Repertoire Post-Acute August 2018 by BOC design Inc

vol.26 no.5 â&#x20AC;˘ August 2018

Primary Care at Home The Independence at Home Demonstration

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AUGUST 2018 • VOLUME 26 • ISSUE 8

Big Time Selling equipment to today’s consolidated customers

20 CHRONIC CARE MANAGEMENT

Primary Care at Home

PUBLISHER’S LETTER Selling Season...................................................................6

PHYSICIAN OFFICE LAB Lab Capital Equipment

The lease you can do..................................................................8

DISTRIBUTION

McKesson MedicalSurgical

meeting

page

IDN OPPORTUNITIES Feet on the Street

GPO sales reps are the glue for regional purchasing groups......................................... 16

LEADERSHIP

The Independence at Home Demonstration

Lead on: PWH Summit.........................................................18

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

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August 2018

AUGUST 2018 • VOLUME 26 • ISSUE 8

POST ACUTE CARE: HIDA INSIGHTS

HEALTHY REPS

Medical Products Key For Improving Post-Acute CMS Star Ratings............................. 36

HIDA GOVERNMENT AFFAIRS UPDATE

Distributors Descend on Capitol Hill for HIDA Washington Summit.......................... 46

Health news and notes

QUICKBYTES Technology news........................................................ 52

REP CORNER

WINDSHIELD TIME

Automotiverelated news 4

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Sellstrong Deanna Reinhart brings on the challenges.................. 54

INDUSTRY NEWS News........................................................................................... 58

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

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PUBLISHER’S LETTER

Selling Season Its hard to believe we are already in August and on the cusp of kids going back to school

and the doctor. Each year we go in to these last few months knowing it’s selling season, because more doctor visits equals more table paper, more gloves, more strep tests, etc. While these products are typically givens and those sales will come in simply due to the visits, we decided August was the perfect month to do a story on selling equipment. Mark Thill spoke with three individuals on selling equipment in a consolidated health system world. Here is one of the highlights of the article: Though consolidation and centralization may be good for providers, they can present challenges for non-acute reps, particularly those used to selling to small or independent practices.

Scott Adams

But successful reps have discovered ways – some of them time-tested, others specially suited for a consolidating marketplace – to sell in such an environment. They include: • Identifying the decision-makers. • Carefully listening to the customer and understanding their priorities. • Demonstrating value after the sale, such as in delivery and setup. • Working in tandem with manufacturers, who are, after all, the product experts. • Serving as a credible, accessible resource of information and products on an ongoing basis. Whether you’re a rookie or seasoned veteran, please take the time to read this article, because it’s selling season once again, and all your manufacturer counterparts have quotas to meet, your practices need the latest equipment and their patients deserve the best care available. On a separate note, I wanted to thank the sales reps and the sponsors for attending each of our Rep Mixers last month. This year we went from 2 events to 4, and to date, we have had over 100 reps at the mixers representing over 15 different distributors; including each of the Nationals. The next mixer will be held in Atlanta at Sweetwater on November 1, so stay tuned for how to RSVP. Dedicated to the industry, R. Scott Adams repertoire is published monthly by Share Moving Media 1735 N. Brown Rd., Suite 140, Lawrenceville, GA 30043 Phone: (800) 536-5312, FAX: (770) 709-5432; e-mail: info@sharemovingmedia; www.sharemovingmedia.com

editorial staff editor

Mark Thill lthill@sharemovingmedia.com managing editor

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

Alan Cherry acherry@sharemovingmedia.com art director

Brent Cashman bcashman@sharemovingmedia.com

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vice president of sales

Jessica McKeever

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

Alicia O’Donnell

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

Tyler Moss

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

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

publisher

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

Brian Taylor btaylor@ sharemovingmedia.com circulation

Laura Gantert lgantert@ sharemovingmedia.com

Subscriptions

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

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PHYSICIAN OFFICE LAB

By Jim Poggi

Lab Capital Equipment The lease you can do You KNOW you’re ready to step up to sell moderate

complexity lab solutions. PAMA is putting emphasis on reducing cost per test and the larger systems typically have bigger test menus and lower cost per test. Your customers also know this and are asking you for advice. You learned about how to move your client to moderate complexity, selling proficiency testing and LIS systems from this column. And, you know these systems provide a five-year annuity stream of reagent, calibrator, control and consumable revenue for you. You are ready to go, until the customer brings up financing. Did you think they were going to write you a check for that fancy $50,000 lab system? Maybe hand you a bucket of bitcoins? Nope. Leasing is the way most

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customers acquire higher cost lab equipment. This means you had better come up to speed on the basics of leasing quickly. As in all aspects of the lab sales process, don’t expect to become the expert. Know enough to pre-qualify the prospect and know when to contact the experts. So, what are the basics you need to know?

Understand whether leasing is a solution your customer wants to consider This may sound obvious, but every customer does not want to lease with you, and some would not qualify. Other options include the customer implementing a line of credit or lease directly through their financial institution. This is not as common as it used to be, but is still a

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PHYSICIAN OFFICE LAB viable option. Two quick qualifying questions will get you the answer quickly and easily: Ask “How did you acquire this type of equipment in the past?” Or ask: “How do you prefer to acquire these types of assets?” Then, think about these other qualifying factors: 1. Is this a new business? 2. Is this business non-physician owned? If the answers to those two questions are yes, then you should discuss with your leasing resource before getting too far down the road. New businesses are very difficult to get approved for a lease when they are not physician owned.

• Do you believe you will want to keep the instrument after the lease is over? If so, a “buck out” lease offers the lowest guaranteed cost at the end of the lease. An “I don’t know” answer can suggest the *fair market value lease option below. • Is the monthly cost of the lease more important than end of term acquisition options? If the answer is “yes”, then fair market value leases are probably a better fit for your client. If in doubt, plan your financing strategy directly with your key lab instrument supplier and your leasing source. A five-year lease on most lab equipment over $10,000 or more is typical.

Selecting a leasing company Many distribution companies make this easier for you by selecting leasing companies and easy to implement leasing solutions for you. If you are that fortunate, make sure to introduce yourself to the leasing representative, learn about their products, promotions and sales tools and understand how they typically help in the sales process. Will they visit customers with you or tie in by telecon? Will they explain the advantages of one type of lease over another? Can they handle poorer credit prospects? Know the landscape and how they can help. And, as always, USE their expertise in the sales process.

Selecting leasing options One of the classic blunders in selling capital equipment is offering too many leasing options. DO NOT offer multiple year terms and a combination of fair market value and “buck out” leasing options. This confuses the customer and is a serious impediment to the close. The pros ask a couple of qualifying questions and bring forward THE BEST FIT OPTION and hold a backup option just in case. The prospect qualifying questions I like are:

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Leasing is the way most customers acquire higher cost lab equipment. This means you had better come up to speed on the basics of leasing quickly. As in all aspects of the lab sales process, don’t expect to become the expert. Know enough to pre-qualify the prospect and know when to contact the experts.

What can (should) you add in to the lease? A comprehensive solution is usually the best choice. Recommend adding the LIS system, if needed, as well as service contract coverage for the life of the lease. If there are higher cost accessories such as water systems or UPS systems, check with your leasing source to make sure they will let you add them in and then offer a complete package as your first choice. If your customer balks (which is somewhat unlikely), you can always take an accessory or two out of the lease and have the customer buy them up front. As far as service contracts go, be sure you have service coverage in place through the duration of the lease. Failure to do so ALWAYS results in costly unexpected service visits, angry customers and negotiations with all parties to calm the waters. It is a needless and avoidable waste of time. Lastly, make sure that the Leasing Company you are working with can handle pass-thru service payments to the manufacturer. Many of them cannot, so it’s important to ask this question of your Leasing Source

before getting too far down the road with pricing this type of opportunity. The leasing companies that can handle pass-thru service may have different lease rates than your originally intended source.

What to avoid Stay out of the accounting and financial treatment of leases area. When your customer asks for the relative advantages for their practice to leasing options, encourage them to discuss their specific situation with their financial advisor. Your leasing source can provide some general guidelines in the differences between capital and operating leases, but the customer must be held accountable for selecting the right lease solution for their specific financial situation.

One of the classic blunders in selling capital equipment is offering too many leasing options. DO NOT offer multiple year terms and a combination of fair market value and “buck out” leasing options. This confuses the customer and is a serious impediment to the close.

Implementing the lease paperwork

Handling renewals

This is typically pretty straightforward. Most lenders require a credit check document and a leasing agreement. The cost of the capital equipment is paid directly to your company, by your leasing company, when the equipment is delivered and invoiced. The customer makes the monthly payments directly to the leasing company for the duration of the lease. Your company may require specific customer paperwork for reagent standing orders. Be sure to check before writing up a leasing proposal for the customer. Your manager or lab equipment specialist should have sufficient experience to assist you on the first deal or two. Ask your leasing source if they would be willing to attend the proposal delivery meeting, or at least tie in by phone. This assures expert help as needed.

If you handle the first lease well, your customer will want to lease upgrades or additional lab equipment from you. This is proof of good work. You can’t start the renewal process too early. The most experienced account managers begin the process of discussing renewals as early as 18 months before the current lease ends. As always, proper planning leads to good results and the best solutions. Leasing is the classic way for customers in our market to acquire the large scale and cost lab equipment they need to run an efficient and profitable lab. Armed with the information you now have, and with the advice of your lab equipment specialist, manager and leasing source, you should be ready to take the step into financing higher end lab equipment. You are ready to step up!

* Fair Market Value leases typically have documentation caveats that can impact the amount of money the customer will have to spend at end of term in order to send the equipment back to the leasing company. For example, the customer is required to pay for return shipping and they also have to pay someone to bring the equipment up to current manufacturer specs and re-saleable condition. They may also have to ensure that the manufacturer will re-certify the equipment for ongoing maintenance. These three factors could cost more in the long run that just doing the $1 Buyout lease in the first place. Lastly, the FMV lease does not qualify for any Section 179 benefits since the Leasing Company owns the equipment and not the customer. Always suggest to your customer that they read the fine print of the Lease Agreement so that there are no surprises later as end of term surprises could cost you a new sale.

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August 2018

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DISTRIBUTION

McKesson MedicalSurgical meeting McKesson Medical-Surgical’s 2018 national

sales meeting – “Deliver the Difference” – drew 1,400 sales reps and 800 vendor representatives to Orlando, Florida, in May. “We delivered a different type of meeting to help the sales team grow,” said a spokesman. We gave our reps tools to deliver the difference to their customers.”

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IDN OPPORTUNITIES

Feet on the Street GPO sales reps are the glue for regional purchasing groups in membership in an alliance, with its regional pricing and programs, which even with today’s national giants, small groups remain a strong factor in group are more specific to a smaller group,” purchasing. Hence, regional purchasing coalitions, regional alliances and affiliates. she says. “I generally introduce that as an option to new Intalere members.” She seldom has to These subgroups exist largely on the energy, commitexplain the concept of group purchasing to her accounts, ment and participation of their supply chain members. as most are familiar with the concept. In some cases, it is But they grow with the help of GPO sales reps. Reprethe non-acute distributors that have introduced them to it. senting national group contracting portfolios, reps such Lisowski brought distributor experience with her when as Intalere’s Emily Hughes and Janice Lisowski also serve she joined Intalere in April 2015. She held sales positions as key contacts – some might say the “glue” – of regional with Cardinal Health and Kreisers (now Concordance groups. Hughes was named West Alliance Rep of the Healthcare Solutions), as well as a couple of medical prodYear, and Lisowski was named East Alliance Rep of the ucts manufacturers. That experience has served her well at Year at Intalere’s 2017 member conference. Intalere. For one thing, she understands how pricing is set Lisowski calls primarily on non-acute providers in in the non-acute market, and she works with both memIllinois and Iowa. She represents Intalere’s national conbers and distributors on pricing issues. Second, having been tracts and works closely with the Intalere IKOINM Alliexposed to thousands of products as a distributor rep, she ance (an acronym standing for Illinois, Iowa, Kentucky, knows the brands on contract, as well as their competitors Ohio, Indiana and Michigan). “Our members find value Most metropolitan and state hospital-council GPOs have disappeared. But

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The Council is a decades-old group of supply chain executives from key HRS facilities in the Pacific Northwest and Alaska. “We’re focused on maximizing Intalere agreements, but also negotiating regional agreements where there is a need,” Hughes says. “Based on direction from the Council, we have signed agreements for medical commodities, construction and, most recently, print services.” Food service is another expanding area, given its importance to senior living facilities. Hughes enjoys watching the Council grow and change, as memAlways evolving bers retire and new ones join, and Emily Hughes is regional manager as the group continues to evolve for Health Resource Services (HRS), and shift its focus. “We’re constantly the Seattle, Washington-based affili– Emily Hughes looking to our members and asking, ate of Intalere, and an independent ‘What are your hot spots now? How can we help bring LLC within the Virginia Mason Health System. She calls in suppliers to address them? What are we as a GPO on hospitals and surgery centers and clinics, as well as missing?” The group meets three times a year, and those a growing number of long-term-care and senior-living meetings often involve an educational component. “It’s facilities. On a day-to-day basis, she may be promoting an opportunity to learn about things that we can be helpIntalere national contracts or Intalere National Healthing each other with, the day-to-day things that people are care Alliance contracts (a group of five Intalere affiliates). up against. Or she may be promoting the HRS Northwest Healthcare “We’re always trying to evolve. It’s a unique group.” Supply Chain Council, which she facilitates. “I can say to an account, ‘We don’t have that brand on contract, but we have others,’” she says. How closely do her accounts identify as Intalere members or IKOINM Alliance members? “It really depends on the customer,” she says. “First and foremost, I want them to know they are a member of Intalere. But I also want them to know they have this regional resource. I explain, ‘You’re getting the advantage of national contracts, but you also get the camaraderie of a regional group, and contracts specific to your region.’”

“We’re always trying to evolve. It’s a unique group.”

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August 2018

LEADERSHIP

Lead on: PWH Summit One hundred and seventy-five people

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Big Time Selling equipment to today’s consolidated customers

t’s no mystery why many hospital systems and multisite physician clinics want to standardize equipment selection and purchasing. There are economies of scale, the desire to connect multiple sites to an electronic medical record, the benefit of ensuring that staff are proficient on the equipment used at all sites, etc.

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Though consolidation and centralization may be good for providers, they can present challenges for nonacute reps, particularly those used to selling to small or independent practices. The people in the office on whom they used to call may be out of the decision-making loop. Purchasing decisions may be made by committee. Then there’s the temptation for a large organization to try online purchasing. But successful reps have discovered ways – some of them time-tested, others specially suited for a consolidating marketplace – to sell in such an environment. They include: • I dentifying the decision-makers. • Carefully listening to the customer and understanding their priorities. •D emonstrating value after the sale, such as in delivery and setup. •W orking in tandem with manufacturers, who are, after all, the product experts. • S erving as a credible, accessible resource of information and products on an ongoing basis.

Getting the right people involved

Amat speaks of one customer that had recently acquired several facilities. “They were not standardized,” he says. “So now we’re getting phone calls for EKG paper. But there are three different EKG machines across their facilities. When I talked to their VP of operations, I told him, ‘It would behoove you to consolidate all this; I can get you a better deal, and you’ll spend less money on consumables and supplies.’ “Depending on how forward-thinking the practice is, they might say, ‘Let’s talk.’ Or they might say, ‘We just spent a lot of money buying practices, so let’s wait and see.’ Those with the foresight will be more receptive to standardizing equipment across their facilities.”

“ We handle everything, including tracking of items, staging in warehouses, delivery, setup, removal of debris or old equipment, hanging of items, and so much more.”

“We have been successful in standardizing multisite customers,” says Victor Amat III, president, American Medical Supplies & Equipment, Miami, Florida. “It is a longer process, and it takes getting the right people involved in the decisionmaking process.” For one multisite customer, American Medical leveraged long-term relationships with clinicians to get in front of key decision-makers as they planned a new facility. “They made the decision to standardize to power examination tables with built-in scales, because those tables provide better patient care and reduce the equipment footprint in the exam room,” says Amat. Some multisite practices simply aren’t as organized as others, he says. Equipment buying can be scattered, even haphazard. “You have to navigate the waters based on who your customer is.”

– Eric Kessel

Like their smaller counterparts, recently consolidated practices are susceptible to an age-old malaise: sticker shock. “The value of workflow improvements and better patient care usually trumps price,” says Amat. “The distributor rep needs to know the customer and what they are trying to achieve, and then bring to them the products or solutions to those issues.” The rep’s commitment – and opportunity – extends beyond the sale, he adds. “I believe that from the delivery to the installation, the distributor rep needs to be 100 percent involved, especially on major multiexam-room projects,” says Amat. “We hear a lot about the ‘customer experience.’ It needs to be a good one in order to form a good partnership with the end user going forward.”

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August 2018

Equipment Selling Decision-making teams Eric Kessel, vice president of physician office capital sales for Medline, says that distributor reps can play a key role in the selling of equipment in any environment. “The only difference in those situations where decisions are made centrally is that the rep needs to ensure that he or she is dealing with the decision maker. This makes the process more efficient and impactful for both the customer and the rep. “In general, most of the IDNs we deal with use a standardized list for capital equipment, and are pretty successful in standardization,” he continues. “Their clinical team has worked with the manufacturers to determine the best fit for their entire system and negotiated contract cost.”

With the equipment manufacturer’s help, the rep can help the customer identify what would make better sense, perhaps through an onsite product fair, and then bring that solution to the attention of those in charge of purchasing. From logistics to training, the distributor is essential for a positive customer experience, continues Kessel. “Our customers have specific needs for every delivery, and every delivery is different. We handle everything, including tracking of items, staging in warehouses, delivery, setup, removal of debris or old equipment, hanging of items, and so much more. Our reps are also at every capital equipment delivery, and they provide training when necessary. There are many moving parts when it comes to the sale of capital equipment, and Medline is there to help.”

“ The manufacturer rep can help determine the right product for the solution needed, arrange demos, provide training, troubleshoot any issues after delivery, and is an integral part of the sales cycle.” Successful provider organizations have strong, centralized decision-making teams, says Kessel. “They gather input from the clinical leads/providers to determine what functions the equipment needs to perform in that specific portion of the continuum of care.” They reevaluate their choices periodically to determine if the equipment on which they standardized in the past still fits their needs. And distributor reps can help. “Our reps have that day-to-day contact with clinicians in the offices,” he says. “They are in tune with what’s going on.” For example, the distributor rep may hear complaints about a product or piece of equipment that isn’t meeting the needs of the staff in a particular office, says Kessel.

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Working with the manufacturer

In equipment sales to large groups and IDNs, the manufacturer can serve as a resource to the distributor, and vice versa, according to those with whom Repertoire spoke. The distributor acts as a liaison between manufacturer and end user to provide one point of contact, says Doug Harper Jr., an independent manufacturers rep serving the – Eric Kessel Northeast. “Distributors can provide white glove delivery that may not be offered by the manufacturer, and a single solution for post-installation supplies, reducing the number of purchase orders. “As a manufacturers rep, I find it incredibly helpful if I can use the distributor rep’s relationships to talk to the right people to set up training,” continues Harper. “It helps to have that key point person I can be candid with.” Harper also encourages alternate-site distributor reps to stay in touch with their counterparts who serve the acute-care side of the health system. “The acute care reps are the eyes and ears in the hospital,” he says. They learn about upcoming projects, including those involving outpatient facilities, and they can steer the alternate-site rep to key decision-makers, such as the CIO, biomedical department head and materials management.

Dynarex Corporation Introduces “Wound Hub” A New Interactive Advanced Wound Care App

AVAILABLE NOW!

Advanced Wound Care Information At Your Fingertips! Now distributors can help educate their customers with clinical wound care information. Users will have access to guides on wound stages, dressing techniques, training and tips. Through our partnership with the Wound Care Education Institute individuals can view the WCEI’s videos and webinars, register for courses and even obtain CEU credits at a discounted rate. The App Offers: • Wound care staging guides • On-demand webinars • How-to videos • Continuing Education Units (CEU) • Product photos • Sku level information and more!

For more information contact your local Dynarex distributor or sales representative. Or call 888-396-2739 to find your nearest distributor. 10 Glenshaw Street • Orangeburg, NY 10962

Equipment Selling and customer – happens, the better the result for the customer. “And the customer will appreciate, value and remember the collaborative team effort.” Says Victor Amat, “The manufacturer rep needs to be involved in the sales process from the beginning.” He or she can assist with demos or mock exam room setups, and the manufacturer itself can offer some flexibility in payment terms to accommodate snags in the construction process. – Doug Harper Jr. Adds Kessel, “Medline values our relationships with our manufacturer partners. We rely heavily on this relationship to ensure our customers’ needs are met, from product selection to training. “At a rep level, our reps work closely with their regionCollaborative effort al manufacturer rep,” says Kessel. “The manufacturer rep “A distributor rep has a lot of experience in many things, but can help determine the right product for the solution needmight not be as familiar or might find themselves in an uned, arrange demos, provide training, troubleshoot any iscertain situation with respect to a particular product,” he says. sues after delivery, and is an integral part of the sales cycle. “The manufacturer’s rep, on the other hand, has likely been in From a leadership standpoint, it is imperative that our goals this situation many times and is best suited to support it. The are aligned and we are working closely to help facilitate our manufacturer’s rep is there for you to present, conduct evalutwo teams working as well together as possible. ations, and construct a deal that works for all sides. There “Manufacturers play a key role throughout the is strength in numbers and partnerships, and the earlier the sales process.” collective engagement – distributor rep, manufacturer rep David Bussa, executive vice president, The Brewer Company, says equipment manufacturers value the distributor rep as a “customer advocate who alerts them to all the choices available and brings credibility to the table. “Customers standardize based on informative support and evaluation,” he says. “The distributor rep who drives and provides choice and consideration will, more often than not, be the one who wins the account.” Bussa encourages distributor reps to leverage the product expertise of equipment manufacturers “early and often.”

“Distributors can provide white glove delivery that may not be offered by the manufacturer, and a single solution for postinstallation supplies.”

August 2018

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Get a Grip on Personal Protective Equipment: Protect Your Customer, Protect Yourself The phone rings. It’s your top customer. And they’re

not happy. They think you pulled the bait and switch. Gloves are breaking. They blame you, because you’ve sold them a product that was inconsistent with the sample you provided. You have put their facility, staff, and patients at risk. You call the manufacturer to see what happened. Meanwhile, you reach – quickly -- for an alternative to fill the void. Sound familiar?

monthly income sources. Hand protection alone can be a multi-million dollar line item for most healthcare networks.

Grasping the Responsibility, Grabbing the Opportunity So what does all of this mean? It means that you have both a responsibility and an opportunity when it comes to infection prevention and personal protective equipment a responsibility to protect your customer’s interests, and an opportunity to protect yourself. Protecting Your Customer One of the best ways to protect your customers is to provide them with product consistency. Seek out and establish relationships with PPE manufacturers that have a history of reliability and quality. Explore and educate yourself on new and unfamiliar brands that may offer the level of protection, consistent product quality, price point, and customer experience your buyers are looking for.

Grappling with the Risks Your customer is absolutely right to be upset. Inconsistencies in personal protective products put an entire facility at risk from patient, to staff, to visitor. According to the Centers for Disease Control and Prevention, personal protective equipment (PPE), including gloves, protects healthcare personnel from exposure to infectious diseases. Simply put, infection prevention. While the rate of hospital-acquired infections has decreased since publication of the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination (HAI Action Plan) in 2013, there is still cause for concern due to the increase of antibiotic resistance, the resurgence of vaccine-preventable viruses and the disheartening fact that hand hygiene is still a top issue in 2018. What’s more, PPE product disparities put you, the rep, at risk. While PPE disposables are commonly low-cost, lowcommission items, they are often high-volume and steady

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Protecting Yourself Nobody wants that phone call, nor do they want to lose a piece of their hard-earned business to a competitor. After all, customer dissatisfaction impacts your relationships, your perceived trustworthiness, your personal brand, and your income. Distribution reps still hold significant influence in healthcare buying decisions. While you cannot control manufacturing processes and sourcing, you can control which manufacturers’ products you present to your customers. Introduce proven producers that provide consistent in-use clinical performance. You have a great opportunity to demonstrate to your customers that no matter how small the product or how seemingly insignificant the issue may be, you value them, their concerns, and their business. Being their “go to” resource creates long lasting relationships and a level of integrity that will last throughout your career.

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CHRONIC CARE MANAGEMENT

Primary Care at Home The Independence at Home Demonstration

Editor’s note: Demographics are changing. Venues of care are changing. Reps’ call points and the products in their bags are changing too. With this issue, Repertoire begins a series of articles on chronic care management. 28

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Chronic diseases and conditions – such as heart disease, stroke, cancer, type 2

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

In the next 20 years, the number of Americans who are 65 years old or older will nearly double to more than 72 million – one in five Americans, reports the National Association for Home Care & Hospice, or NAHC. Many will live with disability and multiple chronic illnesses. Authorized by the Affordable Care Act, the Independence at Home Demonstration is designed to provide chronically ill patients with a complete range of primary care services at home. Medical practices led by physicians or nurse practitioners provide primary care home visits tailored to the needs of beneficiaries with multiple chronic conditions and functional limitations. The Demonstration also tests whether home-based care can reduce the need for hospitalization, improve patient and caregiver satisfaction, and lead to better health for beneficiaries and lower costs to Medicare.

Primary care team

Karen Abrashkin, M.D., medical director of Northwell Health House Calls, an Independence at Home participating practice.

CMS program The demonstration project began in 2012 and was originally authorized for three years. It was subsequently extended for two additional years through September 30, 2017, by the Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015.

“ The individuals we’re really looking for are the sickest of the sick, homebound patients, who are at risk of going into the hospital or suffering a poor outcome because they don’t want to go to the hospital, or because going to the hospital may present its own risks.”

“I do think we are a nice option for office-based providers to know that there is a team of primary care providers who will see patients in the home,” says Ina Li, M.D., program director for Christiana Care Health System’s Independence at Home Demonstration Program and director of clinical geriatrics for Christiana Care in Wilmington, Delaware.

A typical referral is a patient who has had a stroke, chronic obstructive pulmonary disease and severe arthritis, she says. “This patient is no longer able to walk down her front steps and can no longer make it in to see her primary doctor. The doctor who sees the patient may not have seen them in a year. Due to this situation, the doctor makes a referral to my practice for our team to see the patient and take over their care. We are then able to provide timely care to the patient and, hopefully, maintain and improve their quality of life and reduce their burden of illness and symptoms.” “The individuals we’re really looking for are the sickest of the sick, homebound patients, who are at risk of going into the hospital or suffering a poor outcome because they don’t want to go to the hospital, or because going to the hospital may present its own risks,” says

– Karen Abrashkin, M.D.

The Bipartisan Budget Act of 2018, enacted Feb. 9, 2018, extended the demonstration for an additional two years through Sept. 30, 2019. To qualify for an incentive payment, participating practices must meet the performance thresholds for at least three of six quality measures: • Follow-up contact within 48 hours of a hospital admission, hospital discharge, and emergency department visit. • Medication reconciliation in the home within 48 hours of a hospital discharge and emergency department visit. • Annual documentation of patient preferences. • All-cause hospital readmissions within 30 days. • Hospital admissions for ambulatory care sensitive conditions. • Emergency department visits for ambulatory care sensitive conditions.

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CHRONIC CARE MANAGEMENT In the second performance year of the demonstration – the most recent year for which data was available at press time – 10,484 beneficiaries were enrolled in 15 participating practices. The data shows that all 15 practices improved performance from the first performance year in at least two of the six quality measures. Four practices met the performance thresholds for all six quality measures. All together, the 15 practices saved $10.6 million, and seven participating practices earned incentive payments of $5.7 million.

Northwell Health Northwell Health’s demonstration program is directed by physicians and nurse practitioners, with the aid of an entire team, including technicians, social workers and others, says Abrashkin.

social work care-manager visits, and interventions, such as IV medications.” Specially trained emergency triage nurses are available telephonically 24/7. The House Calls team includes community paramedics, that is, specially trained paramedics who can, under the orders of a physician, evaluate and provide treatment in the home around the clock. The average response time is 21 minutes, and they can perform EKGs, blood glucose monitoring and CO2 tests; administer more than 20 medications (either through an IV, inhalation or orally), and more. “There are very few things in life that physicians and patients love, and that also save money,” says Abrashkin. “But the patient satisfaction rating for our community paramedicine program is through the roof, and we’re offering a new career option to paramedics. By building this team and this program, we are able to give patients safe and reliable ways to receive care at home, where most of our patients prefer to remain.” During the second year of the Independence at Home demonstration project, Northwell’s House Calls practice provided care to 357 patients in Nassau and Suffolk counties as well as Queens in New York City. In addition to improving health Ina Li, M.D. outcomes, Northwell’s clinicians reduced costs that year by $6,816 per patient per year, for total savings to Medicare of $1,641,825. This was the second highest savings performance among the demonstration sites. After accounting for Medicare withholds, Northwell earned $874,151 in incentive payments.

“ To manage homebound patients who have a high disease burden, including medical, psychological, and socio-economic issues, a teambased model of care is essential.” “By providing home-based primary care and a reliable alternative to receiving care through the emergency room and hospital (which many of our patients do not want), we were able to show savings in the total cost of care while honoring our patients’ wishes for where and how they receive medical interventions. “Our home visits are just like office visits, but with a lot more behind them, including more frequent regular checkups as well as sick/urgent visits when necessary,” she says. The House Calls team makes visits Monday through Friday, and a primary care provider is on call 24/7 to answer questions and get patients the care they need, says Abrashkin. “We are able to take care of many diagnostics in the home, such as X-ray, lab work, EKG, ultrasound, sleep studies and occupational and speech therapy. We deliver care in the home through primary care, nurse and

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Christiana Care Health System Christiana Care began participating in the Independence at Home Demonstration in 2012. “The Independence at Home program is a delivery model where we are the primary care providers for homebound patients,” explains Li. “We provide primary care in the patient’s home. Primary care providers who work in offices refer their homebound patients to our program for us to take care of in a longitudinal fashion. The officebased primary care providers relinquish control of their patients once they enter our program.

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CHRONIC CARE MANAGEMENT

NAHC a big supporter The National Association for Home Care and Hospice is a self-proclaimed strong supporter of the Independence at Home Demonstration. IAH works because: • It is designed to provide appropriate levels of care for a carefully targeted group of the most complex, high-cost beneficiaries. • I t requires an interdisciplinary team to provide access to care 24 hours a day, seven days a week, and to offer in-home visits within 48 hours of hospital or emergency room discharge, including medication reconciliation. • I t prevents unnecessary hospitalizations and misuse of medications, and discourages overuse of services. • I t has rigorous quality standards that assure better patient and family experience, and better clinical outcomes. • I t is backed by a substantial body of evidence showing that home-based primary care, as applied in the IAH demonstration, enhances quality of care and reduces cost for seriously ill elderly Americans. • It saves Medicare money. “The Independence at Home demonstration project is focused on very high-risk patients, generally, the top 5 percent highrisk Medicare patients, so it is appropriate that medical practice takes a predominant role,” says NAHC President William A. Dombi. “Will that change in the future? It certainly could, but probably not to the point of being driven by a non-medical focus. Home health could certainly become more involved in the future, thanks to technological improvements, but currently home health is more appropriate for the other 95 percent of Medicare patients.”

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“We work closely with Christiana Care’s Visiting Nurse Association, as they are another referral source for us,” adds Li. “As many of our homebound patients require in-home skilled nursing and physical, occupational and speech therapies, we often refer to our Visiting Nurse Association for assistance. “In terms of outcomes, we have worked hard to reduce our inpatient hospital and skilled nursing facility admissions,” she says. “By focusing on these two specific measures, we have reduced the average Medicare payment per beneficiary per month by 22 percent in the last five years. We are in the process of designing a tool for patient experience to better understand how we can most effectively serve the needs of our patients.” Implementing Independence at Home has been a learning experience, says Li. “We have found that high utilization of skilled nursing facilities and care for dialysis patients were big factors in [our] expenditures,” she says. “Compared to other Independence at Home programs, we had higher proportions of both. We are now modifying our program to better control these costs.” That said, Li is convinced that the team-based approach of Independence at Home is a sound one. “To manage homebound patients who have a high disease burden, including medical, psychological, and socio-economic issues, a team-based model of care is essential,” she says. “Since these patients have complex issues, [they need] the support of many disciplines to ensure that they can receive their care at home and avoid having to be admitted to the hospital.”

Lessons learned Independence at Home has given Northwell Health House Calls a chance to transform its approach to homebased primary care by adopting some best practices, says Abrashkin, who served as a hospitalist before getting involved in House Calls six years ago. “Independence at Home has provided financial support and a platform to support our care model,” she says. “There are many expenses in our program – such as care manager visits and community paramedics – that are not reimbursed by Medicare but that are important to providing high-quality care at home. Independence at Home has helped provide funding for these services and also has allowed us to create a network across the country of other practices involved in IAH to share best practices.

INNOVATION EXPO

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CHRONIC CARE MANAGEMENT is also a role for telemedicine that is not currently reim“We have applied the quality markers of Indepenbursed, which could allow us to increase our footprint dence at Home across our whole patient population – and provide more care across our area. But without supthings like advanced care planning to really understand port for these services, it is very difficult to develop prowhat our patients want for their care, having a provider grams that could potentially be helpful.” on call by phone 24/7 to give a meaningful alternative The Northwell Health team has also learned that to calling 911, and making an in-person visit within 48 organization and predictable workflows are essential to hours of hospital discharge to check on the patient and the success of a program such as Independence at Home. reconcile medications if they do go into the hospital for “With a mobile workforce, comtreatment. We know that these are munication can be more difficult than important to the outcomes of our in an office or hospital,” says Abrashpatients, and have applied them to all kin. “What you might discuss over patients, whether they are enrolled in lunch with your colleagues now has Independence at Home or not. to be communicated deliberately to a “This work is very meaningful, group who is driving across Queens both to our staff and to our patients and Long Island. This also goes for coland their families, but also very diflegial discussions amongst physicians or ficult,” she continues. “Going into care managers about difficult cases and the home setting, where the typical how to proceed. These discussions have resources of a hospital or an outpato be built into the work week or else tient facility are not available, pushes they won’t happen, and they are very our team to think outside the box on important for holistic team-based care. a daily basis. Our staff encounters “Having a medical record that new and different situations and chalsupports your work is very necessary lenges every day. The people working – Karen Abrashkin, M.D. for day-to-day work and communiin our program are doing this work cation as well as reporting. This is a because they are truly dedicated to real challenge when working remotely.” their patients. But the payoff makes the effort worthwhile. “We have also learned that regulations set for tradi“A major lesson learned is just how meaningful this tional office-based settings may hamper growth of prowork is,” she says. “Going into someone’s home allows grams delivering home-based primary care. For example, you to get a real insight into their life and allows you to the oxygen saturation readings measured by our commurealize that, as a medical provider, your care is only one nity paramedics cannot be used to certify a patient for slice of what is going on in a person’s life and influencing home oxygen; instead, we need to send a physician or his or her health outcomes.” nurse into the home to retake the measurement. There

“Our home visits are just like office visits, but with a lot more behind them, including more frequent regular checkups as well as sick/urgent visits when necessary.”

Participants The following organizations are participants in the Independence at Home Demonstration: • Boston Medical Center • Christiana Care Health System • Cleveland Clinic Home Care Services •D octors Making

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Housecalls, LLC • Doctors on Call • House Call Doctors Inc. • Housecall Providers, Inc. • MD2U-KY, MD2U-IN • Mid-Atlantic Consortium

• Northwell Health Care • VPA Dallas • VPA Flint • VPA Jacksonville • VPA Lansing • VPA Milwaukee

Health plan waives cost for chronic-care meds A health plan in Massachusetts has begun offering a

program that waives co-pays for 11 common prescription medications that treat chronic conditions, such as high cholesterol, high blood pressure, heart disease and depression. The program will be offered by Neighborhood Health Plan on a selection of commercial plan designs for large employer customers. Neighborhood Health Plan is a member of Partners HealthCare. “Care Complement” also gives members access to prevention services, such as diabetic education and nutritional counseling, at no additional cost. Cost-sharing is

waived for certain pain treatments offered in place of opioid prescriptions, as well as for cardiac rehabilitation services to speed recovery after a heart attack. “Care Complement improves adherence and management of chronic disease, and offers affordable alternatives to opioids for the treatment of pain,” Dr. Anton B. Dodek, chief medical officer for Neighborhood Health Plan, was quoted as saying. “By eliminating cost sharing, this benefit design encourages members to work with their doctors and optimally manage their conditions, which results in healthier outcomes and improved patient satisfaction.”

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August 2018

POST ACUTE HIDA INSIGHTS

Medical Products Key For Improving

Post-Acute CMS Star Ratings By Ann Peters, Manager, Research & Analytics, HIDA

Post-acute providers are highly focused on attaining

an excellent score under the Centers for Medicare and Medicaid Services’ (CMS) five-star rating system, according to HIDA’s 2018 Provider Survey: The Impact Of Five-Star. This survey of skilled nursing facility (SNF) owners, chief executives, and administrators looks at how CMS’s five-star program has shifted organizational priorities, and what this means for healthcare manufacturers and distributors.

Most executives (71%) report the program has had a strong impact on their facility in several ways, such as driving additional referrals from hospitals, strengthening partnerships with other providers, or enhancing their marketing efforts. A majority of executives (70%) believe medical products can improve their five-star rating. Other key insights from this research include:

Most SNFs partner with hospitals to reduce readmissions The vast majority (82%) of survey respondents said they partner with hospitals to help reduce readmissions. The primary reason for these partnerships is due to the fact that hospitals are a primary referral source. Only 14% of respondents listed common ownership as a reason for working with hospitals.

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Hospital referrals are a key driver of occupancy in SNFs. Two-thirds (66%) of respondents said patients from hospitals accounted for more than half of their total occupancy, and 34% said hospital referrals accounted for 90% or more of their total occupancy.

SNFs plan to add new services Respondents indicate they are planning to expand the range of services they offer. Cardiac, pulmonary, and orthopedic rehabilitation are the leading services SNFs plan to offer, though other new services mentioned include memory care and assisted care. To support new services, responding facilities plan to invest in new equipment. This year, 22% will invest in orthopedic rehabilitation equipment, while 21% will also invest in cardiac equipment. Overall, SNFs plan to increase their per-patient spending this year, with more than half reporting a 1% to 5% increase in spending. Inflation and acuity were the most commonly cited drivers of increases in medical supply budgets.

Participation in CMS value-based programs has increased Over the past two years, the share of facilities participating in new CMS payment programs has risen. This year, 56% of SNFs are participating in an accountable care organization, up from 47% in 2016. Meanwhile, the share of SNFs participating in bundled payment programs increased from 42% in 2016 to 52% in 2018. For more information, and to see additional research reports in HIDA’s Provider Survey series, visit www.HIDA.org/ProviderSurveys.

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GPOs and distributors. They can work together. We’ll show you how.

Let’s be honest. The history between distributor sales reps and group pur-

chasing organizations (GPOs) has been a little rocky. The bad blood stems from reps viewing GPOs as competitors who reveal base prices to customers, knocking down margins.

But in fact, distributors and GPOs can play complementary roles. Both want to maximize profitability while serving customers’ needs—and both can.

Increase ‘stickiness’ In today’s rapidly changing healthcare environment, with constant

“Distributors get more value, and they pay less for products. That’s our goal.” – Joshua Fitzgerald, vice president of sales, Irving, Texas-based Provista

Joshua Fitzgerald

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pressure for lower costs, distributors can benefit from engaging with GPOs to drive down costs and reach a wider customer base, says Joshua Fitzgerald, vice president of sales for Irving, Texas-based Provista, the nation’s largest non-acute GPO. “A GPO/distributor rep partnership can move the distributor from a secondary to a primary position,” Fitzgerald says. “We help distributors get better pricing, which means they can increase their profit margin and still offer great savings to

customers. This increases customer ‘stickiness,’ which is when customers want to buy more products from that distributor. The distributor might get 60 percent to 70 percent of spend from a customer, versus the 10 percent it was getting before. “Distributors get more value, and they pay less for products,” says Fitzgerald. “That’s our goal.” GPOs also educate their customers about distributor programs and services. For example, Provista informs customers about specialized capital management planning and installation services as well as standardization and formulary management programs. When GPOs serve as an extension of the sales team and promote these services, they reach a larger audience. This supports a distributor’s entire portfolio across both the GPO’s and the reps’ customers.

Why Provista? Founded in 1994, Provista is dedicated to helping customers in the nonacute space. As the largest non-acute GPO, its sales teams have a strong presence in local markets. The company’s deep expertise in the non-acute supply chain, coupled with its strategic emphasis on strong and mutually beneficial relationships with distributors, reps and supply chain partners, enable customers to gain new levels of efficiencies, effectiveness and profitability.

Mutual benefit GPO pricing allows reps to be competitive in markets like ambulatory surgery centers (ASC), which are aggressively seeking lower prices. “Everyone is utilizing GPO pricing,” says Fitzgerald. “We’ve taken the approach that we’re going to offer better than GPO pricing through market-specific aggregation programs to help reps stand out in a highly saturated market.” The Provista contract implementation team has made it a priority to get reps’ customers on contract, which can save time and money, says Fitzgerald. Provista works with suppliers, handles the logistics, and implements the contracts to simplify and streamline processes for distributors. “We are hyper-focused on making our company easy to do

business with,” he says. “We build relationships, and we help reps meet their numbers.” “By working with GPOs, distributor reps can offer customers a greater portfolio of products and services, protect them with ironclad contract terms and conditions, and deliver more favorable pricing,” says Fitzgerald. “By working with a GPO, distributor reps can be more flexible in their costs and have a lower invoice to the customer across more products. We play really well with distributors and view them as customers, not competitors.”

“We’ve taken the approach that we’re going to offer better than GPO pricing through marketspecific aggregation programs to help reps stand out in a highly saturated market.” To talk to a Provista distribution team member, email distributorinfo@provistaco.com

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August 2018

HIDA GOVERNMENT AFFAIRS UPDATE

Distributors Descend

on Capitol Hill for HIDA Washington Summit

HIDA President & CEO Matthew J. Rowan; Bob Schruender, Sekisui Diagnostics; Steven Sepulveda, Mesa Biotech; and HIDA Board of Directors Chairman Chris Kerski, Cardinal Health, walk to a meeting with Rep. Sean Duffy (R-WI).

More than 70 HIDA members and their manufacturer partners went to Washington,

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

D.C., in early June to educate lawmakers on key issues affecting the healthcare supply chain. Attendees at the annual HIDA Washington Summit conducted 130 Capitol Hill meetings, including twice as many with members of Congress than in 2017. Participants reported productive discussions with lawmakers and their senior staff who sit on key committees that influence the healthcare supply chain, including the Senate Finance, Armed Services, and HELP (Health, Education, Labor, and Pensions) Committees, as well as the House Ways and Means, Energy and Commerce, and Armed Services Committees. Meetings focused on a number of key topics, including pandemic preparedness, purchasing rules under the FY2018 National Defense Authorization Act, and international trade policy. Here is a look at some of the key topics members discussed with their elected representatives:

Pandemic and Emergency Preparedness In their meetings on Capitol Hill, Summit participants educated policymakers on the supply chain’s role during public health events, like the recent hurricanes in Puerto Rico and Texas. Distributors also explained that the healthcare supply chain is extremely lean, and ongoing efforts are needed to ensure greater elasticity when epidemics or disasters occur that strain available inventories.

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HIDA members’ conversations came at a key time as lawmakers work to reauthorize emergency preparedness legislation. The Senate’s Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAI) of 2018 contains a number of measures that recognize the important role of the healthcare supply chain. These include: •P rovisions that underscore the value of public and private sector coordination during an emergency. •T he requirement that ancillary products needed to deliver medical countermeasures are incorporated into the Public Health Emergency Medical Countermeasure Enterprise planning process. • The request to the Secretary of Health and Human Services (HHS) that manufacturing capacity and outside sources of medical supplies are considered when replenishing the Strategic National Stockpile (SNS). HIDA members shared their support for these key provisions, and detailed how the passage of PAHPAI would strengthen their ability to work with federal and local governments during a crisis. In addition to seeking PAHPAI’s passage, HIDA members also value the development of transparent communication pathways between public and private partners, as well as the establishment of stable funding to support training, planning, and stockpiling efforts.

purchase online. Mistakes made during the purchase of medical goods can risk patient safety and create liability. In their conversations with lawmakers, HIDA members raised the following concerns: • Mistaken delivery of medical products could delay critical patient surgeries or procedures, and would needlessly put patient lives at risk. • Many medical items have specific storage and handling requirements. The integrity of these goods can be negatively affected by the number of times they have been shipped and handled, by the environments to which they are exposed, and by co-mingling them with non-medical freight.

Rep. Dave Loebsack (D-IA) discusses pending emergency preparedness legislation with Jim Burns, HD Supply, and Emily Berlin, Cardinal Health

The National Defense Authorization Act (NDAA) Under the NDAA, the U.S. General Services Administration (GSA) is tasked with reforming the system under which federal departments and agencies acquire commercial products. A key part of this reform is to expand the range of products acquired through e-commerce platforms. Unfortunately, this legislation did not receive public comment and lacked both Congressional review and regular order oversight. HIDA members explained to legislators that medical products are unlike most other goods that the federal government buys, and are not always suitable for

• Department of Defense and Veterans Affairs hospitals rely on stable sources of supplies, as well as the vital infrastructure supplied by their distributor partners. Many suppliers have employees based in these provider facilities to manage logistics and ensure products get to where they are needed on time. While recognizing the importance of a streamlined government acquisition process, HIDA members reminded lawmakers that the procurement and contracting process for healthcare goods is unique. They added that distributors have long been proactive partners in helping to streamline this process. Through collaborations like the Prime Vendor Program, for example, suppliers are able to

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August 2018

HIDA GOVERNMENT AFFAIRS UPDATE

Republican and Democratic Chiefs of Staff provide insider perspectives on health reform’s future and the upcoming midterm elections.

incorporate best practices from the commercial marketplace into the federal government’s acquisition process.

International Trade and Tariffs Many participants also spoke to members of Congress about the negative impact proposed tariffs could have on healthcare. The healthcare supply chain for the U.S. is both global and complex. Vital equipment and parts from oversees support all aspects of medical care, from routine wellness visits to lifesaving operations. In addition to raising the cost of healthcare, these tariffs could also impair ongoing emergency preparedness efforts, distributors warned. As of June 15, certain medical and ancillary products were included in the $50 billion in tariffs the U.S. has imposed on China, such as electrocardiographs, sterilizers, X-ray machines, and surgical instruments.

Assistant Secretary for Preparedness and Response, HHS, discussed various challenges faced both during and in advance of national emergencies. He praised commercial supply chain expertise, adding HHS plans to take steps to incorporate additional opportunities for private sector engagement and collaboration to continue improving U.S. preparedness capabilities. Efforts to eliminate the Affordable Care Act (ACA) are unlikely in the near future. Citing the upcoming midterm elections, and the popularity of certain components of the health law, several Democratic and Republican Chiefs of Staff believe it is unlikely Congress will attempt another ACA repeal in 2018. Expressing concern about the rising cost of healthcare to federal payers, policy experts commented that further reform to the healthcare system would be politically difficult without broad public support.

Additional Policy Speaker Takeaways The second day of the Washington Summit featured lawmakers and experts who shared their insider perspectives on various political and industry issues. Among some takeaways: The private sector has a lot to offer for pandemic and emergency preparedness efforts. Dr. Robert Kadlec,

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HIDA regularly advocates for distributors through regular meetings with lawmakers and partnerships with federal agencies year round. If you would like to get more involved, or would like more information about the HIDA Washington Summit, please contact us at HIDAGovAffairs@HIDA.org.

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.

Automotiverelated news

Atomium Sky

On-demand deliveries by drone

The connection of the real and virtual world as well as the relationship of earth and space is captured in the BASF Coating’s key color, Atomium Sky, predicted to influence 2022 vehicle models in North America. This is the second consecutive year that BASF selected a blue as its key color, demonstrating its growing prominence in this region. “Atomium Sky is a deeply saturated blue with a medium coarseness that transitions to a softer, semi-opaque hue, exuding playfulness while demonstrating futuristic and forward-thinking,” says the company. Atomium Sky is just one of 65 colors for automotive surfaces featured in BASF’s 2018-19 Automotive Color Trends. Others include Metal’s Mettle, Centripetal Blue and Kleur.

Boeing announced its investment in Matternet, a Menlo Park, California-based startup pioneering on-demand unmanned aerial vehicle (UAV) delivery operations in urban environments. Matternet’s logistics platform – combined with Boeing’s expertise in complex logistics, integration and manufacturing capabilities – will further enable reliable, efficient cargo air transportation, according to the companies. Matternet received authorization to launch UAV operations over densely populated areas in Switzerland in 2017. Leveraging its Matternet Station, M2 drone and Cloud platform, the company achieved safe flights over densely populated areas and partnered with Swiss Post for on-demand deliveries of medical samples to hospitals in Switzerland.

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August 2018

WINDSHIELD TIME Replace your own car key No more trips to the dealer to replace a lost key. The product development division of Louisville, Kentuckybased Car Keys Express released a consumer-programmable, universal aftermarket key for Ford, Lincoln, and Mercury vehicles. The key, with integrated remote, is said to have the same functionality as standard OEM versions and was scheduled to be available for purchase in August. This key is the second device to be released in the company’s new product line, Simple™ Key. Each key in the product line allows retailers to offer consumers a simple, “do-it-yourself ” solution for replacing modern car keys. These products include a universal key and, if required, an EZ Installer™, allowing customers to pair the key Apple CarPlay to their vehicle. Once cut, and Google’s consumers follow instrucAndroid tions to pair the key in just Auto are less a few minutes.

Scoot to your next call

distracting to drivers when compared to built-in vehicle infotainment systems designed by automakers, according to research from the AAA Foundation for Traffic Safety.

Driving in a busy metro area? Go to your next call in a VehiGo – a three-wheel, standup electric scooter said to guarantee riders a safe and natural trip. Users can stand on the feet plate without holding the handlebar and keep natural balance. Lean left or lean right – it won’t tumble. With 360-degree limitless steering, users can operate forward and backward without stepping off the scooter. The 130MP wide lens camera will record the riding and automatically upload to cellphone, which allows the user to share the riding story to friends, family – or sales manager. And when the ride is done, users can fold and drag the VehiGo like luggage on the street, get in the elevator, subway or hospital hall, or put it next to the working desk. The manufacturer, Alllu, has started a Kickstarter campaign.

Less distraction Apple CarPlay and Google’s Android Auto are less distracting to drivers when compared to built-in vehicle

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infotainment systems designed by automakers, according to research from the AAA Foundation for Traffic Safety. While many of today’s infotainment systems create potentially unsafe levels of distraction by allowing drivers to perform complex tasks like programming navigation or sending a text, CarPlay and Android Auto were 24 percent (5 seconds) faster on average than the vehicle’s native system when making a call, and 31 percent (15 seconds) faster when programming navigation. This difference is critical, as drivers who take their eyes off the road for more than two seconds double their risk of a crash. AAA says it is encouraged by these findings, as they indicate that popular infotainment systems can be designed in a way that is less distracting. Distracted driving is responsible for more than 390,000 injuries and 3,500 deaths every year.

Get in the know Spiffy Blue is an on-board diagnostics sensor said to give car owners unparalleled access to information – like a fitness tracker for the car. “Since 1996, every car in the U.S. has been required to have an on-board diagnostics port, but until recently, only professionals had access to scanning technology,” Scot Wingo, CEO of Durham, North Carolina-based Get Spiffy Inc. is quoted as saying. “Knowing exactly what you need when you go to the shop puts the power back into your hands. You can work with service providers to ensure the right services are performed at a fair price.” Car owners can order the Spiffy Blue on-board diagnostics sensor online from Amazon. com and eBay, and download the free app for Apple iOS and Android.

Car subscriptions Flexdrive, a car subscription company that enables dealers and fleet owners to offer on-demand car subscriptions to consumers via mobile devices, announced that Florida Fine Cars, a dealership with four locations in Florida, will launch AmeriDrive to provide car subscriptions to consumers across South Florida. The dealership partnered with Flexdrive because of the company’s technology platform that enables dealers to manage all aspects of car subscription from fleet management down to individual transactions with consumers, according to Flexdrive. Atlanta-based Flexdrive is a joint venture of Cox Automotive and ARI, a fleet management company.

HELPING YOUR CUSTOMERS BETTER MANAGE THEIR FLU SEASON PREPAREDNESS. Sharing your knowledge of planning and preparedness for flu season is invaluable for your customers. Just as important is the trust you’ve built face-to-face with them. At BD, we believe your knowledge and relationships are the foundation for safer immunization practices, and why customer loyalty is important far beyond the benefit of improved sales. This is why we are committed to supporting you and the customers we serve with innovative products and services that help improve the comfort and satisfaction of every patient’s experience. Discover the difference we can make as partners. Discover the new BD.

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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

Charge it Valencia, California-based Naztech announced the release of its 18W Super Speed Wall Charger, which it says provides the latest high-speed charging technology – USB-C Power Delivery and Adaptive Fast Charging – in a single charger. Both of the charger’s ports deliver up to 18W output and can accommodate all USB-powered devices, including smartphones, tablets, wearables and USB-C laptops. The 18W USB-C PD + AFC Wall Charger is able to quick-charge an iPhone X/8 or Samsung Galaxy 9/9+ from 0 percent to 50 percent in 30 minutes. According to Naztech, the USB PD, or USB Power Delivery protocol, is designed to standardize charging across the latest and future USB electronics. Everything from smartphones and tablets, to high-powered laptops, will soon be able to charge

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from a single device, reducing the need to carry around an assortment of cables and chargers. USB-C PD technology can charge a smartphone up to 80 percent faster than standard USB chargers, and automatically adjusts to deliver the exact power needed for the fastest possible charge.

Smart deadbolt Schlage, the door hardware maker, announced that homeowners can access their Schlage Sense™ Smart Deadbolt using Google Assistant. This functionality can be activated by saying, “OK Google, lock my door” or “OK Google, is my door locked?” The capability of Google Assistant will also extend to Android™ phones or the Google Assistant app on Apple® devices. Using the Schlage Sense Smart Deadbolt with Google Assistant-enabled devices

will require the Schlage Sense™ Wi-Fi Adapter (sold separately). The Wi-Fi Adapter allows iOS and Android smartphone users to gain remote access to their lock through the Schlage Sense app with no monthly fee required.

Knotty problem solved ZIPPEAR is said to employ the power of magnets to prevent earphone cords from becoming tangled and knotted and to remain stylish and nicely bundled when put away. The product is an earphone accessory kit consisting of 10 small plastic clips that clip on your favorite pair of earphones. Each clip contains a small but powerful magnet. “I commute to work on a train every day, and as a music lover, I use my earphones a lot,” inventor Gal Avivi was quoted as saying. “So I grew tired of having to untangle the cords each time I take them out of my bag.” ZIPPEAR has launched an Indiegogo campaign to spread awareness about their product among consumers and the investment community.

Blackberry’s back TLC Communication – a smartphone manufacturer and BlackBerry-brand licensing partner – introduced the BlackBerry® KEY2. Running the latest Android™ 8.1 Oreo operating system, the BlackBerry KEY2 is the firstever BlackBerry smartphone to feature a dual-rear camera. It also includes the introduction of Speed Key, a universal shortcut key that makes it possible to instantly access frequently used functions, apps and contacts anywhere on your device at any time. BlackBerry KEY2 has a redesigned intelligent keyboard as well as a 4.5-inch touch display that includes 2.5D Corning® Gorilla® Glass, said to offer increased scratch resistance and create a more seamless design and edge-to-edge look.

Net neutrality? Not a chance. “Net neutrality was too good for us,” writes Farhad Manjoo in June in The New York Times. “And even if rules are restored, the notion that the Internet should afford at least a minimally competitive landscape for new entrants now seems as antiquated as Friendster. Today, the Internet is run by giants. A handful of American tech behemoths – Amazon, Apple, Facebook, Google and Microsoft – control the most important digital infrastructure, while a handful of broadband companies – AT&T, Charter, Comcast and Verizon – control most of the Internet connections in the United States. The very idea that large companies can’t dictate what happens online is laughable now. Large companies, today, pretty much are the Internet. In this world, net neutrality didn’t have a chance.”

Get my message? Time-released messaging, by TimeSpring, Inc., enables people to share messages with anyone at any age, including children, up to 30 years into the future. Parents and grandparents can create accounts for children too young for email and send a photo or video with a message and have it scheduled to be delivered when the child is old enough to understand and appreciate the memory. The app works like this: Pick a photo or video, write a message, and schedule the date to be delivered to someone up to 30 years into the future. A reported 52 percent of TimeSpring users are sending messages between 10 and 20 years into the future, while the average TimeSpring user creates 1.5 child accounts. It seems, given the opportunity, people want to communicate their stories in the future, especially for their children, according to the company. TimeSpring can be installed for free in Google Play and Apple Store.

“ The very idea that large companies can’t dictate what happens online is laughable now. Large companies, today, pretty much are the Internet. In this world, net neutrality didn’t have a chance.” – Farhad Manjoo, The New York Times

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corner

Reinhart Family

Sellstrong Deanna Reinhart brings on the challenges

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Deanna Reinhart isn’t afraid to get in the trenches. She

did it as a nursing home administrator. She did it when she switched careers and entered medical sales for Seneca Medical (now Concordance Healthcare Solutions). She did it when she took responsibility for servicing a large IDN in northwest Ohio for Concordance. And she did it when she acted as the mascot for her youngest son’s Miracle League baseball team in Findlay, Ohio.

“When I find myself feeling challenged, I stop and think, ‘This is only going to make me stronger,’” says Reinhart, senior account manager for Concordance. “If I am going to be responsible for managing something, I want to understand all aspects of the job. If you want respect, you have to earn it. You have to show people you are not afraid to get ‘dirty.’” Reinhart was born in Michigan and raised in Clyde, Ohio. Her late father, John Bommarito, retired in 2010 following a career in industrial procurement. Her mother, Trudy Bommarito, is a retired childcare provider. “My dad had a very strong work ethic, barely missing any work and working long hours,” she says. “Since my mom was a childcare provider, she was at home with me and my siblings. Both my parents taught me compassion for people. They were always willing to help others, no matter what.”

Long-term interest

director for one of the assisted livings. She assumed several administrator roles for the organization. Reinhart says the best things about her experiences in long-term care were the residents, the employees, and the satisfaction of making a difference in people’s lives. “I truly enjoyed the residents. They saw me through two pregnancies, they would talk to my belly. When my babies were born, my husband and I would bring them in to see the residents; they would hold them and gush all over them. I wouldn’t trade that for the world. Those are memories that I will always hold near and dear to my heart.” During those years, Reinhart learned she was not afraid to get in the trenches. “I wanted to do whatever I could to make my organization and my employees successful, and

“If you want respect, you have to earn it. You have to show people you are not afraid to get ‘dirty.’”

Reinhart graduated from Ohio University with a degree in long-term care administration. She also received a certificate in gerontology. But her interest in long-term care goes back much further. “To be honest, my interest came from my Grandma being in a nursing home. I got comfortable visiting her, growing up and interacting with the residents, [and] the residents intrigued me. To this day, I still remember the names of the residents that I would frequently see and what they looked like.” In high school, she took classes to become a State Tested Nursing Assistant, after which she worked at a local nursing home before going to college. “Working as an STNA is extremely rewarding,” she says. “Not only do you get to help the residents and make a difference in their lives, but you also get to learn their history and get to know their families. It is an amazing opportunity.” After graduating from Ohio University, Reinhart became business office manager for a skilled nursing facility in which she had interned during school. Later, she became administrator at another facility. After that, she worked with an Ohio-based chain, first as assistant administrator at one of their skilled nursing facilities and then executive

Deanna Reinhart

provide the best care and home for my residents (customers),” she says. “I would occasionally cook dinner, serve the residents, and assist them with care if we were having staffing issues. The residents loved when I would cook or wait on them during meals. I would transport them to medical appointments if needed, which allowed me to get to know them.” She recalls snowy weekend trips to the facility to ensure things were running smoothly. One evening she got the snow blower out, so she wouldn’t have to call in the maintenance person. “I wound up breaking it, so maybe I wasn’t so helpful,” she says. “After transitioning multiple times to different nursing homes in different locations, I realized that I was like a chameleon. I was able to adapt to my surroundings, adjust to the environment and make an impact in my short time there.”

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corner Medical sales These skills have suited her well in medical sales, first calling primarily on the long-term-care market, and now, a large IDN. “I had two young children at the time and thought I needed to expand my horizons while continuing to use my long-term care experience,” she says. “When the opportunity arose [at Seneca Medical], I felt I had the best of both worlds. I still was involved in long-term care, but I also had the opportunity to share my experience with the healthcare distribution industry.

“ Having been on the other side as a customer helps me realize I am going to do whatever I can to get product to make their organization be successful.” “My experience working in nursing homes – at one point, being the customer who needed supplies to provide care – helped me to understand, as a rep, the urgency of having product available when needed.” Truth be told, sales and marketing activities weren’t entirely foreign to her. “One of my responsibilities [as a long-term-care administrator] was census development, which is marketing, that is, selling your building and why it is better than the rest,” she says.

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At Seneca, she was initially responsible for developing new business and managing existing accounts. She then became a regional director, primarily overseeing long-term care in Ohio, Michigan and Indiana. In September 2016, following the merger of Kreisers, MMS - A Medical Supply Company, and Seneca Medical to form Concordance Healthcare Solutions, Reinhart accepted a new role – senior account manager with responsibility for a large IDN. “I remember the first month of taking over,” she says. “I felt as if the eight years [in medical sales] I had under my belt went out the window. I had experience in all markets, but never to the magnitude of my new role. I frequently would say, ‘How am I going to figure this stuff out?’ Thankfully, I have wonderful leadership, internal support and a warehouse that helped me along the way. “The health system customer is definitely different than most nursing home customers,” she says. In nursing homes, people still batch orders and call, fax or email them. But IDNs transmit them by EDI. What’s more, the typical IDN has many decisionmakers. “I don’t necessarily have direct access to the end users of product at all times,” she says. “It is a more centralized, streamlined approach vs. long-term care, where I could pretty much go directly to the end user. “One commonality between the IDN and long-term care is they are serving individuals in need of care, and they need the appropriate supplies for that to happen,” she continues. “Again, having been on the other side as a customer helps me realize I am going to do whatever I can to get product to make their organization be successful.

“I frequently would say, ‘How am I going to figure this stuff out?’”

“It took a while to get used to, but now I’m in a rhythm.” Reinhart and her husband, Gary, live in Jenera, Ohio, in northwest Ohio. They have three children: Quinn, 13, a sports lover; Hannah, 11, who has been taking private cooking classes; and Evan, 7, who is on the autism spectrum and diagnosed with epilepsy, and who loves music therapy and playing baseball for the Miracle League.

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Industry news Reps mix it up in Chicago A local brewery in the Ravenswood Industrial Corridor on Chicago’s North Side was the scene of a Repertoire Regional Networking Mixer this summer. The magazine is hosting a series of local events for reps from all distribution companies to get together, chat, perhaps gossip, play a couple of cornhole games and have a refreshment. Sponsors were Dukal Corp., Sysmex, Quidel, Sekisui Diagnostics, MTMC, Zoll, ndd Medical Technologies, Halyard and Health o meter.

Repertoire Regional Networking Mixer

Owens & Minor names new EVP, operations & supply chain - global solutions

ACCOUNT MANAGERS WANTED CME Corp., the national leader in healthcare equipment distribution is seeking talented and motivated sales representatives. This is an unlimited earning, “sky’s the limit” opportunity to join one of the fastest growing companies in the industry. Serving as the major point of contact for all the accounts they represent, the account managers will act as the primary problem solving and information resource, maintain a strong working knowledge of products, and will develop close working relationships with manufacturer sales representatives. The ideal candidate will be able to identify and qualify all the key “Decision Makers” in all target accounts and create value beyond our products and services in a way that differentiates us from the competition. Candidates must be detail oriented, highly organized, with strong computer and communication skills, and must have at least one year of sales experience with a valid driver’s license. Please submit your resume and cover letter to Chris Godfrey (cgodfrey@cmecorp.com) or contact him directly @ 800-338-2372 x 8229 for more information.

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Owens & Minor Inc (Richmond, VA) named Timothy P. Connolly as EVP, operations & supply chain - global solutions, effective June 25, 2018. Connolly will lead the operations of Owens & Minor’s distribution and supply chain network. Most recently, Connolly was SVP, operations, for Uline, an independent distribution company. Prior to Uline, Connolly rose through the executive leadership ranks of Essendant (formerly United Stationers Supply Co.), a wholesale distribution company.

Cleveland Clinic names new chief of population health Cleveland Clinic named Adam Myers, MD, as chief of population health and director of Cleveland Clinic Community Care, Cleveland Clinic’s new population health approach. Myers will direct a team that includes physicians and advanced practice providers from Internal Medicine, Family Medicine, Hospital Medicine, Geriatrics and General Pediatrics, supported by Wellness, Express Care, Medical Care at Home, and the Quality Alliance. Prior to coming to Cleveland Clinic, Dr. Myers served as SVP/ chief medical officer and operations officer of Texas Health Physicians Group/Enterprise.

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

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