REP Sept 18

vol.26 no.9 • September 2018

The Flu

Forecast Flu season is approaching.

repertoiremag.com

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SEPTEMBER 2018 • VOLUME 26 • ISSUE 9

The Flu

Forecast

PUBLISHER’S LETTER Ready or Not.......................................................................6

PHYSICIAN OFFICE LAB Tomorrow is Here

A review of tumor markers....................................................8

IDN OPPORTUNITIES

Flu season is approaching.

Capstone Ready to Cover New Ground...... 12

CHRONIC CARE MANAGEMENT A Primary Concern

Primary care docs take charge of chronic care management............................................. 32

TRENDS

16

A New Wrinkle

Two IDNs acquire multistate LTC providers............ 38

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

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SEPTEMBER 2018 • VOLUME 26 • ISSUE 9

HEALTHY REPS

QUICKBYTES

Health news and notes

Technology news........................................................ 46

REP CORNER

The Un-sales Rep

Jill Borysiak doesn’t sell.

She meets customers’ needs............................................ 48

40 WINDSHIELD TIME

HIDA GOVERNMENT AFFAIRS UPDATE CMS Proposes Key Changes to Competitive Bidding......................................... 52

LEADERSHIP

Addressing Your Team’s Needs

How to galvanize your team when times are tough........................................ 54

SMART SELLING The Complicated Relationship Between Supplier Salespeople and GPOs..................... 56

Automotiverelated news 4

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44

LETTER TO THE EDITOR The medical device tax: Let’s be honest about it................................................ 57

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

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

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

John St. Leger

Vietnam veteran, Marathon Medical Founder

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

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

PUBLISHER’S LETTER

Ready or Not Raise your hand if you’re sick of the flu!

After the year we just had, I’m sure everyone who had the flu is sick of it. I got it twice within the last 12 months, so I am definitely taking precautions this year.

I am writing this on the first week of school for kids in Georgia. Like it or not, we are headed into flu season.

I recently attended AACC in Chicago, where I interviewed several flu companies about the upcoming season. The overwhelming theme was that you cannot prepare your clients soon enough. “ If the industry learned anything from the 2017–18 influenza season, it is to be prepared and make sure your customers are prepared. Many customers are in a state of flu fatigue, but it is up to us to keep them ready and prepared, because flu is coming.” – Susan Ward of Sekisui Diagnostics

Scott Adams

“ As flu season approaches we at BD cannot stress enough the importance of being prepared for this year’s season. Our reps in the field are ready and willing to work with our distribution partners to help their accounts assess the type of testing they need to give better patient care. You can find a list of our reps in Repertoire’s RepConnect under the BD listing.” – Jessi Irwin of BD “ Our distribution partners should remember that, while the reclassification has to do with clinical performance, the physician office lab is also concerned about the patient experience and operational factors, like workflow.” – Nate Patton of Roche Diagnostics “ Since each influenza season is unpredictable in arrival as well as volume, it’s never too early to have the conversation with your suppliers.” – Tammi Ranailli of Quidel Whether you are “Flu Season” fatigued or not, it is that time of year and this cover story is just what the doctor ordered to get you and your caregivers ready for the fight.

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

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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

Same people.

Same company.

Now, with a renewed focus.

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

© 2018 Midmark Corporation, Dayton, OH

PHYSICIAN OFFICE LAB

By Jim Poggi

Tomorrow is Here A review of tumor markers

Quick – name a category of lab testing for a serious

patient disease state that spans CLIA waived, moderate and high complexity.

For bonus points, name a lab testing category rapidly expanding with advances in molecular testing and new multi-analyte assays with algorithmic analysis (MAAA), the latest category of testing recognized under the Clinical Lab Fee Schedule.

And no fair doing a google search on tumor markers, because that is the answer I’m looking for.

There’s a lot going on in the world of tumor markers, from new recommendations on colorectal cancer (CRC) screening beginning earlier (age 45 instead of 50), to new FIT/DNA tests for colorectal cancer, new molecular markers for a wide variety of cancers and the latest recommendations on prostate cancer screening – from the US Preventative Services Task Force which re-asserts the value of PSA testing in men aged 55 to 69.

Starting point With all there is to cover, where to start? While we discuss tumor marker tests with customers nearly every day, I think it pays to start with a definition of tumor markers.

This one is from the National Cancer Institute: “Tumor markers are substances that are produced by cancer or by other cells

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of the body in response to cancer or certain benign (noncancerous) conditions. Most tumor markers are made by normal cells as well as by cancer cells; however, they are produced at much higher levels in cancerous conditions. These substances can be found in the blood, urine, stool, tumor tissue, or other tissues or bodily fluids of some patients with cancer. Most tumor markers are proteins. However, more recently, patterns of gene expression and changes to DNA have also begun to be used as tumor markers.”

All by itself, that definition tells us why current tumor markers lack a key requirement to be excellent diagnostic tools; they lack specificity since both cancerous and noncancerous cells produce the substances we use as tumor markers today. This is the reason there has been so much debate about the usefulness of PSA in particular. Tumor markers when used for screening purposes today have an incidence of “false positive results” which future tumor markers aim to correct.

The future is coming fast. In addition to improved specificity of some new molecular markers, newer tumor markers hold promise to aid in assessing pre-disposition of patients to cancer, and are already being used to predict which therapeutic choices will be most effective.

The range of diagnostic benefits of the newer markers is expanding quickly, as are the number of new tumor markers being brought to market.

Some of the classic tumor markers on the market today are summarized below: Tumor Marker FIT PSA/Free PSA

CA 19-9 CA 15-3/CA 27.29 CA-125 AFP

Associated Cancer CLIA Category Developments/Clinical Utility Colorectal Cancer Waived New blood based tests and FIT/DNA tests are entering the market Prostate Cancer Moderate Multianalyte assays with algorithmic analysis (MAAA) are entering the market to improve positive predictive value Pancreas, GI Moderate Assess treatment response System Cancer Breast Cancer Moderate Assess treatment response Ovarian Cancer Liver Cancer

Moderate Moderate

For diagnosis and treatment response For diagnosis and treatment response

Some of the newer tumor markers entering the market are summarized below: Tumor Marker ALK gene rearrangements and expression BRAF V600 mutations EGFR gene mutation analysis Estrogen receptor/ Progesterone receptor BRCA1, BRCA2 KRAS gene mutation analysis Methylated DNA biomarkers (Septin 9; others in development)

Associated Cancer Non Small Cell Lung Cancer Colorectal Cancer and Cutaneous Melanoma Non Small Cell Lung Cancer Breast Cancer Ovarian Cancer CRC and Non Small Cell Lung Cancer CRC and Other Cancers

CLIA Category High complexity High complexity High complexity High complexity High Complexity High complexity High complexity

Future impact You may be thinking “Wow, that’s a lot of science. Does it impact me and my customers? If so, how?”

It’s a big deal, and we are just beginning to see the changes in the tests we will use in the future to diagnose and treat cancer. Most of the newer tests are still too complex or sophisticated to be useful in the physician office, but that is likely to change. In my opinion, there is probably no area of lab testing undergoing more rapid, and more fundamental, change today than in tumor markers.

A lot of the changes have to do with the quality of the tumor marker tests. Historically, tumor markers tended to be developed as “incidental findings” associated with development and progression of cancer. PSA and early fecal occult blood tests for colorectal cancer are excellent examples. Both are often present or elevated in the presence of cancer, but neither are as specific as clinical practitioners need them to be as perfect lab diagnostic tools. But, the changes we are experiencing today with newer tumor marker tests add numerous clinical benefits including greater specificity and accuracy, the

Developments/Clinical utility Biopsy; used to determine treatment and prognosis Match patients to the most effective treatment Help determine treatment and prognosis Select patients who would benefit from hormone therapy or other alternate therapies Assess patients for most appropriate therapy Assess patients for most appropriate therapy Help diagnose

opportunity to help tailor treatment methods and the beginnings of understanding the genetic changes brought about by the development and progression of cancer.

Staying informed keeps you sharp as a consultant and helps you maintain your competitive edge. As an important side note, some of the new tumor marker tests are now classified in the category of Multianalyte Assays with Algorithmic Analysis (MAAAs), which are the fastest growing category of Medicare reimbursement for lab tests, because their reimbursement per test is so high, and also because the number of these tests available is growing rapidly and their clinical importance is increasing.

How else can you keep up with the rapid changes in the tumor marker market?

• Discussions with key PC suppliers • Ask your category team • Watch this space • Follow the news (via AACC and other clinical resources) Stay informed. Tomorrow is here. Be part of it.

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When it comes to testing for Influenza,

one size does NOT fit all At Quidel, we know flu.

We know there’s no one-size-fits-all solution, especially for flu. From nurse practitioner to laboratorian, from physician’s office lab to clinical virology lab, whether your customers need a quick and easy visual read, or accurate, objective and automated results in as few as 3 minutes, or the next-level sensitivity of a molecular assay — we’ve got a better fit for them.

Timely, accurate results are only the start. Virena,® coupled with Sofia® 2 or Solana,® provides your customers with valuable data, enabling them to observe, track, report and respond at the earliest sign of an emerging influenza trend — ultimately keeping them ahead of demand and leading to a healthier community.

For a better fitting, more accurate, efficient and complete influenza testing solution for your customers, contact your Quidel account manager.

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IDN OPPORTUNITIES

Capstone Ready to Cover New Ground Five years after the launch of its new name and corpo-

rate structure, Premier owner and Certified Sponsor Capstone Health Alliance is running at full power and is eager to bring new services and opportunities to its members.

An offshoot of WNC Health Network (an Asheville, North Carolina-based alliance formed in 1994), Capstone officially took off in October 2013 after plans were formalized to separate the WNC Health Network’s group purchasing program from other operating divisions.

Today the GPO has more than 250 hospital members in 23 states, and its purchasing volume exceeds $7 billion.

“We are proud to have more than 675 contracts in our portfolio, which are either Premier-enhanced contracts or Capstone local agreements,” says President and CEO Tim Bugg. “Our logic is that through aggregation and collaboration, there is opportunity everywhere.

“Led by our two executives – Mark Landau, COO, and Robin Lincoln, SVP Contracting Operations – Capstone

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has more than 90 agreements negotiated for our membership on Capstone paper, and more than 575 Premier aggregated or enhanced agreements,” says Bugg. Capstone is an active member and holds a board seat in the Healthcare Supply Chain Association (HSCA), and follows all safe harbors and codes of conducts related to GPOs. “To be clear, Premier brings us tremendous opportunities in the sheer number of contracts and programs it allows us to work with, and we are proud to support the Premier ASCEND program, which includes more than 70 percent of our membership,” he says. “The fact that Capstone operates as a regional GPO does

“We are also looking forward to continued expansion in the non-acute market.”

Passion and partnership are at the center of everything we do.

What is the DUKAL DNA? At DUKAL, we are dedicated to improving patients’ lives through our expanding product line, bringing even more solutions to the market and bundling them into an offering you can trust. www.dukal.com | 1-800-243-0741

IDN OPPORTUNITIES Purchasing, and IPC Group Purchasing, which have large non-acute memberships. Our job is to work collectively with them to affect cost in all markets of care.

not negate or devalue our belief in Premier as a GPO. We believe that together, we bring sustained value to our shared memberships.”

Capstone contracting decisions are member-driven, through a committee process, he says. A team of region managers – all of whom have healthcare supply chain experience – call on Capstone members “not to sell contracts, but to identify savings and help the members improve the supply chain in their respective organizations.”

Variance in care

Purchased services Like other GPOs and alliances, Capstone sees tremendous savings opportunities in non-traditional areas, such as purchased services. Capstone has

Tim Bugg

“While contracting and aggregation will always be the core of what we do, our long-term goal is to use aggregation and collaboration to tackle variance in care using best practice/ best outcome models. We obviously realize this is a big dot goal, but to really reduce cost in healthcare, the strategy has to be broader than just contracting. We are proud to be an owner and partner of Premier, and we are continually impressed by Premier’s successes in being more than a GPO. Premier leads the way in helping its members not only reduce cost, but improve quality with data-driven results. Our hope is to use our regional model with Premier’s national experience to further enhance our member facilities’ ability to achieve success in this new era of healthcare.”

Director of Member Services Kristin Scott helps evaluate and understand members’ needs.

“Our members expressed a need for continued learning and training,” recalls Bugg. “In our discussions we found there weren’t many affordable options for them to train incoming staff or keep their own knowledge up to date. As a result, we developed the Capstone Learning Academy, an online portal housing supply chain modules on tactical and strategic topics designed by subject matter experts from our membership.” Topics covered include purchasing, supply chain and inventory control. Upcoming modules were scheduled to be released, with a secondquarter focus on value analysis.

“Essentially, at the core of it, we are a GPO married to a GPO, and we use all resources necessary to provide our members with as many cost reduction opportunities as possible,” says Bugg. “Our job is to reduce cost in the healthcare space, and that’s what we strive to do every day.”

“ Our logic is that through aggregation and collaboration, there is opportunity everywhere.” expanded its purchased-services portfolio by close to 700 percent since 2015. Its portfolio now includes opportunities for IT, human resources, facilities, clinical and professional services, as well as finance.

“We have a member-led Purchased Services oversight committee that reviews all opportunities, both at the regional level and for all Capstone members,” says Bugg.

“We have seen many savings opportunities and successes in purchased services from a variety of areas outside of supply chain. We have found that partnering a member with a service vendor in a nontraditional area, then sharing the value the member realized, helps our membership better understand the potential value a contract offers.

“As with most GPOs and regional aggregation groups, physician preference items are a priority, and Capstone will continue to strive to find solutions for our organizations using our member-driven model,” he says.

“We are also looking forward to continued expansion in the non-acute market. We have large member partners, such as CHAMPS Group Purchasing, Vantage Group

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The Flu

Forecast Flu season is approaching.

T

he 2017-2018 flu season was a tough one. More than 170 children under 18 died because of flu. And 20182019 could be tough as well, with some of the more virulent strains expected to make an encore appearance.

There is some good news for Repertoire readers and their customers: Plenty of injectable vaccine should be available for 2018-19, and FluMist® Quadrivalent intranasal vaccine returns to the market following a two-year hiatus.

The not-so-good news? Some experts predict that the CDC-recommended formulation for this season’s vaccine may have the same reduced efficacy against the dominant strain of influenza A (H3N2) as last year’s. Even so, the bottom line for healthcare

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providers and consumers is this: GET THE VACCINE ANYWAY. “Regarding the efficacy of influenza vaccine, for the last two years, it’s been all over the map,” says Gary LeRoy, M.D., FAAFP, a family physician in Dayton, Ohio, and a member of the board of directors of the American Academy of Family Physicians. “Some say it has been 37, 38 or 40 percent effective, and some say it has been as low as 18 percent effective.

“Still, that’s 17 or 18 percent of individuals who might not experience the morbidity or mortality of flu. And if they do get the flu, even with the reduced efficacy of the vaccine, it won’t be as deadly as if they had not had the vaccine. It blunts the effects of the virus. So we continue to stress the importance of everyone getting the flu vaccine to lessen its severity.”

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The Flu Forecast large number of hospitalizations and help protect people from severe, life-threatening illness and complications.”

“This past flu season was a strong reminder that the flu An analysis published in the Proceedings of the National can be unpredictable,” says Heather Levis Guzzi, director, Academy of Sciences estimated that even when flu vacU.S. product communications, Sanofi Pasteur. “Modern cine efficacy is as low as 20 percent, it can help prevent egg-based vaccine production is the most reliable method 130,000 hospitalizations and 62,000 deaths, she says. capable of delivering the volume of safe and effective flu For the 2018-2019 season, Sanofi Pasteur expects vaccines needed each season. to produce nearly 70 million doses of flu vaccines, says “Even in years when vaccine effectiveness is lower Guzzi. This year, in addition to Fluzone Quadrivalent than we would like, available flu vaccines help prevent a and Fluzone High-Dose vaccines, the company will distribute Flublok Quadrivalent vaccine – a recombinant protein-based flu vaccine – for the first time, the result of Sanofi Pasteur’s July 2017 acquisition of Protein Sciences. (Flublok is approved for use in people 18 years of age and older.)

The 2018-2019 flu season will see 12 to 15 times more doses of Flublok Quadrivalent vaccine for the U.S. compared to the 2017-18 season, says Guzzi. It is expected to be available at 10 times as many – Heather Levis Guzzi, director, U.S. product communications, Sanofi Pasteur providers across the country compared to last year. And it has demonstrated 30 percent more protection from PCR-confirmed flu caused by any viral type/subtype, and 43 percent more protection in preventing culture-confirmed flu, compared to a standard-dose quadrivalent inactivated flu vaccine, she says.

Unpredictable

“ This past flu season was a strong reminder that the flu can be unpredictable. Modern eggbased vaccine production is the most reliable method capable of delivering the volume of safe and effective flu vaccines needed each season.”

Effectiveness questionable Even if vaccine is readily available, some are questioning how effective it will be.

In April, a Rice University study predicted that this fall’s vaccine – a new H3N2 formulation for the first time since 2015 – will likely have the same reduced efficacy against the dominant circulating strain of influenza A as the vaccine given in 2016

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and 2017. (Annual flu vaccines are formulated to protect against one type of influenza B and two strains of influenza A – one H3N2 strain and one H1N1 strain.)

“The vaccine has been changed for 2018-19, but unfortunately, it still contains two critical mutations that arise from the egg-based vaccine production process,” Michael Deem, Rice’s John W. Cox Professor in Biochemical and Genetic Engineering and professor of physics and astronomy was quoted as saying. “Our study found that these same mutations halved the efficacy of flu vaccines in the past two seasons, and we expect they will lower the efficacy of the next vaccine in a similar manner.”

Full efficacy data for the 20172018 flu season were still being compiled, but Rice researchers predicted

it would be around 19 percent against H3N2, the type of influenza A that infected most people in the U.S. in each of the past two years. The Food and Drug Administration chose the same vaccine formulation in 2017 and 2016, in part because the dominant circulating strain stayed the same. In 2016, the vaccine had an efficacy of 20 percent, almost identical to the efficacy of 19 percent predicted by the Rice study.

(Efficacy is the measure of how effective a vaccine is at protecting the overall population. A 20 percent efficacy means that in a population, 20 percent fewer vaccinated people will get the flu compared to the unvaccinated people.)

“Getting the season’s vaccine is the best way to protect against seasonal influenza,” says LeRoy.

“The vaccine has been changed for 2018-19, but unfortunately, it still contains two critical mutations that arise from the eggbased vaccine production process.”

– Michael Deem, Rice’s John W. Cox Professor in Biochemical and Genetic Engineering and professor of physics and astronomy

Why get vaccinated?

The effectiveness of flu vaccine can vary, but you should still get one every year. According to the Centers for Disease Control and Prevention, flu vaccination: • Can keep you from getting sick with flu.

• Can reduce the risk of flu-associated hospitalization, including among children and older adults.

• Has been associated with lower rates of some cardiac events among people with heart disease, especially among those who experienced a cardiac event in the past year.

• Has also been associated with reduced hospitalizations among people with diabetes (79 percent) and chronic lung disease (52 percent).

•H elps protect women during and after pregnancy.

•C an protect a baby after birth from flu.

(Mom passes antibodies onto the developing baby during her pregnancy.)

•C an significantly reduce a child’s risk of dying from influenza (per a 2017 study).

•M ay make your illness milder if you do get sick.

•P rotects people around you, including those who are more vulnerable to serious flu illness, like babies and young children, older people, and people with certain chronic health conditions.

Source: The Centers for Disease Control and Prevention

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The Flu Forecast Introducing the 2018–19 influenza vaccine The Food and Drug Administration’s Vaccines and Related Biologic Products Advisory Committee recommended in June that the 2018–19 trivalent vaccine to be used in the United States contain an A/Michigan/45/2015 A(H1N1)pdm09like virus, an A/Singapore/INFIMH-16–0019/2016 A(H3N2)-like virus, and a B/Colorado/06/2017like (B/Victoria lineage) virus. The quadrivalent vaccine recommendation included the trivalent vaccine viruses as well as a B/Phuket/3073/2013like (B/Yamagata lineage) virus.

The B component recommendation represents a change in the influenza B/Victoria lineage

component recommended for the 2017–2018 Northern Hemisphere and 2018 Southern Hemisphere influenza vaccines. The A(H3N2) recommendation represents an update to the 2017–2018 Northern Hemisphere vaccines but is the same A(H3N2) virus recommended for the 2018 Southern Hemisphere vaccine. The decision to update the A(H3N2) component was not made to address antigenic drift, but rather because the egg-propagated A/Singapore vaccine virus is antigenically more similar to circulating viruses than the egg-propagated A/Hong Kong vaccine virus recommended for the Northern Hemisphere 2017–2018 vaccine.

Source: The Centers for Disease Control and Prevention

Intranasal vaccine to make a return FluMist® Quadrivalent intranasal flu vaccine from AstraZeneca will in all likelihood be back on the U.S. market after a couple of years off.

In February, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention voted in favor of a renewed recommendation for the product for the 2018-2019 flu season following positive test results. FluMist is a live attenuated influenza vaccine (LAIV) that is sprayed into the nose. It can be used in children, adolescents and adults ages 2 through 49.

At press time, AstraZeneca – which makes FluMist – was awaiting FDA approval of the 2018-19 FluMist Quadrivalent vaccine for use during the 2018-19 season. Provided FDA approval is received, the vaccine will be available in the U.S. for the 2018-19 season, according to a company spokesperson.

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“Quantities of FluMist Quadrivalent will be manufactured to meet expected U.S. demand,” says Kevin Springman, executive director, U.S. sales and marketing, infectious diseases, AstraZeneca.

In June 2016, ACIP recommended against using FluMist based on data showing poor or relatively lower effectiveness of LAIV from 2013 through 2016. The product remained off the U.S. market in the 2017-18 season.

Recent study results demonstrated that the new 2017-2018 H1N1 LAIV post-pandemic strain (A/Slovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (A/ Bolivia), which was previously associated with reduced effectiveness, according to AstraZeneca. The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic.

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The Flu Forecast

This is a Test Flu testing in the upcoming season Expect some changes in the flu-testing market in the

upcoming season: •A ntigen-based rapid influenza diagnostic tests have to meet new minimum performance standards in 2018-19, after being reclassified as Class II devices by the U.S. Food and Drug Administration in February 2017.

•M olecular-based tests are likely to have more of an impact in 2018-19 than ever before.

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Repertoire asked three experts to talk about the implications for distributor sales reps: • Susan Ward, senior global product manager, point of care, Sekisui Diagnostics.

• Nathan Patton, director of marketing, cobas Liat system, Roche Diagnostics Corporation.

• Jessica Irwin, national distribution manager, non-acute, BD. • Tammi Ranalli, PhD, VP, Marketing North America, Quidel.

MAYBE THERE’S A BETTER OPTION FOR FLU TESTING

Does the rapid antigen test you use for influenza A/B meet FDA requirements?

New FDA performance requirements are now in effect for antigen-based rapid influenza diagnostic tests.1 If you are considering upgrading to a more accurate diagnostic test before next flu season, now is the time to take action. Upgrade to the cobas® Liat® PCR System which provides lab-quality results with 100% sensitivity for Influenza A and Influenza B, at the point of care.

Visit go.roche.com/takeaction to learn more about upgrading your institution’s flu test with the cobas Liat PCR System.

1 FDA: Microbiology Devices; Reclassification of Influenza Virus Antigen Detection Test Systems Intended for Use Directly with Clinical Specimens, January 12, 2017. Available at: https://www.federalregister.gov/documents/2017/01/12/2017-00199/ microbiology-devicesreclassification-of-influenza-virus-antigen-detection-test-systems-intended-for#h-9 (Accessed July 3, 2018).

COBAS is a trademark of Roche. All other product names and trademarks are the property of their respective owners. © 2018 Roche. MC-US-00758-0718 Roche Diagnostics 9115 Hague Road Indianapolis, IN 46256 1-800-852-8766

The Flu Forecast Repertoire: First, some questions about the reclassification of antigen-based rapid immunoassay tests (RIDTs) to Class II devices. Did that have any impact on the usage or sale of flu tests during the 2017-18 season? If so, can you elaborate?

Susan Ward: The 2017–18 influenza season saw a perfect storm with regard to influenza testing. Not only was there a very virulent strain (H3N2), there was decreased effectiveness of the vaccine and a FDA reclassification, all of which led to an increase in flu testing. Sekisui Diagnostics, like many manufacturers, saw a large spike in demand, due to the pandemic season. The reclassification did pave the way for increased demand for tests that met the new criteria. However, the larger demand came from the nature of the long pandemic season itself.

Nathan Patton: Roche is not an RIDT manufacturer, but we think the FDA’s decision supports the importance of increased sensitivity in respiratory testing, and will contribute to improved patient care. Without question, the reclassification led to an increase in provider concern and greater interest in more sensitive testing for acute respiratory infections. Many of our customers were already making a transition from RIDTs to a molecular point of care (POC) test, but the FDA’s position on the less-thanoptimal performance of RIDTs clearly created a greater sense of urgency.

Jessica Irwin: Based on reported distributor sales tracings, there was definitely an increase in usage of flu tests during the 2017-2018 season. However, the increase is attributable to higher-than-average disease incidence as measured by the CDC’s flu surveillance program rather than the FDA re-classification. In other words, facilities testing for flu saw an increase in symptomatic patients, which accounted for the increased sales. It is not possible to determine how much, if any, of the increased sales was due to the FDA reclassification.

Tammi Ranalli: Each of Quidel’s market leading antigen-based rapid immunoassay influenza test products (Sofia, Sofia2 and QuickVue) meets the Class II requirements. Thus, as some RIDTs were removed from the market due to not meeting the reclassification specifications, additional customers turned to Quidel to address their testing needs.

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Repertoire: Providers were allowed to purchase the non-reclassified (Class I) products until January 12, 2018, and to use them until expiration of shelf life.

Do you expect that any of these products will be used during the 2018-19 season?

Ward: Due to the nature of the long pandemic season, many facilities may have quickly exhausted their inventory of the Class I products, which created a high demand for products that met the new criteria. With the high demand from the 2017-18 influenza season, many manufactures rationed the Class II compliant products; therefore, it appears that there would be a very limited amount of noncompliant products on the market.

Patton: We don’t have visibility to provider inventories of RIDTs, but given the size of the market and the extraordinary incidence of flu rates last year, we would not be surprised if many of them already exhausted their inventories.

Roche was able to maintain its influenza A/B molecular assay supply for the cobas Liat PCR system for our distribution partners throughout the peak of the 2017-2018 flu season.

We were well aware of the impact that supply shortages of flu testing assays were having on many providers.

Ward: The reclassification has led to tests with higher sensitivity. However, sensitivity can change based on antigenic drift, circulating strains, age of the patient and other factors, including the quality of the sample.

The FDA has put into place new performance criteria, which must be met by manufacturers. The new criteria have led to better performing tests. This will provide clinicians access to products that have proven their performance in a clinical setting, with additional control testing of circulating or emergent strains, thereby providing clinicians assurance that they are utilizing high performing tests, such as the CLIA-waived OSOM Ultra Flu A&B Test.

Patton: Healthcare providers can continue to use existing inventory of the non-reclassified products that they purchased through January 12, 2018. Customers who switch to a new reclassified product will have to do test validation prior to clinical use – the same as they do with any new laboratory test. So distributor reps can guide their customers on optimal planning to account for those Irwin: We expect facilities that used a non-compliant product to switch to a compliant flu test this summer/fall, prior to the flu season. It is never easy to adjust protocols and meet regulatory guidelines while in the middle of a flu season. Several products in the market, including the BD VeritorTM Plus System, offer a simplified workflow with CLIA-waived tests to minimize conversion hiccups and increase compliance.

“ Many customers are in a state of flu fatigue, but it is up to us to keep them ready and prepared, because flu is coming.”

Ranalli: Given the intensity of the 2017-18 respiratory season, it would seem unlikely if providers still had inventory of the non-reclassified products. However, if there are several providers with remaining non-reclassified influenza tests, it would seem reasonable they would take the opportunity now to switch to an approved Class II test before the 2018-19 respiratory season begins and avoid the risk of having to make a test change during the season.

Repertoire: What should distributor reps know about the impact of reclassification on antigen-based RIDTs for the upcoming flu season?

– Susan Ward

procedural requirements. They can find out more about the reclassification in the FDA Fact Sheet.

For customers who haven’t yet switched from nonreclassified RIDTs, this is a great opportunity for distributor reps to educate them on the reason for the FDA’s decision and the benefits of moving to higher sensitivity options, like molecular PCR technology at the point of care.

The reclassification has not had any impact on the tests Roche offers on the cobas Liat system, because the real-time (RT) PCR technology it uses is the existing laboratory standard for confirmatory flu testing and already meets or exceeds the minimum required sensitivity. Roche does not currently sell rapid-antigen testing, so the only direct impact we’ve experienced with the reclassification is increased demand for our cobas Liat system and flu assays.

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The Flu Forecast

Irwin: With the FDA reclassification there are two sets of standards – one for tests that reference performance to viral culture and another for tests that reference performance to PCR or NAAT. It is also important to note how many different flu A+B strains were tested and detected.

The BD VeritorTM Plus System is a digital immunoassay that references performance for flu A+B to PCR and has shown analytical reactivity to 81 flu A+B strains.

Ranalli: The re-testing of products with the circulating strains is a highly effective way for providers to have confidence in the performance of specific products every respiratory season.

Repertoire: Let’s talk about the market for molecularbased flu tests.

Ward: Over the past several years, the market has seen growth in the use of nucleic acid amplification, or molecular tests, for influenza. These tests are higher performing, but they have a higher price tag, and may have contractual elements or capital investment costs. Due to the higher cost, there is a slow adoption in certain markets.

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This has challenged manufacturers to develop more cost-effective molecular platforms, such as Silaris™.

The CLIA-waived Silaris™ Influenza A&B Test is a molecular in vitro diagnostic test utilizing polymerase chain reaction (PCR), microfluidics, and lateral flow technology, performed on the Silaris Dock. The Dock is compact and portable, providing a costeffective option for any healthcare setting, including point-of-care, emergency rooms and core laboratories.

These options in testing have shaped the use of testing algorithms.

Many clinicians have adopted a testing algorithm using a high-performing RIDT and confirming all negatives with a molecular system.

Some clinicians have made the jump straight to molecular testing. Sekisui supports all customers by offering both the OSOM Ultra Flu A&B Test, which is Class II compliant, and a molecular offering – Silaris Influenza A&B Test. The Silaris Influenza A&B Test will also support a standalone testing option for clinicians.

Patton: The reclassification [of RIDTs to Class II devices] has already begun to generate increased demand for molecular-based flu tests, because it has fueled the conversation about the need for higher sensitivity testing.

Molecular tests, such as what Roche offers on the cobas Liat system, already provide an accurate and convenient solution that contributes to improved patient care.

Irwin: Molecular tests have grown in popularity, mainly in acute settings such as hospitals. However, it is important to balance increased costs, increased time to results, and overall complexity vs. the benefits they bring regarding performance.

There is an increased number of flu testing systems to address varying needs that healthcare facilities have. For example, we have found that hybrid systems that include a molecular test for critical patients and a rapid flu test for the general population help meet the demand for improved patient

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The Flu Forecast outcomes while maximizing clinical efficiencies, such as fast turn-around-times and low operational budgets.

Ranalli: The reclassification provided an impetus for end-users to re-evaluate their influenza testing algorithms and choices. This has resulted in some customers making the choice to implement a molecular test.

However, due to the high cost and extended turnaround times that come with a molecular solution, the best in class RIDTs, such as Sofia, Sofia2 and QuickVue, still have a critical role in influenza testing and continue to be the best solution for most providers from a patient care and economic perspective.

Repertoire: Anything else Repertoire readers should know about flu and flu testing as they prepare to talk to their customers about the upcoming flu season?

Ward: If the industry learned anything from the 2017–18 influenza season, it is to be prepared and make sure your customers are prepared. Many customers are in a state of flu fatigue, but it is up to us to keep them ready and prepared, because flu is coming. Research and know all the options that are on the market so that when you are talking to your customers about their pain points for testing, you can provide them with the right fit for their needs.

Most customers in the POL and ER setting will be looking for options for molecular testing with little or

By the numbers: The 2017-2018 flu season Statistics from the Centers for Disease Control and Prevention for the flu season starting Oct. 1, 2017, and ending May 19, 2018 (rounded for simplicity): • Clinical laboratories tested approximately 1.2 million specimens for influenza virus. Of them, 224,000 (19 percent) tested positive – 151,000 for influenza A and 73,000 for influenza B. • Nationally, the percentage of clinical laboratory–tested specimens positive for influenza virus peaked for five consecutive weeks from Jan. 13 through Feb. 10.

• Regionally, the week of peak clinical laboratory influenza positivity varied, ranging from the week ending Dec. 30, 2017, to the week ending Feb. 17.

• Public health laboratories tested 98,000 specimens between Oct. 1, 2017 and May 19, 2018.

Of them, 54,000 (55 percent) were positive for influenza viruses – 38,303 positive for influenza A and 15,000 for influenza B. • Whereas influenza A(H3N2) viruses accounted for the majority of circulating viruses, the proportion of influenza A viruses subtyped as A(H1N1)pdm09 ranged regionally from 9 percent in the central United States to

approximately 24 percent in the northwestern and southeastern United States.

• F rom early March to late May, influenza B viruses were more commonly reported than were influenza A viruses. The proportion of influenza B viruses reported regionally ranged from 23 percent in the Midwest to 41 percent in the northwestern United States.

• Among 47,000 (88 percent) patients who tested positive for seasonal influenza virus by public health laboratories and for whom age data were available, approximately 4,000 (8 percent) were aged 0–4 years; 12,000 (25 percent) were 5–24 years; 16,000 (33 percent) were 25–64 years; and 16,000 (34 percent) were 65 years or older.

• Influenza A(H3N2) viruses predominated among all age groups, ranging from 51 percent of viruses among persons aged 5–24 years to 70 percent among persons aged 65 or older.

• The largest proportion of reported influenza B viruses (37 percent) occurred in persons aged 5–24 years.

Source: Centers for Disease Control and Prevention, “Virus Surveillance,” June 8, 2018

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The Flu Forecast no capital costs, no contractual obligations and a small footprint to provide additional testing in an affordable manner. CLIA-waived would obviously be a large benefit.

Keep up on the latest information on flu and prevalence, and work closely with your manufacturing reps on the latest and greatest tools.

Patton: Our distribution partners should remember that, while the reclassification has to do with clinical performance, the physician office lab is also concerned about the patient experience and operational factors, like workflow. The cobas Liat PCR system can meet the clinical performance goals of the practice, but the system also has low hands-on processing time and fast time-to-result, and it can help improve the patient experience, because there is no need for confirmatory testing after a negative result, not only for influenza, but also RSV and Group A Strep. So the patient doesn’t have to go home and wait for a definitive diagnosis, and clinicians can confidently prescribe appropriate viral or antibiotic therapy for the patient. This directly supports healthcare providers with

their antibiotic stewardship efforts so they can appropriately prescribe antibiotics only when necessary.

Irwin: Improving patient outcomes when it comes to flu starts with flu testing, whatever the testing system may be.

More than ever, it is important to be diligent when dispensing antibiotics. Flu testing helps prevent the unnecessary prescription of antibiotics. This in turn helps reduce the threat of antimicrobial resistance.

Ranalli: Readers should be asking their influenza test suppliers if they have the capabilities to consistently supply tests at the peak of the coming respiratory season. As experienced in the 2017-18 respiratory season, many test suppliers went on extended backorder status. Quidel is confident in our world-class manufacturing capabilities to meet the supply needs for all of our influenza testing platforms (QuickVue, Sofia, Sofia2, Solana), no matter how robust the season. Since each influenza season is unpredictable in arrival as well as volume, it’s never too early to have the conversation with your suppliers.

Could flu tests go OTC? Two potential diagnostic tests for influenza designed to be purchased over-the-counter for home use will move into advanced development with new support from the U.S. Department of Health and Human Services.

The Biomedical Advanced Research and Development Authority (BARDA), part of the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR), announced in July that it is partnering with Cue Health Inc., of San Diego, California, and Diassess Inc., of Emeryville, California, to develop these testing devices.

BARDA will provide $14 million to Cue Health and $10 million to Diassess for advanced development of diagnostic tests for influenza A and B viruses that are being developed for purchase over-thecounter or administration by professionals. The

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agreement with Cue Health can be extended for up to $30 million over 60 months, the agreement with Diassess can be extended for up to a total of $21.9 million over 60 months.

HHS reports that both companies are designing their devices to be able to give results within 25 minutes. Both devices use mobile technology so that patients who test positive for influenza can receive a telemedicine consultation and, if needed, a prescription for antiviral drugs without leaving home. The devices also may include the capability to report de-identified influenza data to local health departments in real-time.

The Diassess testing device would be disposable and battery-powered for use in the field. Cue Health also is developing its device to test for other viruses, including Zika and HIV.

800-431-2123 info@polymedco.com

.

CHRONIC CARE MANAGEMENT

A Primary Concern Primary care docs take charge of chronic care management

By David Thill

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

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

At less than five square miles and a population of 10,230 at

last count, the southern Nebraska town of Lexington won’t likely be making national headlines in the near future. But Dr. Brady Beecham’s patients at Lexington Regional Health Center are facing challenges similar to those of patients across the country, particularly when it comes to chronic disease.

Beecham, a family physician, estimates that about half of the 25 or so patients she sees each day are older adults with chronic conditions. About 117 million people,

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or half of all adults in the U.S., had one or more chronic health conditions as of 2012, according to the Centers for Disease Control and Prevention. And the cost is exorbitant: Eighty-six percent of the $2.7 trillion in annual health care expenditures is for people with chronic and mental health conditions.

Traditionally, treatment for patients with chronic conditions such as heart disease and cancer – which have long been the top two causes of death in the U.S.

and together accounted for almost 46 percent of all deaths in 2014 – has fallen to specialists in many different areas of care. But as chronic conditions become more widespread, primary care physicians like Beecham are playing a more important role in orchestrating the care of these patients. With only about 15 minutes allotted for patient visits in many clinics, much of the work is done outside the clinic by nurses and other mid-level practitioners – but the primary care doctor is involved.

Beecham focuses first on prevention. “As primary care physicians, we’re really trying to be more systematic and careful about screening and diagnosing,” she says. This includes, for example, blood sugar screenings to determine a patient’s risk for diabetes.

For patients with one or more chronic conditions, the goal is to minimize complications, she says.

For example, blood pressure management is important to keep diabetes in check. Since patients often visit the clinic just once or twice a year, Beecham makes sure she checks their blood pressure when they visit.

For example, perhaps a patient works a night shift in a factory and doesn’t have a break where they can take their evening dose of insulin. The CDE might come up with a medication plan, coordinated with the patient’s primary care provider, that allows them to take their insulin at another time of day.

McIntyre also believes it’s important for patients to have an active role in their care. “What we’ve found is that by having patients empowered, they’re more likely to better self-manage,” she says.

For the past five years, HRHCare doctors have given patients blood pressure monitors to use at home. As a result, 71 percent of HRHCare patients are controlled for hypertension, compared with 53 percent nationally, says McIntyre.

“ As primary care physicians, we’re really trying to be more systematic and careful about screening and diagnosing.”

Empowering patients About 1,500 miles east of southern Nebraska, Dr. Sophia McIntyre and her team at Hudson River Health Care – HRHCare for short – are also helping patients manage chronic conditions.

McIntyre is a family physician and the chief medical officer at HRHCare, a community health center that serves the Hudson Valley and Long Island. HRHCare’s patients – many of whom are uninsured and most of whom are below the national poverty level – face several challenges that limit their access to adequate medical care.

Among these challenges is a lack of education about disease prevention and healthy living.

To address that issue, HRHCare offers patients with diabetes the opportunity to meet with a Certified Diabetes Educator. The CDE – usually a registered nurse or nutritionist – meets with the patient to address social, medical and financial issues that might not arise during a usual primary care visit, says McIntyre. But these issues can affect the patient’s understanding of their condition and their ability to adhere to their medication schedule.

– Dr. Brady Beecham

Programs like this may be helpful for patients, but adequately reimbursing the primary care team for their time and effort is another matter.

The payment problem Commercial insurers cover CDE visits at HRHCare, says McIntyre. Medicaid, however, does not. Nor does the program cover the diabetes education classes she would like to offer.

To subsidize the at-home blood pressure monitoring program, HRHCare relies on grant support from organizations like the local Department of Health, YMCA and the CDC. As it is, about 100 monitors are available for patients. The program would be accessible to far more patients if commercial insurers and government programs like Medicaid covered them, McIntyre says.

But insurers don’t cover these services for “uncomplicated” patients, she says. In other words, they don’t often focus on prevention. If insurers did address prevention, McIntyre believes expenses like the $320 billion spent on diabetes care each year could be reduced. “Why are we waiting for patients to have advanced disease before we cover these devices?” she says.

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CHRONIC CARE MANAGEMENT Lack of insurance is also a challenge for many of Beecham’s patients in Lexington. For the most part, pills are inexpensive, she says. But other necessary care, like insulin and certain equipment, is much more expensive. She recalls a patient who, in an effort to save money, made his own walker. “We really end up working a lot with suppliers” to try to make high-quality equipment like walkers, oxygen and hospital beds available for patients,” Beecham says.

Quality reporting programs, where payers cover monitoring and recording of information in patients’

electronic medical records, help encourage prevention of complications, says Beecham. Incentives like Medicare’s chronic care management program, which allows providers to bill for non-physician care outside the clinic, also encourage effective management, she says.

Since much of that management can be done by nurses and other mid-level providers, she can address more pressing patient concerns in the exam room. As a doctor, says Beecham, “it really is helpful to have that whole team helping to manage” chronic conditions.

David Thill is a contributing editor to Repertoire.

CPT codes for chronic care management In 2015, Medicare began paying separately under the Medicare Physician Fee Schedule for chronic care management services provided to Medicare patients who have multiple chronic conditions. In addition to physicians, certain non-physician practitioners can bill for chronic care management services, including certified nurse midwives, clinical nurse specialists, nurse practitioners and physician assistants.

The three chronic care management codes reimbursed under Medicare are: •C PT 99490: Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements: • Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient • Chronic conditions place the patient at significant risk of death, acute exacerbation or functional decline

•C omprehensive care plan established, implemented, revised or monitored

•C PT 99487: Complex chronic care management services, with the following required elements: • Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient •C hronic conditions place the patient at significant risk of death, acute exacerbation or functional decline • E stablishment or substantial revision of a comprehensive care plan •M oderate or high complexity medical decision making • 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month •C CPT 99489: Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month

Source: Centers for Medicare and Medicaid Services: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagement.pdf

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CHRONIC CARE MANAGEMENT

Chronic disease: An overview • Chronic diseases and conditions – such as heart disease, stroke, cancer, type 2 diabetes, 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. Two of these chronic diseases – heart disease and cancer – together accounted for nearly 46 percent of all deaths.

• Obesity is a serious health concern.

Total annual During 2011–2014, cardiovascular more than onedisease costs third of adults (36 percent), or about to the nation 84 million people, averaged were obese $316.1 billion (defined as body in 2012–2013. mass index ≥30 kg/m2). About one in six youths (17 percent) aged 2 to 19 years was obese (BMI ≥95th percentile).

• Arthritis is the most common cause of disability. Of the 54 million adults with doctordiagnosed arthritis, more than 23 million say they have trouble with their usual activities because of arthritis.

• Diabetes is the leading cause of kidney failure, lower-limb amputations other than those caused by injury, and new cases of blindness among adults.

The cost of chronic disease In the United States, chronic diseases and conditions and the health risk behaviors that cause them account for most health care costs.

• E ighty-six percent of the nation’s $2.7 trillion annual health care expenditures are for people with chronic and mental health conditions. These costs can be reduced.

• Total annual cardiovascular disease costs to the nation averaged $316.1 billion in 2012–2013.

Of this amount, $189.7 billion was for direct medical expenses and $126.4 billion was for lost productivity costs (from premature death).

• Cancer care cost $157 billion in 2010 dollars.

• The total estimated cost of diagnosed diabetes in 2012 was $245 billion, including $176 billion in direct medical costs and $69 billion in decreased productivity. Decreased productivity includes costs associated with people being absent from work, being less productive while at work, or not being able to work at all because of diabetes.

• The total cost of arthritis and related conditions was about $128 billion in 2003. Of this amount, nearly $81 billion was for direct medical costs, and $47 billion was for indirect costs associated with lost earnings.

• Medical costs linked to obesity were estimated to be $147 billion in 2008. Annual medical costs for people who were obese were $1,429 higher than those for people of normal weight in 2006.

• F or the years 2009–2012, economic cost due to smoking is estimated to be at least $300 billion a year. This cost includes nearly $170 billion in direct medical care for adults and more than $156 billion for lost productivity from premature death estimated from 2005 through 2009.

• The economic costs of drinking too much alcohol were estimated to be $249 billion in 2010. Most of these costs were due to binge drinking and resulted from losses in workplace productivity, health care expenses and crimes related to excessive drinking.

Source: United States Centers for Disease Control and Prevention: https://www.cdc.gov/chronicdisease/ overview/

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TRENDS

A New Wrinkle

Two IDNs acquire multistate LTC providers

– Randy Oostra, ProMedica president and CEO

In June, Sioux Falls, South Dakota-based Sanford Health and the Evangelical Lutheran Good Samaritan Society announced a similar merger, to be completed by the beginning of next year.

Sanford “never had a very specific approach to longterm care,” Grant Tribble, Good Samaritan’s chief financial officer, told Skilled Nursing News at the time. The merger could allow the combined organizations to deliver a broader range of care, Tribble said.

Each acquisition means a significant expansion for the health systems involved. ProMedica, which currently operates in six states, will operate in 30 states and employ about 70,000 people once it acquires HCR ManorCare. The combined network’s projected annual revenue is $7 billion.

Sanford operates in nine states, and shares little overlap with Good Samaritan, which operates in 27 states.

The merger could potentially add 19,000 Good Samaritan employees to the 28,000 Sanford already has. At the time, the question was raised as to whether this would mean downsizing for Good Samaritan’s skilled nursing facilities – it currently has about 80 – though at press time that question remained unanswered.

“The lines are blurring between where health care begins and stops,” Randy Oostra, ProMedica’s president and CEO, said at the time. “This acquisition provides us the platform to think differently about health and aging.”

Americans 65 and older are the fastest growing segment of the population, meaning adequate post-acute care – and the ability for patients to transition effectively between post-acute and hospital care – is in demand.

Visit Repertoiremag.com for links to more information on the mergers and their potential implications: •P roMedica Health System to Acquire HCR ManorCare Redefining Care for Seniors (a ProMedica press release) • Good Samaritan, Sanford Target Continuum Control with Merger Deal (Skilled Nursing News) • NHI Sees Promise As Health Systems Move Into Skilled Nursing (Skilled Nursing News)

Perhaps it was bound to happen. In the past half-year,

two health systems have acquired large, multistate providers of long-term care services. It’s too early to tell whether this could mark a new trend in caring for patients with critical needs.

In April, Toledo, Ohio-based ProMedica health system announced plans to acquire HCR ManorCare, also based in Toledo and the country’s second largest postacute care provider, according to a press release announcing the merger.

“ The lines are blurring between where health care begins and stops. This acquisition provides us the platform to think differently about health and aging.”

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HEALTHY REPS

Health news and notes Addressing PTSD Posttraumatic stress disorder (PTSD) affects an estimated 6 percent of adults in the United States at some point in their lives. It can cause flashbacks of upsetting events and difficulty sleeping, among other symptoms. With funding from the Patient-Centered Outcomes Research Institute, the Agency for Healthcare Research and Quality reviewed PTSD treatment studies published since 2012 and found strong support for the effectiveness of certain types of cognitive behavioral therapy in treating patients with PTSD. Cognitive behavioral therapy is a type of talk therapy that focuses on helping patients become aware of negative thought patterns and beliefs, and develop constructive ways of thinking. It also found moderate

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evidence that the antidepressant medications fluoxetine (Prozac), paroxetine (Paxil), and venlafaxine (Effexor) can help reduce PTSD-related symptoms.

Putting menopause on pause A study from the United Kingdom suggests that eating a high intake of oily fish delayed onset of menopause by 3.3 years per portion per day, and a high intake of legumes delayed onset by 0.9 years per portion per day.

In addition, higher intake of two micronutrients – vitamin B6 and zinc – delayed onset by 0.6 and 0.3 years, respectively. The research also found that higher intakes of refined pasta and rice led to earlier menopause by 1½ years. A team from the University of Leeds followed 914

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women for four years, examining their food and nutrient intake related to age of natural menopause, reports the Washington Post. Legumes, vitamin B6 and zinc all have antioxidant properties, and oily fish are associated with potentially improving antioxidant capacity.

So, the results, and data from other studies, suggest that an antioxidant-rich diet can potentially delay onset of menopause, which is associated with greater life expectancy and reduced risk of cardiovascular disease and osteoporosis. More established research suggests that consuming heart-healthy and bone-strengthening foods, exercising and avoiding weight gain are good strategies for avoiding the cardiovascular disease and osteoporosis that so often are associated with menopause.

The ‘in’ crowd Dieting? You’re not alone. According to the Centers for Disease Control and Prevention: • I n 2013–2016, 49.1 percent of U.S. adults tried to lose weight within the past 12 months.

•A higher percentage of women (56.4 percent) than men (41.7 percent) tried to lose weight.

•A lower percentage of non-Hispanic Asian adults (41.4 percent) than non-Hispanic white

11/30/17 11:27 AM

(49.4 percent), non-Hispanic black (48.0 percent), and Hispanic (49.1 percent) adults tried to lose weight.

• The percentage of adults who tried to lose weight increased with family income and with weight status category.

• Among adults who tried to lose weight, the most commonly reported methods were exercising (62.9 percent) and eating less food (62.9 percent), followed by consuming more fruits, vegetables, and salads (50.4 percent).

The company you keep Do the people you surround yourself with influence a healthier lifestyle or bring you down? “Researchers have found that certain health behaviors appear to be contagious and that our social networks – in person and online – can influence obesity, anxiety and overall happiness,” Tara Parker-Pope writes in the New York Times.

“A recent report found that a person’s exercise routine was strongly influenced by his or her social network.”

Parker-Pope describes the “moai,” a social network concept from Japan, where a group of five friends are connected for life as a source of social, logistic, emotional and financial support.

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HEALTHY REPS Hypertension in pregnancy

Turn off the juice

Women with pregnancies complicated by high blood pressure may benefit from cardiovascular screening throughout their lives. That’s because those with a history of preeclampsia or gestational hypertension in pregnancy developed chronic hypertension at a two-to-three-fold higher rate and had 70 percent and 30 percent higher rates of type 2 diabetes and high cholesterol, respectively, than women who had normal blood pressure in pregnancy, according to a study published in the Annals of Internal Medicine.

Between 10 to 15 percent of women experience hypertensive complications during pregnancy, and evidence shows that these women are more likely to have a heart attack or stroke later in life, even if their blood pressure returns to normal immediately following pregnancy.

Soda pop and sports drinks are a major source of added sugar for Americans, and they contribute 145 calories a day to our diets, report researchers in a New York Times article. How about juice? Despite all the marketing and government support, fruit juices contain limited nutrients and tons of sugar. In fact, one 12-ounce glass of orange juice contains 10 teaspoons of sugar, which is roughly what’s in a can of Coke.

Worse, juice isn’t the same as eating whole fruit. While eating certain fruits like apples and grapes is associated with a reduced risk of diabetes, drinking fruit juice is associated with the opposite, according to the researchers. Juices also have less fiber, which makes you feel full. Because juice can be consumed quickly, it is more likely than whole fruit to contribute to excess carbohydrate intake.

Despite all the marketing and government support, fruit juices contain limited nutrients and tons of sugar. In fact, one 12-ounce glass of orange juice contains 10 teaspoons of sugar, which is roughly what’s in a can of Coke. Worse, juice isn’t the same as eating whole fruit.

A walk in the park What does it mean to take a “brisk walk?” About 100 steps per minute, of 2.7 miles per hour, according to a study published in the British Journal of Sports Medicine. Just count how many steps you take in 10 seconds and multiply that number by six, advises Dr. Catrine Tudor-Locke, a professor of kinesiology at the University of Massachusetts Amherst.

“The good news is that this pace will probably not feel strenuous to most healthy people,” she says.

When games are no longer fun “Gaming disorder,” with its online and offline variants, has been included in the draft of the 11th edition of the International Classification of Diseases (ICD-11) as a clinically recognizable and clinically significant syndrome, when the pattern of behavior is of such a nature and intensity that it results in marked distress or significant impairment in personal, family, social, educational or occupational functioning, reports the World Health Organization. (ICD-11 was scheduled to be released in June 2018.) Health concerns associated with gaming behavior include other aspects of health (e.g. insufficient physical activity, unhealthy diet, problems with eyesight or hearing, musculoskeletal problems, sleep deprivation, aggressive behavior and depression) and psychosocial functioning.

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Rising form of hepatitis Liver specialists say there’s a form of hepatitis that is sneaking up on about 12 percent of the U.S. population, or an estimated 25 million Americans, reports the Sacramento Bee. Called nonalcoholic steatohepatitis, or NASH for short, it does not result from drug use, alcoholism, sexual contact, water contaminants or viruses. Rather, it occurs when too much fat is stored in liver cells. Primary care providers are urged to look for risk factors among patients, including high blood pressure, high cholesterol, diabetes, and a body mass index of 30 or higher. Definitive diagnosis requires a noninvasive liver ultrasound called a FibroScan. Early detection can lead to management of the disease.

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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 Free floatin’

Superfly

Free-floating carshare service car2go launched in Chicago, marking the company’s 25th global city. In a pilot program, the company will offer a fleet of 400 vehicles for rent, including fortwos and Mercedes-Benz CLA and GLA vehicles. car2go members can make one-way trips without having to pick up or return vehicles at fixed locations or at a designated time. Insurance, fuel, maintenance and parking are included in the service’s rates.

It’s new, and is said to be outrageously fast. The 2019 YENKO/SC® Stage II Corvette, from Specialty Vehicle Engineering of Toms River, New Jersey, is powered by a custom built 1000-hp 416 C.I.D. (6.8L) supercharged LT-1-based engine. Only 25 of these Limited Edition cars will be built, and all will be based off the 2019 Corvette Grand Sport (Coupe and Convertible) model, which is said to include the handling, appearance, and body components featured on the Z06. Take a peek at specialtyvehicleengineering.com.

Cool N Dry car seats Britax Child Safety Inc. introduced its Cool N Dry Collection, available on buybuybaby.com. The new line of car seats is said to feature a high-performance Thermo5™ knit blend with 30 percent Bamboo Charcoal, which wicks away moisture and naturally allows air to flow. The collection is comprised of an infant car seat, a convertible car seat and a belt-positioning booster for all ages and stages.

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Room for one more Baby Jogger® says it is helping parents get more out of a vehicle’s back seat with the new City View™ Space Saving All-in-One Car Seat. At 17.4 inches across, the slim silhouette is said to allow extra space for additional passengers while providing a comfortable ride for baby.

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Designed with enhanced convenience and safety features, the stylish City View ensures that families – that includes sales reps – can venture out on the open road with greater ease and peace of mind.

Digital showroom for Hyundai Hyundai introduced a digital showroom on Amazon. com, which offers car buyers the ability to compare pricing and reviews, book test drives, check dealer inventories and other conveniences. The digital showroom can be found at amazon.com/Hyundai.

Bluetooth motorcycle helmet Sena Technologies Inc. announced the release of its Bluetooth-integrated open-face motorcycle helmet, the Savage, a 3/4 helmet said to pack premium Bluetooth communication technology. Bluetooth 4.1 allows riders to connect with up to three other riders via built-in intercom up to 1 mile, listen to music, GPS directions, or take phone calls.

The helmet was designed with a composite fiberglass shell and multi-density EPS for added protection in the case of impact. The helmets range in size from XS through XXL, are available in Matte Black or Gloss White, and include both long and short visor options.

Uber and Lyft take on the world Uber and Lyft came to prominence with their ridehailing services. But increasingly they’re betting on other modes of transportation – with the aim of becoming the only service people need to get around cities, reports the New York Times. Lyft recently struck a deal to acquire parts of Motivate, the parent company of CitiBike in New York and seven other bike-sharing programs around the United States. Previously, Uber had acquired Jump, a company that rents dockless electric bikes in six U.S. cities. Both companies are experimenting with scootersharing programs, but they have bigger plans: They want people to use their apps for navigating around cities. “Whether it’s taking a car, whether it’s taking a pooled car, whether it’s taking a bike, whether you should walk or even … take a bus or subway,” Uber CEO Dara Khosrowshahi was quoted as saying earlier this year. “We want to be the A-to-B platform for transportation.”

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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

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Expand your desktop

Alexa at mealtime

Kensington’s SD7000 Surface Pro Docking Station is said to enable users to expand their desktop setup to include two 4K external monitors, connect to a wired network, and sync up their favorite USB accessories. Built on Microsoft’s proprietary Surface Connect technology, the docking station ensures seamless syncing and charging. The SD7000’s articulating hinge is designed to allow the Surface Pro to be comfortably positioned upright as a display or at a drafting table angle. A magnetic connection for Surface Pen keeps it handy and ready for use. The optional Lock Module for SD7000 Dual 4K Surface Pro Docking Station secures the Surface Pro when docked to deter theft.

Parents can now ask Amazon Alexa for songs and sounds designed to make mealtime engaging and exciting for babies and toddlers. Sprout Foods says its Alexa skill works with Amazon’s Echo and Dot, and features three different modes: songs (each featuring a different musical style and healthy food focus), mealtime adventures (fun sound effects) and “Eat & Sing with Sophie Sprout,” which encourages kids to take sips of their Sprout organic food pouches.

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Say again?

Speaking of Alexa, or rather, speaking to Alexa: The Washington Post teamed up with two research groups to study the

accent imbalance of Amazon’s Alexa and Google’s Assistant. People with Southern accents were 3 percent less likely to get accurate responses from a Google Home device than those with Western accents. And Alexa understood Midwest accents 2 percent less than those from along the East Coast. People with nonnative accents fared even worse. People who spoke Spanish as a first language were understood 6 percent less often than people who grew up in California or Washington.

Power watch Joseph Fahys & Co. says its soon-to-be-released In-Touch will be the most advanced smartwatch in the world. The self-charging watch features the Qualcomm® Snapdragon™ Wear 2100 processor with 1 GB RAM and 8GB of storage, 9-Axis, optical heart rate monitor, Bluetooth 4.2, WLAN and GPS.

That’s fast

The $995 oven is available for pre-order, with ovens expected to ship in November.

When coffee spills If you flood your laptop with a latte or other beverage, turn it off immediately and unplug the power cord – and any other hardware attached to it, such as external drives, advise the technology editors at the New York Times. If your model has a removable battery, take it out. Tilt the computer to drain any excess liquid. Mop up as much of

Brava can cook an entire meal with less energy than it takes to preheat a traditional oven, with multi-zone capabilities to cook different food groups at distinct temperatures simultaneously, according to the company.

It’s the fastest oven in the world, says Brava, a San Francisco-based company of its new oven. Its Pure Light Cooking™ technology is said to enable its lamps to reach full power – the equivalent of an oven reaching 500 degrees – in under one second, virtually eliminating the need to preheat. Brava can cook an entire meal with less energy than it takes to preheat a traditional oven, with multi-zone capabilities to cook different food groups at distinct temperatures simultaneously, according to the company. A heat-resistant internal camera allows you to monitor cooking progress, with the ability for a remote view into the oven on smartphones.

the spill as you can with a towel or other absorbent material, preferably by blotting instead of wiping (and potentially pushing liquid deeper into the machine). You may be able to revive the laptop by letting it drain and dry upside down overnight if water or small amounts of non-sugary liquids were spilled onto it. If significant amounts of a complex coffee creation, juice, soda, cocktails or other alcohol were the culprit, consider taking the machine to a computer repair shop as soon as possible for a professional cleaning and consultation. Good luck.

Bluetooth earrings Bluetooth earrings for pierced ears are part of a recently launched Kickstarter campaign

by Scandi Electronics. Swings Bluetooth Earrings are simple to wear, provide stability and combine function with fashion, says creator Melissa Eldridge. Users wear Swings as earrings and then can “swing” them into the ear when they want to listen to audio. Swings come in three versions: Swings, Swings Sport, and Swings “Bling” Swarovski Crystal. The earrings have dual microphones with calibrated noise cancellation technology for superior call quality. Battery life is five hours; 15 minutes of charging gets three hours.

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corner

The Un-sales

Rep

Jill Borysiak doesn’t sell.

She meets customers’ needs.

How many high schoolers do you

know who dream of pursuing a career selling dental equipment?

It happened to Jill Borysiak while touring a dental chair manufacturing plant as part of a dental vocational program in school. “I listened as they went through the features and benefits of the chairs, and I thought, ‘This is so cool that they have come up with a way to meet the needs of their customers; I’d like to do that too,’” says Borysiak, who is senior national sales consultant for Lynn Medical, Wixom, Michigan.

Borysiak has been out of high school awhile now, but after 30 years in medical sales, she still hasn’t lost her desire to help customers identify and fill their equipment and medical supply needs.

A Michiganer then and now, she grew up in a Henry Ford Historical Home in Dearborn, Michigan. Her parents – Ann and Bob Borysiak – were teachers. “My work ethic and honesty come from both of them,” she says. (She lost her father in 2003.)

She got something else from them: A love of activity and adventure. Her father was always active, and

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Jill Borysiak

coached many sports, including some of the intramural sports in which Jill participated. Both parents were avid golfers (as is Jill today). Her mom, at 79 years old, participates in two golf leagues – one in northern Michigan, another in Florida.

Shortly after graduating with a marketing degree from Ferris State University in Big Rapids, Michigan, Borysiak took a job as an inside sales representative for Veratex, a division of TIDI, selling everything from equipment to pharmaceuticals to disposables and supplies. Five years later, the company was acquired

by Henry Schein, for whom she worked an additional five years.

www.repertoiremag.com

3 Reasons GPOs Are Good for Distributors’ Business

Distributor customers who use GPOs actually buy more GPOs provide better pricing, which increases customer “stickiness,” so they buy more from the distributor

GPOs help distributors be more competitive The aggregated purchasing power of a GPO lowers costs to help distributor reps stand out in a crowded, highly competitive marketplace

1 2 3

GPOs make distributors’ jobs easier

Getting reps’ customers on contract saves time and money for distributors and their customers

Why Provista?

Provista leverages more than $100 billion in purchasing power across an extensive portfolio. Dedicated to helping customers in the non-acute space, the company’s sales teams have deep expertise and a strong presence in local markets.

Find out more at

Provistaco.com/partners

corner When Henry Schein closed its sales office in Michigan, Borysiak was offered an opportunity to relocate and stay with the company, but decided to stay in Michigan and find something new. She found Lynn Medical.

“The fact that Lynn manufactured electrodes, had a strong specialized private label, and was a specialty distributor, interested me,” she says. She was ready for the challenge to learn about more complex medical products and to become a specialized consultant to her customers.

Today Lynn Medical is a distributor only, focusing on diagnostic solutions and the technology to complement it.

Its target market is cardiology.

Inside sales is a continuation of Borysiak’s high school dream.

“When we reach out to physicians, we have a dialogue with them, so that we understand their exact needs and determine a solution that will be beneficial to them in regard to patient care, financial investment, workflow and ease of use,” she says. “Equipment such as ultrasound and stress systems, Holter monitors, ECGs, Dopplers, and ABIs and the related disposables, are just a few of the products we continually educate ourselves on.”

Even as an inside rep, Borysiak has set up many cardiology offices, from soap dispensers to ultrasound equipment. But she doesn’t do it alone.

“We have a strong, long-standing relationship with the manufacturers and their representatives in this market,” she says. “As a Lynn Medical sales representative, I pride myself on making the process of purchasing capital equipment easy and smooth for my customers and the manufacturer reps.

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My years of experience and expertise allow me to streamline the process, proactively address problems before they arise, and make it a stress-free transaction for both the partners and customers.

“Over the course of my 30-year career in the ever-changing medical industry, I’ve learned that understanding my customers’ needs is the most important component to being successful,” she says. “I don’t just offer a great price to my customers. I set my bar much higher, and I provide them a high level of service and consulting. I could go as far to say that I have become part of each of my customer’s own procurement team.

“Instead of looking at what I do as a ‘sales’ job, I look at it as providing options, solutions, ideas, and consulting. Ultimately, when the time is right, they will make a purchase. So I have definitely gotten better at being patient.”

At Lynn Medical, Borysiak has also learned to navigate through change. “The company is proactive in communicating any changes coming down the line, and providing a plan of action that will help our customers, our manufacturers, and ourselves overcome any obstacles that the changes could cause. Additionally, the representatives at Lynn Medical don’t try to be all things to all people; we look for specialized customers and offer knowledgeable, customized services and solutions.”

When she is not selling, Borysiak is probably on one of Michigan’s many beautiful lakes with long-term friend Rick Helzer, wakeboarding, kayaking or boating in general. “If there’s an activity that has to do with being on the water, I guarantee it’s in our wheelhouse,” she says. She has worked out at the gym daily for decades. “Not only does it energize me for the day, but that’s my time to clear my head.” And, like her mom, she is an avid golfer.

And as far as she’s convinced, the medical space is the only place to be.

“Healthcare providers have so many priorities. They balance quality patient care and patient satisfaction with meeting regulations and changing reimbursement. You can make a difference by being informed and helping them navigate the supply chain decisions, so they can spend more time on what is really important – patient care and patient satisfaction. The best way to do that is to continually educate yourself on what’s happening in the market and on current technology.

“It’s never boring. I’ve never considered changing fields.”

Calling all Manufacturers!!!

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Our content-rich program will arm you with information to help chart your 2019 business and activities as we hear from industry leaders on essential and relevant topics.

• Key Trends in the US Healthcare Market - Ryan Evans, Sr. Partner with The Brooks Group, Inc. • Supply Chain Strategy: Distribution, GPO, IDN, and beyond – John Pritchard, President & CEO of Share Moving Media • Amazon Healthcare today and tomorrow – Jennifer Stockman, Jay Ross & Jason Linscheid • The Power of Meaningful Use of Social Media – Jan Beery, CEO of KBK Communications

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

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

HEALTHCARE MANUFACTURERS MANAGEMENT COUNCIL

HIDA GOVERNMENT AFFAIRS UPDATE

CMS Proposes Key Changes to Competitive Bidding The Centers for Medicare and Medicaid Services (CMS) has released a proposed rule

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

that would significantly change bidding and pricing methodologies under the durable medical equipment prosthetics orthotics and supplies (DMEPOS) competitive bidding program. CMS stated that the goal of the rule is to “relieve regulatory burdens for providers, support the patient-doctor relationship in healthcare, and promote transparency, flexibility, and innovation in the delivery of care.” Here is a look at what the change would mean for distributors and their provider customers.

Background The Affordable Care Act of 2010 implemented the competitive bidding program for DMEPOS nationwide beginning in 2016. The program fundamentally changed how Medicare reimburses DMEPOS suppliers, from fee schedules to a bidding process. The winning bids are used to establish a single Medicare payment for each item in each bidding area. The bidding process is repeated every three years.

Current DMEPOS competitive bidding contracts expire at the end of 2018. CMS has not yet begun the recompete process, which generally takes between 18 and 24 months. Because of this time lag, part of the proposed rule would put the competitive bidding program on hold starting January 2019 likely through the end of 2020. Beginning on January 1, 2019, beneficiaries may receive DMEPOS items from any willing supplier until new contracts are awarded under the DMEPOS competitive bidding program. CMS notes they will provide more information at a later date.

Proposed rule brings bidding, pricing methodology changes The proposed rule released on July 11 would change bidding and pricing methodologies, if adopted. Changes under the proposed rule include: •R evising the DMEPOS competitive bidding program by implementing more streamlined pricing rules.

•E stablishing a new method for determining what DMEPOS suppliers are paid.

•E stablishing three different temporary fee schedule adjustment methodologies depending on the area in which the items and services are furnished: 1. One set of payment rules for durable medical equipment furnished on or after January 1, 2019 in areas currently subject to competitive bidding.

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2. Another set of rules for items and services provided between January 1, 2019 – December 31, 2020 in areas that are currently not subject to competitive bidding rules, and are either rural areas or not part of the lower 48 states.

3. Another fee schedule adjustment methodology for items and services provided between January 1, 2019 – December 31, 2020 in areas that are currently not subject to competitive bidding rules, are not rural, and are part of the lower 48 states.

Looking ahead This proposed rule underscores the administration’s interest in changing the competitive bidding program. While the Medicare Payment Advisory Committee (MedPAC) recently recommended expanding the program, it is more likely that CMS will continue moving in the opposite direction.

The proposed rule could have a positive effect on suppliers and the post-acute providers and patients they serve. In addition to streamlining the current process, the recent delays indicate CMS may be willing to reevaluate the program. This provides HIDA Government Affairs the opportunity to advocate for additional changes sought by distributors, such as the exclusion of enteral nutrition products from the program.

At this point, there has not been any independent analysis on how the program has affected the availability of medical products and physician decisions when clinically preferred products are not available. Because of the potential impact any changes could have on the distributors and providers, along with the paucity of information, HIDA will continue to engage policymakers and our members as we work to submit comments to CMS. To learn more, please contact HIDAGovAffairs@HIDA.org.

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LEADERSHIP

Addressing Your Team’s Needs How to galvanize your team when times are tough

By Lisa Earle McLeod

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Welcome to the new normal. We’re adding jobs daily,

No 1. Connection: Get emotional

but most people are still miserable at work. Workplace study data confirms what leaders are experiencing: work is harder, over half of all employees are disengaged and many people actively hate their jobs.

In the old days leaders could rally the troops by painting a picture of a glorious, prosperous future, garlanded with bonuses, perks and advancement. Today, people want both money and meaning. They’re also less trusting of senior leadership promises having seen evidence that a merger, acquisition, economic downturn, or CEO change makes all past promises null and void.

Given the climate, how can well-intended leaders galvanize their teams? It’s simple, but not easy. You must go beyond the traditional transactional approach to work and address three core human needs:

Discussing emotions at work can make people queasy.

But have you ever noticed that you never hear managers saying, “Please don’t get so excited?” Emotions are at the center of every human endeavor.

What would happen if you walked in one day, looked one of your employees in the eye and told him or her, “I’m so grateful you’re on our team, and it’s not just about the work; it’s also about how much you as a person add to this place. I love having you here”?

It sounds hokey, but every time I suggest this in a presentation, people’s eyes fill with tears. Human connection isn’t a nice thing to have; it’s a must-have.

Meaningful connections provide people with the internal fortitude they need to stay productive during tough times.

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No 2. Meaning: Provide context We all want to know our lives – and work – actually count for something. A person who makes widgets may do a good job of quality control. But if his boss holds a team meeting every Monday morning and shares stories about people who bought the widgets and how their lives were made better, more fun, more interesting, safer or easier as a result, that imagery is going to stick. The person responsible for stamping out part 357A will know his work counts for something more than a production number. He has a purpose.

We make needles that make everyone comfortable.

No. 3. Leadership: Apply daily It would be nice if we all went through our days feeling beloved by our families and co-workers secure in the knowledge our work makes a real difference.

Sadly, angst and worry are the typical default setting for the human brain. Left Revenue to the mercy of our own objectives, perceptions, our jobs can descend into an endless market share series of meaningless targets and tasks. That’s why we need productivity leaders who can reset us numbers are in times of uncertainty worthy goals. and challenge.

In fact, one of the But the secret of true emotional essential roles of a leader engagement is is to remind your team to get beyond why their work matters.

When employees seem the numbers like they don’t care, it’s and make it often because leadership personal. hasn’t given them anything important to care about. Revenue objectives, market share targets and productivity numbers are worthy goals. But the secret of true emotional engagement is to get beyond the numbers and make it personal.

People who are connected to each other and have a sense of purpose about their work will push through tough conditions to get things done. If your team is facing a challenge, or they seem to be disengaged, ask yourself: Do they know why their work matters? And most importantly, do I as a leader reinforce meaning and connection every single day?

A lot hinges on having the right needles. That’s why Terumo’s SurGuard®3 offers some very convincing benefits.

Sharper – Patients benefit from a more comfortable injection, as our needles are 10%* sharper than the market leader and sharpest on average among major brands Safer – Safety mechanism includes a lock for both the needle and the hub, and is designed to minimize the ability to be removed Smarter – Clinicians can choose how they activate the safety mechanism using their finger, thumb or hard surface as dictated by the clinical situation We make some great points. Whatever you’re looking for in a safety needle, SurGuard®3 from Terumo has you covered. For more information, call Terumo at 800-888-3786 or visit terumotmp.com to find your Terumo representative.

TERUMO and SurGuard are trademarks owned by Terumo Corporation, Tokyo, Japan, and are registered with the U.S. Patent and Trademark Office. ©2018 Terumo Medical Corporation 6/18.

All rights reserved. PM-00628. *Data on file. Terumo Medical Products, April 2016.

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SMART SELLING

DISTRIBUTOR SALES STRATEGIES FROM HIDA

The Complicated Relationship

Between Supplier Salespeople and GPOs Ask manufacturer or distributor sales reps what they think about group purchasing orga-

nizations, and you’ll get a wide array of responses. Some value the opportunities that a GPO contract creates to grow sales in the GPO members’ facilities. But many complain – some noisily – about high fees, complicated contracting processes, and barriers that GPO agreements can create for non-contracted suppliers.

Here’s my two cents: Reach customers through GPOs are here to stay. Sure, multiple channels the landscape is changing rapidly, with regional purchasing

By Elizabeth Hilla, • Sell at the GPO, system, and field level Senior Vice coalitions, local contracting, (relationships still matter!)

President, HIDA and so on. But providers’ • Work closely with your channel partners: desire to aggregate their purdistributor, manufacturer, GPO, buying group chases and achieve volume discounts, sharebacks, and • Align messages within the company: marketing, other benefits, hasn’t changed. field sales, corporate sales, telesales So it seems to me that successful suppliers should • Utilize various channels of communication: social find ways to work within this landscape to build partmedia, email, advertising, and selling nerships and grow sales.

Here are some insights I’ve collected from folks who work closely with GPOs and their members: • If your company is not a contracted supplier, consider • Sure the national GPO contract is just a “hunttrying to work with local health systems or regional ing license” – but it’s a valuable hunting license. It aggregation groups. If you succeed, you’ve not only gives the salesperson the opportunity to work with, gained some business, you’ve better positioned your rather than around, supply chain leaders in a facility. company to win a deal next time the contract comes up.

(Often, if your company is not on GPO contract, • Also be sure to investigate the dozens of GPOs and you won’t be welcome in the member facility.) aggregation groups that aren’t in the top 5. Many •H owever, just because you win a contract, don’t just provider associations sponsor their own group purassume that the GPO will push your products for chasing programs, and there are a number of smaller you. Instead, meet with the GPO’s sales team and independent GPOs. Check to see which ones, if any, put together a strategy for helping shift business are a good fit with your sales goals. over to your contract.

• S imilarly, don’t assume that your great contract To connect with some 40 GPOs, regional purchasing pricing will be sufficient to generate demand with groups, and health systems, be sure to attend the GPO & GPO members. The attractive pricing must be IDN Reverse Expo at HIDA’s Streamlining Healthcare Expo backed up with a strong sales and marketing mes& Business Exchange, September 25-27 in Chicago. sage to member providers.

Stay informed on group purchasing trends 56

September 2018

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1. Regional affiliates and aggregation groups – multiplying, competing for members especially in non-acute 2. Large IDNs – consolidating, leveraging their volume, in some cases forming their own GPOs

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3. Non-acute providers – big growth area for group purchasing 4. Broader scope of contracts – GPOs moving into purchased services, PPI, and more

LETTER TO THE EDITOR

The medical device tax: Let’s be honest about it To the editor: The medical device industry needs to be more trans-

parent in its actions and its voice. The ongoing debate about the 2.3 percent medical device tax offers the perfect opportunity to do so.

The tax has been written and talked about over the last five years, much as vendor credentialing was in the past. It’s as if we’ve beaten credentialing to death, so now it’s time for a new villain. At least that’s the way it appears to a skeptical public.

Vilifying the device tax has become a cottage industry in itself, with seminars, television interviews, podcasts, articles, meetings with legislators, and on and on. Honest policy discussions have been outflanked by slogans. Facts with practical and sustainable solutions are not discussed. It has become a zero-sum discussion.

The tax has been blamed for everything from higher manufacturing costs to job elimination. Along with the threat of repositioning manufacturing to outsourced locations, the population hears about further cuts in product development cycles and everything in between. And they have their doubts.

I’m raising the issue to highlight how many industry colleagues present confusing and often frustrating comments with their constant chatter on the subject.

Often, I hear non-industry individuals and some clinicians ask, “What are they talking about?” They can’t believe

Generalized charts and studies shouldn’t be the response.

There’s enough of that garble coming out of our nation’s capital.

a 2.3 percent tax increase could be a problem for an industry that appears to be making so much money. They question whether it’s a smokescreen to rationalize raising prices.

Others view it as a ploy to reduce or move jobs, thus generating more profits for the companies and their leaders.

I know for sure that this issue, like most others in healthcare, has many complex angles and certainly many perspectives. I’m also a committed capitalist. I just want the industry to become more transparent in its actions and voice.

Generalized charts and studies shouldn’t be the response. There’s enough of that garble coming out of our nation’s capital. For the benefit of patients, our industry needs to do better. The industry has to describe in detail exactly what happens when a tax such as this gets applied to each manufacturer. Honest dialogue – not just sound bites – has to take place so that the public and those actually paying the bill can see for themselves the true impact of the tax. (Who knows, maybe we’ll find out the tax should be higher?)

There needs to be an unemotional discussion on the historical information: How did we get here? Why does the industry feel it was singled out? How would ongoing efforts to change the law affect healthcare dynamics?

If jobs were to be lost, how many are we talking about?

Where did they go? How much research was curtailed?

What were the actual revenues and profitability of these organizations? Would medical device companies reduce their prices if the tax were permanently dropped?

As with many issues, our industry has spent too much time, money and resources on a subject that has become highly charged and emotional. Instead, we should focus our energies on creating new cures and treating patients more effectively. The rest is industry noise.

Bruce J Stanley The Stanley East Consulting Group Ipswich, Massachusetts brucejstanley@gmail.com

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September 2018

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Industry news

58

CME Corp names Amy Annis as Director of Kaiser Sales

Bovie Medical to sell core business segment to Symmetry Surgical for $97M

CME Corp (CME) announced the promotion of Amy Annis to Director of Kaiser Sales, as the comprehensive healthcare equipment and turn-key logistics company strengthens its relationship with Kaiser Permanente (Kaiser). CME’s California team, led by Amy Annis, has established a successful relationship with Kaiser, providing procurement, warehousing, assembly, staging and directto-site delivery services for Kaiser’s new construction projects across the western region, according to a release.

As Kaiser continues to expand its national footprint, CME has also expanded its services and footprint. CME now offers its logistics services anywhere in the U.S. as well as new services that include biomedical, IT and installation services. A 27-year veteran of the industry, Annis has been with the company for 19 years and has shepherded the CME-Kaiser relationship since its inception.

As Director of Kaiser Sales, Annis will oversee CME’s entire Kaiser program, working with field sales and service teams across the nation to ensure compliance and top-of-the-line service for any of Kaiser’s facilities.

Bovie Medical Corporation (Clearwater, FL) entered into a definitive agreement with Specialty Surgical Instrumentation Inc, a subsidiary of Symmetry Surgical Inc, pursuant to which Bovie Medical will divest and sell the core business segment and the Bovie brand to Symmetry for gross proceeds of $97 million in cash. The agreement is subject to customary closing conditions, including approval by Bovie’s stockholders. Bovie is retaining its Advanced Energy and OEM businesses, its facilities in Clearwater, Florida, and Sofia, Bulgaria, and certain intellectual property related to specialty generators. As part of the agreement, President and Director J. Robert Saron will join Symmetry and resign from the board of directors following the closing of the transaction. The Company and Symmetry will also enter into a transition services agreement, a patent licensing agreement, a disposables supply agreement, and a generator manufacturing and supply agreement, the latter of which will establish Bovie as an OEM-provider of generators to Symmetry for a period of at least 10-years. The transaction is expected to close in Q3 2018.

September 2018

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