dedicated, and creative.

Please spend a few minutes reading the stories of both of these reps.

Scott Adams

Dedicated to the Med-Surg Industry, R. Scott Adams Publisher PS: We’ve begun to build a nice library of podcasts in the Road Warriors and Their Untold Stories series. To listen, go to RepertoireMag.com and click on the podcast tab. So far we have Brian Taylor, Eddie Dienes, Brad Connett, and Tony (Doctor Ben) Melaro. Coming soon: Jay Keene, Ty Ford, and Chris Verhulst.

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

editorial staff editor

Mark Thill lthill@sharemovingmedia.com managing editor

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

Alan Cherry acherry@sharemovingmedia.com

Jessica McKeever jmckeever@sharemovingmedia.com (800) 536.5312 x5271

publisher

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

sales executive

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

founder

Brian Taylor

Subscriptions

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2019 editorial board Richard Bigham: IMCO Eddie Dienes: McKesson Medical-Surgical

btaylor@ sharemovingmedia.com

Joan Eliasek: McKesson Medical-Surgical

circulation

Doug Harper: NDC Homecare

Ty Ford: Henry Schein

art director

Laura Gantert

Mark Kline: NDC

Brent Cashman

lgantert@ sharemovingmedia.com

Bob Ortiz: Medline

bcashman@sharemovingmedia.com

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vice president of sales

April 2019

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Keith Boivin: IMCO Home Care

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PHYSICIAN OFFICE LAB

At the Press of a Button The CBC: 3, 2, 1 … blast off!

By Jim Poggi The finger resting on the button knows that once it

presses the button things will change. Excitement and anticipation builds. Whether the finger is resting on the button that launches a rocket, starts a Formula 1 race car or a sleek, speedy ocean racer, it knows that pressing the button will set exciting events into motion and that nothing will ever be the same again.

The finger resting on the “start” button of a hematology analyzer has tremendous power as well. In less than the time it takes for the Formula 1 racer to complete one lap, this finger will perform one of the most important lab tests there is, the complete blood count with differential, or “CBC with diff ” as it is often referred to. As a result, typically in one to three minutes, the clinician has the power to know everything a CBC with differential can determine: general health status, anemia, infection, blood loss due to trauma and a host of other diagnostic indications. Whether used in primary care, internal medicine, oncology, rheumatology, urgent care or an ER clinical setting, the CBC with differential changes everything in under three minutes with a single press of the button.

What’s the big deal clinically?

The CBC with differential, CPT code 85025, was the single most frequently performed lab test in the United

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States in 2016 with 42 million tests performed. That’s as many as the number of basic metabolic panels, hemoglobin A1c and vitamin D tests combined that year.

Clinically, CBC is the champ for the quantity of clinical information it provides with a single button press. It’s fast, works with whole blood, is easy to perform, always performs the same tests, and delivers 15 or more important clinical results quickly and reliably. The typical CBC is also economical, and most hematology instrument suppliers offer CBC reagent costs in the $1.50 to $2.50 per sample range, depending on testing volume, number of test parameters and automation provided and whether the instrument also performs some of the newer hematology parameters, including reticulocytes.

Many contemporary hematology instruments offer closed tube cap piercing for additional speed and safety.

There is an excellent range of high-quality hematology system choices available for the physician practice, including some with novel test parameters and even a new, waived system option. Instrument choices also span a wide range of prices and automation options that allow the hematology analyzer to fit well into virtually any size clinical practice and fit most work flow needs. Hematology customization choices offer a solution for virtually any size practice and clinical need. As always, talk to your

Realize the value of Point-of-Care PT/INR ® Realize the of testing CoaguChek solutionsPT/INR Realizewith the value value of Point-of-Care Point-of-Care PT/INR ® testing testing with with CoaguChek CoaguChek® solutions solutions Point-of-care (POC) PT/INR testing can be a valuable component of a successful warfarin therapy program. Rather than sending patient blood samples to the lab and waiting days for Point-of-care (POC) PT/INR Point-of-care (POC) PT/INR testing testing can can be be aa valuable valuable component component of of aa successful successful warfarin warfarin results, in-office testing: therapy program.

Rather than sending patient blood samples to the lab therapy program. Rather than sending patient blood samples to the lab and and waiting waiting days days for for results, in-offi ce testing: results, in-office testing: therapy decisions by delivering • Enables immediate on-the-spot results •• Enables Enables immediate immediate therapy therapy decisions decisions by by delivering delivering • Saves valuable time and unnecessary steps on-the-spot results on-the-spot results •• Helps reduce risk and cost of treatment related complications1 • Saves Saves valuable valuable time time and and unnecessary unnecessary steps steps 2 1 •• Improves patient satisfaction • Helps Helps reduce reduce risk risk and and cost cost of of treatment treatment related related complications complications1 2 •• Improves Improves patient patient satisfaction satisfaction2

To learn more about POC PT/INR testing with CoaguChek systems, POC visit coaguchek-usa.com To To learn learn more more about about POC PT/INR PT/INR testing testing with with CoaguChek systems, visit coaguchek-usa.com CoaguChek systems, visit coaguchek-usa.com

1 Wurster M, et al. Dis Manag. 2006 2 Campbell PM, et al. Dis Manag Clin Outcomes. 2002 2 Giles T, Roffidal L. Results of the prothrombin office-testing benefit evaluation [PROBE]. Cardiovasc Rev Rep. 2002;23:27-33.

1 Wurster M, et al. Dis Manag. 2006 2 Campbell PM, et al. Dis Manag Clin Outcomes. 2002 1 Wurster M, et al. Dis 2006 2 Campbell PM, et al.

Manag Clin Outcomes.

2002 COAGUCHEK isManag. a trademark of Roche. ©Dis 2019 2 Giles T, Roffidal L. Results of the prothrombin office-testing benefiRoche. t evaluationMC-US-03073-0119 [PROBE]. Cardiovasc Rev Rep. 2002;23:27-33.

2 Giles T, Roffidal L. Results of the prothrombin office-testing benefit evaluation [PROBE]. Cardiovasc Rev Rep. 2002;23:27-33.

COAGUCHEK is a trademark of Roche. © 2019 Roche. MC-US-03073-0119 COAGUCHEK is a trademark of Roche. © 2019 Roche. MC-US-03073-0119

PHYSICIAN OFFICE LAB favorite hematology system suppliers to find out what’s new and discuss prospects in your area to target for discussions about this important and efficient test system.

How does it fit in the typical primary care practice?

For years, CBC testing has been regarded as the “gateway to moderate complexity testing” due to its unique one-button operation, high clinical utility, economy of operation and ease of training. Most customers who consider embarking on moderate complexity testing start with hematology. The typical reasons cited by practices who have adopted hematology testing include: •C linicians are confident and familiar with the tests in the CBC • One-button simplicity makes use and training a breeze • EASILY fits in the “15-minute” patient visit window • Safety • Economy • Gets the job done clinically •T remendous range of excellent products and suppliers suits virtually any size practice

While virtually all systems offer connectivity solutions to LIS and EMR, some include required connectivity software and hardware as part of their system. Some systems offer novel test parameters including C-reactive protein, reticulocytes, immature granulocytes, and others. Some also offer the option to test body fluids other than whole blood. Others claim the ability to handle difficult patient samples including pediatric and oncology patients. In addition, most hematology instrument manufacturers offer a choice of 3 part or 5 part differential systems to tailor the amount of available information to the varying clinical needs and experience of individual clinical practices.

Managing the hematology opportunity Your role as a key consultant to the physician practices who rely on you makes it important that you stay informed. You need to know the needs of your clients who already use a hematology system and are considering upgrading, and also be able to guide the practice just considering adding hematology testing. With the vast number of changes and choices available, it’s easy to default to the “well, many of my customers prefer this option” approach and close for a demonstration of the product you are most familiar and comfortable with. As in most areas of testing, this approach may lead to a solution that may not be the best fit for a specific customer.

Dig deep and get to what matters most to your customer or prospect. Knowing the volume of tests they plan to perform, their available space, clinical preferences (which elements of the CBC are most important), staff knowledge, experience and interest in testing help get you off to a good start. Consulting with your most trusted suppliers and getting their advice on qualifying questions is also useful, as are ride-days with these suppliers. You will learn quickly and be able to deliver highly qualified prospects to follow up and close with your hematology supplier.

The well-informed distributor rep not only makes sure the customer is pressing the “hematology button,” but also makes sure it is the right button with the right solution for them.

The CBC with differential, CPT code 85025, was the single most frequently performed lab test in the United States in 2016 with 42 million tests performed.

That’s as many as the number of basic metabolic panels, hemoglobin A1c and vitamin D tests combined that year What differentiates choices and preferences for CBC instruments?

Overall accuracy and precision, reliability, small footprint, RBC, WBC and platelet histogram displays and economy of operation have become “table stakes” among hematology systems from all major suppliers. Differentiation among supplier choices involves automation, closed tube sampling options, and throughput options to suit the clinical needs of individual practices.

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NEW PAMA CPT codes now available in the app

Pama updated CPT codes 2018 Infectious Disease Tests Test - Panels Basic Metabolic Panel (9 tests) Comprehensive Metabolic Panel (17 tests) Electrolyte Panel (4 tests) Hepatic Function Panel (10 tests) Lipid Panel (6 tests) Renal Function Panel (12)

CPT 80048/QW 80053/QW 80051/QW 80076 80061/QW 80069/QW

2017 Fee $11.60 $14.49 $9.62 $11.21 $18.37 $11.91

2018 Fee $10.44 $13.04 $8.66 $10.09 $16.53 $10.72

Change -10% -10% -10% -10% -10% -10%

Cardiac/Liver/Other Tests Albumin (Serum) Albumin (Urine) ALP ALT Aspirin Therapy AST Bilirubin, direct Bilirubin, total BNP CK,MB CK/CPK GGT LD Microalbumin (Quantitative) Microalbumin (Semi-quantitative) Total Protein Troponin I

82040/QW 82042/QW 84075/QW 84460/QW 85576/QW 84450/QW 82248 82247/QW 83880/QW 82553 82550/QW 82977/QW 83615 82043/QW 82044/QW 84155/QW 84484/QW

$6.79 $7.10 $7.10 $7.27 $29.47 $7.10 $6.88 $6.88 $46.56 $15.84 $8.93 $9.88 $8.28 $7.93 $6.28 $5.03 $13.50

$6.11 $7.78 $6.39 $6.54 $26.52 $6.39 $6.19 $6.19 $41.90 $14.26 $8.04 $8.89 $7.45 $7.14 $6.23 $4.53 $12.47

-10% 10% -10% -10% -10% -10% -10% -10% -10% -10% -10% -10% -10% -10% -1% -10% -8%

Lipid Tests HDL LDL Lp(a) Apolipoprotein Total Cholesterol Triglycerides

83718/QW 83721/QW 82172 82465/QW 84478/QW

$11.24 $13.09 $21.26 $5.97 $7.88

$10.12 $11.78 $21.09 $5.37 $7.09

-10% -10% -1% -10% -10%

Diabetes Tests Fructosamine Glucose on home use meter-type device Glucose Tolerance Test, each additional specimen > 3 Glucose Tolerance Test, initial 3 specimens Glucose, quantitative blood type Hemoglobin A1c

82985/QW 82962 82952/QW 82951/QW 82947/QW 83036/QW

$20.68 $3.21 $5.38 $17.66 $5.39 $13.32

$18.61 $3.28 $4.84 $15.89 $4.85 $11.99

-10% 2% -10% -10% -10% -10%

Renal Function Tests BUN Creatinine Creatinine (Urine)

84520/QW 82565/QW 82570/QW

$5.42 $7.03 $7.10

$4.88 $6.33 $6.39

-10% -10% -10%

Individual Tests Amylase Calcium Ferritin Iron

82150/QW 82310/QW 82728 83540

$8.89 $7.08 $18.70 $8.88

$8.00 $6.37 $16.83 $7.99

-10% -10% -10% -10%

Find the new codes in The Black Book

Other tools available for distributors are: vol.26 no.1 • January 2018

repertoiremag.com

January 2018

2 Minute Drill Videos

Podcasts

PAMA: The Stage is Set — How will the new rates impact providers, distributors and manufacturers?

PAMA: Jim Poggi, Tested Insights, LLC

The Stage is Set

How will the new rates impact providers, distributors and manufacturers?

Twitter

IDN OPPORTUNITIES

Dennis Mullins: Steering a vehicle for change at IU Health

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Strategic thinkers: The healthcare supply chain needs

more of them.

However, a strategic thinker who lacks good communication skills or change-management skills risks either failing in whatever initiative they are involved, or succeeding painfully, says Dennis Mullins, senior vice president of supply chain operations at Indiana University Health.

Mullins was named Contracting Professional of the Year for 2019 by the Journal of Healthcare Contracting, sister publication to Repertoire.

Mullins learned the importance of clear communication and organizational change management through his experience in the armed forces, and supply-chain positions at Columbia/HCA, Shands at the University of Florida, and Baylor Scott & White in Dallas, Texas.

In May 2015, he joined IU Health to help direct the design, construction and implementation of that IDN’s Integrated Service Center, which opened for shipments in May 2018 – the first such center he was able to build from the ground up.

The 300,000-square-foot service center, located in the western Indianapolis suburb of Plainfield, is equipped with robotic goods-to-person picking technology, which allows staff to pick low-unit-of-measure supplies at a rate currently exceeding 130 lines per person per hour.

“We transformed our entire supply chain, and moved to self-distribution and self-contracting,” he says.

“I’m not sure everybody totally understood what it was we were doing. But knowing we have an impact on over 30,000 people who work here, we knew it was important that they understood at a high level – and some at a more granular level – what was going on, and what was to come.”

“I’m the youngest of four boys,” he says. “All of my brothers enlisted in the military right after high school, so it seemed like the logical thing for me to do at 17 years old.” He received training as a tank driver while a reservist in the U.S. Marine Corps. “I wanted to go to active duty, so I asked my oldest brother – who was an active duty Marine – for his advice. He told me to make sure I got a job that I could use on the outside.” But the Marines wouldn’t commit to anything other than what he had been trained on – driving a tank. “So I walked outside and went next door to the Air Force recruiter.”

Though he would have preferred training in air traffic control, he was assigned to medical supplies.“ Needless to

“ My time in the Air Force gave me a sense of purpose and a realization that the work we do in healthcare supply chain is bigger than ourselves. We provide vital care to those in need. I tell my staff that even though we are not in patient-facing jobs, we still provide healthcare, because we support the hands that heal.”

Air Force training Mullins was born and raised in The Bronx, New York.

He holds an MBA from Amberton University and is a candidate for a doctorate in business administration from Grand Canyon University. He served in the United States Air Force for 10 years as a medical materials specialist.

say, I grew to love the job, and am thankful that I’m not an air traffic controller,” he says.

“Life has a funny way of just happening,” he continues. After serving eight years of active duty service that included a deployment to Saudi Arabia in support of Desert Shield and Desert Storm, Mullins became a single parent of a three-year-old girl. “I continued to serve two more years with her by my side, but I came to realize that being a single parent in the military wasn’t the ideal situation for my daughter. It all worked out though. She’s 29 now, and I met my beautiful wife of 22 years, Audrey, because of it, too.

“I would have to say that my time in the Air Force gave me a sense of purpose and a realization that the work we do in healthcare supply chain is bigger than ourselves. We

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Sofia 2 Lyme FIA: CLIA-waived Results in minutes, not days.

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Sofia 2 Lyme FIA is the only rapid, near-patient testing solution that provides IgM and IgG differentiated results in a single test. It has demonstrated accuracy on par with current testing methods — all with less than 1 minute hands-on-time. And as you’ve come to expect from Sofia 2, our Lyme assay functions in WALK AWAY and READ NOW modes, providing flexible workflow options based on your needs.

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IDN OPPORTUNITIES provide vital care to those in need.

I tell my staff that even though we are not in patient-facing jobs, we still provide healthcare, because we support the hands that heal.

When it rains, it pours

“Taking time to let people know what we were working on set us up for success.”

Indiana University Health is the largest hospital system in Indiana by revenues, with 16 acute care hospitals, physician offices, ambulatory care ranging from home health to surgery centers, and a health plan. It has a partnership with Indiana University School of Medicine, the largest U.S. medical school by enrollment. The Academic Health Center in downtown Indianapolis includes Riley Hospital for Children at IU Health, the state’s most comprehensive children’s hospital; and IU Health Methodist Hospital, the largest hospital in the state.

Mullins joined IU Health in 2015, attracted by what he calls an opportunity to strategically make a difference.

“During my interview process, I got the sense from the executive team that they would be supportive of my vision of a world-class supply chain. We are still moving

toward that goal, but I believe that through the support they provide and the hard-working team that I have, we are well on our way.”

A rainstorm was the event that expedited IU Health’s decision to move ahead with an integrated service center. “Our building that held medical records and equipment was badly damaged, and we needed to make some short-term and longterm decisions,” says Mullins. “I felt that the integrated service center was the best business model.”

Despite prior experience with service centers throughout his career, Mullins took nothing for granted at IU Health, touring what he considered to be the bestin-class consolidated centers around the country.

He took a journalist’s approach to helping his team and others at IU Health understand the scope of the project, framing it in three simple questions: • What are we doing?

• Why are we doing it?

• How will we achieve it?

One goal As hospitals and non-acute-care sites merge to form large health systems, supply chain leaders face some human-relations challenges, says Dennis Mullins.

“ It’s a constant reminder: One team, one mission, one goal.”

“Over the past 30 plus years, I’ve watched and experienced the transformation of the healthcare supply chain,” he says. “Our career field has essentially gone from being just a support service department in the basement, to a strategic partner poised to help hospitals stay in the black. That’s a very exciting place to be.

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“However, that transformation has created a talent gap between facility operations and corporate operations. I’m passionate about my career, and I love helping those around me who have the ambition to grow their careers. I feel strongly that if they are not able to gain experience on both sides, we run the risk of having future leaders making strategic business decisions without the perspective to maximize patient care.”

Newly hired supply chain employees at IU Health facilities visit the IDN’s Integrated Service Center and gain exposure to related functions, such as value analysis and contracting, explains Mullins. “We hard-wire what we’re doing at the Integrated Service Center with what they will be doing at the site level.

“It’s a constant reminder: One team, one mission, one goal.”

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He posted placards with those questions – and answers – in every supply chain department. After that, he shared them with administration and clinical leaders.

“Taking time to let people know what we were working on set us up for success.”

Robotically controlled system The bulk of the IU Health’s investment in the service center was a robotically controlled picking system. Robots on rails operate on top of a cubic grid. After receiving orders wirelessly, the robots lower their gripper plates into a stack, grab the bin and lift it to the grid surface. If the robot needs a bin on, say, level 9, it digs out eight bins and places them on top of nearby stacks, using the space as a temporary placeholder. When finished, the robot puts the bins back in the same order. Orders are delivered to the port, and the operator picks up the product and prepares it for further processing.

“When you look at supply chain organizations in other industries, they’ve been using technology like this for years,” he says. “Anyone who knows me knows I’m a tech-y person, so robots picking supplies fits right in.

“Seriously, though, we selected a great partner at the Integrated Service Center, whose vision aligned with ours. I believe the ability to pick low-unit-of measure at

high accuracy and velocity sets us up well to support our 400-plus non-acute locations around the state.”

In 2018, the supply chain team focused on bringing all of IU Health’s 16 hospitals into the integrated service center. Today, supply chain purchases the majority of the IDN’s supplies directly from manufacturers, while continuing to rely on distributors for secondary support.

In 2019, Mullins and his team will explore and act on opportunities for product standardization across the system, as well as on reducing operating costs. “Every truck that leaves our dock costs money,” he points out. “If we can streamline deliveries and routes, thereby reducing the number of deliveries, we will save money.”

In fact, Mullins believes that the Integrated Service Center will help IU Health save up to $3 million annually, considering pricing discounts (through direct purchasing from manufacturers), product standardization, inventory reduction and improved logistics. “And the self-distribution of medical supplies is only the first step,” he says.

With approximately 120,000 square feet of the Integrated Service Center yet to be built out, the center can offer IU Health’s acute- and non-acute-care facilities pickup-anddelivery services for many other kinds of goods.

“It is the vehicle for change,” he says. “There’s so much more value this business model can bring to IU Health.”

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17

Excellence in Sales W

hat is excellence in sales? Numbers help, for sure. But every Repertoire reader knows it’s more than that. It’s that drive to get better, to help people, to have an impact on something meaningful. More often than not, it’s also fun.

This year, as we have since 2000, Repertoire recognizes two people – one from the distributor side, one from the manufacturer side – who embody that excellence. See if you can’t find something of yourself in their stories.

2019 2018 2017 2016 2015 2014 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000

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Distributor

Manufacturer

Jarrel Watkins, McKesson Mike McGoldrick, Henry Schein Victor Bakkar, McKesson Medical-Surgical Mike Ludwig, Henry Schein Todd Matthews, McKesson Medical-Surgical Chuck Ryan, McKesson Medical-Surgical Paul Lilly, McKesson Medical-Surgical KC Meleski, Claflin Equipment Steve Marshall, Cardinal Health Rich Bilz, Henry Schein Tom Jacob, McKesson Medical-Surgical Dick Daley, Affiliated Healthcare Systems Mike Leva, Claflin Company Marty McCurdy, PSS Denise Hassler, Caligor James Barnes, Cardinal Health Jim Wheeler, Seneca Medical Linda Phillip, McKesson Extended Care Brad Jacob, McKessonHBOC

Stephen Raggio, Welch Allyn Dianna Hundl, Quidel Patrick Thombs, Clorox Healthcare Chris Huppert, Midmark Nick Riordan, Welch Allyn Nate Williams, Midmark Louis Cupo, Cardiac Science Mimi Hobson, Terumo Mike Paige, Med Care Associates Tommy Whitehead, Midmark Denny Monnin, Midmark Bob Chaldu, TIDI Products Jack Moran, Med Care Associates Steve Bakalar, Welch Allyn Jeff Daner, Midmark

www.repertoiremag.com

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Excellence in Sales

The Natural Twenty-three years into it, Jarrel Watkins is still learning about the industry he was born into

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When Jarrel Watkins began his career in medical sales

Work ethic

23 years ago, he thought it was all about selling his products. He has since learned otherwise.

“I wish I had known 20 years ago the value of consultative selling,” he says. “It’s so much more productive and sustainable to have a conversation with a customer rather than a sales call.”

Watkins, account executive for McKesson MedicalSurgical servicing Jackson, Mississippi, and surrounding areas, is the recipient of this year’s Repertoire/HIDA Excellence in Sales Award for a distributor.

Watkins was born and raised in Jackson. His father, Angus “Dan” Watkins, was a Korean War veteran who worked for most of his life in the medical distribution industry, first with Whittaker General Medical, then Stover Co. – both of which are now McKesson Medical-Surgical.

Dan Watkins was a sales rep for a while, then vice president of operations for General Medical. Later, he ran operations for a small Jackson-based medical supply company named Healthcare Suppliers. His son, Jarrel, worked in the warehouse during summers while attending college.

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Better Together At McKesson, we’re proud of the strong relationship between our sales teams and our suppliers. Together, we bring value to our customers that is Hall of Fame worthy.

Thank you!

Š 2019 McKesson Medical-Surgical

Excellence in Sales “Sometimes he has a better understanding of the customer’s needs than the customer.”

and assume a position with more reDan Watkins died at age 52, sponsibility. He did so. But after bewhen Jarrel was 18, but not before ing back a few years, he realized he teaching his son some valuable lesmissed medical sales. sons about work and life.

“Being around the warehouse “My father prided himself in with my father as a child and workknowing every item he had in inventoing there with him while I was in high ry, no matter what the computer said,” school” was one reason he missed the says Watkins. “I don’t know if there industry. “I just liked that there were was ever a time when he wasn’t workso many different products I could ing a spreadsheet at his desk at home.

–Andrew Price sell. I always felt like I belonged here.

He also taught me humility. I don’t I also think part of me felt it kept me ever recall him talking about himself, close to my father in some way. because it was never about him.”

“So I decided if the right opporHis father’s sudden death taught tunity came available, I would try to Jarrel another valuable lesson – the get back into the industry I missed fragility of life and how quickly one’s so much,” he says. In 1995 he saw circumstances can change. an ad in the local paper for a posiFollowing his father’s death, tion with General Medical. “I could Jarrel’s mother, Cleo, demonstrated not believe it. It was like it was meant amazing strength and toughness, he to be.” He interviewed with Alan says. Not surprising. She had been Ramsey. “I think I called him every one of 13 kids growing up in rural day for six months, asking for the Mississippi, where she worked in the job.” He was hired in March 1996. fields on the family farm. “She said the only reason her parents had so many kids was for the free labor,” he Selling style says. “Again, strong work ethic. She “Jarrel has amazing customer relaeven built a beauty salon on the front tionships,” says Scott Cunningham, of our house when I was around nine or 10, just to have area sales manager for McKesson Medical-Surgical, who her own money.” once competed with Watkins in the Jackson territory when Cunningham was a PSS rep. (McKesson Medical-Surgical acquired Jacksonville, Florida-based PSS in 2013.) “He The call of medical sales has figured out that this is a relationship business, and Graduating from the University of Southern Mississippi he has spent years developing the trust it takes to be sucwith a degree in business administration, Watkins took a cessful in this industry. He is consistent, prompt with job as a sales representative for a small food manufacturer follow-up, and offers a consultative selling style. in Mississippi. “They had a representative for their retail “I would also say that he understands precisely the market, but needed [someone] for food service,” he reever-changing landscape of healthcare, and has a very dicalls. The owner had previously used a broker, but wanted verse customer base,” he continues. “Not only is he profito build more direct relationships with distributors. cient with the independent market, he has navigated quite But medical sales called. His father’s former emnicely into the IDN market space, the ambulatory surgery ployer, Healthcare Suppliers, needed a rep to call on freecare market, and the physician office laboratory. standing dialysis centers in Houston. Watkins took the job “Jarrel has a lot of respect for our manufacturing and moved there. partners, and he works closely with them to bring soluAfter a couple of years, his former employer, the tions to his customers,” adds Cunningham. “He is open to food company, invited Watkins to come back to Jackson

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Excellence in Sales working with all of them, but he has excelled by focusing on the POL and working closely not only with our laboratory partners, but also our own McKesson resources.”

Watkins was an early adopter of the technology McKesson has developed to help account executives navigate and streamline their business, he says.

Watkins himself believes that technology is the driving force behind many changes taking place in healthcare today, including the electronic medical record, changes in reimbursement and other things.

“ If you’re focused, and you know what you can bring to the table – that’s how you build relationships.”

– Jarrel Watkins

“With all these massive changes, it’s more important than ever for my customers to have access to as much information as possible to make successful decisions for their practice or organization,” he says. They want to know where their spend is going, better ways to manage their business, and how to keep control of their budget.

“That puts me in a great position, because no company in our industry makes more analytics available to their customers than McKesson.”

Empathy Watkins knows how to build strong relationships with his manufacturer partners, says Andrew Price, territory portfolio manager for Midmark.

“Jarrel has an ability to empathize with others,” he says. “It’s a fast-paced business. You can be doing 20 things one day, a hundred the next. He gets that. He understands that most likely, the person he’s contacting is just as busy as he is. So it’s not, ‘What can you do for me now?’ but ‘How can we coordinate our efforts?’”

With customers, Watkins goes above and beyond, adds Price. For example, if a practice says it needs an exam table, Watkins doesn’t merely fill the order, but instead takes the time to learn why the practice is looking

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for a table. “Sometimes he has a better understanding of the customer’s needs than the customer. He’s not just checking boxes and trying to fill orders.

“He’s not an account manager. He’s a solutions provider.”

Says Watkins, customers are busier than ever, and they don’t have time to sit down and talk about the kids or their vacation. “But they will have time for you if you come with a purpose. If you’re focused, and you know what you can bring to the table – that’s how you build relationships. That’s when you become more of a consultant.”

Twenty-three years into his career, Watkins is still learning.

“I think medical sales is one of the most diverse career paths out there,” he says. “From equipment and diagnostics, to technology and everything in between, there is unbridled opportunity. And the caliber of people you get to meet and interact with is as diverse as the products. It makes it a lot more fun.”

One of his greatest sources of joy is his 15-year-old daughter, Zoe. “Her sense of humor, kindness, and toughness make me excited for her future and mine as well,” he says. Another source of joy is his partner of the last four years, Lisa. A single mother of three children, she moved to America from India in 1996 at the age of 26. “Her ability to ‘just get it done’ knows no bounds,” he says.

So many mentors When asked about mentors, Jarrel Watkins points first to Drayton Holley, whom he worked with in Houston for Healthcare Suppliers. “That guy was unflappable in front of a customer, and he had a great business acumen,” he says. And at McKesson Medical-Surgical, he points to many peers and team members who were strong in sales and eager to help others succeed.

“Guys like Mitch Schidler and Will Stone on my first team; David Songy, Bobby Kahn, Scott White, Chris Walter on my second team; David Gentry, Don Davis, Tim Hicks on my current team. And so many others along the way.”

And lower in cost!

Excellence in Sales

Getting Better all the Time Stephen Raggio looks, listens, learns, then improves his game

Want to learn about B2B sales? Try selling copiers.

“I’ve never heard that many ‘no’s’ in a single day – every day,” says Stephen Raggio about his first sales job, with office equipment maker Ricoh USA. “It builds grit and determination.”

Raggio learned from the experience, then entered medical sales in 2016, and today is an ambulatory care sales representative for Welch Allyn in Louisiana and Mississippi. He is also the recipient of the Repertoire/HIDA Excellence in Sales Award for a manufacturer.

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Tested and proven accuracy

When accuracy counts, you can count on Welch Allyn.

Healthcare providers are treating patients with more complex conditions as almost one-third of Americans live with multiple chronic diseases.1 And with chronic conditions expected to rise,2 accurate screening tools are more vital than ever for reliable detection, diagnosis and management.

The Welch Allyn ConnexÂŽ Spot Monitor acquires a full set of accurate patient vital signs in just under a minute,3 sending results directly to the EMR. Plus, automated blood pressure averaging provides enhanced decision support4 through a series of averaged readings to help practitioners detect and diagnose hypertension with confidence.

Blood pressure averaging view

Experience the confidence that comes with accurate, reliable readings.

Contact your Welch Allyn representative today, or visit us online at www.welchallyn.com/ConnexSpotMonitor to learn more.

1

Agency for Healthcare Research and Quality. Multiple Chronic Conditions Chartbook: 2010 Medical Expenditure Panel Survey Data. (2014) Accessed at http://www.ahrq.gov/professionals/ preventionchronic-care/decision/mcc/mccchartbook.pdf

2

Tackling the burden of chronic diseases in the USA. Lancet 2009;373(9659):185. Accessed at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60048-9/fulltext

3

Estimate based on standard acquisition times for Welch Allyn sensors: Approximately 15 seconds for blood pressure, 4 to 7 seconds for temperature, and 8 to 12 seconds for SpO2.

4

Robert Smith, MD. Blood pressure averaging methodology: Decreasing the risk of misdiagnosing hypertension

Š 2019 Welch Allyn

MC15655

Excellence in Sales Born and raised in and around New Orleans, Raggio thought about a medical career – but not sales – while in school.

His father, Christopher Raggio, has always been in sales, currently working as a territory manager for Cordstrap, which makes container lashing equipment. His mother, Susan Giurintano, recently retired after a 30-year career working as an office manager for an orthopedic surgeon.

Raggio himself graduated from Louisiana State University with a degree in kinesiology and exercise science, and worked as a physical therapy technician while completing his degree. But the more he learned about physical therapy, the more he questioned whether it was his calling.

only people who stick it out are those who can hustle, grind, deal with rejection,” they told him. What better proving ground than copier sales?

He called the Ricoh manager. They were hiring. He took the job … and found out that his friends were right.

“I saw a lot of people come onto the sales team, then leave three months later,” he says. “It’s not fun being told ‘No’ or ‘Get out of my office.’ But it definitely taught me discipline.” He maintained a rigid schedule, making as many as 100 cold calls and four meetings a day.

With that experience under his belt, Raggio decided to pursue a career in medical sales, attracted by the opportunity to work independently and to run a territory as his own “business.” “There were also so many different avenues in medical sales,” he says. “I was intrigued by the future possibilities once I broke into the field.” In 2016, he joined Trumpf Medical, a manufacturer of OR equipment.

He loved the job, but saw that advancement in the company would probably mean moving out of state. When an opportunity with Welch Allyn opened up in Louisiana, he threw his hat into the ring.

“What was most important to me was staying close to my family and friends, and being able to live in New Orleans,” he says. He was also impressed by the tenure of Welch Allyn representatives, many of whom had been with the company from 10 to 20 years.

“My main goal was to find a position I could treat as a lifelong career, and not another ‘job,’” he says. He joined Welch Allyn in March 2018.

“ Distributors have much better relationships with customers than I do, so when I am brought in, it is my job to keep their relationship intact and, hopefully, make it even stronger than before.”

For one thing, physical therapy involved a lot more administrative work than he had anticipated, he says. “I was more interested in the medical aspects.”

For another, he wondered where this career would take him long-term.

Searching “When I decided not to become a physical therapist, I was stumped on what to do, so I turned to my father for some advice. I knew I wanted to do something in healthcare, and I had heard that medical sales could be a very good field. He told me medical sales was an extremely tough field to break into, but people can excel in it and have very good careers.

“After that conversation, I did tons of research through online forums, my network of friends and their parents, basically anyone who would take five minutes to talk to me about their experience.”

Many of those people told him that B2B sales – cold calling – would be a fast track to medical sales. “The

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A learner “One of the very first things that jumped out about Stephen was his coachability,” says Mark York, area vice president, ambulatory care for Welch Allyn. “We all have seen individuals who do a great job listening and seeking advice only to go straight back to their previous habits. Stephen always seems to put a plan around the advice he receives from leadership and peers. I can almost ask him about any conversation

we had about a challenging account, and even three to four months later he will tell me the strategy he put in place after our discussion, and the next steps involved.

“His contributions to our team discussions are always well thought out and have a lot of actionable items the team can feed off of. But more important, he constantly seeks information from his peers. I love the fact that he can have the results he has, lead with so much information, but remain humbled enough to continue to learn from the rest of the team.”

Raggio works with over 50 distributor representatives on a weekly basis, and continually targets strategic IDN and large end-user clinical groups as well, says York.

“He has taken a role that historically has been very transactional and has adapted to the changing healthcare market to make his efforts much more strategic.” What’s more, he has found a way to break down walls and penetrate difficult accounts, he adds.

“The most important thing I have learned with distribution is to be reliable, trustworthy and professional,” says Raggio. That means returning phone calls and emails promptly, providing regular updates on Welch Allyn equipment and how it can be of value to customers, and to follow through on things he has promised.

“I ensure the customer is always No. 1 and always taken care of, because at the end of the day, [my distributors’] customers are my customers. If the customer is happy, they will continue to work with my distributors, and my distributors in turn will continue to support me.

Distributors have much better relationships with customers than I do, so when I am brought in, it is my job to keep their relationship intact and, hopefully, make it even stronger than before.”

job at Ricoh in order to leverage that experience to break into the medical field. He also helped me immensely in the medical device interview process.”

• Brent Pasquarella, a competing copier rep out of Florida, “who helped me immensely in sticking to my goals during my time at Ricoh and worked with me through role plays, business planning, etc.”

• TJ Corkery, with Trumpf Medical, who “taught me how to effectively cold call and create value for the customer and build strong, lasting relationships with my customers.”

“ Stephen always seems to put a plan around the advice he receives from leadership and peers.”

– Mark York

• Matt Gleason with Welch Allyn, who had Raggio’s territory in Louisiana almost five years ago. “I still speak to him multiple times almost every week about current customers, understanding the territory, getting advice on working with my distribution partners, etc.

He is always available to me and I cannot put enough emphasis on how much I value his help and insights.”

• The entire Welch Allyn team in the South Central Region. “I have talks with each of these individuals on a regular basis, and I can ask them anything and get a very quick response. … They have been instrumental in getting me up to speed and allowing me to understand the business.”

Mentors Raggio says he could name many people who have mentored him since graduating from college, including people he currently speaks with for advice. Some of them are: •R yan Stropolo, “a Stryker representative who also worked for Ricoh a few years before me, who taught me the importance of standing out in my first B2B

Raggio has two brothers: Daniel, who works for JP Morgan in Dallas; and Blake, an ENT doctor who at press time was about to begin his fellowship in facial plastics.

Raggio’s fiancée, Layne Neitzschman, is in physician assistant school at LSU Health in Shreveport. The two plan on getting married in December 2019.

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SPONSORED: ARKRAY USA

A simple solution for swallowing difficulties The ability to swallow is something that young people

seldom think about. But for the elderly, it can be an issue.

That’s because aging can negatively impact one’s ability to swallow. That in turn can threaten a person’s ability to eat nutritious food, remain hydrated, and even take medications.

ARKRAY USA’s Assure® Slide swallowing aid is a simple solution for those who have difficulty swallowing pills, capsules or tablets.

A condition among the elderly Anatomical issues that can adversely affect swallowing –particularly among the elderly – include reduced tongue size and strength, reduced strength in the upper throat, reduced size and strength of the vocal cords, or a poor ability of the lower

throat (esophagus) to move food into the stomach, according to the American Academy of Otolaryngology.

In the long-term-care setting, one finds all of these conditions and others, says long-term-care nutrition expert Brenda Richardson, MA, RDN, LD, CD, FAND. One resident may have a tumor, or may suffer from a condition such as ALS, Bell’s Palsy, multiple sclerosis or Parkinson’s Disease, all of which can affect one’s ability to swallow, she points out. Stroke can have an adverse effect as well. So can taking multiple medications, which can lead to dry mouth – and difficulty swallowing.

Dealing with these issues is a team effort, says Richardson.

Staff may have to teach one resident how to eat more slowly,

while for another, proper positioning of the head, chin and even shoulders, hips and knees is of paramount importance.

A simple solution For residents with difficulty swallowing pills and capsules, caregivers often crush the medications and administer them in a liquid or soft food. But that’s not always a suitable solution, says Richardson. Some pills or tablets can lose their effectiveness if crushed, and some are not intended to be mixed with others.

ARKRAY USA’s Assure® Slide can simplify the way tablets, capsules and powders are administered. It works in four ways: • The gel is thick and smooth to allow for easy swallowing of tablets and a smooth passing through the esophagus to the stomach.

• Assure Slide moistens the mucous membranes in the mouth and throat cavity, allowing the tablet, capsule or powders to pass smoothly through the esophagus.

•A ssure Slide breaks down immediately in the stomach and does not affect the absorption rate of medication.

• The fresh flavor and aroma of Assure Slide may eliminate the unpleasant taste and smell of tablets, capsules and powders.

“As a leader in the long-term care market, ARKRAY is always looking for innovative products to bring to our customers,” says Richard Slouffman, vice president of the Professional Healthcare Division at ARKRAY USA. “Up to 33 percent of long-term care residents have some degree of swallowing difficulty for reasons such as fear of choking, dry mouth, or dysphagia.

“Assure Slide has been extremely well received in Europe and Australia by healthcare professionals who use it instead of food carriers, such as applesauce or pudding, to provide residents a more positive and comfortable experience when administering medication,” he says. “This helps to ensure complete therapeutic benefit of the medication.

“Assure Slide has the potential to greatly improve clinical protocols when caring for people with swallowing issues by helping them maintain compliance with medication regimens.”

For more information on Assure Slide, visit our website at Assureslide.com, or call (800) 818.8877.

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Assure Slide is a swallowing gel designed to help those Assure Slide isswallowing a swallowing gel designed help those with difficulty tablets, capsulestoand powders. with difficulty swallowing tablets, capsules and powders. + Easy to access + Store Easy to onaccess the medical cart Store on the medical cart + No food carrier needed + No food carrier No need to use aneeded fruit sauce, No need use carrier, a fruit sauce, yogurt orto other to aid yogurt or other carrier, to aid with swallowing with swallowing + Pleasant-tasting + Pleasant-tasting Raspberry or vanilla flavored Raspberry or vanilla flavored

+ Only a small amount is needed + Only a small amount is needed One teaspoon helps tablets One teaspoon helps tablets glide down the esophagus glide down the esophagus + No known effect on absorption + No known effect on absorption Breaks down immediately in Breaks downand immediately the stomach does not in affect the stomach does not affect absorption ofand medication absorption of medication + Offered in two thicknesses + Offered in two thicknesses – Zero (moderately thick) – Zero (moderately thick) – Forte (extremely thick) – Forte (extremely thick)

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SA012-00 Rev. 02/19

POST-ACUTE CARE

The Sepsis Puzzle Sepsis disguises itself too well

Sepsis: It’s subtle, and deadly. It offers some clues of

its existence, but you have to be watching for them. Early diagnosis is essential to stop it in its tracks.

Sepsis impacts between 900,000 and 3 million people in the United States each year, according to Terri Lee Roberts, BSN, RN, CIC, FAPIC, senior infection preventionist for the Pennsylvania Patient Safety Authority, who has written and spoken extensively about the subject. Over a two-year period (April 2014 – March 2016), 486 potential occurrences of sepsis with 17 potential

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sepsis-related fatalities were recorded for residents in long-term care in Pennsylvania, she says.

With a mortality rate of 15 percent to 30 percent, it is a leading cause of death in the United States. Adults age 65 years or older are five-fold more likely to have sepsis than younger adults (6.5 percent vs. 1.3 percent), and nursing home residents are seven-fold more likely to have sepsis, compared with sepsis rates in adults not residing in a nursing home (14 percent vs. 1.9 percent). Eighty percent of sepsis cases occur outside of the hospital.

“Over 70 percent of patients who present with sepsis will recover if treatment is initiated on a timely basis and pursued aggressively,” says lab expert Jim Poggi, principal, Tested Insights, Providence Forge, Virginia.

“The key is early diagnosis and initiation of treatment, typically with broad spectrum antibiotics and fluid replacement therapy.”

But oftentimes, early identification and treatment fail to occur.

“The signs of both infection and organ dysfunction may be subtle and difficult to recognize in older adults with multiple comorbidities,” says Roberts.

“Fever may be absent. There is a lower incidence of tachycardia and hypoxemia. Confusion, delirium, weakness, falls, anorexia, and incontinence may be symptoms of sepsis, but they can be non-specific in older adults.”

What’s more, in long-term-care facilities, it’s often a certified nursing assistant (CNA) – not a professional nurse – who is at the bedside with the resident, and the CNA may not recognize these subtle changes in a resident’s medical condition as an early sign of sepsis, she adds.

What it isn’t … and what it is “First of all, a couple of things sepsis is NOT,” says Poggi. “It is NOT a disease and it is not contagious.

While its onset is a complication of an infection, sepsis is the body’s overwhelming and life-threatening response to the infection.”

While any infection can lead to that life-threatening response, some have a higher association with sepsis, says Poggi: •R espiratory infections including pneumonia, group A streptococcus and influenza.

• Urinary tract infections.

• Enteric (GI) diseases, including C. difficile.

• Skin infections, including MRSA. • Blood stream infections (bacteremia).

In 2016, the Third International Consensus Definitions for Sepsis and Septic Shock defined sepsis as the development of systemic inflammatory response syndrome (SIRS) in addition to a documented or presumed infection, continues Poggi. SIRS symptoms include: •F ever of more than 38°C (100.4°F) or less than 36°C (96.8°F).

• Heart rate of more than 90 beats per minute.

• Respiratory rate of more than 20 breaths per minute or arterial carbon dioxide tension (PaCO2 ) of less than 32 mm Hg. • Abnormal white blood cell count (>12,000/µL or < 4,000/µL or >10% immature [band] forms).

The Sepsis Alliance – a nonprofit organization dedicated to raising awareness of sepsis – uses an acronym to define typical patient conditions that can lead to a presumptive diagnosis of sepsis: • S: Shivering, fever or very cold.

• E: Extreme pain or discomfort.

• P: Pale or discolored skin.

• S: Sleepy, difficult to rouse, confused.

• I: “I feel like I might die.”

• S: Shortness of breath.

Diagnosis On the laboratory front, sensitivity, specificity and speed of available tests have presented challenges, says Poggi.

CBC tests, including elevated WBC and decreased platelets, are sensitive but non-specific. The same is true of lactate and C-reactive protein. While microbiological cultures can identify specific organisms, routine plated media methods have lacked the speed needed to support a rapid diagnosis.

Lab diagnostic tools include: • Blood, wound or urine culture.

• Molecular testing for specific pathogens.

• Complete blood count with differential.

• Serum lactate.

• Procalcitonin.

• Metabolic and organ panels, including Basic Metabolic panel, AST, ALT, creatinine and urea nitrogen.

“Recent advances in molecular assays that can diagnose a variety of pathogens within hours have substantially improved speed of result for bacterial identification,” says Poggi.

Procalcitonin is a newer assay that is highly correlated to sepsis as well as its progression, he continues. Procalcitonin concentration is < 0.15 ng/ml in normal patients, but quickly rises in concentration with severity of the disease process (0.15-2.0 ng/ml for mild bacterial infections and > 2.0 ng./ml for sepsis). In addition, the procalcitonin test can be performed within hours rather than days.

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POST-ACUTE CARE

Sepsis: After the hospital stay Sepsis is the leading cause of death of hospital patients, and half of survivors do not completely recover, with a third of those dying in the following year and a sixth experiencing severe, persistent physical disabilities or cognitive impairment. In one study, only 43 percent of previously employed patients returned to work within a year of contracting septic shock and only 33 percent of patients living at home prior to contracting sepsis returned to living independently by six months following their discharge.

University of Pittsburgh and University of Michigan medical scientists studied the issue and developed recommendations for posthospital recovery care.

“We need to focus not only on saving the patient’s life, but on ensuring the patient will have the best possible quality of life after leaving the hospital,” said Derek Angus, M.D., M.P.H., chair of University of Pittsburgh’s Department of Critical Care Medicine, and an author of a recent article about sepsis in the Journal of the American Medical Association.

In the public eye Awareness of sepsis among the public is higher than ever, but there is more work to be done, says Roberts.

A 2012 incident involving a 12-year-old boy in New York drew national attention to sepsis.

On March 28, 2012, the boy, Rory Staunton, scraped his arm diving for a ball in gym class. No one recognized the early signs of sepsis and he was misdiagnosed with dehydration. By the time he was diagnosed with sepsis, it was too late, and Rory died on April 1.

His death was a springboard for a discussion about the seriousness of sepsis.

The Centers for Disease Control and Prevention (CDC) launched a comprehensive campaign targeting clinicians and the public on how to prevent sepsis, how to identify risk factors, how to recognize warning signs, and why medi-

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Angus and lead author Hallie Prescott, M.D., M.Sc., assistant professor of pulmonary and critical care medicine in University of Michigan’s Institute for Healthcare Policy & Innovation, recommend three strategies to prevent long-term disabilities: • High-quality early sepsis care that includes rapidly following protocols to help the patient fight infection, managing pain through light sedation that allows for the patient to be awakened and reoriented daily, and encouraging early mobility while the patient is still hospitalized.

• Post-discharge assessment and treatment that gets patients into rehabilitation with physical, occupational and speech therapy shortly after discharge, and quick referral to therapists if new impairments develop.

• Screening of patients for conditions that may have been present prior to hospitalization, such as high blood pressure, and tailoring post-discharge medications to account for individual patients’ increased susceptibility to new complications.

cal attention should be sought immediately, as sepsis is a medical emergency. The CDC wanted people to ask the question, “Could this be sepsis?” says Roberts.

“Sepsis Alliance has done a great job of raising awareness that people who were otherwise healthy have succumbed to this syndrome,” says Roberts, who has had personal experience with sepsis. About 10 years ago, her 10-year-old nephew almost died from sepsis after developing an infection from a splinter of mulch under his fingernail. Several days passed before the infection – and resulting sepsis – was finally identified, and he is healthy today.

Screening for sepsis Although anyone can get an infection, and any infection can lead to sepsis, some people are at higher risk of infection and sepsis, says Roberts. They include:

Q2 2019 MEDICAL PROMO APRIL 1 – JUNE 30, 2019

• Adults 65 or older and children less than 1.

• People with chronic medical conditions such as diabetes, lung disease, cancer, and kidney disease.

• People with weakened immune systems, such as those who have had a solid organ transplant, people who are on long-term steroid therapy or taking chemotherapy. Additionally, immune function decreases with age.

Because of the difficulty in identifying sepsis, a long-term-care-specific sepsis screening tool may help to optimize safety in this population, she says. INTERACT’s “Stop and Watch Early Warning Tool” or the Minnesota Hospital Association’s LTC-specific “Seeing Sepsis Tool Kit” to facilitate early detection of sepsis are available for healthcare providers to use. “I am often called upon to provide education regarding

“ It’s the team members who spend the most time with the resident – not just licensed professionals – who can best recognize subtle changes in a resident’s condition.” –Terri Lee Roberts the early detection of sepsis in all healthcare facility types, whether it be through professional conferences, statewide/multistatewide webinars, or in-person presentations,” she adds.

Judicious use of an electronic health record can help.

“The EHR has the strong potential to improve the detection of sepsis early by collecting and organizing the clinical data required to make the diagnosis,” says Roberts.

More specifically, a facility’s EHR system could collect vital signs and laboratory test information on patients, triggering a “sepsis alert” for those with the facility’s defined parameters, such as ≥2 SIRS (systemic inflammatory response syndrome) criteria (fever, tachycardia, tachypnea, leukocytosis) plus ≥1 major organ dysfunction (SBP ≤ 90 mm Hg, lactic acid ≥2.0 mg/dL).

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POST-ACUTE CARE

Reprinted permission of the Minnesota Hospital Association

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“A facility could incorporate their chosen sepsis screening tool into their EHR system, and a positive screening could trigger a ‘sepsis alert,’” she adds.

Communication Screening and early detection are just the beginning.

Without good communication among the long-term-care team, little action may result.

“Because the sepsis syndrome is comprised of a constellation of signs and symptoms, and because no one test can identify sepsis, the healthcare team must communicate effectively and timely to recognize the signs of early sepsis and implement evidence-based therapies to improve outcomes and decrease mortality,” says Roberts.

“Healthcare providers – not just LTC team members – may have different communication styles. Differences in training, cultural differences, culture barriers, etc., may lead to lack of communication, miscommunication, or ineffective communication.” Exacerbating the situation are high turnover rates among CNAs, decreased continuity of care, and the fact that many clinicians are not onsite to be able to communicate with the rest of the healthcare team directly.

“It’s the team members who spend the most time with the resident – not just licensed professionals – who

can best recognize subtle changes in a resident’s condition,” she says.

“When I worked in a facility as an infection preventionist, I made everyone my front-line ‘infection prevention eyes.’ “I would tell them, ‘If you see something you don’t think is right, tell someone.”

“ While its onset is a complication of an infection, sepsis is the body’s overwhelming and life-threatening response to the infection.”

– Jim Poggi

She recalls a situation where an environmental services staff member recognized that one patient – a 16-year-old boy – was acting differently. Over about 12 hours, the patient had lost his interest in video games and didn’t want to talk, as he had before. It turns out the boy had indeed developed sepsis. But he was treated in time to save his life.

“Everyone plays a role.”

Editor’s note: INTERACT® (Interventions to Reduce Acute Care Transfers) is a quality improvement program from Pathway Health (www.pathway-interact.com) that focuses on

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POST-ACUTE CARE

Rory Staunton’s story The parents of 12-year-old Rory Staunton have done much to raise the public’s awareness of sepsis. They tell his story on the website of the Rory Staunton Foundation for Sepsis Prevention.

“In March 2012, our son Rory was a strong, 5-foot-9-inch, 169-pound, 12-year-old boy, living a life full of laughter and love. … On Wednesday March 28, 2012, Rory dived for a ball during gym class at the Garden School in Jackson Heights, NY, and cut his arm. The gym teacher did not send him to the nurse, who was on duty in her office, but instead applied two band-aids. He did not

The laboratory in the hospital had flagged Rory’s blood as showing an abnormality within an hour of Rory’s arrival there, but there was no system in place and no one took the time to alert the emergency room with this information. clean Rory’s wound. After midnight Rory woke up moaning with a pain in his leg. We coaxed him back to sleep and the following morning he had a fever of 104.”

The pediatrician diagnosed a stomach virus that had been making its way around New York.

“She advised us to take him to the hospital for rehydration and fluids, she said he would have diarrhea the next day and the virus would run its course. Dr. Levitsky assured us there was ‘nothing to worry about.’

“We made our way to the ER department at a major New York medical institution, where the doctors said Rory’s discomfort was caused by a sick stomach and dehydration. They gave him two bags of intravenous fluids. Three vials of blood were drawn and he was given a prescription for an anti-nausea drug called Zofran.

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“The pediatrician at the hospital who examined Rory wrote ‘pt improved’ on his chart before discharge. She said it was a stomach virus and that Rory could take up to a week to recover.

“We brought Rory home on that Thursday night; he fell into a deep sleep but the following morning Friday, he continued to complain of pain.

We repeatedly called his pediatrician … and told her Rory wasn’t eating and we couldn’t control his temperature with Tylenol or Motrin. We brought Rory back to hospital on Friday evening and this time they admitted him to the ICU. He was gravely ill.

“Rory was fighting a serious infection. This infection had been in his blood when we brought him to his pediatrician and to the hospital on Thursday. Bacteria had entered his blood, through the cut on his arm. Rory was in septic shock.

“When we brought Rory to his pediatrician and the emergency room on Thursday night, he was in fact fighting for his life. Critical information gathered by his pediatrician and at the hospital that night had not been viewed as important. In fact, Rory’s vital signs had worsened before he left the emergency room on Thursday night.

“The blood values that the doctor ordered stat (immediate) were not viewed by the hospital doctor who ordered them. The laboratory in the hospital had flagged Rory’s blood as showing an abnormality within an hour of Rory’s arrival there, but there was no system in place and no one took the time to alert the emergency room with this information. When the critical value tests returned showing Rory was extremely ill, we had already left the hospital.

“The hospital made no attempt to follow up with us, his family, to inform us that he was seriously ill. Our pediatrician did not follow up with the hospital on Friday when we called her with our concerns that he was not improving.

“Rory fought valiantly to survive throughout Friday and Saturday but it was too late. On Sunday evening, Rory died.”

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DIABETES

Diabetes: In the News Updated recommendations from ADA The American Diabetes Association’s (ADA’s) Standards of Medical Care in Diabetes is updated and published annually in a supplement to the January issue of Diabetes Care. Based on new data, ADA changed the criteria for the diagnosis of diabetes to include two abnormal test results from the same sample (i.e., fasting plasma glucose and A1C from same sample). Additional conditions were identified that may affect A1C test accuracy including the postpartum period.

The ADA’s Professional Practice Committee, which includes physicians, diabetes educators, registered dietitians, and public health experts, develops the Standards.

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The Standards include the most current evidence-based recommendations for diagnosing and treating adults and children with all forms of diabetes.

Look up Standards of Medical Care in Diabetes — 2019, American Diabetes Association, at http:// clinical.diabetesjournals.org/content/37/1/11?utm_ s o u r c e = Tr e n d M D & u t m _ m e d i u m = c p c & u t m _ campaign=Clin_Diabetes_TrendMD_0

‘Midlevel’ providers not so ‘midlevel’ Patients with diabetes who received care from nurse practitioners and physician assistants working within the U.S. Veterans Affairs health system had outcomes

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DIABETES equivalent to those of patients cared for by physicians in a primary care setting, according to a study published in the Nov. 20 issue of the Annals of Internal Medicine.

Data was analyzed from 568 VA primary care centers, involving more than 350,000 adults with pharmaceutically treated diabetes.

The upshot? By using a team approach, healthcare providers are fully capable of providing high-quality care to patients with chronic disease.

“Given the right system – with resources to provide education and support, along with referral to an endocrinologist or a diabetes team if needed, and including

Researchers led by the Massachusetts of Technology have developed a drug capsule that could be used to deliver oral doses of insulin, potentially replacing the injections that people with type 1 diabetes give themselves every day, reported MIT in February. more innovative programs, such as telehealth, online programs, and device-based data transfer and support – persons with diabetes can achieve their goals,” writes Anne L. Peters, M.D., Keck School of Medicine of the University of Southern California, in an editorial. “Moreover, it is time to stop calling NPs and PAs ‘midlevel’ providers, as is common in certain systems. Nurse practitioners and PAs are competent PCPs in their own right and should be fully accepted as such.”

Racial, ethnic disparities Based on nationally representative data from 2015 and 2016, the Agency for Healthcare Research and Quality in December published a “Statistical Brief ” regarding treatment and monitoring of adults with diabetes age 18 and over. The report offers estimates of the prevalence of

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reported diagnoses by race/ethnicity, and then focuses on differences among racial/ethnic groups in treatment and monitoring of the condition. Here are a few findings.

• An average of 10 percent (about 24.8 million people) were ever told by a health professional they had diabetes. Overall, blacks (13 percent) were more likely to have been diagnosed with diabetes than Hispanics (10.3 percent), whites (9.4 percent), or Asians (8.9 percent).

• Obesity is highly associated with diabetes, and the likelihood of being obese varies by race/ethnicity.

In 2015-16, on average, about one-third (31.6 percent) of U.S. civilian non-institutionalized adults age 18 and older were obese (i.e., their body mass index – BMI – was 30 or higher). Blacks (41.7 percent) were more likely to be obese than Hispanics (34.9 percent) and whites (30.7 percent), while Asians (8.4 percent) were much less likely to be obese than those in other racial/ethnic categories.

•A mong obese adults, Hispanics (14.8 percent) were less likely than blacks (18.2 percent) or whites (17.4 percent) to be reported as having been told they are diabetic.

•R egardless of race/ethnicity, in 2015-16, only a small proportion (2.3 percent) of adults age 18 and older with diagnosed diabetes reported not having their condition currently treated with insulin injections, oral medication, and/or diet modification.

• The percentage of people with diabetes using insulin injections was much lower for Asians (15.2 percent) than for the other racial/ethnic groups (28.2 to 32.0 percent). Conversely, Asians were more likely to report having their condition treated by both diet modification and oral medication (but no insulin injections) (57.0 percent) than those in other racial/ethnic categories (45.1 to 48.7 percent).

Regarding diabetes-monitoring services: •B lacks (82.8 percent) and Hispanics (81.5 percent) were less likely than whites (89.0 percent) to have had their blood cholesterol checked.

• Hispanics (62.2 percent) and Asians (61.4 percent) were less likely than whites (71.6 percent) and blacks (69.3 percent) to have had their feet checked.

•H ispanics (59.3 percent) and Asians (56.5 percent) were less likely than whites (67.1 percent) to have had an eye examination.

• While nearly three-fourths of adults with diabetes (72.1 percent) reported having had the A1C test, over one-fifth (22.3 percent) did not know if they had that test during the year.

•W hites (76.7 percent) were more likely than the other racial/ethnic groups (63.4-66.3 percent) to report having had the A1C test and were less likely to report not having had the test (3.7 versus 7.4 to 9.0 percent). Moreover, whites were less likely to report not knowing whether they had the test than the other race/ethnic groups (19.5 versus 25.5 to 29.2 percent).

The size of a blueberry Researchers led by the Massachusetts of Technology have developed a drug capsule that could be used to deliver oral doses of insulin, potentially replacing the injections that people with type 1 diabetes give themselves every day, reported MIT in February.

About the size of a blueberry, the capsule contains a small needle made of compressed insulin, which is injected after the capsule reaches the stomach. In tests in animals, the researchers showed that they could deliver enough insulin to lower blood sugar to levels comparable to those produced by injections given through skin. They also demonstrated that the device can be adapted to deliver other protein drugs.

“We are really hopeful that this new type of capsule could someday help diabetic patients and perhaps anyone who requires therapies that can now only be given by injection or infusion,” said Robert Langer, the David H. Koch Institute Professor, a member of MIT’s Koch Institute for Integrative Cancer Research, and one of the senior authors of the study.

The research team also included scientists from the pharmaceutical company Novo Nordisk.

A heads-up on glucose events A new app feature uses artificial technology to assess whether someone with diabetes has a low, medium, or high likelihood of experiencing a low-glucose event in the next one to four hours. The new feature – called IQcast™ – was developed by Medtronic plc and IBM Watson Health, and is part of Medtronic’s Sugar.IQ™ personal diabetes assistant app.

The Sugar.IQ app is available to users of the Medtronic’s continuous glucose monitoring system, the Guardian™. With predictive alerts up to 60 minutes before a low or high event and within one to four hours of a low event, Guardian Connect and the Sugar.IQ app have been shown to help people with diabetes achieve an extra 36 minutes per day in a healthy glucose range of 70-180 mg/dL, including 30 minutes less time in hyperglycemia and 6 less minutes in hypoglycemia.

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LEADERSHIP

Why Nice People Start Turf Wars

By Lisa Earle McLeod

Steve knew he was facing a challenge. As he walked

into the budget meeting, he squared his shoulders and took a deep breath.

The facts were on his side. Now it was time to convince the rest of the senior team, and, most importantly, his CEO. The challenge at hand was the marketing budget. For the last two budget cycles, Steve had been shorted. Or at least that’s how he perceived it. His budget had been cut to the bone while the IT and Operations budgets grew.

This time he was ready. Armed with data about market share and competitive spending, he wasn’t going to let his department go underfunded again.

His team was counting on him.

Steve was relatively new to the senior leadership team. He’d only had a few years as a manager before he’d gotten promoted. But one thing he learned early on was, good leaders fight for their people. For Steve it was all about his team.

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The problem was, Steve was fighting for the wrong team.

If you ask most leaders who their team is, they’ll tell you it’s their direct reports. Yet in more successful organizations, a leader’s first alliance is to the larger team. In Steve’s case, that was his peers and the CEO.

Danger of silos Patrick Lencioni, author of the classic book The Five Dysfunctions of a Team, says, when team members put their individual needs or even the needs of their divisions above the collective goals of the team it creates inattention to results. A leadership team with 10 agendas is never as effective as a leadership team focused on one agenda.

Steve is like many well-intended leaders. He cares deeply about his people, and he also cares about the organization’s success. Increasing the marketing budget may be the right thing to do. But Steve’s approach, even if he wins, will only accelerate siloed thinking amongst the team.

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In my experience, turf wars are silos with emotion. The original cause is almost never malice. The eventual war is the all too natural result of the three common conditions: No. 1: The expertise trap The VP of marketing is unlikely to know much about IT. Steve is playing in the space he knows, the area he was assigned.

No. 2: Personal connections Most leaders spend more time with their direct reports than their peers. In Steve’s case, he’s relatively new to the role. When you’re in a new job one of the first things you do is connect with your team. Steve has probably been so busy leading his own team he hasn’t built strong relationships with his peers, who he likely only sees at big group meetings.

No. 3: Lack of holistic leadership Because the first two conditions (above) are almost always a given, leaders have to be relentlessly proactive in aligning their teams against the larger organizational goals. If Steve’s boss goes around the table at meetings discussing

06.03.2019 13:50:08

individual goals and budgets, that’s what people are going to focus on. If the leader wants to get everyone going in the same direction, the senior team’s primary alliance must be to each other, and their collective goals.

If the leader wants to get everyone going in the same direction, the senior team’s primary alliance must be to each other, and their collective goals.

Putting department agendas aside in favor of team goals requires trust. Leaders must have confidence their peers are in it for the team, not simply jockeying for themselves. The biggest challenge is, no one wants to go first.

But when teams are brave enough to trust each other, and let go of their divisions, there’s nothing they can not do.

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.

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GENDER PARTNERSHIP: HEALTHCARE’S IMPERATIVE FOR THE 21ST CENTURY GENDER PARTNERSHIP: HEALTHCARE’S IMPERATIVE FOR THE 21ST CENTURY Mike Kaufmann & Rayona Sharpnack Kaufmann, Chief Executive Mike Kaufmann & Mike Rayona Sharpnack

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Women’s Leadership awarding the 2014 “Guys Who Businesswomen’s Association him naming Kaufmann as Get it Award.” its 2012 “Honorable Mentor” and the Institute for Women’s Leadership awarding him the 2014 “Guys Who THIS Get it YEAR’S Award.” SPEAKER LINE-UP INCLUDES: Cardinal Health Mike Kaufmann & Officer, Rayona Sharpnack

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She is one of consulting on Women’s Leadership, sole solution to an organization’s problems.

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Sheitisisone of other’s strengths that will make a difference in the profits and women and men working in partnership and leveraging each the first in the nation to foresee that “more women” isn’t the productivity of our companies—and our world. other’s strengths will make a problems. difference in the profits and sole solution to anthat organization’s Rather, it is more productivity of our companies—and our world. women and men working in partnership and leveraging each other’s strengths that will make a difference in the profits and productivity of our companies—and our world.

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SMART SELLING

DISTRIBUTOR SALES STRATEGIES FROM HIDA

Home Healthcare Providers to Face Worker Shortages You may have heard from many of your post-acute and home healthcare customers about

the difficulties hiring workers in this space. But did you know this is part of a national trend?

Demand for home healthcare workers is expected to outpace supply over the coming decade. Demand for home healthcare aides is expected to grow by 63 percent by 2023, according to a HIDA analysis of data from the Bureau of Labor and Statistics (BLS). Demand for personal care aides is projected to rise by 56 percent during the same period. Meanwhile, separate research suggests that over 446,000 home health aide positions will be unfilled by 2025.

By Elizabeth Hilla, Senior Vice President, HIDA

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Here are some key factors driving this trend: •A ging population. The U.S. population is continuing to age, and will drive demand for home healthcare services. In 2016, 49.2 million Americans were aged 65 and over, according to the U.S. Census Bureau. By 2020, this figure will reach 56.1 million, rising to 73.1 million in 2030 and 80.8 million in 2040.

•L ow pay. Home healthcare continues to be paid among the lowest-paid professions in the United States. Home health aides earned $23,210 on average in 2017, while personal care aides earned $23,210 on average that year. By comparison, janitors earned $24,990 on average.

•H igh turnover. Between 2016 and 2026, 125,000 home health aides will quit their jobs, with 68,500 leaving the field entirely, according to a HIDA analysis of BLS data.

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What does this mean for your customers?

Providers everywhere are looking to do more with less, and this is especially true in the home healthcare segment.

Any time clinical staff spends working on problems that do not directly involve a patient is time that the organization is not getting paid for. Anything you can do to free up time will benefit and help the organization’s bottom line.

There are a several ways distributor reps can help: Make product recommendations. Point your customers to products that are easy to use or transport, ones that improve patient care and are simple to learn.

Demand for home healthcare aides is expected to grow by 63 percent by 2023, according to a HIDA analysis of data from the Bureau of Labor and Statistics (BLS). Demand for personal care aides is projected to rise by 56 percent during the same period.

Meanwhile, separate research suggests that over 446,000 home health aide positions will be unfilled by 2025.

By expertly deploying your knowledge of the products your company carries, you can help your customers select the products and services that are right for them.

Offer logistics expertise. If your home healthcare customers are struggling to manage their inventory space, show them ways to make the most of their limited time and storage space.

Consider customized delivery options. Deliveries to satellite offices or directly to patients’ homes reduce the amount of time home healthcare employees spend in transit, making their lives easier and increasing the time they can devote to patient care.

As HIDA’s research shows, ongoing worker shortages are going to make life more difficult for home healthcare workers. As a rep, you have the opportunity to alleviate these challenges with your insight, experience, and expertise. Helping these providers do more with less will make you a trusted and valuable partner during challenging times.

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

Automotive-related news Dog Mode Tesla recently rolled out a safety and convenience option that car – and dog – owners will appreciate, reports Automotive News. Dog Mode uses automatic sensors to maintain a comfortable temperature for pets inside the vehicle when you have to run errands, while also displaying a message in giant letters to passers-by who might become concerned for pets left in the car. The message will tell anyone looking inside the car that the owner will return soon and display interior temperature. Back in 2016, Tesla already offered a Cabin Overheat Protection feature

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– a more basic version of automatic climate control for when the car is turned off. Dog Mode is the upgrade, offering more user-adjustable settings. Of course, this system is not a replacement for common sense or local laws, especially when it comes to leaving children in the car, reports Automotive News.

Potential rival to Tesla? Amazon Amazon is leading a $700 million investment in Rivian, a Michigan company that is developing a battery-powered pickup truck and an electric sport utility vehicle, reports

The New York Times. Founded in 2009 by an MIT-trained engineer, R. J. Scaringe, Rivian first showed its truck and SUV at the Los Angeles Auto Show in November. The key feature of each is a chassis that is shaped like a skateboard and includes all the components that propel the vehicles – a large battery pack, axles, suspension, cooling system and four electric motors. The company says its pickup will be able to go up to 400 miles on a full charge.

The deal is the latest example of how the auto industry is being reshaped by new technologies and nimble companies that have raced ahead of many traditional carmakers, according to the newspaper.

The best Motor Week announced its 34rd annual Drivers’ Choice Awards, based on factors that (according to the editors) matter most to consumers, including price, practicality, performance and fuel efficiency. Some winners: •B est Small Car: Kia Forte. “This year, better technology, more space and truly dynamic styling are sprinkled into the mix.”

•B est Eco-Friendly: Honda Clarity. “The Honda Clarity PHEV delivers an outstanding MPGe rating, along with great style, and Civic-based interior packaging and driving demeanor.”

• Best Family Sedan: Nissan Altima. “Besides roomy comfort, great tech and style, what really won us over was a big hit in performance – both in suspension tuning, and from its segment-first variable compression 2.0-liter turbo 4-cylinder.”

• Best Small Utility: Toyota RAV4. “Wearing a more rugged design, and gaining a more substantial ride; yet retaining all of its car-like friendliness.”

Windshield cracked? It’ll cost you.

Fixing a cracked windshield used to be the kind of repair a technician could perform in a few minutes in your office parking lot while you were at work. Today, the same repair could take hours and require expensive computerized equipment in a special facility, reports The New York Times. And it will probably cost much more. If the repair is not done properly, it could have dire consequences.

In this new world of advanced driver assistance systems, features like lane-keeping assistance, automatic emergency braking and collision avoidance are integrated with windshields. Cameras nestled behind the windshield, radar sensors hidden in the front grille and

ultrasonic components embedded in bumpers work within narrow tolerances. A seemingly minor impact can knock them out of alignment. A camera that hasn’t been recalibrated after a windshield repair, for example, could mean the difference between keeping you between the lines or steering you off a cliff. And a relatively minor driving misjudgment that damages a side mirror and rear bumper could require fixing rear radar sensors used with blind-spot monitoring and rear cross-traffic alert systems.

The price? As high as $2,050.

Hot or cold, your electric vehicle will suffer Minus 25 degrees is just a bad memory for some Repertoire readers. But if you’re thinking about buying an electric vehicle, and you live North, be warned: Electric vehicle driving range decreased by 41 percent when the mercury dips to 20°F and the heating system inside is on, according to new research by the American Automobile Association, reports Automotive News. That means for a 100mile route, an electric-powered vehicle could go only 59 miles. Lower range translates into more frequent charging and higher operating cost for users. In case you’re interested: Loss of range at low temperatures is due to the reduced mobility of electrons in the battery, the use of thermal management systems in many cars to keep the battery warmed and the fact that an EV has to generate electricity for heating rather than relying on waste heat from an internal combustion engine. By the way, AAA’s research also found that when outside temperatures heat up to 95°F and air-conditioning is used inside the vehicle, driving range decreases by 17 percent.

A good deal for a compact The 2019 Kia Soul won Kelley Blue Book’s 5-year Cost to Own Award in the compact car segment, reports Kia. “The key advantage that the Soul has over its competitors is its high residual values,” Eric Ibara, director of 5-Year Cost to Own for Kelley Blue Book, was quoted as saying.

“This year, the Soul ranked third in Best Resale Value, which translates into a low depreciation cost – the factor that accounts for one third of its overall ownership costs.” The Soul also has the lowest financing costs and state fees in its segment, he said. The 5-Year Cost to Own is the total amount of vehicle-related costs the car owner will likely have to cover during the first five years of owning a car. This includes out-of-pocket expenses like fuel and insurance, and vehicle depreciation (loss in value).

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

Technology news Stop the porch pirates Thirty percent of Americans have experienced package theft, reports Mercury News. Video doorbells help catch porch pirates in the act. But a new partnership between Amazon and Chamberlain Group, a manufacturer of automatic garage door openers, offers a more foolproof solution: in-garage delivery, known as Key for Garage. Amazon already offers in-home delivery, but many homeowners

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aren’t comfortable with delivery persons entering their home. With Key for Garage, you install a device to your garage door opener that allows the delivery person access to your garage and notifies you along the way.

Standing desks The editors of The Wirecutter, a New York Times Company, write that the Uplift bamboo stand-up desk and V2 frame

is the best deal for people who want a relatively stable surface that looks good, moves quickly and quietly, and presents few problems in working every day. “The Uplift bamboo desktop was every tester’s favorite, particularly the (optional) ergonomic groove cutout in front,” according to the editors. “You can kit out the Uplift with a number of accessories that match your desk style, including power and cable organizers.”

Shades from Bose It’s difficult to determine whether to classify the $199.95 Bose Frames as Bluetooth earphones or headphones, as they make no contact with your actual ear, says PC Magazine. But they are sunglasses. And surprisingly, they succeed on both fronts, delivering crisp and clear audio through a classic, stylish design, according to the editors. The Frames present several limitations, however.

They are, after all, sunglasses, so unless you work in an exceptionally bright room, you won’t be wearing these at your office desk.

And they lack prescription lenses.

Bose says you can add prescription lenses without disrupting the internal electronics, but doing so will void the warranty.

recommendations based on their interests in authors, books, games, music, movies, TV shows and podcasts. Users get recommendations based on what they like, while registered users are provided with additional features, such as sharing a taste profile, receiving personalized recommendations, and taking part in a global community of like-minded users.

Flicker-free lighting If your current office lighting is making life flash or at least flicker before your eyes, ask your manager to install the GAYA flat panel fixture from Access Fixtures. Designed for installation in a grid ceiling, the GAYA LED

Whether you’re scanning an old photo, your kid’s artwork, or an excerpt from a book, the LiDE 220 is fast, accurate, and affordable.

Compared to its closest competitors, the LiDE 220 produced the clearest scans with the most visual accuracy from a variety of materials and had the most accurate text recognition across all documents.

A good cheap scanner The $90 Canon LiDE 220 is the fastest, most accurate, and most intuitive flatbed scanner for everyday users, according to The Wirecutter. “Whether you’re scanning an old photo, your kid’s artwork, or an excerpt from a book, the LiDE 220 is fast, accurate, and affordable,” according to the editors. “Compared to its closest competitors, the LiDE 220 produced the clearest scans with the most visual accuracy from a variety of materials and had the most accurate text recognition across all documents. It’s light and compact, can be used upright, and because it requires just one USB port, it won’t clutter up your workspace.”

For the connoisseur Qloo, an artificial intelligence platform for culture and taste, has acquired TasteDive, a cultural recommendation engine and social community. TasteDive is said to help consumers discover their taste across broad categories of entertainment choices by identifying, matching and making personalized

flat panels boast an L70 rated life of 50,000 hours. And they are guaranteed to be flicker-free, and they won’t produce glare. Available in 30w, 40w, 50w, and 75w.

Triple-rear cameras Will 2019 be the year of triple-rear cameras? The launch of the Galaxy S10, LG G8 and Xiaomi Mi 9, along with numerous rumors about the next iPhone, point to this trend growing, according to CNET. “Even though Apple, Samsung and others aren’t the first to add three cameras to the back of a phone (that would be last year’s Huawei P20 Pro, and the LG V40 has them, too) the fact that some of most the popular phone-makers are embracing them, or plan to, will surely ensure widespread use.”According to CNET, the standard Galaxy S10 gets you three rear cameras – a 16-megapixel ultrawide sensor with fixed focus, a main 12-megapixel dual aperture wideangle lens with OIS, and a 12-megapixel telephoto lens with OIS that can achieve 2x optical zoom. “That means you’re able to take portrait photos and photos from any of the sensors, just by toggling on the screen.”

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HEALTHY REPS

Health news and notes Delay the inevitable Here’s good news for those who can’t stand the thought of getting – and using – a gym membership. Physical activity of any intensity – even if it means just walking around for a bit – provides health benefits. “If you have a job or lifestyle that involves a lot of sitting, you can lower your risk of early death by moving more often, for as long as you want and as your ability allows,” said Dr. Keith Diaz at Columbia University, referring to a study funded in part by NIH’s National Institute of Neurological Disorders and Stroke. Research has shown that long periods of sitting increase the risk of heart disease and death overall. But the amount of activity needed to counter these dangers has been unclear. The Columbia study included almost 8,000 participants aged 45 and older. All participants wore an activity monitor for a week between 2007 and 2013. The device recorded how often they moved while awake and the intensity of their activities.

Deaths were tracked through April 2017. The researchers then used this data to model how, when substituting for

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sitting, various amounts and intensities of activity affected the risk of death from any cause. The team found that any amount of activity was better than sitting. People who swap 30 minutes of sitting for 30 minutes of light-intensity activity per day would have a 17 percent lower risk of death. Light-intensity activities include walking and doing chores that require moving around.

Obesity in the four-legged population Humans are not the only residents of the United States gaining weight. So are their dogs, according to Nationwide, a provider of pet health insurance, as reported by The New York Times. Obesity among dogs and cats has risen for eight years in a row, along with claims for ailments related to being overweight. In 2017, obesityrelated insurance claims for veterinary expenses exceeded $69 million, a 24 percent increase over the last eight years, Nationwide reported in January. With only 2 percent of pets covered by insurance, the costs to owners of overweight pets is likely to be in the billions. A study of 50

HEALTHY REPS obese dogs enrolled in a weight-loss program at the University of Liverpool demonstrated the value of losing excess body fat. The 30 animals in the study that reached their target weight had greater vitality, less pain and fewer emotional issues than the animals that remained too fat.

Pet owners: Learn to resist dogs that beg for more food than they need, suggested John P. Loftus, veterinarian at the Cornell University College of Veterinary Medicine.

“If you’re already meeting your pets’ nutritional needs, they’re not hungry. What they’re really asking for is your attention. Better to distract them with an activity.”

from 2017, and was driven by an increase in e-cigarette use. E-cigarette use increased from 11.7 percent to 20.8 percent among high school students and from 3.3 percent to 4.9 percent among middle school students from 2017 to 2018. No change was found in the use of other tobacco products, including cigarettes, during this time.

Among youth: 1) e-cigarettes are still the most commonly used tobacco product, ahead of cigarettes, cigars, smokeless tobacco, hookah, and pipes; 2) e-cigarettes are the most commonly used product in combination with other tobacco products; and 3) e-cigarette use is highest among boys, whites, and high school students.

Sleep tight Researchers say they are closer to solving the mystery of how a good night’s sleep protects against heart disease. In studies using mice, they discovered a previously unknown mechanism between the brain, bone marrow, and blood vessels that appears to protect against the development of atherosclerosis, or hardening of the arteries – but only when sleep is healthy and sound. “We’ve identified a mechanism by which a brain hormone controls production of inflammatory cells in the bone marrow in a way that helps protect the blood vessels from damage,” explained Filip Swirski, Ph.D., the study’s lead author who also is an associate professor at Harvard Medical School and Massachusetts General Hospital in Boston. “This anti-inflammatory mechanism is regulated by sleep, and it breaks down when you frequently disrupt sleep or experience poor sleep quality. It’s a small piece of a larger puzzle.” The study was funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.

Need another reason to quit smoking?

African-Americans who smoke appear to be at greater risk for peripheral artery disease, or PAD, new research has found, reports the National Institutes of Health.

Additionally, the findings suggest that smoking intensity – how many cigarettes a day and for how many years – also affects the likelihood of getting the disease. PAD affects 8 to 12 million people in the United States and 202 million worldwide, especially those age 50 and older. It develops when arteries in the legs become clogged with plaque, which are fatty deposits that limit blood flow to the legs. The impact of cigarette smoking on PAD has been understudied in African-Americans, even though PAD is nearly three times more prevalent in African-Americans than in whites. For the study, researchers divided the 5,258 participants into smokers, past smokers and never smokers. They found that those smoking more than a pack a day had significantly higher risk than those smoking fewer than 19 cigarettes daily. Similarly, those with a longer history of smoking had an increased likelihood of the disease. Despite strong associations between smoking and PAD, however, the findings do not establish a causal link, according to the study’s authors. Nor can they be generalized to people of African descent from other regions or countries, since the study was conducted in a single community of African-Americans.

E-cigarette use increased from 11.7 percent to 20.8 percent among high school students and from 3.3 percent to 4.9 percent among middle school students from 2017 to 2018. No change was found in the use of other tobacco products, including cigarettes, during this time.

Tobacco use: Going up Tobacco product use among U.S. youth is increasing, reports the Centers for Disease Control and Prevention.

More than one in four high school students and about one in 14 middle school students in 2018 had used a tobacco product in the past 30 days. This was a considerable increase

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corner

Energizer Salesman When Steve Amadio wants something, he goes after it – with vigor.

Steve Amadio says he’s pretty laid back. “But when I

want to do something, I don’t stop until I do it.”

That’s how he got his job in 2012 with McKesson Medical-Surgical, doing inside sales of medical equipment and furniture to the extended care market. That’s how he closes sales every day as LTC equipment team lead. And that’s how he lost 230 pounds about 14 years ago.

“I was 22 or 23,” he explains. “I’d been heavy my whole life. One day, I bent down to tie my shoes, and when I came up, I was completely out of breath. And I said to myself, ‘If I don’t make some changes, I’ll be dead by the time I’m 30.’” Today he’s up at 4:30 every morning hitting

the gym. He’s a healthy 190 pounds, and he’s already outlasted the 30-year mark by six years.

Crash Born and raised in South Jersey, Amadio had once hoped to become a teacher. Instead, he worked in finance and car sales before joining Madison Credit Management Services in 2006 as a title and appraisal service team leader. He coordinated residential mortgages, loan closings, title services and appraisal inspections.

One year after joining the firm, the housing market crashed.

“I survived while many of my peers were being laid off, until one day they decided it was time to lay off my

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corner entire office, except for our manager,” recalls Amadio of the crash and its aftermath. “It was the first time I found myself unemployed. I regrouped and networked with friends and former associates. One of them took my resume to his manager at McKesson – Tom Whalen.

“I am a firm believer that every life experience molds, prepares, and readies you for the next. So, yes, my time in the mortgage business has proved useful. But so has every position I have held, including my high school job stocking shelves at Drug Emporium – where we used to get weekly McKesson deliveries.”

“I survived while many of my peers were being laid off, until one day they decided it was time to lay off my entire office, except for our manager.”

That said, Amadio’s experience in the mortgage industry prepared him particularly well for his work at McKesson Medical-Surgical.

Big decisions “When somebody is investing in a mortgage, it’s a big decision for them,” he says. “I learned how to communicate with home buyers so they knew I understood the huge decision they were making.”

Amadio takes the same approach with owners of longterm-care facilities and CEOs of chains, as they contemplate big decisions, like a facility remodel. “I tell them, ‘We know how important this is to you, and McKesson will be there for you.’”

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He wasn’t sure that inside sales in healthcare would be a good fit for him, but he did know that he wanted no more of the mortgage industry.

“I followed up with Tom Whalen monthly and sometimes weekly until he brought me in for an interview with my current manager – and mentor – Ruth Schultz,” Amadio recalls.

He got the job in 2012, and hasn’t stopped learning since.

“When I first started in 2012, I noticed the market was mainly pricedriven,” he says. “But in recent years, our customers are looking more closely at value than price.

“Anyone can drop a price or sell a low-cost option, but at McKesson, we not only look to give our customers the best price, but we partner with them too. When someone is purchasing capital equipment and furniture, we want to make sure they are getting something that will last, that will help the staff, and will aid and benefit residents’ wellbeing.

This is where McKesson excels, and how we separate ourselves from our competition.”

In 2014, Amadio became team leader. He still operates his Florida territory, but serves as a “coach” to the other reps on the team. “Ruth mentored me in my transition from being a sales rep to being a leader too,” he says. “In fact, with direction from Ruth and Tom [Whalen], I have been able to develop here at McKesson.”

Amadio got married to his wife, Kathy, in November 2018. “She is what truly motivates me and drives me,” he says. “She means the world to me.” The two have a dog and a cat, and they volunteer at the Burlington County Animal Alliance.

He likes stand-up comedy and performed on a local channel a few times. (His favorite comedian? Probably Jim Gaffigan.) And because of that experience, he has hosted the McKesson Extended Care Awards the last two years.

“That was a blast,” he says.

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NEWS

Urgent care industry experiencing growth boom affiliating with one,” said Laurel Stoimenoff, PT, CHC, CEO of UCA. “As a result, the patient populations utilizover-year growth as more patients seek on-demand care for ing urgent care centers are evolving, with Millennials leadnon-emergency conditions, according to a report from the ing the way in driving demand and increased utilization.

Urgent Care Association (UCA). As of November 2018, And as Baby Boomers are aging into Medicare, we are the total number of urgent care centers in the U.S. reached also seeing year over year growth in that sector as well.”

8,774, up 8 percent from 8,125 in 2017. The UCA’s 2018 According to the report, a median of 35 percent of patients seeking care at urgent care centers YOY Growth – Urgent Care Centers are unaffiliated with a primary care provider or a medical home. Urgent 20% 10,000 care centers serve as the “front 8,000 door,” often connecting these 15% patients with a medical home or 6,000 specialists. In addition, the number 10% 11.7% 4,000 of Medicare and Medicaid patients 8.5% 8.0% seeking services at urgent care cen5% 2,000 ters continues to grow, accounting 4.9% 4.7% for nearly 27 percent of all visits in 0% 2018. This can be attributed, in part, 2013 2014 2015 2016 2017 2018 to Baby Boomers who were already using urgent centers and are now starting to tap into Medicare benefits.

Benchmarking Report found more than 70 percent of pa“Urgent care centers continue to expand their scope tients wait less than 20 minutes to see a provider at an urgent of services, catering to the needs of local patient populacare center, and nearly 94 percent are seen in less than 30 tions,” said Stoimenoff. “Specialty services such as occuminutes. In terms of total visit time, nearly 85 percent of pational medicine, pediatric care and telemedicine are patients are taken care of in less than 60 minutes, according becoming more prevalent, increasing access for patients to the report. across the country, particularly in underserved commu“Urgent care centers play an increasingly vital role in nities. These services help alleviate crowded emergency the continuum of care, providing services for a wide array departments while reducing the impact of physician of patients who may be unable to see a primary care shortages in communities nationwide.” physician for various reasons, including simply not yet The urgent care industry continues to experience year-

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Calling all Manufacturers!!!

Calling all Manufacturers!!!

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

HMMC is pleased to introduce our new “Education Excellence” conference being held at The University of Wisconsin School of Business Madison on May 21-23, 2019.

Join us while we continue our commitment to provide for our members a platform focused on “Education for Ongoing Success.”

During our meeting you will have the opportunity to improve your Business GPA = Goal attainment, Processes & Actionable takeaways.

To learn more about HMMC please visit our website: www.HMMC.com

HMMC is committed to help you Learn, Network & Succeed!

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NEWS

Industry news U.S. measles cases already surpass 2016, 2017 totals The CDC has confirmed that, as of February 14, there have been 127 measles cases this year, surpassing the annual totals for both 2016 and 2017. In 2017, the U.S. saw 120 measles cases. In 2016, the CDC reported only 86 for the whole year. Measles cases in 2019 have been reported in 10 states: California, Colorado, Connecticut, Georgia, Illinois, Kentucky, New York, Oregon, Texas and Washington. Nearly half of all cases reported in 2019 occurred in Clark County, Washington. The county has seen 61 cases since January 1. Washington Gov. Jay Inslee declared a state of emergency due to the outbreak January 25.

U.S. health spending estimated to reach nearly $6 trillion in 8 years According to federal estimates published in Health Affairs, national health spending is projected to grow 5.5 percent on average annually and represent 19.4 percent of the GDP ($6 trillion) by 2027. Following a ten-year period largely influenced by the Great Recession and major health reform, national health spending growth during 2018–27 is expected to be driven primarily by demographic and economic factors fundamental to the health sector. Additionally, prices for healthcare goods and services are projected to grow 2.5 percent per year, on average – faster than the average price growth experienced over the last decade – and will account for nearly half of projected personal healthcare spending growth.

Mayo Clinic debuts first-aid voice skill for Google Assistant Mayo Clinic (Rochester, MN) released Mayo First Aid, a first aid tool for Google’s voice assistant. Mayo First Aid

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can give advice on how to treat various conditions, such as fevers, spider bites or cuts. It also provides information on how to respond in select emergency, such as how to preform CPR. Mayo Clinic initially launched the too on Amazon’s Alexa voice assistant in late 2017. Now, users of Google Assistant-enabled devices will be able to access the voice application. Mayo Clinic also recently launched a web-based version of the voice application on the health system’s website, where users can access the tool without Amazon Alexa or Google Assistant.

Alfa Wassermann announces 2018 President’s Club winners Alfa Wassermann Diagnostic Technologies (West Caldwell, NJ) announced its 2018 President’s Club winners, David Christy (Business Development Manager of the Southeast region), John Husted (Business Development Manager of the Midwest region), and Jennifer Kennedy (Business Development Manager of the West region). President’s Club is the highest honor awarded to the top sales representatives in the 2018 calendar year.

[left to right: Mark Gnagy, Vice President of Sales; David Christy; Jennifer Kennedy; John Husted; Peter Napoli, COO & President]

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