vol.26 no.7 • July 2018
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Back to School It’s bad news for kids, but not so much for parents, doctors or sales reps
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JULY 2018 • VOLUME 26 • ISSUE 7
PUBLISHER’S LETTER Our Voices Heard............................................................6
PHYSICIAN OFFICE LAB
Back to School
Lab Inspections
I’d rather get an injection!........................................................8
DISTRIBUTION
It’s bad news for kids, but not so much for parents, doctors or sales reps
28 DISTRIBUTION
Make it Happen Together
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Twentieth annual national page sales meeting for Henry Schein
DISTRIBUTION
16
Stronger by Association
IMCO hosts its annual Convention and Tradeshow
Taking Point
Distribution has to be part of the solution, says 2018 HIDA Chair Chris Kerski.................................20
repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2018 by Share Moving Media. All rights reserved. Subscriptions: $49.00 per year for individuals; issues are sent free of charge to dealer representatives. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address. POSTMASTER: Send address changes to Repertoire, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors. Periodicals Postage Paid at Lawrenceville, GA and at additional mailing offices.
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JULY 2018 • VOLUME 26 • ISSUE 7
TRENDS
HEALTHY REPS Health news and notes.......................................... 26
CONTRACTING EXECUTIVE PROFILE
The Blunt Truth About Sharps Safety Things are getting better. But ‘better’ isn’t ‘great.’
48
QUICKBYTES
Donna Van Vlerah, senior vice president, support division, Parkview Health....................................................... 33
TRENDS Flu Fighters The 2018-2019 flu season is coming. Already............. 34
PAMA: Six Months Later........................................ 44
HIDA GOVERNMENT AFFAIRS UPDATE Top Lessons From This Year’s UDI Conference.................................. 53
SMART SELLING Tips For Selling The Value Of Your Service.................................... 58
WINDSHIELD TIME Automotive-related news.................................... 62
REP CORNER
Mike Garza: Keep Current
Technology news 60 4
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64 INDUSTRY NEWS News........................................................................................... 66
Longer length peripheral catheters help facilitate IV procedures involving: • • • •
INTROCAN SAFETY® DEEP ACCESS IV CATHETERS Help reduce the risk of complications associated with accessing deeper veins Visible under ultrasound3, the Introcan Safety Deep Access IV Catheters are designed to extend indwell time and prevent accidental needlesticks.
1 2 3
Stone, Phillip, RN, and Britt Meyer, MSN. “Ultrasound-guided Peripheral I.V. Access: Guidelines for Practice.” American Nurse Today. N.p., Aug. 2013. Web. 05 June 2014. Elia, Fabrizio, M.D., Ferrari, Giovanni, M.D., Molino, Paola, M.D., Converso, Marcella, M.D., De Filippi, Giovanna, M.D., Milan, Alberto, M.D., Apra, Fanco, M.D. “Standard-length catheters vs long catheters in ultrasound-guided peripheral vein cannulation.” The American Journal of Emergency Medicine. 2012. Vol. 30. Data on file (B. Braun ETR NPAK-AKRJQV)
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Ultrasound guidance 1 Access to deeper veins 1 Patients with difficult access 2 Overweight/obese patients 2
PUBLISHER’S LETTER
Our Voices Heard This time of the year is reserved for backyard cookouts, trips to the beach, and an all
around great opportunity to relax. The Fourth of July has always been one of my favorite holidays, and after just returning from lobbying on the Hill, I’m even more appreciative of the freedoms and opportunities we have. Last month through the efforts of HIDA, our industry did a fly-in to Washington, DC, to express our thoughts and concerns on a few hot issues facing us: Emergency Preparedness: We reinforced our position that this is a bi-partisan issue incredibly important to Americans. I am happy to report every office we were in is on board with supporting the initiative.
Scott Adams
NDAA: The National Defense Authorization Act allows federal departments and agencies to buy commercial product via an open marketplace. While this sounds good for common sundries, we feel it puts patient lives at risk for medical supplies. In most offices, once we gave them a few examples of how it could go wrong, they completely understood. We asked them to continue to work with authorized dealers for medical supplies. International Trade Policy: The administration has suggested significant tariffs be put on products imported from China. While we are not opposed to the tariffs, we did ask that medical supplies be exempt. If the goal is to take cost out of America’s health systems, then implementing a tariff on supplies is counterintuitive. The fact that the government, through Medicare, pays for a significant amount of the care in our country would only mean they are ultimately taxing themselves. At this time the tariffs are off the table, but that could change any day, so we wanted to be sure they were thinking through all the issues. All and all, it was a good trip and, we were hopefully able to make a difference. Dedicated to the industry, R. Scott Adams
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2018 editorial board Richard Bigham: IMCO Eddie Dienes: McKesson Medical-Surgical Joan Eliasek: McKesson Medical-Surgical Ty Ford: Henry Schein Doug Harper: NDC Homecare Mark Kline: NDC Bob Ortiz: Medline Pam Wedow: Independent consultant Keith Boivin: IMCO Home Care
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PHYSICIAN OFFICE LAB
Lab Inspections I’d rather get an injection! By Jim Poggi Fear of a lab inspection is one of
the most common reasons customers do not invest in CLIA moderate lab testing, or choose to reduce testing to CLIA waived tests, even if they know they need many of the CLIA moderate tests available to help them initiate or modify a patient’s treatment plan. There are several reasons, including lack of knowledge of CLIA moderate complexity requirements, how to manage a lab, or ignorance of resources available to help the practice. Fear of failure to pass an inspection, lack of confidence in the practice’s ability to successfully manage the lab, concerns about the time needed to manage the lab or concerns about staff turnover and continuity of lab management are also factors. Each of us knows a potential lab prospect who heard the story of a peer or colleague whose lab ran into inspection issues and ultimately stopped testing. Myths and ignorance typically fuel reluctance to initiate CLIA moderate complexity testing or panic when the lab is informed that an inspection is planned. A few of the classics are provided here. Each of us could add a few more, I am sure.
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Myths vs. reality MYTH
REALITY
Few labs get inspected; why waste Failure to plan is planning to fail; time planning and organizing? this attitude spells disaster when an inspection takes place. Managing a lab to be ready for inspection is hard and time consuming
It takes knowledge of what you need to do, commitment to success and some effort EVERY DAY
The lab staff needs to do all the The best managed labs have work to be ready for an inspection thoughtful engagement and oversight from the lab director Drag out the “books” when the inspector shows up to dazzle them with paper
Be prepared and have key documents ready (personnel training records, QC, policies and procedures). Know where your records are; take out what you need WHEN you need it. Newer solutions are software based.
Inspectors are out to find problems and cite the lab
Inspectors want to find evidence of on-going planning and management of the lab consistent with CLIA and the lab’s policies and procedures
One “bad inspection” and the lab gets shut down
Big deficiencies can be problems, but most labs are simply asked to correct deficiencies on a timely basis
So, knowing this and knowing how much value your customers can get from initiating and properly managing a CLIA moderate lab, what can you do in order to help them confidently manage their new lab and be ready for an inspection?
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PHYSICIAN OFFICE LAB Knowledge Arm yourself with knowledge of CLIA requirements and the available resources your company offers. Local lab consultants with good reputations and publicly available resources like COLA can also help organize the lab and keep it running smoothly. Understand the help available from your key lab suppliers; they are the experts and many companies offer assistance with applicable CLIA standards, compliance manuals, understanding of how to write policies and Many of the most procedures, quality control and other important elements of successful account managers I know managing a lab successfully. include a review of Traditional CLIA complithe lab’s operation ance tools have been paper docwith their quarterly uments, but newer electronic business reviews. solutions are software based Key suppliers “fill in the blanks” solutions should be a that guide the client through welcome addition CLIA requirements and help to the attendees at them prepare appropriate docthese meetings. umentation. These new tools offer a level of expertise and guidance that greatly simplifies daily lab operation and makes preparation for an inspection far easier. It adds confidence for you and your customers.
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implementation process to review the key actions needed to conform to CLIA moderate complexity lab management practices. Make a check list, assign activities such as developing QC testing practices, procedure manuals and personnel records to the right members of the practice and diligently work to assure all the open action items get resolved satisfactorily. Time spent now reaps rewards in increased confidence, reduced anxiety and more efficient operation of the laboratory over time. The lab that starts out with a patient-centric mission to improve care and use lab tests to create or modify patient treatment plans combined with a well thought out process for managing the lab is in a much better position to deal with the inevitable challenges that managing a lab as part of the physician practice encounters.
Monitor performance of your current customers’ POL
Some publicly available resources can be found by using the following links: •C LOA http://www.cola.org/ •A merican College of Physicians https://www.acponline.org/system/files/documents/ running_practice/mle/clia-and-your-lab.pdf • American Academy of Family Practice https://www.aafp.org/practice-management/ regulatory/clia.html
The best account managers are known and respected as consultants to their customers and their help and expertise is expected. This is certainly the case with a CLIA moderate complexity physician office lab. For your established customers, periodic check-ins to review operation of the lab and address issues head on is as important as high-quality implementation as they begin testing. Many of the most successful account managers I know include a review of the lab’s operation with their quarterly business reviews. Key suppliers should be a welcome addition to the attendees at these meetings. Keeping all the resources available to you in mind makes issue resolution far more efficient and assures experts are ready to step in as needed. Probe for issues, ask the right questions and openly discuss improvement needs. This business review is no substitute for a “mock inspection”, but it is part of your commitment to your customer’s success.
Share the information openly and completely with your customers
Do you know how prepared your customers are for an inspection?
As a friend of mine likes to observe, “Hope is not a strategy”. So, sharing the planning needed to implement and maintain a physician office laboratory as you prepare to move a customer from CLIA waived to moderate is critical. Physician offices need to understand what is involved, be committed to daily management of the lab and have policies and procedures in place to assure the smooth functioning of their lab. Nothing manages itself, and lab is no exception. I recommend setting aside time with the practice and your key moderate complexity suppliers early in the
You should. Using the tips provided, all of your company’s and supplier resources and researching newer compliance solutions is in your best interests as well as those of your customers. Make it a practice to provide needed resources and consultative efforts to help your customers manage their labs smoothly and efficiently. Your reward will be fewer headaches, no surprises at inspection time and customers who confidently manage their labs for the health and wellness of their patients. There are over 15,000 CLIA moderate complexity labs in primary care. How are yours doing?
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DEDICATION makes all the difference. With Terumo SurGuard®3, we make some great points. Partner with us to start delivering them to your customers. As specialists in alternate care, Terumo offers you and your customers a high-value partnership. With best-in-class products, innovative support solutions and a proven track record of identifying customer needs, we help you create better sales – and better relationships. Start by experiencing the benefits of our SurGuard®3 safety hypodermic needle. Sharper – Patients benefit from a more comfortable injection, as our needles are 10%* sharper than the market leader 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 want to hear from you! Find your Terumo representative – call 1-800-888-3786, email TMPsupport@terumomedical.com or visit us online at www.terumotmp.com!
TERUMO and SurGuard are trademarks owned by Terumo Corporation, Tokyo, Japan, and are registered with the U.S. Patent and Trademark Office. ©2017 Terumo Medical Corporation 11/17. All rights reserved. Accession TMP-0328-12182017. *Data on file. Terumo Medical Products, April 2016.
DISTRIBUTION
Make it Happen Together Twentieth annual national sales meeting for Henry Schein Henry Schein, Inc. hosted its 20th annual Medical Na-
tional Sales Meeting this spring at the JW Marriott San Antonio Hill Country Resort & Spa in San Antonio, Texas. The meeting brought together more than 1,300 attendees, including supplier partners who exhibited their products and solutions. The theme of this year’s meeting was “Make it Happen Together.” Henry Schein’s leadership team, including Chairman of the Board and CEO Stan Bergman, and Brad Connett, who was recently named president of the company’s U.S. Medical Group, led presentations that encouraged the team to work faster to meet the evolving needs of medical customers. Schein reps participated in breakout sessions, educational seminars and the supplier exhibit. Henry Schein awarded the third annual Henry Schein Cares (HSC) Medal to The Night Ministry of Chicago,
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Illinois, which received the gold medal. Care 2 Communities in St. Paul, Minnesota, received the silver medal, and Community Volunteers in Medicine Inc., in West Chester, Pennsylvania, received the bronze medal. The HSC Medal is awarded annually to three organizations that demonstrate excellence in expanding access to medical care for the underserved. “The National Sales Meeting provides an opportunity for our sales representatives to celebrate their contributions to Henry Schein Medical, and continue to develop their skills to ensure that our customers can rely on us as a trusted advisor,” said Connett. “Thank you for your steadfast commitment to the company. Through your efforts, we continue to expand access to care through the spirit of Team Schein.” Schein team members came together to participate in the We Care Global Challenge, a newly launched
DISTRIBUTION companywide initiative in which Team Schein members at six national sales meetings throughout the year attempt to assemble a combined 10,000 hygiene kits packed with essential healthcare and hygiene supplies. These kits will then be sent to children and adults living in international emergency areas around the world. Partnering with two global nonprofit organizations – Heart to Heart International and Save the Children – the Challenge embodies the Henry Schein Cares mission to “help health happen” for people living in underserved, at-risk, and remote communities, according to the company. New to this year’s national sales meeting was the launch of Henry Schein Medical President’s Club, which recognizes sales reps for their outstanding contributions. Additionally, awards recognizing 2017’s top Team Schein members, supplier partners, and products in the following categories were presented: • Unified Sales Team (UST) of the Year David Vann Award. • Solutions Rep of the Year (Telesales, Field). • National Account Manager (NAM) of the Year. • Ambulatory Surgery Center (ASC) Strategic Account Manager (SAM) of the Year. • Strategic Account Managers (SAM) of the Year (Midmarket and Upmarket).. • Telesales Manager of the Year • Regional Sales Manager of the Year. • Telesales Consultant of the Year. • Field Sales Consultant of the Year. • Rookie of the Year. • Insource Sales Consultant of the Year. • Performance Health Sales Consultant of the Year (Telesales, Field). • Emergency Medical Services (EMS) Sales Consultant of the Year. • Dialysis Sales Consultant of the Year. • Capital Equipment Specialist (CES) of the Year • Clinical Lab Specialist of the Year. • Innovative Solution of the Year. • Best New Product of the Year • Supplier Partner of the Year (Solutions, Pharma, Lab, Equipment, Med/Surg). • Spirit Award. • Healthy Lifestyles, Healthy Communities.
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DISTRIBUTION
Stronger by Association IMCO hosts its annual Convention and Tradeshow “Stronger by association” was the theme of IMCO’s An-
nual Convention and Tradeshow, held this spring in Orlando, Florida. “As the industry continues to change and grow, independent distributors will continue to partner with vendors to provide their mutual customers the best products at competitive prices,” said IMCO President and CEO Bill McLaughlin Jr. “This partnership between IMCO members and vendors will provide tools and services necessary to separate themselves from other competitors in the market.” At the event, IMCO announced: •A new B2B e-commerce platform. •T he launch of IMCO Collaborate, an open forum for members to post questions and share thoughts and ideas with other members. •A n exclusive group purchasing organization for nursing home distributors. •A redefined home care program “designed to better help members compete in the growing home care market,” said McLaughlin. Education highlights included the following: •K eynote speaker Mike Rayburn kicked off the event by asking attendees to challenge themselves to keep asking “What if,” to create solutions, and then to follow up on the ideas. Rayburn mixed his remarks with accomplished guitar-playing and song modification skills.
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• Rebecca Gecan-DiGiaimo of KBK Communications presented a standing-room-only presentation on “Understanding social selling and how to get started.” •C hris White from Traction Florida provided insight into business management in a presentation titled “Do you have a grip on your business, or does your business have a grip on you?” • Joe Colavito, Corvu, discussed “Becoming a trusted partner” and “Reaping a harvest from telesales opportunities.” • Joey Asher, Speechworks Inc., discussed “Effective messaging in the C-suite” and “Capturing an audience and building relationships.” • Josh Babb, director of government affairs of HIDA, provided an update on governmental and regulatory programs affecting the healthcare system. • Product Showcases highlighted solutions for patient and provider needs. Vendor partners DUKAL Corp., GOJO Industries, Health o meter Professional Scales and ZOLL Medical Corp. provided product information and selling strategies. • Market-specific roundtable discussions provided members an open forum in which to discuss key issues in the market. • The Owners/Managers Roundtable provided a casual session where member owners and senior management had an opportunity to exchange insights, workshop problems, and explore shared opportunities. The collective knowledge and experience of this group provided an excellent forum to examine issues impacting our industry, said McLaughlin.
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DISTRIBUTION
Award winners IMCO awarded five SEL Convention Scholarship winners based on nominations from vendor partners: •M att Rabin, Cara Medical. •N ick Merritt, Grove Medical. • J ennifer Ramirez, Medical Wholesale. •L indsay Tarter-Medina, Quick Medical. •R yan Boshulte, Supply Resources. The top 10 EPIC (Equipment Performance Incentive Contest) participants in 2017 were announced and presented with travel voucher awards: •K yle Miller, Booth Medical Equipment Co. • S ergio Bustamonte, American Medical Supplies & Equipment. •P am Gall, Foremost Medical Equipment. •D avid Gordon, Unimed USA. •G loriana Feddema, Canada Medical. •T yler Reichenbach, Medical Resources • J onathan Leiva, Dealmed Medical Supplies. •M arie Rabin, CARA Medical. •G erry Volponi, Canada Medical. •D avid Ellis, Atlantic Medical Solutions. Arkray USA was announced as IMCO 2017 Vendor of the Year. “They were voted as our top vendor in 2017
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for their incredible products, customer support, communication from field level to top management, and overall support of IMCO and our members,” said McLaughlin. Meanwhile, Tradex International captured the Best Booth Award, with a circus theme that featured two performers displaying acts of strength and flexibility throughout the day.
Nighttimes The Convention encompassed more than learning about medical products sales. One night began with “an incredible Pentathlon featuring some amazing athletic prowess by many of our members and vendors,” said McLaughlin. “All the games required intense focus, incredible talent, and a lack of fear of moving your hips.” But it was all for a great cause, he added – providing backpacks full of food for kids in elementary school who don’t get a meal outside of school hours. IMCO donated more than $12,000 to Provision Packs, a group that puts together backpacks full of food every week to help these children and their families. Tuesday evening featured a ‘Super’ Evening, in which members and vendors showed up dressed as their favorite super hero. The night was capped off with a drawing for two $3,000 travel vouchers. The member winner was Dennis Loflin of NH Medical Services, and the vendor winner was Mark Schnoerr of Nurse Assist.
800-431-2123 info@polymedco.com
.
DISTRIBUTION
Taking Point Distribution has to be part of the solution, says 2018 HIDA Chair Chris Kerski
Editor’s note: Chris Kerski, senior vice president of Scientific Products at Cardinal Health, brings a rich variety of experiences to his role as 2018 HIDA chair. He recently shared some of those experiences, as well as his observations about distribution’s role in today’s healthcare system, with Repertoire. Chris Kerski
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Repertoire: You graduated from West Point in 1983. Talk about your time in the service, and your career in the years following. How, when and why did you get into healthcare distribution? Chris Kerski: From my time at West Point and through my years of service, I have carried with me numerous experiences and lessons. First and foremost, I’ve learned that the importance of leadership can never be underestimated. Leadership manifests itself in numerous ways and can be exhibited regardless of your rank, role, or business. Across the numerous teams that I have led throughout the years, I have always instilled the value of leadership. From rising to the occasion on an individual assignment to providing structure and vision for a cross-functional team, to leading a large, diverse sales force, you always have an opportunity to be a leader. The other critical learning I had from my time at West Point was the importance of teamwork. Assembling and contributing to a high performing TEAM is a key component of organizational success. The time I spent in the Army was a great precursor to entering healthcare distribution. The Army has a strong foundation in logistics, which – little did I know at the time – would serve me well for years to come. I also had an assignment in Germany, which broadened my perspective and allowed me to be immersed in different cultures. As we operate in a global economy, this international experience will become increasingly important. At the end of my service, I came out as a Junior Military Officer (JMO) and started with Baxter Healthcare. I found that the organizational and operational skills gained during my time in the military aligned well with my role at Baxter. As my career in healthcare distribution evolved, I leveraged the lessons learned in the Army. The difference is, at the end of our mission in healthcare distribution, there is a patient. And that patient is someone’s loved one. It is our responsibility to ensure that they (patients) have the highest quality products delivered efficiently and reliably so that they (the patients) have the best care possible.
Repertoire: What are your goals for your term as 2018 HIDA chair? Kerski: As chair, I have three goals that will impact the HIDA organization as well as our industry as a whole, and ultimately the patients we all serve. They are: continued education, leadership development, and expanding engagement with HIDA. Continued education: The pace at which healthcare continues to evolve underscores the need for continued education for our members, the manufacturing community, our customers, and our lawmakers. Our industry plays a critical role in ensuring a reliable supply of products day-in
Across the numerous teams that I have led throughout the years, I have always instilled the value of leadership. From rising to the occasion on an individual assignment to providing structure and vision for a cross-functional team, to leading a large, diverse sales force, you always have an opportunity to be a leader. and day-out, regardless of situation. We have a responsibility to educate not only on what we do, but on the impact of legislative activity. Increasing participation in the Capitol Hill fly-in event is just one way that our knowledgeable constituents can help educate legislators on what we do, the importance of public-private partnerships, and the downstream implications of legislative actions. Leadership development: As chair, I feel a great deal of responsibility for ensuring that we attract, develop and retain future leaders in healthcare distribution. We will need fresh perspectives, innovative approaches, and a diversity of experiences to ensure that healthcare distribution stays ahead of the change curve and helps
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DISTRIBUTION
TALKING POINTS: Chris Kerski • The importance of leadership can never be underestimated. The opportunities to demonstrate it are numerous. • HIDA is working with the administration to establish a process to facilitate the transportation and distribution of essential healthcare goods during a presidentially declared emergency or major disaster declaration. • As consolidation continues, distributors ensure continuity of supply and consistency of care delivered to patients. • Diversity of thought, background and experiences becomes a catalyst for innovative thinking. • Increase the awareness of the value of distribution, and elevate the conversation to problem-solving, not transactions. • Technology, data and analytics, and communication will be critical drivers of success in the next decade. • Relationships, visibility, and concise communication will always be important attributes for a sales rep. • Ultimately, our success as an industry is rooted in the ability to deal with change
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health systems implement supply chain solutions that support evolving care delivery models. Expand membership: The HIDA organization is not just for large healthcare distributors. Becoming a member or participating in HIDA events, such as Streamlining Healthcare and the Executive Conference, provide beneficial learning to manufacturers and healthcare executives as well. It is important for HIDA to learn from and cross-pollinate ideas with each stakeholder in the healthcare supply chain. Repertoire: What are the three greatest challenges for HIDA and its members in 2018? Kerski: Although we have made strides and improvements upon the challenges facing HIDA and its members, there is still work to be done. The first is the continued challenge of elevating the awareness of the value of distribution. Distribution is more than just moving goods from point A to point B. Distributors partner with their customers to help them achieve performance goals, ensure their organization has access to technology, streamline the ordering process, and support various inventory management programs, such as JIT, stockless, and low unit of measure. Each of these activities helps make the supply chain more efficient, which ultimately reduces the cost of healthcare delivery. Industry consolidation presents a unique set of challenges. Health systems, manufacturers, group purchasing organizations, and even distributors are consolidating. As this consolidation continues, distributors play a key role in ensuring continuity of supply and consistency of care delivered to
patients. This challenge also presents an opportunity to identify efficiencies, increase standardization and reduce SKU complexity so that costs do not increase as organizations merge. Repertoire: How about the three greatest opportunities? Kerski: Our greatest opportunity is to address the challenges mentioned previously. By increasing the awareness of the value of distribution, we elevate the conversation. The conversation becomes focused on solving problems and less rooted in the transactional aspects. Another great opportunity is for diversification. Diversity of thought, background and experiences becomes a catalyst for innovative thinking. And innovative thinking is necessary in order to advance public-private partnerships on things such as pandemic and disaster preparedness. Lastly, education will always be an opportunity, which is why it is one of my three main goals as HIDA chair. We must continually communicate and educate on what we do, and on the impact distribution has on lowering healthcare costs. As a conduit to health systems, we should understand their challenges, arm them with information and resources to address, and be a voice to legislators regarding these challenges. Repertoire: The Affordable Care Act has been modified following a variety of actions by the executive and legislative branches of government (e.g., the elimination of the individual mandate). What challenge (or opportunity) does this present to HIDA members and/or their customers? How should HIDA members respond?
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Kerski: Congress and the Administration have made changes to the Affordable Care Act in a piecemeal process, resulting in more flexibility for states to administer plans. Bipartisan attempts at market stabilization, to try to spur insurer participation and restore cost-sharing reductions, have not been successful, so states are taking market stabilization efforts into their own hands. HIDA members must be flexible and creative to adapt to an ever-changing healthcare landscape to successfully serve their customers. Repertoire: What other legislation or policy decision(s) might have an impact on HIDA and/or its members this year? Kerski: Public-private partnerships are important to the healthcare supply chain to ensure the availability of critical medical products during any emergency, pandemic response, natural disaster or public health emergency. A major “lesson learned” from the recent hurricane season is the need for rapid re-entry of healthcare supply chain personnel after a disaster. Unfortunately, issues and inefficiencies arose that prohibited distributors from adequately responding, thus creating barriers to accessing essential goods. For these reasons, HIDA is working with Congress and the administration, through the Assistant
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Secretary of Preparedness and Response, to establish a process to facilitate the transportation and distribution of essential healthcare goods during a presidentially declared emergency or major disaster declaration. Repertoire: What is the niche of the traditional distributor in the “point and click” world, that is, the world of virtual commerce? How can HIDA members thrive? Kerski: Distributors are afforded a unique opportunity due to the breadth and depth of the relationships we have with our customers. Our personal interactions result in a deep understanding of the challenges our customers face. With this understanding comes an ability to identify solutions proactively. The result is a relationship that is personalized and feels like collaboration, not just a transaction. Distributors often help educate customers on trends in the marketplace, which comes from deep industry experience and knowledge. Repertoire: How will the medical sales rep of 2028 differ from that of 2018? What skills will he or she need to cultivate now in order to be successful 10 years from now?
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DISTRIBUTION
Speaking of lab Editor’s note: Given Chris Kerski’s experience in lab, Repertoire recently took the opportunity to ask the 2018 HIDA chairman a couple of lab-related questions. Repertoire: As hospital systems acquire physician practices, is that affecting the physician office lab or the lab market at large? If so, how? And what’s the impact on HIDA members? Chris Kerski: Consolidation always has a downstream impact but, in many instances, the net result of the impact is positive. Specific to the lab market, aggregating/in-sourcing the test volume from physician practices to acute labs results in platform standardization across a network. The benefits of this include standardized and consistent test results and reference ranges, staff efficiencies with employees being trained on one protocol, and reduced costs. This all results in the potential for enhanced patient care and safety. Repertoire: In January 2018, CMS began using private insurer rates to calculate
Kerski: Technology, data and analytics, and communication will be critical drivers of success in the next decade. Business analytics, predictive analytics and the ability to manipulate large data sets will become a prerequisite for success in working with healthcare systems. The ability to
Medicare payment rates for lab services, as part of the Protecting Access to Medicare Act (PAMA). What impact has this had on hospital labs? Physician labs? Distributors? Kerski: The PAMA legislation resulted in significant rate cuts to the Clinical Lab Fee Schedule (CLFS). Initial estimates from the OIG had savings projected at $390 million annually, yet when the final rates were calculated, the numbers were nearly two times the initial estimate – $670 million. We are only a couple of months into the new fee schedule, so the long-term impact is yet to be fully understood. When rate cuts are this severe, laboratories evaluate how to offset the reimbursement losses. Offsets can come in the form of growth, expansion of their footprint and number of covered lives, operational efficiency gains and standardization.
Relationships, visibility, and concise communication will always be important attributes for a sales rep. Increasingly, managing personal brand will be as important as company brand, as personal brand is the cornerstone of trust built with a customer.
Our industry plays a critical role in ensuring a reliable supply of products day-in and day-out, regardless of situation. We have a responsibility to educate not only on what we do, but on the impact of legislative activity. distill insights from these data sets and turn them into actionable projects with customers will become an expectation. Healthcare customers will rely on the analytics and insights provided by distributors to help inform their long-term decision making, especially as it relates to managing across the continuum of care and the ability to provide a longitudinal view across a network.
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Repertoire: Anything else you’d like to share with Repertoire readers? Kerski: Healthcare is an exciting, dynamic industry, yet cost escalation is not sustainable. Healthcare systems need partners that understand the challenges and present innovative solutions for growth and cost containment. Distribution is an excellent business to be in, as we can bring scaled, costeffective solutions to a diverse set of customer interactions. A key element to success will be our ability to help lower the cost of care. Ultimately, our success as an industry is rooted in the ability to deal with change. We have adapted to the evolving needs of healthcare customers, which is why I remain excited and optimistic for our future.
HEALTHY REPS
Health news and notes
Reverse physiology If you sprain an ankle or break a wrist this summer and lose the use of one of your limbs, the muscles there will weaken and shrink – unless you exercise those same muscles in your other limb, reports The New York Times. According to a study by researchers from the University of Saskatchewan, working out the muscles on one side of the body can keep the muscles on the other side strong and fit, even if we do not move them at all. The researchers studied two sets of muscles in the wrist joint: the extensors, which move the wrist back and away from the body; and the flexors, which pull it in, toward the forearm. Sixteen students volunteered to have their left forearm and wrist put in a hard cast. Half went about their normal lives and avoided exercising their arms. The others began a workout program that targeted the flexor muscles in their wrists After a month, the left wrist flexors among volunteers who had failed to exercise were about 20 percent weaker – and 3 percent smaller –
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than they were at the beginning of the experiment. But the group that had exercised their right wrists’ flexor muscles had maintained almost all of those muscles’ original size and strength on the left.
I’m going out for a plog Plogging is turning out to be one of the fitness trends of the year, reports the Washington Post. The word – derived from the word “jogging” and the Swedish term for pickup, “plocka upp” – means you pick up trash and recyclables in plastic bags while jogging. It is said to help runners work on muscles they typically don’t focus on, and the slower pace can serve as the “perfect recovery day,” according to one plogger. “We were squatting, bending and activating the glutes,” another told the Post. “The risk of injury in running is that you’re maintaining weaknesses in the muscles you don’t use directly.” Plogging takes care of that.
Plogging tips: •B e aware of your surroundings. •W ear gloves. If you’ll be in an area where you might encounter glass or other sharp objects, consider gardening gloves rather than latex. •B ring separate bags for waste and recyclables. •C arry extra bags. You might be surprised at the amount of trash you find, and running with overstuffed bags or empty bottles can be a hazard. •D o a full-body warm-up. •W hen you pause to pick up trash, do so by squatting down instead of bending over. •W hen you’re in a group, make sure you let people know when you’re stopping.
Spinal stimulation overcomes paralysis A UCLA-led team of scientists reports that six people with severe spinal cord injuries – three of them completely paralyzed – regained use of their hands and fingers for the first time in years after undergoing a nonsurgical, noninvasive spinal stimulation procedure. The researchers placed electrodes on the skin to stimulate the circuitry of the spinal cord. In the stimulation, electrical current was applied at varying frequencies and intensities to specific locations on the spinal cord. In the training sessions, the participants squeezed a small gripping device 36 times (18 times with each hand) and held their grip for three seconds; the researchers measured the amount of force they used. The training consisted of two sessions a week over four weeks; the eight sessions each lasted about 90 minutes. At the beginning of the study, three of the participants could not move their fingers at all, and none could turn a doorknob with one hand or twist a cap off a plastic water bottle. Each of them also had great difficulty using a cellphone. After only eight training sessions with the spinal stimulation, all six individuals showed substantial improvements. From before the first session to the end of the last session, the participants improved their grip strength. In addition to regaining use of their fingers, they also gained other health benefits, including improved blood pressure, bladder function, cardiovascular function and the ability to sit upright without support.
Whose memory is that? Repertoire makes no claim that the following item has any application to reps’ health, but it is an interesting story. UCLA biologists report they transferred a memory from
one marine snail to another, creating an artificial memory, by injecting RNA from one to another. This research could lead to new ways to lessen the trauma of painful memories with RNA and to restore lost memories. “I think in the not-too-distant future, we could potentially use RNA to ameliorate the effects of Alzheimer’s disease or post-traumatic stress disorder,” said David Glanzman, senior author of the study and a UCLA professor of integrative biology and physiology and of neurobiology. The team’s research was published May 14 in eNeuro, the online journal of the Society for Neuroscience. The researchers gave mild electric shocks to the tails of a species of marine snail called Aplysia. The snails received five tail shocks, one every 20 minutes, and then five more 24 hours later. The shocks “I think in the enhance the snail’s defennot-too-distant sive withdrawal reflex, a future, we could response it displays for potentially protection from potential use RNA to harm. When the researchameliorate ers subsequently tapped the the effects of snails, they found those that Alzheimer’s had been given the shocks disease or post-traumatic displayed a defensive constress disorder.” traction that lasted an average of 50 seconds, a simple – David Glanzman, senior type of learning known as author of the study “sensitization.” Those that and a UCLA professor had not been given the of integrative biology and physiology and of shocks contracted for only neurobiology. about one second. The life scientists extracted RNA from the nervous systems of marine snails that received the tail shocks the day after the second series of shocks, and also from marine snails that did not receive any shocks. Then the RNA from the first (sensitized) group was injected into seven marine snails that had not received any shocks, and the RNA from the second group was injected into a control group of seven other snails that also had not received any shocks. Remarkably, the scientists found that the seven that received the RNA from snails that were given the shocks behaved as if they themselves had received the tail shocks: They displayed a defensive contraction that lasted an average of about 40 seconds. “It’s as though we transferred the memory,” said Glanzman, who is also a member of UCLA’s Brain Research Institute.
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Back to School It’s bad news for kids, but not so much for parents, doctors or sales reps
T
he words “Back to school” may be disheartening to kids, but not to their parents or their pediatricians. And to med/surg distributors, back-to-school represents an opportunity to prepare their customers for flu season and vaccinations. “Regular history and physical exams including back-to-school checkups … provide a chance to make sure a child is healthy, and catch and treat any newly discovered medical problems sooner rather than later,” says Jennifer Shu, MD, FAAP, Atlanta-based pediatrician and author, and spokesperson for the American Academy of Pediatrics. “These visits are an excellent opportunity for children to receive adjustments or refills for medicines, such as asthma inhalers, or to make adjustments in their lifestyles, which can positively impact their health. When possible, it’s best to have these visits at your child’s ‘medical home’– that is their usual pediatric office where the physicians are familiar with the child’s health history.”
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Back to School “From a clinical standpoint, the general practitioner will tell you that the back-to-school checkup is one of the most important tools they have for treating school-age children,” says Josh McCreary, field sales consultant for Henry Schein in the Kansas City metropolitan area. “As they see them through the years, they build a medical history, so they can spot patterns or identify risks to that child’s health. Those checkups help them identify milestones and guide the children toward a holistic view of health. “Of course, financially, the back-to-school checkups are beneficial for the practice,” he adds.
child’s specific challenges and provide guidance to families for improvement.” They also use the back-to-school checkup to assess a child’s emotional and social well-being as well as any safety risks that need addressing, says Shu. “In the past 10 years, mental health has become more of an issue in back-to-school checkups. Pediatricians can help students and their families navigate through learning difficulties such as ADHD as well as mental health concerns, such as anxiety.”
Vaccines, diagnostics The checkup “All kids should have an annual checkup, whether it’s right before school starts or anytime in between school years,” says Shu. The goal is to check whether the child is healthy
Sales reps are seeing signs of a shifting emphasis by pediatricians as well. “I’ve seen the vaccine business grow exponentially,” says McCreary. “As early as mid-July, we’re starting to see an enormous spike in vaccines.” That’s particularly true among proactive practices, that is, those that take the time to plan and execute communication and marketing campaigns before school starts. Today’s back-to-school visit “isn’t just about a stethoscope and blood pressure cuff,” adds McCreary. “A lot of kids are coming through the door with diabetes, prediabetes, high cholesterol – chronic conditions that be– Josh McCreary gin in pediatrics. “The American Academy of Pediatrics now recommends cholesterol screening for these kids. That’s why the diagnostic side has gone up pretty significantly.” Reps should consider back-to-school time as an opportunity to let customers know that they care about what’s important to the customer, McCreary adds. “Focusing on doing well in back-to-school in that July-to-September period can really help enhance your one-on-one relationships with customers, and align yourselves – and dental professionals – with the dental industry’s goals of improving access to care. If you go in, talk to the practice, help them run a successful campaign and bring in patients, you are helping the doctor, the practice and the patient,” McCreary adds. Manufacturers can help, adds McCreary.
“ The general practitioner will tell you that the back-to-school checkup is one of the most important tools they have for treating school-age children.” enough to go to school and participate in activities, and that no new medical conditions have appeared since the last visit. In addition to measurements such as height and weight and vital signs (such as blood pressure and heart rate), depending on a child’s age, diagnostic testing may include screening for vision, hearing, cholesterol, anemia, scoliosis and more. “These checkups are a great time to get any recommended vaccines,” she adds. Today, pediatricians are watchful for such challenges as “lack of sleep due to early school days and late homework and activities, an increase in the use of electronic devices inside and out of school, and the possibility of a more sedentary lifestyle in kids where PE is not required at school or who don’t have much physical activity outside of school,” says Shu. “Pediatricians can help identify each
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Back to School “We all like education – end users, doctors, practices and sales reps,” he says. “We like to be educated on changes that have occurred in the past year.” Manufacturers can alert their sales reps to changes in their vaccines or in vaccination protocols, and their reps can pass that knowledge on to the distributor rep. “They might suggest, ‘You might want to remind your doctors that certain vaccination guidelines have been changed. The same is true with things like cholesterol screening. Even though the doctor might already have gotten information from the
“There is new technology available for the point of care that enables a physician to move beyond the ‘flip of a coin’ diagnostic uncertainty of many rapid antigen tests and gain the confidence that goes along with lab-quality molecular testing,” says Dukarm. Molecular testing for flu, strep and RSV benefit the practice and patient several ways, he says. “First, it provides significant benefit for patients in knowing that when an antibiotic is required, such as for a diagnosis of Strep A, treatment can begin immediately. Second, physicians can avoid prescribing unnecessary and ineffective antibiotic therapy for patients who don’t have a bacterial infection, which until the advent of molecular testing, needed to be confirmed via bacterial culture, often delaying patient care by as much as 24 to 48 hours. “The 2017-2018 flu season caught many people by surprise in terms of its severity, and that painful sting is still fresh in many people’s minds. To equip their cus– Jason Dukarm tomers for success, reps should encourage practices that are in need of more innovative testing methods to make that transition now, versus waiting.” Roche has partnered with a number of its distributors to provide field demo incentives with the intent of driving activity today that benefits them tomorrow, says Dukarm. “Many practices are very set in their ways in terms of their work processes. The move to molecular testing does require change management in terms of setting staff expectations. However, distributor reps who have a firm understanding of a practice’s testing and patient workflow through a standard office visit will best be able to service their accounts with optimal solutions and ease their implementation experience as well.”
“ One of the most important considerations for a physician practice is how best to prepare for the demands of respiratory illness testing and patient management.” American Academy of Pediatrics or elsewhere, it always helps to reinforce the education.”
Back to flu For one manufacturer – Roche Diagnostics Corp. – “back to school” means back to flu season. “The beginning of the school year means that flu season is right around the corner, so one of the most important considerations for a physician practice is how best to prepare for the demands of respiratory illness testing and patient management,” says Jason Dukarm, group marketing manager, point-of-care, cobas Liat & Channel Marketing. “It can put significant stress on a practice’s resources, especially if we have another flu season like last year’s.
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IDN OPPORTUNITIES
Supply Chain Leaders Donna Van Vlerah, senior vice president, support division, Parkview Health
Editor’s note: Donna Van Vlerah, senior vice president, support division, Parkview Health in Fort Wayne, Indiana, was featured as a “Woman Leader in Supply Chain” in the December 2017 issue of the Repertoire’s sister publication, the Journal of Healthcare Contracting.
From the nomination, submitted by Bobbie Smith,
account manager, Intalere, St. Louis, Missouri: Donna Van Vlerah joined Parkview Health in 2010 from ITT, for whom she served as chief compliance and ethics officer in the Space Systems Division. Prior to this, Donna served a 20-year career in the U.S. Marine Corps, retiring in 2005. She served in various positions within the logistics and acquisition community, specializing in supply chain, facility maintenance and change management. She served as the deputy director for the Maritime Supply Chain for the Defense Logistics Agency, serving worldwide customers. Her supply chain strategies at Donna Van Vlerah Parkview have included: Collaboration with suppliers to manage flow of goods and achieve cost reduction; deployment of Parkview Health’s Distribution Center (PDC), enabling centralized purchasing activities, consolidated receiving functions, and enhanced distribution management practices across all of its hospitals and clinics with “pointof-use” technology; automation and management of inventory at each point-of-use to support clinical
staff ’s ongoing needs and facilitate just-in-time delivery; and real-time visibility across the hospitals’ network, including “virtual inventory” for supplies used at clinics and nursing stations.
Donna Van Vlerah joined Parkview Health in 2010 from ITT, for whom she served as chief compliance and ethics officer in the Space Systems Division.
Regarding mentors and/or key events in her life, Donna Van Vlerah says: “I was aide to General Charles Krulak during Operations Desert Storm and Desert Shield in 19901991. He taught me three lessons: 1) the importance of having the right people around you, 2)the importance of technology platforms, as they become an enabler to what you’re trying to accomplish, and 3)the importance of effective processes. General Krulak [who became 31st Commandant of the U.S. Marine Corps in 1995] was a visionary navigator, that is, someone who not only has a great idea, but someone who can get you to that dream. That’s the true mark of the leader. He was also someone who appreciated and empowered women, and said that without the women reporting to him, he would not be combat-effective. He advocated for us at every level.”
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TRENDS
Flu Fighters The 2018-2019 flu season is coming. Already. It’s summertime. For many, that means
weekend trips to the beach, outdoor concerts, baseball under the stars, and such. But for healthcare providers, it’s time to seriously prepare for the 2018-2019 flu season. At least, it should be, given the suddenness and severity of the 2017-2018 season, which many consider to have been the worst in years. “According to the Centers for Disease Control and Prevention, [the 2017-2018] flu season was dominated by the H3N2 strain, which has a propensity to be more severe in nature and with an increase in mortality related to the virus,” says Kristi Kuper, PharmD, BCPS, senior clinical manager, infectious diseases center for pharmacy practice excellence, Vizient. “What was somewhat unusual was that this strain not only affected those most vulnerable – such as the elderly and children, those with chronic health conditions, and the immunocompromised – but there were also flurelated deaths in patients with no reported underlying health conditions. “Although we did not see as many influenza cases and deaths as we did during the 2009-2010 H1N1 (pandemic) flu season, this season was one of the busiest on record,” she continues. “What was unique about this past season was the timing of the disease. Typically, we see a gradual increase in flu diagnoses as it geographically spreads across the country. However, this year,
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the depleted ranks of supply chain departments, themselves succumbing to flu and flu-like illness. “Various market factors – including hurricane damage to Puerto Rico-based manufacturing facilities – constrained the availability of IV solutions, resulting in manufacturers imposing limited allocations on products in order to manage inventory and mitigate shortages,” says Stephanne Hale, PhD, RN, senior clinical manager, sourcing operations, Vizient. “The already serious IV solutions shortages were exacerbated by a surge in
almost every state and territory was reporting widespread flu activity by the end of 2017, so it basically hit the U.S. all at once.” Says Steve Ellis, director, corporate supply chain services, Palomar Medical Center Escondido (California), “This was the worst flu season in memory, eclipsing even the H1N1 pandemic in 2009. The flu hit early, with patients flooding the Emergency Department shortly after Christmas. We saw an average increase of about 60 to 100 patients per day for several weeks following the initial surge.”
Surge tents
“ The market continues to move toward premium influenza vaccine products, such as high dose, which contributes to the year over year cost increase to vaccinate a population.” – Tim Franke
Palomar Medical Center was one of many facilities around the country that set up surge tents to assist with triage efforts. “Our EDs experienced considerable volume increases, causing longer wait times and challenges with space needed to accommodate patients needing initial screening, diagnosis and treatment,” says Ellis. The tent – which was set up by the hospital’s facilities management and emergency management teams – was in place for three weeks during the extreme peak period, beginning Dec. 30. “It felt like it happened overnight,” says Ellis, referring to flu onset. “There was no gradual increase. One weekend, I went in to the ER in our busiest facility; it was overflowing; standing room only. The demand was so high, with limited space to triage folks doing initial diagnoses, we set up the tent primarily for triage purposes. We would process quickly those with the most severe situations.”
Meeting demand Keeping up with the demand for flu-related products and protective wear kept supply chain officers busy in the first quarter of 2018. The difficulty of keeping clinical areas supplied was exacerbated by product shortages from hurricane-stricken Puerto Rico, as well as
demand caused by the season’s widespread flu activity and associated hospitalizations and need for IV medication and fluids for patient treatment. “In addition, some pharmacies, especially in the retail setting, reported difficulty obtaining oseltamivir [Tamiflu], which is the most common antiviral for treating influenza,” she says. “On the positive side, we did not see any shortages of the flu vaccine or personal protective equipment, including masks and gloves.” Palomar’s purchasing and distribution teams exerted “substantial effort” to source products and replenish the surge tent and other areas within Palomar Health hospitals, says Ellis. Products in demand included hand sanitizer, personal protective equipment (masks, gowns, gloves, etc.), disinfectant wipes/cleaners and lab supplies (influenza testing kits), he says. Despite the fact that Palomar maintained a substantial safety stock of protective masks in its warehouse, “we
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TRENDS were going through them almost quicker than we could source them,” says Ellis. “It wasn’t a doubling or even tripling of normal usage; it was 10 to 20 times normal.” Usage of the masks soared not only among clinical staff and hospital employees, but visitors too. Any visitor presenting with flu- or cold-like symptoms, such as coughing and sneezing, were given masks. Influenza test kits presented significant challenges as well, he says. “We were exhausting our regular suppliers, so we sourced from a variety of resources.” All the while the Palomar team was hustling to fill demand, they were doing so with a proverbial hand tied behind their backs.
many providers. We partnered with our members in escalating urgent needs with manufacturers and in prioritizing urgent shipments. “We served as a unified voice to industry in pressing for concerted mitigation strategies, which resulted in suppliers assessing their own vulnerabilities in the face of shortages and constrained supplies caused by both disaster and the flu-related surge in patient demand.” As a result of efforts such as these, some suppliers obtained FDA approval to import products from manufacturing sites overseas, and to extend the shelf life of certain products, says Guess. Others ramped up production at other manufacturing sites in North America and allocated shipments based on historical purchases.
“ Part of the challenge we experienced with supplying the tent and other locations involved our staffing levels, as we were not exempt from the flu or flu-like illness.” “Part of the challenge we experienced with supplying the tent and other locations involved our staffing levels, as we were not exempt from the flu or flu-like illness,” says Ellis. “From time to time, staffing levels within Supply Chain and other departments were affected due to illness as well. I don’t know of many people who were able to stay healthy through it all,” himself included. “So our patient volume was much higher than usual, and we had a less than optimal workforce.” Health systems demonstrated creativity not only in sourcing supplies, but in using them efficiently. And they got help doing so. Christi Guess, senior director, member input and clinical solutions for Vizient, says that the GPO was able to serve as a “vital intermediary” between members, suppliers and distributors. “We provided various resources to members, including clinical guidance on conservation strategies for IV solutions, which resulted in reported reduction in utilization well in excess of 25 percent for
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Lessons learned
If the 2017-2018 flu season had any kind of silver lining, it was in the lessons learned by providers and suppliers. “Organizations should have an influenza shortage mitigation strategy in place that addresses and triages needs from the various care settings,” says Tim Franke, RPh, senior director, pharmacy, – Steve Ellis laboratory and imaging contracting, Intalere. “That includes prioritization of patient types, influenza vaccination settings, intra-company product allocation, and vaccine logistics within a centralized or decentralized distribution model. “Developing and improving engagement strategies with caregivers, particularly in the ambulatory setting, will enable greater visibility into the needs of those clinicians and more predictability in forecasting demand for the upcoming influenza season,” he adds. Sharon Carlson, director of emergency preparedness for Sharp HealthCare, says, “We practice for a ‘surge of patients’ consistently, and we need to continue to do so.” Sharp Grossmont Hospital in La Mesa, California, set up a surge tent for a short time this winter to screen incoming patients with flu-like symptoms. “Supplies may run low,” she continues. “Sometimes it may be supplies that one doesn’t plan to run short of. We ran low on blood culture tubes, but were able to work with vendors and share with other hospitals.”
H3N2 a formidable foe A Rice University study predicts that this fall’s flu vaccine – a new H3N2 formulation – will likely have the same reduced efficacy against the dominant circulating strain of influenza A as the vaccine given in 2016 and 2017, due to viral mutations related to vaccine production in eggs. “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.” 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, according to Rice. The H and N refer to hemagglutinin and neuraminidase, two proteins that cover the outside of invading flu
The 2017-2018 flu season validated some practices already in place at Palomar, says Ellis. Those practices include: •H ave a good emergency management plan with an up-to-date call list. “The increased volume began around the Christmas and New Year’s holidays. Much of the work involved management and staff not scheduled to work due to the holidays.” •M ake sure supply reorder points/quantities of basic and normally needed supplies have an adequate safety level built to accommodate periodic spikes in usage. Create emergency stock within your inventory location if the space is available or with key distributors.
particles that can cause infection when inhaled. The human immune system targets these particles for destruction based on their H and N sequences, and flu viruses constantly evolve the sequence of amino acids in these proteins to evade detection.
Most flu vaccines are produced with a decades-old process that involves culturing viruses in hundreds of millions of chicken eggs. Because the strain of flu that infects people is often difficult to grow in eggs, vaccine producers must make compromises to produce enough egg-based vaccine in time for fall flu shots, according to Rice. Unintended effects of this process have reduced vaccine efficacy against H3N2 the past two years, Deem said.
• Maintain flexibility within the support services areas to create awareness on the core mission with capabilities to flex and respond to urgent situations to meet community needs. Christi Guess from Vizient points out that Vizient’s contracts require suppliers to have a business continuity plan. “In general, most medical device and product manufacturers do have contingency plans and redundant supply chain strategies in place,” she says. But surges such as those experienced in the most recent flu season can uncover weaknesses in those strategies. “In these cases, including this most recent episode, Vizient
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TRENDS
Nasal vaccine gets CDC backing for 2018-2019 After refusing to recommend the nasal flu vaccine FLUMIST® QUADRIVALENT for the past two flu seasons, the Centers for Disease Control and Prevention recommended it (in addition to injectable flu shots) for the 2018-2019 flu season. The recommendation follows the presentation of positive results from a U.S. study in children between the ages of 2 to <4 years evaluating the shedding and antibody responses of the H1N1 strain in the live attenuated influenza vaccine, according to drug company AstraZeneca. FLUMIST QUADRIVALENT is a vaccine that is sprayed into the nose to help protect against influenza. It can be used in children, adolescents, and adults ages 2 through 49. FLUMIST QUADRIVALENT is similar to MedImmune’s trivalent influenza vaccine, except FLUMIST QUADRIVALENT provides protection against an additional influenza strain.
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has joined with members to formally challenge our supplier partners to improve, and we will hold them accountable to do so now and in the context of future competitive bids.” Adds Kuper, the 2017-2018 flu season demonstrated the need for healthcare facilities to review current policies regarding preparedness and prevention efforts, and enhance them as necessary. “Patients and staff need to get an annual flu vaccine,” she says. “Even though the vaccine’s effectiveness against the predominantly circulating strain was low this year, it still protects against other circulating strains, e.g., H1N1 and influenza B, which can cause flu. “Hospitals and health departments learn from every outbreak, whether it is the flu or something more deadly, such as Ebola,” she says. “They are sharing their experiences and refining their approach to treating patients and protecting the health of their communities.”
“ It is important to do this over the summer so that the health system is well prepared before the 2018-2019 season begins this fall.–”Stephanne Hale
A look to 2018-2019
Preparing for the upcoming flu season calls for adaptability, creativity and hard work. “While influenza vaccine suppliers continue to focus on incentivizing healthcare organizations to standardize their influenza vaccine selection, there is inherent value in diversifying product selection to mitigate product shortages and ensure influenza vaccine is available for patient care,” says Franke. “Healthcare providers need to find the appropriate balance of those two sometimes competing forces. “The market continues to move toward premium influenza vaccine products, such as high dose, which contributes to the year over year cost increase to vaccinate a population,” he continues. (The high-dose vaccine, approved for use in the United States in 2009, is designed specifically for people 65 and over and contains four times the antigen as the regular flu shot.) “It is imperative that healthcare providers develop and implement an evidence-based vaccination approach to effectively manage the various patient segments and associated costs.” Says Stephanne Hale, “Flu prevention and treatment during outbreaks is a collaborative effort. Identify all of the key stakeholders and engage them as early as possible. Convene a group of experts to review how the hospital managed the 2017-2018 season. This would include evaluating the supply of personal protective equipment and the accessibility by staff. In addition, work with Pharmacy to assess antiviral stock and availability in the wholesaler. This should help identify opportunities for improvement. “It is important to do this over the summer so that the health system is well prepared before the 2018-2019 season begins this fall.”
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The breakdown of LUX
you need to focus on just a few key points: Kelvin, LUX, LED life, lighting circuits, dimmers, and movement. Here’s what we mean.
What does Kelvin color temperature mean? A light’s Kelvin rating refers to color temperature. The “warmest” lights are in the 2000-3000K range; medium lights lie somewhere between 3100 and 4500K, while “cool” lights are in the 5000K range. If a rating is too low, the lighting effect will be yellow. On the other hand, a too-high Kelvin rating will cast a blue light. That’s OK in your house, but not a surgical suite. When referencing the perfect daylight range you will find the Kelvin to be between 4800-6500. This range is outside the medical environment lighting choice, which typically is 4000-5000K. When helping your customers determine what Kelvin number is right for their office or surgical suite, choose the number within the preferred medical lighting range, that is, between 4000-5000K. Surgeons want the lighting to be as close to daylight as possible to determine the health of the tissue. However, keep in mind if the Kelvin is over 5000K, the tissue will appear blue; below 4000K, it will appear yellow.
LUX (also known as Light Intensity) indicates the brightness or intensity of the light. The higher the LUX number, the brighter the light. When you’re talking about intensity, you also have to talk about the distance of the light from the subject. A true LUX rating is measured at the standard positioning of 39 inches from To avoid all lighting surgical site. If the from shutting down light is installed below the standard 39 inches, in the middle of a the true LUX rating procedure, your will be distorted. customer should Think of it like this: Have you ever choose lighting used a flashlight to options that have find your way in the several circuits, dark? When you use therefore eliminating it to take a broad view of the room, the light the stigma, “one light is distributed over a goes out, they large area, and it is less intense. The closer you all go out.”
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SPONSORED BOVIE bring the flashlight to the object you are viewing, the smaller the area illuminated. But it will be brighter. Medical lighting is like that flashlight.
LED life Most lighting options are now LED, due to its increased life expectancy and the fact that LED lighting doesn’t radiate heat, as halogen lighting does. That’s a plus in the OR. But LED lighting can be costly, so help your customer settle on a lighting option that lasts a long time. The LED life of Bovie lighting is 50,000 hours -- the highest rating available. Longer-lasting LEDs mean reduced inventory and reduced biomedical costs for change-outs.
If one light goes out, do they all go out? Performing a surgical procedure in the dark doesn’t work out well for anyone. To avoid all lighting from shutting down in the middle of a procedure, your customer should choose lighting options that have several circuits, therefore eliminating the stigma, “one light goes out, they all go out.” This means the surgical team will still have a lighting source to continue the procedure. They will thank you. So will patients, as soon as they come out of anesthesia.
Dimming and positioning Your customers need a lighting option that will allow them to adjust brightness and positioning without leaving the sterile field. Autoclavable handles allow the physician to adjust brightness and lighting position in the sterile field.
Why Bovie lighting? It’s simple. • 4300K color temperature is a perfect range • Dimming options without leaving the sterile field • Positioning with one hand, without leaving the sterile field • LED life 50,000 hours reduce Bio-Medical labor costs • Multiple circuits, so the team won’t be left in the dark when one light goes out. • Three- year warranty.
If you would like to learn more about our lighting for Family, Dermatology, OBGYN, Acute or Ambulatory surgery centers, contact Bovie Medical @ info@boviemed.com
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TRENDS
PAMA: Six Months Later Providers and suppliers may be
restless about reimbursement cuts for lab tests as a result of the Protecting Access to Medicare Act, or PAMA. But six months after PAMA rates went into effect, it’s still unclear how big an impact the legislation will have on physician practices’ bottom lines, and to what extent the new reimbursement rates may change the way they conduct point-of-care testing. What is clear is that Repertoire readers will be called on to emphasize the overall value of the tests they sell. Not only does that refer to reimbursement and profitability, but patient satisfaction and convenience, outcomes, and reduced costs to the healthcare system and the patient. So what else is new? “We have heard from our members that payment reductions are impacting their physician office labs,” says Mollie Gelburd, associate director, government affairs for the Medical Group Management Association. “At this point, the cuts are not at the point where labs are closing their doors. But they are threatening access to point-of-care testing, modifying clinical workflows, and delaying equipment upgrades.”
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Gelburd shared the following quote from an MGMA member: “The cuts to reimbursement this year have kept us from upgrading some of our equipment. We had several equipment contracts that ended late last year, which has helped to offset the drop in reimbursement. We now own four of our instruments and are leasing three. “We usually upgrade or replace an analyzer very close to the time when the contract ends, because as they age, they become more subject to mechanical issues,” said the MGMA member. “We have elected to keep the instrumentation we have at this time. However, on a go-forth basis, this is simply a stopgap measure. We will not be able to go back into an instrument agreement any time soon based on continued reimbursement cuts. We are also working on renegotiating our leases, but not sure how successful we will be. These are essentially one-time solutions and are not sustainable as a permanent offset to the cuts.”
Reductions just starting for some “AMA is still working to ascertain the impact of the new, lower reimbursement rates on physicians,” a representative from the American Medical Association told Repertoire. “Due to differences in billing practices, some members have just started to see the reductions to reimbursements over the last couple of months. Because the PAMA reductions were capped at 10 percent this year, we are not anticipating a major disruption this first year, and are mostly hearing about – AMA confusion from members over the new rates. “We have not yet heard that physicians are discontinuing services at this time. However, as the full reductions are phased in over the next three years, we anticipate a much larger disruption to physician practices. Physicians offering these testing services do so on very thin financial margins; reductions of over 30 percent for these tests will likely make these tests cost more than the reimbursement, at which time we anticipate practices will discontinue these services. If that happens, patients will be forced to seek additional appointments to receive these testing services at other locations.” Jim Poggi of Tested Insights LLC says, “I have not seen a drop in lab test orders in primary care yet, but I do expect it. I presume that the tests like PT/INR and some waived chemistries may encounter challenges with the lower reimbursement due to their costs and reimbursement being pretty close together even before PAMA. “CMP and BMP should hold up pretty well since they are so important to initiating and/or modifying a patient treatment program,” says Poggi, former director of lab business development for McKesson Medical-Surgical. “I believe the same holds true of CBC, especially with the emphasis on infection prevention and antibiotic stewardship.”
“ We are not anticipating a major disruption this first year, and are mostly hearing about confusion from members over the new rates.”
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TRENDS Questions raised early on Medicare pays approximately $7 billion a year to Medicareenrolled laboratories for more than 1,300 types of clinical laboratory tests on the Clinical Laboratory Fee Schedule, according to the Centers for Medicare and Medicaid Services. Medicare’s fee schedule rates had remained relatively unchanged since 1984, apart from setting payments for new tests or implementing across-the-board statutory payment updates, says the agency. The Protecting Access to Medicare Act of 2014 was an attempt to lower those costs to Medicare by making the agency’s reimbursement for tests more closely match those of private payers. For the first three years after implementation, the statute limits any reduction to 10 percent per year; then to 15 percent per year for the following three years. (Payment rates under the revised CLFS will be updated to reflect market rates paid by private payers every three years for most tests, according to CMS.) From the beginning, provider and supplier groups questioned the method by which CMS gathered data with which to set the new rates. PAMA called for a sample of labs to report the amounts paid by private insur– Jim Poggi ers for tests. Medicare then used those private insurer rates to calculate Medicare payment rates for tests paid under the CLFS beginning Jan. 1, 2018. The agency relied on data gathered by a representative sample of so-called applicable labs, referring to those that receive at least $12,500 in Medicare revenues from laboratory services paid under the CLFS, and more than 50 percent of their Medicare revenues from laboratory and/or physician services. They were required to report lab-related revenues from private payers for the period between Jan. 1 and June 30, 2016. (Originally, they were to have completed their reporting by March 31, 2017, but CMS extended it to May 30, 2017.)
“ Ultimately, manufacturers of new tests will be under more pressure than ever before to offer a unique combination of improved diagnostic utility and economic value.”
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“There was a lot of confusion over who had to report data,” says Gelburd. The regulation required reporting labs to have their own National Provider Identifier, or NPI, she explains. But that excluded many physician office labs, because few have their own NPI; rather, they operate under the physician practice’s NPI. What’s more, the labs that were required to report data had a difficult time discerning the actual rates CMS wanted and the amount of data they had to submit. “We talked to members who, despite their due diligence, found they had reported data incorrectly. So we had reports of inaccurate data submission,” she says. The fact that CMS extended the deadline for reporting to May 30 speaks to the fact that CMS itself was aware of the confusion, she adds. “They recognized all these issues, yet continued to move forward.” The American Clinical Laboratory Association objected so strongly to the data collection method that it filed suit against the U.S. Department of Health and Human Services. ACLA charged that “the vast majority of the data collected by the Secretary [of Health and Human Services] was collected only from the nation’s two largest, independent laboratories, which are located predominantly in large, urban areas, and have much lower cost structures. “[E]xcluding important sectors of the clinical diagnostic laboratory market from PAMA’s reporting requirement means Armageddon for laboratories serving elderly patients in skilled nursing facilities, nursing homes, and other long-term care facilities,” said the association in a subsequent filing for summary judgment. “If the Secretary’s failure to require data reporting for all applicable laboratories is not corrected, one of ACLA’s member companies will be out of business within ‘one or two years’ – after having been in operation for more than 45 years as a family-owned business.”
‘A little early’ “We think it’s a little early to tell what the impact [of PAMA] will be on patient access to in-office testing,” says John Daly, M.D., chief medical officer, COLA, an accrediting agency of medical laboratories. “When physicians with laboratories are only billing a few of these tests at a time, a 10 percent cut may be a little more difficult to notice. “Ironically, it is the low volume that will ultimately be what hurts these practices the most when it comes to the PAMA cuts. Physicians providing in-office laboratory
services have higher costs, for example, because they do not normally buy supplies – reagents, controls etc. – in bulk, like a larger reference or hospital laboratory. This leads to physician office laboratories having higher costs on a per test basis than a reference laboratory. Because a physician office wouldn’t necessarily track these costs the same way that a reference laboratory would, it will take time for a physician’s office manager to notice the cuts in reimbursement. But they eventually will. “As we saw when we did interviews with practices in rural communities, practices don’t do laboratory testing as a profit center,” says Daly. “They do it as a matter of convenience for their patients. Which also means that these laboratories are not operating at a profit, nor do they have any intention to. Rather, they want to ensure they have the diagnostic information they need to treat their patients. “As the price point on many of these common laboratory tests start moving towards the weighted median, it will make it increasingly difficult for these laboratories to continue operating.” Poggi believes that POLs will, in general, fare reasonably well. “The physician practice is where demand for lab tests originate,” he says. “I foresee some shrinkage in testing at the lower volume practices as well as some up market, where the lab will feel a higher amount of financial pressure. “There is a prediction that rural markets and nursing homes may experience reductions in testing, which would be disappointing, given the need for testing for these patients,” Poggi continues. “To remain financially viable, the labs that serve these patients will need to reduce costs and offer a new mix of tests that includes higher profitability tests. If they don’t, they may face the prospect of closing up or being acquired by a larger entity. “Ultimately, manufacturers of new tests will be under more pressure than ever before to offer a unique combination of improved diagnostic utility and economic value. I believe some areas of testing, such as colorectal cancer screening, and other cancers, such as lung and prostate, will benefit from development of better tumor markers. Their challenge will be to offer these new tests at reasonable cost/price points in addition to telling a compelling story of why they offer better clinical outcomes.”
Manufacturers’ perspective PAMA’s full impact among diagnostics manufacturers remains to be seen. “In many cases, with our point-of-care immunoassay products, very little change to the overall reimbursement occurred, so the impact has been minimal,” says Tammi Ranalli, PhD, vice president of marketing for Quidel. “In a few selective cases, the reimbursement actually increased due to PAMA. Furthermore, our molecular platform, Solana, provides one of the strongest combinations of exceptional test performance with exceptional value in a changing reimbursement environment and thus hasn’t been significantly impacted by PAMA. “Relative to our portfolio, we haven’t seen any significant changes in testing behaviors,” says Ranalli. “However, we do realize that our customers are now taking a closer look at the testing they are implementing going forward.
“ It will take time for a physician’s office manager to notice the cuts in reimbursement. But they eventually will.” – John Daly
“As it relates to our products, we continue to push the message of the right test, the right place, and the right time. There is no one-size-fits-all testing solution for every customer, and we empower our team and the distributor sales rep to work with the customer to provide the solution that best fits the customer’s needs, whether it’s an immunoassay or a molecular test.” David Franklin, western regional sales manager for Sekisui Diagnostics, notes that Sekisui’s immunoassay and molecular products are already low on the price spectrum, and PAMA’s impact on its customers may be minimal. “Nevertheless, [POLs] will make less, that’s the reality.” They will be financially challenged to perform the tests that are needed and beneficial to the patient. “They have to adapt to the changes,” he says. “Distributors and manufacturers need to continuously educate themselves on their customers’ needs and changes in the market. Just because you sold something yesterday, doesn’t mean it’s the best fit today.”
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TRENDS
The Blunt Truth About Sharps Safety Things are getting better. But ‘better’ isn’t ‘great.’
Twenty-six years after the OSHA
Bloodborne Pathogens Standard and 18 years after the Needlestick Safety and Prevention Act, people are still getting stuck with sharps – doctors, nurses, phlebotomists, environmental services staff, and others. Part of that is due to shortcomings in safety technology. But human factors – including inadequate staffing and a pressure to see more patients can result in a lack of concentration, a lack of knowledge or a failure to best prepare for adverse events – are also factors. Repertoire spoke with Amber Hogan Mitchell, DrPH, MPH, CPH, president and executive director of the International Safety Center. The Center is a non-profit organization that provides the Exposure Prevention Information
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Network (EPINet®) to healthcare facilities around the world. EPINet provides healthcare facilities with a standardized system for tracking occupational exposures that put healthcare staff at risk. The EPINet surveillance system includes employee incident reports on needlestick and sharp object injuries and on blood and body fluid exposures. Repertoire: Are you optimistic about what is occurring insofar as sharps safety is concerned, or are you concerned? Amber Mitchell: There have been successes that help us maintain optimism, but there have also been ongoing challenges that continue to frustrate professionals in the
field of sharps injury prevention. Successes have included improvements in innovative safer device design, which have resulted in reduced injuries in blood collection, IV insertion and infusion. However, injuries from sutures continue to climb, especially among physicians. According to our 2017 Exposure Prevention Information Network (EPINet®) Summary Data, injuries from suture injuries (26.1 percent) have now surpassed injuries from disposable hypodermic needles/syringes (24.6 percent). More needs to be done to move uptake of alternate technologies for skin closure, where blunt tip sutures cannot be used. Also, as it relates to injuries from hypodermic syringes, 27.2 percent are from insulin needles. Healthcare facilities – including long-term care, behavioral health, schools, and wherever else needles are being used to inject insulin – should evaluate and consider the use of safer devices, including sharps injury prevention (SIP) needles for syringes used with vials and pen needles. We still see a discouragingly high percentage of injuries occurring from recapping and inappropriate disposal. These types of injuries are 100 percent preventable with better practice and improvements in accessibility to sharps containers. Finally, when employees indicate they were injured from a needle or sharp, more than 30 percent say they were from devices with safety features; of those, more than 65 percent did not activate the safety feature. If they did, almost 20 percent indicate that the injury occurred after safety mechanism activation.
is the reason why compliance with the OSHA Bloodborne Pathogens Standard is so important with regard to frontline, non-managerial employee involvement in device selection. Our focus moving forward really has to be not just on the uptake of devices with safety mechanisms, but also making sure that employees evaluate and select devices that improve compliance with safety mechanism activation, and that the safety mechanism offers full protection after it has been activated. This ensures not just the safety of the user, but also anyone who may encounter it downstream, such as those in environmental services, laundry, waste haulers, team members, etc. What’s more, according to EPINet data, 49 percent of injuries from devices with safety mechanisms occur
With the ongoing pressure to increase patient turnover and increase numbers of surgeries from a financial point of view, we need to tackle this issue now before injuries increase exponentially.
Repertoire: How can injuries occur after activation of the safety mechanism? Mitchell: If frontline patient-care providers were not involved in the identification, evaluation and selection of devices with safety mechanisms, the user may not know how to best operate its features. The clinician may push too hard – or not hard enough – on a sheath, button or needle cover. Or he or she may not be aware that the safety mechanism is supposed to have an audible click to lock. This can result in an injury and
before those features can be activated, because the patient may have jumped or jarred. Future device designs should incorporate patient comfort elements that decrease pain and discomfort for the patient. These features can improve not just patient safety, but also worker safety and well-being. An important area of focus should be blood collection and skin injection, as these two procedure types make up the majority of incidents occurring in the patient or exam room when the patient is conscious. All safety features – including active, passive and those I call “passively active,” like IV stylets, can be subject to failure, just like with any medical device or instrument. The best way to prevent sharps injuries is adhering to the hierarchy of controls and identifying ways to eliminate the use of sharps if possible. An example for reducing suture injuries from skin closure might be the use of new technologies, including adhesives and zipper-like closures.
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TRENDS In the OR Repertoire: In November 2017, you and two coauthors published an article in Infection Control Today titled â&#x20AC;&#x153;Sharps Injuries Remain Major Occupational Safety Concern for Healthcare Personnel.â&#x20AC;? In it you point out that evidence suggests that OR sharps injuries are actually increasing. What do you make of that? Mitchell: Nurses are making great strides in improving uptake of devices with safer designs, especially in patient and exam rooms and procedure rooms. Unfortunately, injuries in the OR (sutures and scalpel blades) are on the rise, especially among physicians and to non-users. This means that uptake of SIP devices among physician com-
numbers of surgeries from a financial point of view, we need to tackle this issue now before injuries increase exponentially. Repertoire: The article also says that as many as 80 percent of sharps injuries from 2010 to 2015 involved devices that lacked an engineered sharps injury protection mechanism. I thought engineered sharps injury protection mechanisms were mandated by law. What am I missing? Mitchell: Unfortunately, despite the requirement to use engineering controls, including those with sharps injury protection features, since 1992 with the OSHA Bloodborne Pathogens Standard, and then renewed focus from the 2000 incorporations from the Needlestick Safety and Prevention Act, uptake is much lower than ideal. Sharps that lack safety features are still available on the market. If they cost less than safety devices, even despite federal regulations, people will still buy them. In other cases, the end user may put together syringes with non-safety needles, or non-safety scalpel handles with nonsafety blades. Manufacturers need to work on innovative ways to get around this and to make sure that users are protected. We cannot lose focus on improving uptake of current SIP devices; improving designs to increase safety feature activation; designing devices that eliminate the need for a sharp/ needle; and continuing to provide ongoing training and education not just about device use but about risk and risk mitigation. This includes making sure the data that a facility collects are being put to use. Robust surveillance systems like EPINet are a way to identify exactly where injuries are occurring and from what types of procedures and devices. It also allows a facility to focus efforts on targeted intervention programs that can have measurable impact. It is also critical to provide feedback to manufacturers and
If frontline patient-care providers were not involved in the identification, evaluation and selection of devices with safety mechanisms, the user may not know how to best operate its features. munities is lower than nursing communities, and that in the OR, injuries are occurring to surgical team members from unsafe hand-to-hand passing or when devices are not disposed of safely. Focus in the OR should be on instituting safer practices for nohands, neutral zone passing; better uptake of alternates for skin closure; improvements in use of blunt tip sutures for internal fascia and muscle; and an uptake of safer devices for cutting (disposable and reusable scalpels with safety features) as well as innovative designs for cutting devices that reduce injuries. With the ongoing pressure to increase patient turnover and increase
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We still see a discouragingly high percentage of injuries occurring from recapping and inappropriate disposal. distributors so that they know what’s happening and how to improve inservicing and device design. Repertoire: Downstream injuries appear to be a nagging problem. How are successful healthcare providers helping environmental services and members of the clinical team avoid such injuries? Mitchell: Nearly 30 percent of all sharps injuries and needlesticks happen to non-users. These include not just members of clinical teams, but environmental services, laundry, waste haulers, visitors, and administrative staff. These are groups that did not knowingly sign up for that kind of risk at work. Incorporating a comprehensive sharps safety program into any facility or community means that we are protecting not just clinical users of devices, but anyone who may come into contact with devices later in the disposal or waste stream. Even if we become complacent about protecting ourselves, we should never lose sight of our role in protecting those around us. Sharps safety is really a poignant public health issue for this very reason, especially as emerging infectious diseases continue to remain a global threat. Properly disposing of sharps in sharps containers is important in preventing downstream injuries. Just as important is taking precautions against injuring others on the clinical team. In the OR, that means no more hand-to-hand passing of sharps; use
Facts about sharps injuries • Injuries from suture injuries (26.1 percent) have now surpassed injuries from disposable hypodermic needles/syringes (24.6 percent). • Of injuries from hypodermic syringes, 27.2 percent are from insulin needles. • When employees indicate they were injured from a needle or sharp, more than 30 percent say they were from devices with safety features. Of those, more than 65 percent did not activate the safety feature. And if they did, almost 20 percent indicate that the injury occurred after safety mechanism activation. • Forty-nine percent of injuries from devices with safety mechanisms occur before those features can be activated, because the patient may have jumped or jarred. • Nearly 30 percent of all sharps injuries and needlesticks happen to non-users (e.g., members of clinical teams, environmental services, laundry, waste haulers, visitors, and administrative staff).
of a neutral zone is preferred. Some providers have gone so far as to institute mini timeouts prior to use of a sharp at the bedside, particularly important in crowded patient rooms. In such cases, the caregiver might announce, “I am about to give an injection. Be still. Be aware. Be careful.” If you fail to do this, you risk turning around and accidently injuring the person behind or next to you.
Get the total staff involved Repertoire: You have reported that inactivation of sharps injury prevention mechanisms was associated with about 72 percent of reported downstream injuries in the OR. Even today, people are still failing to activate safety mechanisms? How can that be? Mitchell: They may not be familiar or comfortable with the safety mechanisms in use at their facilities. One of the most overlooked requirements of the OSHA Bloodborne Pathogens is the following requirement: “An employer, who is required to establish an Exposure Control Plan, shall solicit input from non-managerial employees responsible for direct patient care who are potentially exposed to injuries from contaminated sharps in the identification, evaluation, and selection of effective engineering and work practice controls and shall document the solicitation in the Exposure Control Plan.” 1910.103(c)(1)(v). This means that device evaluation must not just be done by device committees, materials management or
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TRENDS
purchasing. Rather frontline employees must be active in identifying, evaluating, and selecting devices. This serves several purposes. First, compliance with the intent of the standard is achieved. Second, well-rounded and comprehensive feedback is collected. Third, the safest devices are selected that positively impact both patient and worker safety. Finally, improvements with safety feature activation take place because employees are using devices that are intuitive and are ones they feel most comfortable with. Win, win, win, win. Repertoire: Can you comment on sharps injuries in non-acute
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Incorporating a comprehensive sharps safety program into any facility or community means that we are protecting not just clinical users of devices, but anyone who may come into contact with devices later in the disposal or waste stream.
settings, particularly the physician office or skilled nursing facility? Mitchell: Sharps injuries that occur outside of acute-care hospital settings can be even more devastating than those occurring in hospital settings. This may seem counterintuitive, but consider that hospitals have tons of resources, employees, departments, committees, funds, and expertise. Offices, clinics, outpatient settings, long term care, behavioral health, home health and other faster growing segments of healthcare are limited in staffing, size and access to expertise. What’s more, they often have greater geographical reach with higher patient loads. A sharps injury in an office setting can mean that one of a staff of four or five is now unable to perform patient care. That can be devastating not only to the person being injured, but to the office and its ability to keep up its patient load, not to mention its reputation in the community and with employee recruitment. Incorporating the safer devices in smaller health settings makes more business sense than in any larger facility. That isn’t to say that it doesn’t make business sense in hospitals. It unequivocally does. But the impact can be seen more clearly and more immediately in an outpatient setting. Non-hospital settings typically do not have full-time employee or occupational health professionals nor infection preventionists, which is all the more reason to rely on networking, building awareness, relying on external stakeholders, and partnering with organizations like the International Safety Center. They can help them build their programs at no or minimal cost – with big impact.
HIDA GOVERNMENT AFFAIRS UPDATE
Top Lessons From This Year’s UDI Conference Every year, the UDI conference offers guidance and training to those
impacted by unique device identifier (UDI) regulations. The Food and Drug Administration (FDA) has made several important changes in recent years, and to help manufacturers, distributors, and group purchasing organizations, HIDA shared its expertise with participants. This year’s conference was especially pertinent, as the compliance deadline for certain class II devices is September 24 of this year. The deadline had originally been September 24, 2016, but the FDA extended this deadline to give the supply chain more time to ensure compliance.
GUDID changes The most important changes discussed at the UDI conference were this year’s updates to the FDA’s Global Unique Device Identification Database (GUDID). Here are the key highlights: • A number of new data elements have been added to the GUDID download files. These include the device’s premarket submission number, the labeler DUNS number, and the public device record key. •T he GUDID release scheduled for the end of summer will include the premarket submission number and supplement number data. Device labelers must make sure their GUDID records include all relevant listing numbers. •A head of the summer GUDID release, labelers also need to make sure they review (and update, if necessary) the confidentiality designations they have assigned to their device listing records. As always, if you would like more information, or have any questions, feel free to contact us at HIDAGovAffairs@HIDA.org.
By Linda Rouse O’Neill, Vice President, Government Affairs, HIDA Forthcoming HIDA resource HIDA will release a new white paper later this summer to assist manufacturers and distributors in staying UDI compliant while developing and distributing product through LUM programs. This new resource builds on our previously-released best practices to provide tangible insights for trading partners to work together on compliance in LUM programs. As we have discussed in earlier articles, LUM and JIT programs can create compliance headaches for distributors and their trading partners. With the new best practices outlined in this forthcoming resource, distributors and manufacturers can make sure they are all on the same page.
For more information on upcoming deadlines, resources, or for ways you can get involved and learn more about UDI, please contact us at HIDAGovAffairs@HIDA.org.
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GPOs Manufacturers
Distributors
IDNs
The Only Event That Brings Together Leaders From Across The Healthcare Supply Chain www.HIDAStreamlining.org 54
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Attend And Get More
More Face Time, Less Travel Time
In a single event, you can meet face to face with more than 1000 decision-makers, strategize with current partners, make new connections, keep up with the latest trends, and stay competitive!
More Ways to Meet
Meet and strategize with your most important partners at the Innovation Expo, Executive Business Exchanges, and Reverse Expos.
More Types of Companies to Meet With
Take advantage of the new opportunities to meet with manufacturers, distributors, GPOs, health systems, and regional purchasing coalitions.
Large and Small Companies
Meet decision-makers from independent and national companies.
Register: www.HIDAStreamlining.org www.repertoiremag.com
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More Ways to Network Walk-up Meetings at the Innovation Expo and Reverse Expos
INNOVATION EXPO
Wednesday, September 26 | 11:00am – 4:00pm Connect with 50+ Manufacturers and Service Providers
Thursday, September 27 | 8:00 – 10:00am Connect with 60+ Distributors at the Reverse Expo
Thursday, September 27 | 11:30am – 1:30pm Connect with 30+ Group Purchasing Organizations and Integrated Delivery Networks For more information visit www.HIDAStreamlining.org/expos
Pre-scheduled Meetings at the Executive Business Exchanges DISTRIBUTOR
EXECUTIVE BUSINESS EXCHANGE Wednesday, September 26 | 8:00 – 11:00am Pre-Scheduled, Efficient Meetings Led by Distributor Teams GPO & IDN
EXECUTIVE BUSINESS EXCHANGE Wednesday, September 26 | 4:00 – 6:00pm Pre-Scheduled, Efficient Meetings Led by GPO and IDN Teams Register before June 29, 2018. For more information visit www.HIDAStreamlining.org/EBE
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Network and Learn Independent Distributors Summit Tuesday, September 25 | 3:00 – 5:30pm ● Exclusively for independent distributors with 50 employees or less ● Discuss technology solutions with peers: sales/e-commerce, customer service, human resources, warehousing and logistics, marketing and accounting
Contract Administration Update and GPO Panel Discussion Tuesday, September 25 | 3:00 – 5:30pm ● The latest on standards for contracting efficiency ● Levels and models of contracting and aggregation ● Perspectives from national and regional group purchasing executives
Education Sessions Making the Case For Quality Products Wednesday, September 26 | 8:30 – 10:30am The Changing Political Landscape And Its Impact On Healthcare Supply Chain Wednesday, September 26 | 4:00 – 5:00pm Key Trends Impacting Healthcare Supply Chain Thursday, September 27 | 9:00 – 10:30am Attendance at this session is limited to GPO and IDN attendees.
ShareGroups Join discussion groups focusing on topics of common interests in the supply chain. Diversity Supplier ShareGroup Tuesday, September 25 | 1:15 – 2:45pm For business leaders from minority-owned, woman-owned, and veteran-owned companies. Vendor Relations ShareGroup Thursday, September 27 | 10:15 – 11:15am For supply chain professionals who manage manufacturer-distributor relationships. Medical Sales Leader ShareGroup Thursday, September 27 | 10:15 – 11:15am For leaders and managers of sales teams. GPO & IDN ShareGroup Thursday, September 27 | 10:15 – 11:15am For GPO and IDN attendees.
Supply Chain Continuity Summit Shortages, Disruptions, and Solutions Thursday, September 27 | 1:30 – 4:30pm ● Designed for manufacturers, distributors and providers ● Discuss supply chain continuity with government officials ● Participate in table top exercises to work collectively on solutions Add-On Fee: $299 per person
Register: www.HIDAStreamlining.org www.repertoiremag.com
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SMART SELLING
DISTRIBUTOR SALES STRATEGIES FROM HIDA
Tips For Selling The Value Of Your Service Distributor sales reps have many responsi-
By Elizabeth Hilla, Senior Vice President, HIDA
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bilities – introducing new products, growing market share for key manufacturer partners, finding new customers, and much more. I’d argue that your single most important job is to sell the value of your company’s distribution services – to differentiate your company from its competitors, and to ensure that your customer understands the value of using a distributor vs buying direct. For this month’s Smart Selling column, I thought it might be useful to review all that
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ways that distributors add value – real, measurable financial gains – to healthcare customers.
The value of reduced transactions Reducing transactions is at the core of a distributor’s value and it drastically reduces costs for your customers. Imagine how many transactions a hospital or nursing home customer would incur by buying products from several hundred manufacturers in a world that had no distributors. Imagine how many full-time employees would need to be hired
just to manage the processes that the customer would have to take on. Consider accounts payable as one example. Industry averages show that the full cost of paying an invoice is around $15 per invoice and can run as high as $40. (It’s less if payments are all done electronically, but that’s less common when a healthcare provider is paying a small directselling manufacturer than when paying its prime vendor distributor.) These estimates are based on the time required to process the payment and the cost of that time in staff wages. Whatever the actual cost for your customers, they save substantially when they deal with just one distributor rather than with hundreds of direct-selling suppliers. This same type of savings is repeated in the customer’s purchasing department and in the receiving process.
The value of reduced finance costs
Distributors can significantly help these customers cut costs through redesigning processes to reduce or eliminate staff time required to order, distribute, or use products.
The value of information Distributors help their customers make better decisions by providing them with accurate data and information related to purchase history, product characteristics, product alternatives, and more. For example, a nursing home customer might use purchase history data from its distributor to determine its highest-dollar product categories, in order to develop standardization goals and save money. In the physician setting, distributors are a valued source of information on new technologies and products. For
Reducing transactions is at the core of a distributor’s value and it drastically reduces costs for your customers. Imagine how many transactions a hospital or nursing home customer would incur by buying products from several hundred manufacturers in a world that had no distributors.
Cash flow is essential to most healthcare providers, who depend on thirdparty reimbursement for the majority of their revenues and often must wait weeks or even months to receive that reimbursement. By providing a reliable source of products, and delivering on short notice, distributors reduce the amount of money providers must dedicate toward inventory, thereby improving cash flow. Inventory reductions also reduce costs for storage space and lessen the risk of loss from product obsolescence or damage. In addition, distributors offer favorable credit terms that allow customers to better manage their cash flow.
The value of efficiency Distributors work with their customers to evaluate how medical supplies are purchased and to find ways to improve the processes related to ordering, receiving, redistributing, and paying for medical products. In physician offices, for example, doctors and nurses see hundreds of patients and don’t have time to order medical supplies. Distributors solve this problem by managing inventories, developing standard orders, and offering customized ordering platforms. Hospitals have more people and more expertise in supply chain, but often, too much staff time is spent on activities like breaking cases and redistributing supplies.
example, they often show their physician customers how they can attract more patients or increase efficiency by investing in new types of equipment that allow them to perform more procedures in their offices.
The value of reliability The value you provide starts with the things your company does every day such as delivering product and taking orders over the phone. Your customer may be so accustomed to your reliability in these areas that he or she may not even see these services as adding value, but they certainly do. Likewise, standard services such as prompt delivery, high fill rates, credit services, multiple ordering methods, and customer service all are valuable services that every distributor provides. Although you don’t control the services your company chooses to offer, you can control whether your customers are aware of their value. Know your services and use them as important selling tools to increase the value you bring to your accounts.
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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 Where the millionaires are Are you a successful single? Making good money? Here’s a way to enhance your success. MillionaireMatch is a specialized dating site and app, which helps successful singles meet fellow millionaires. The company recently crunched its data and revealed where membership growth is climbing fastest – which might be a clue as to where the millionaires are. From the top, they are New York, Los Angeles, Houston, London, Chicago, Beverly Hills, Dallas, Atlanta, Miami and Washington.
Navigating dating apps Marriage and family therapist Emma Pineda and mobile app entrepreneur Zorric Sia have launched a new podcast series, The Date Podcast, to help singles navigate the ins and outs of popular dating apps. The podcast covers the use of dating apps, etiquette, and news. One weakness Sia found among dating apps is their dependence on direct messaging and static photos. That prompted him to develop and launch bopsee, which is a video-based dating app. “Video prevents the dreaded – and all too common – experience of meeting someone for the first time and dis-
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covering that they look nothing like their profile picture,” Sia added. Listeners can tune in to The Date Podcast on the website (http://www.datepodcast.com) or via iTunes or Google The dating app bopsee can be downloaded on iTunes or Google.
All bets are on Fantasy sports business DraftKings Inc. didn’t waste any time announcing that the company would enter the sports betting market. The company announced its decision on May 13 – the same day the U.S. Supreme Court overturned the Professional and Amateur Sports Protection Act, a federal law that limited sports betting. “Today’s Supreme Court ruling is welcome news to the millions of Americans who currently wager $150 billion illegally each year through off-shore, black market bookies,” said Jason Robins, CEO and co-founder of DraftKings. In anticipation of a favorable ruling by the Court, DraftKings had been preparing since 2017 to launch a sports betting platform for mobile. The company is working with state regulatory officials to apply for operating licenses in those states that have already passed legislation authorizing sports betting.
Nice earrings FaceCake says its Dangle AR – an iOS mobile app for earrings – solves the biggest digital shopping challenges for earrings, that is, actual size and how shape and color fit the user’s personal style. Dangle uses algorithms for relative sizing and placement, allowing users to virtually try on earrings in real time as though they’re looking in a mirror. Dangle says it features a “curated set of statement earrings from the hottest brands.” FaceCake users can also try on celebrity red carpet styles and receive recommendations with its Visual Search to “Get the Look for Less,” allowing shoppers to purchase similar earrings.
How to play it safe with public Wi-Fi Tips from the Federal Trade Commission: •W hen using a hotspot, log in or send personal information only to websites you know are fully encrypted. To be secure, your entire visit to each site should be encrypted – from the time you log in to the site until you log out. If you think you’re logged in to an encrypted site but find yourself on an unencrypted page, log out right away. •D on’t stay permanently signed in to accounts. When you’ve finished using an account, log out. •D o not use the same password on different websites. It could give someone who gains access to one of your accounts access to many of your accounts. •M any web browsers alert users who try to visit fraudulent websites or download malicious programs. Pay attention to these warnings, and keep your browser and security software up-to-date. •C onsider changing the settings on your mobile device so it doesn’t automatically connect to nearby Wi-Fi. That way, you have more control over when and how your device uses public Wi-Fi.
• If you regularly access online accounts through Wi-Fi hotspots, use a virtual private network (VPN). VPNs encrypt traffic between your computer and the Internet, even on unsecured networks. You can get a personal VPN account from a VPN service provider. In addition, some organizations create VPNs to provide secure, remote access for their employees. What’s more, VPN options are available for mobile devices; they can encrypt information you send through mobile apps. • Some Wi-Fi networks use encryption: WEP and WPA are common, but they might not protect you against all hacking programs. WPA2 is the strongest. • I nstalling browser add-ons or plug-ins can help. For example, Force-TLS and HTTPS-Everywhere are free Firefox add-ons that force the browser to use encryption on popular websites that usually aren’t encrypted. They don’t protect you on all websites – look for “https” in the URL to know a site is secure.
Dangle uses algorithms for relative sizing and placement, allowing users to virtually try on earrings in real time as though they’re looking in a mirror.
For more information, visit the FTE at www.consumer.ftc.gov/articles/0014tips-using-public-wi-fi-networks
Which way is up? Have you ever emerged from the subway or a large building uncertain of which way to go? Your directions say “head north,” but which way is north? According to PC Magazine, Google is combining walking directions with augmented reality to fix the problem. During its I/O developer conference, the tech giant demo’ed a feature coming to Google Maps that will tap into your smartphone’s camera to tell you which direction to walk. Essentially, it’ll meld your phone’s camera view with Google’s mapping service to point out when you need to turn left or right. Unfortunately, Google didn’t say when the feature might arrive, according to PC Magazine. But currently, Google Maps gives out walking directions by showing you a 2D grid over your phone and drawing a blue trail to the destination. A virtual arrow on the map tells you what direction you’re walking.
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WINDSHIELD TIME Chances are you spend a lot of time in your car. Here’s something that might help you appreciate your home-away-from-home a little more.
Automotive-related news
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WATCH OUT! A TURKEY!
Under pressure
A total of 1,740,425 animal-related insurance claims were processed, with 1,739,687 of them – 99.9 percent – involving vehicles, reports the National Insurance Crime Bureau, an agency that monitors insurance fraud. The actual number of incidents is likely much higher since many drivers do not choose to carry coverage for that type of event. About 640,000 of the claims specified one of the top five animals involved – deer (584,165), raccoons (22,644), dogs (20,610), turkeys (7,289) and coyotes (6,023). The top five states where the incidents occurred were: Pennsylvania (145,728), New York (115,670), Texas (105,036), Wisconsin 81,282) and North Carolina (79,252). The top five cities where these encounters were: San Antonio (3,945), Austin, Texas (2,452), New York (2,442), Pittsburgh (2,115) and Rochester, New York (1,929).
Nissan is trying to take out the guesswork when inflating your tires, with its Easy Fill Tire Alert system, reports motor1.com. The system works by alerting the driver when a tire is inflated properly. To engage the system, the driver must put the vehicle in park, apply the parking brake, and leave the ignition on in the accessory mode position. Once the driver starts filling up a tire, the exterior lights flash, indicating the system is monitoring the change in tire pressure. Once the correct tire pressure is reached, the vehicle’s horn sounds. If the tire is over-inflated, the horn sounds again and the hazard lights flash three times. There’s no seeking out what the necessary tire pressure is and no wondering if the air pump gauge is correct. The vehicle does all the work.
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Oh the calls you can make NASA has signed a second space act agreement with Uber Technologies, Inc., to further explore concepts and technologies related to urban air mobility (UAM) to ensure a safe and efficient system for future air transportation in populated areas. Under this agreement, Uber will share its plans for implementing an urban aviation rideshare network. NASA will use the latest in airspace management computer modeling and simulation to assess the impacts of small aircraft – from delivery drones to passenger aircraft with vertical take-off and landing capability – in crowded environments. This is NASA’s first such agreement specifically focused on modeling and simulation for UAM operations.
milk home when they are traveling for business. Milk Stork – said to be the only breast milk shipping company in the U.S. – sends packing materials and a pharmaceutical-grade cooler ahead of time so supplies are available to the nursing mother when she arrives at her destination. The cooler contains an internal mechanism that, once activated, keeps its contents chilled for up to 72 hours. Once ready to ship, the employee drops the cooler off at the hotel front desk or any FedEx shipping location to be overnighted to their baby. The Nissan Group employs about 22,500 people throughout the U.S. and Canada, including major operations in Arizona, California, Michigan, Mississippi, Tennessee, Texas and Ontario, Canada
Going for the green Two years ago, the Ford Motor Company boasted about having been named Interbrand’s “Best Global Green Brand” and said it was committed to working to meet stricter fuel economy standards. But in April, after lobbying with the rest of the industry to strike down those standards, Ford announced that it would largely abandon the American passenger car market in favor of building more trucks, crossovers and SUVs. Automobile Magazine notes that Ford’s announcement marks a significant turning point for the American auto industry. “The only heritage United States carmaker that didn’t go bankrupt in the Great Recession of 2008, Ford had become one of its greenest. But its decade’s worth of investment in developing more fuel-efficient cars is now taking a back seat to profit.” To be sure, today’s crossovers and SUVs are safer, cleaner and more fuel-efficient than their predecessors, the magazine points out. “But they’re still no real match for passenger cars – sedans, hatchbacks and wagons – when it comes to fuel economy and reduced emissions.”
For the traveling mom For its employees who are breast-feeding, Nissan will cover all expenses of shipping nursing mothers’ breast
Dirty work Professional salespeople may not be averse to negotiating, but millions of consumers are, particularly when it comes to buying a car. That’s why some are turning to professional automotive negotiators, says an article in The New York Times. Negotiators claim their services protect consumers from unscrupulous dealers, save time and most of all, save money on new and used cars, whether bought or leased. Owen Weintraub, owner of Tarzana, California-based Authority Auto, has periodically accepted a public challenge to prove his worth. In August 2017, the syndicated TV program “Money Talks News” pitted him against USAA (a financial services company and partner of the buying service TrueCar) and the show’s host to buy a Mercedes that listed for more than $46,000. Weintraub’s total discount of more than $7,200 beat the next best deal by more than $2,000. But finding a negotiator can be tricky, according to the article. There is no standard name for these services – some call themselves a buying service, others a negotiating service, some a broker, still others a concierge. And each seems to operate in its own way.
NASA will use the latest in airspace management computer modeling and simulation to assess the impacts of small aircraft – from delivery drones to passenger aircraft with vertical take-off and landing capability – in crowded environments. www.repertoiremag.com
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corner
Keep Current Learning about and embracing new technologies has been key to Fisher Healthcare Mike Garza’s 50 years in lab sales
Mike Garza
Even as a young adult, Mike Garza was never too far
from a medical laboratory. After nearly 50 years in laboratory sales, the same can be said of him today. Garza is a senior account executive for Fisher Healthcare, part of Thermo Fisher Scientific, calling on major customers in the Los Angeles area, including UCLA Health, Kaiser Permanente Regional Reference Laboratories and the Los Angeles County + USC Medical Center, to name a few. He and his wife, Karen, live in San
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Clemente, California, a couple of miles north of La Casa Pacifica, Richard Nixon’s “Western White House.” With them are their three Whippets (a breed that looks like small greyhounds, but actually are two-thirds greyhound, one-third terrier). Growing up in Saginaw, Michigan, Garza was the youngest of five children whose parents stressed the importance of higher education. He graduated from Michigan State University with a degree in microbiology and
public health, hoping to work in some type of medical research. He enrolled in the master’s program in immunology at Wayne State University, and worked as a supervisor at Henry Ford Hospital’s virus and immunology lab.
Into sales While working at Henry Ford, Garza came to a life-changing conclusion. “I was a good tech,” he says. And he enjoyed the job. “But I was working with some brilliant people, and I knew I couldn’t come up with the same kind of original thinking they did.” So he sought a job that would help him stay close to the lab, only in sales, not research. He ended up taking a job with Organon (later, Schering-Plough, then Merck), selling diagnostic kits. “It was great,” he says. Soon after, he was named area manager. After working with reps from American Scientific Products, Garza decided he would like to work for a full lab supplier, calling on all departments. “My pal and former MSU classmate Fred Moon, who was already with S/P, helped get me an interview with DM Tony Hackenberg,” he recalls. “What do you know? He hired me, and now I was in the full lab distribution business.” For S/P, he worked a Detroit territory that included such giants as Henry Ford Hospital, William Beaumont Hospital and St. John Hospital. “I was doing very well and comfortable with my customer base,” he says. But in 1989, Karen – who also worked for Baxter, selling critical care products – was offered a management position in Irvine, California. “We decided to take the plunge and move to California,” he says. Six years later, Garza was hired by Fisher Healthcare. At the time, the company was involved in its acquisition of Curtin Matheson Scientific – a supplier of laboratory products and equipment – and no territory was available. So Garza applied for and received the district manager
position, which included Los Angeles, Orange County, Palm Springs, Las Vegas and Hawaii. He spent 10 years “managing a terrific sales team,” but realized he loved selling and wanted to go back into a territory. So he did. “Medical sales and in particular, laboratory sales, has been the best career I could have chosen,” he says. “This business is ever evolving. I am amazed to see what has happened in my lifetime. At one time I sold Coulter Fn Analyzers and IL Flame Photometers. Now I’m selling QuantStudio™, molecular based assays and talking about precision medicine, thanks to Thermo Fisher Scientific
“ This business is ever evolving. I am amazed to see what has happened in my lifetime.”
and the acquisition of companies in this space. I embrace technology; I love seeing what is going on. “My advice to anyone in medical sales is to keep current.” By learning about and embracing new technologies, “your effectiveness as a sales rep will be rewarded,” he says. Garza has served on the President’s Advisory Council multiple times, and has achieved the highest sales level – Circle of Excellence – eight times. He is a long-time member of the prestigious Blue Jacket team. And he has no thoughts about retirement. He serves on the board of the local Boys and Girls Club, and enjoys tennis, golf and skiing. “Karen, the pups and I enjoy driving to Carmel near the Monterey Peninsula. At home, we get to watch the sun set every night over the Pacific. “Retire? Not just yet. Still living the dream!”
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Industry news Henry Schein names Brad Connett as president, U.S. Medical Group Henry Schein Inc (Melville, NY) named Brad Connett as president of Henry Schein’s U.S. Medical Group. Connett was previously president of the company’s Commercial Group for U.S. Medical. In this new, expanded role, Connett will lead the medical group’s strategic direction, management, and business performance. He will also be responsible for the group’s sales, marketing, operations, business development, and technology solutions.
Walmart partners with New England Baptist Hospital on bundled payments Walmart selected New England Baptist Hospital (Boston, MA), which specializes in orthopedic care, as a center of excellence for Walmart employees needing hip and knee replacement procedures. Under the agreement, eligible Walmart medical plan enrollees who undergo joint replacement surgery at NEBH will have their care, travel, and lodging fully covered. NEBH will offer the procedure at a fixed price for a bundled care episode. NEBH has similar arrangements with UniCare and General Electric. This action builds upon Walmart teaming up in April with Emory Healthcare (Atlanta, GA) for an ACO and a bundled payment program for spine surgeries and joint replacements.
PTS Diagnostics announces new global headquarters PTS Diagnostics, a U.S.-based manufacturer of pointof-care biometric testing devices, announced that it is
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expanding operations in Indianapolis and building a new global headquarters. In order to support continued rapid growth, the company is investing in additional manufacturing and office space, and moving its global headquarters to Whitestown, Indiana. The company continues to grow much faster than the rate of industry growth, and this expansion will bring jobs in the finance, marketing, chemistry, engineering, and manufacturing sectors, among others.
Amazon is building a health, wellness team around Alexa Amazon has built a team within its Alexa voice-assistant division called “health & wellness,” according to CNBC. The team includes over a dozen people and is being led by Rachel Jiang, who has spent the last five years at Amazon in various roles, including advertising and video. The team’s main job is to make Amazon’s Alexa voice assistant more useful in the healthcare field, an effort that requires working through regulations and data privacy requirements laid out by HIPAA, according to people familiar with the matter. The group is targeting areas like diabetes management, care for mothers and infants, and aging, said the people. Other key members include Missy Krasner, who joined Amazon last year after leading industry initiatives at Box and Google, and Larry Ockene, a 10-year veteran engineer at Amazon. Yvonne Chou, who has worked at Amazon for eight years across Prime, fashion and retail, is one of the three managers under Jiang. Within the Alexa unit, the team falls under a group called Alexa Domains, according to the internal document
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