JHC June 19

Providing Insight, Understanding and Community

June 2019 | Vol.15 No.3

Steady Progress The infection prevention trends look encouraging, but there’s still work to be done

Lowering total cost of ownership together.

Learn how we worked with one medical center to:

Increase efficiencies

Reduce freight costs

Lower packaging costs

Reduce shipping weight

Read the full case study:

cookmedical.com/tcotogether

cookmedical.com Š COOK 01/2017 HBS-D33288-EN

CONTENTS »» JUNE 2019 The Journal of Healthcare Contracting is published bi-monthly

by Share Moving Media 1735 N. Brown Rd. Ste. 140 Lawrenceville, GA 30043-8153 Phone: 770/263-5262 FAX: 770/236-8023 e-mail: info@jhconline.com www.jhconline.com

Editorial Staff Editor Mark Thill mthill@sharemovingmedia.com

Steady Progress

Managing Editor Graham Garrison ggarrison@sharemovingmedia.com Art Director Brent Cashman bcashman@sharemovingmedia.com Publisher John Pritchard jpritchard@sharemovingmedia.com Director of Business Development Alicia O’Donnell aodonnell@sharemovingmedia.com

The infection prevention trends look encouraging, but there’s still work to be done

Sales Executive Lizette Anthonijs Lizette@sharemovingmedia.com Circulation Wai Bun Cheung wcheung@sharemovingmedia.com

The Journal of Healthcare Contracting (ISSN 1548-4165) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2019 by Share Moving Media. All rights reserved. Subscriptions: $48 per year. 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 Share Moving Media, 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.

4 Editor’s Note

Universal Precautions for Violence

6 Yankee Alliance: Voice.

Service. Leverage.

Thirty-five-year-old RPC upping its game with technology

10 A Makeover at Cleveland Clinic

How a supply chain team is changing the flow of information and products at one of the nation’s largest healthcare systems

14 Protecting the Channel

The Grey market: Financial issue.

Patient safety issue.

26 MRSA: The bug all of bugs?

34 A new kind of medical school for a new kind of doctor

The Journal of Healthcare Contracting | June 2019

18

pg

37 Pricing Accuracy in Practice 41 HSCA

Meet the President

42 Calendar of Events 43 HealthTrust to celebrate platinum anniversary at HTU19 44 Bringing the Energee!

Teamwork and leadership on an NBA dance team

48 Next Steps

An industrywide consortium took a big step this winter in its quest to bring uniformity to the vendor credentialing process.

49 Industry News

Kaiser Permanente School of Medicine to begin accepting applications in June

3

EDITOR’S NOTE

Universal Precautions for Violence

Mark Thill

Unfortunately, all of us have been hearing a lot – too much – about violence in our streets, houses of worship, schools, homes. The hospital is no exception.

Between 2011 and 2013, workplace assaults ranged from 23,540 and 25,630 annually – and 70 to 74% occurred in healthcare and social service settings, according to the Occupational Safety and Health Administration in its 2015 “Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers.” For healthcare workers, assaults comprise 10 to 11% of workplace injuries involving days away from work, as compared to 3 of injuries of all private sector employees.

Among the many things that caught my attention in the guidelines was OSHA’s use of the term “universal precautions for violence.” Violence should be expected, says the agency. “But it can be avoided or mitigated through preparation. In addition, workers should understand the importance of a culture of respect, dignity and active mutual engagement in preventing workplace violence.”

Supply chain professionals have no control over staffing in clinical areas, the crime rate of the surrounding community or the time of days employees must work. But they can help mitigate the impact of violence. The OSHA Guidelines offer a series of checklists for all hospital executives and managers to review. Some examples: •A re areas where money is exchanged visible to others who could help in an emergency?

(For example, can you see cash register areas from outside?)

• Are waiting areas and work areas free of objects that could be used as weapons?

• Are patient or client waiting areas designed to maximize comfort and minimize stress?

• Is furniture in waiting and work areas arranged to prevent workers from becoming trapped?

• Are private, locked restrooms available for employees?

• Is there a secure place for workers to store personal belongings?

• Do workers feel safe walking to and from the workplace?

• Is lighting bright and effective in outside areas?

•D oes the workplace have panic buttons? Metal detectors? Security mirrors? An internal telephone system to contact emergency assistance?

•A re workers trained in the emergency response plan (for example, escape routes, notifying the proper authorities)?

• Are workers trained in ways to prevent or defuse potentially violent situations?

• Are reception and work areas designed to prevent unauthorized entry?

•A re people who work in the field late at night or early mornings advised about special precautions to take?

OSHA suggests that we expect and prepare for violence in the workplace, just as we do bloodborne pathogens. Violence just calls for a different set of universal precautions.

4

June 2019 | The Journal of Healthcare Contracting

Rx Only ©2016 B. Braun Medical Inc. Bethlehem, PA. All rights reserved. 16-5430_JHC_5/16_RTS3

RPC PROFILE

Yankee Alliance: Voice.

Service. Leverage.

Thirty-five-year-old RPC upping its game with technology Yankee Alliance has been identifying opportunities for savings and high-quality care on behalf of its members since 1984. But the Andover, Massachusetts-based GPO does more than identify opportunities. It helps its members realize them, that is, make them happen.

Yankee Alliance comprises more than 16,000 members Amy Campbell in 50 states. The majority of its acute care members are in the Northeast, while its non-acute members can be found throughout the country.

As a Premier owner, Yankee Alliance offers its members access to Premier national contracts. But it also offers its members Yankee aggregations, as well as a portfolio of committed contracts and Yankee-exclusive agreements, says Amy Campbell, chief administrative officer.

“Yankee negotiates with vendors to offer our members enhanced pricing based on our aggregated volume, which is currently over $4 billion annually,” she says. “We also negotiate other value-adds as part of our aggregations, such as rebates and clinical education.” Recently Yankee delivered to its members a $1.1 million savings opportunity and a growth rebate program for disposable non-sterile protective apparel.

Making contracts work Yankee earns pricing concessions thanks to the resources it devotes to contract implementation. “We know our members very well; we’re close to them,” says Campbell. Yankee clinicians sit on members’ value analysis committees to help weigh the merit of potential contracts and product utilization opportunities. Clinicians guide members through the implementation process.

Yankee’s committed contracting program continues to respond to industry changes, says Campbell. “Yankee Alliance recognizes that in order to drive bestin-market price, moving market share and member contract commitment are key. We continue to evaluate opportunities and welcome open discussions with suppliers that can offer additional value through price and other offerings.” One example is a pharmacy wholesaler agreement, which was signed in 2017.

Yankee also negotiates contracts exclusively for Yankee members. Many of these contracts are regional in nature. For example, the GPO has purchased-services contracts to address members’ needs in staffing, plumbing, energy, IT consulting and other areas.

6

“Members are at the center of all we do,” says Campbell. The Partners Advisory Committee (PAC) is Yankee’s strategic committee and consists of supply chain representatives from the five largest Yankee owner/ members. A number of sub-committees (e.g., lab, IT, pharmacy, foodservice, biomedical, nursing, and OR) provide feedback and support in the contract decision-making process.

“The PAC sets the tone of cooperation for the membership by ensuring the members are treated equally, and it serves as the voice of the larger group,” says Campbell. “It provides oversight of Yankee initiatives and provides input into the GPO’s strategic planning and direction,” she continues.

Technology For some time, that strategic direction has led Yankee to be a source of actionable business intelligence for its members. “Upping our technology game is really important,” says Campbell.

Yankee’s SUITEview family of offerings includes: • SUPPLYview, which focuses on contracting utilization, price benchmarking, conversions and standardization.

• CLINICALview, which focuses on clinical utilization and value analysis.

• SERVICEview, which focuses on purchased-services contract analysis, benchmarking and best practices.

• PHARMACYview, which focuses on pharmacy utilization, cost impact and clinical implications of a particular drug or therapeutic class.

June 2019 | The Journal of Healthcare Contracting

Keeping the customer happy.

3

23

12

16

PLATFORMS

TESTS

CLIA WAIVED

RESULTS 10 MIN OR LESS

®

MOLECULAR POINT-OF-CARE

Immunoassay System

SEKISUI DIAGNOSTICS IS YOUR PARTNER IN HEALTHCARE / 800-332-1042 / WWW.SEKISUIDIAGNOSTICS.COM © 2019 Sekisui Diagnostics, LLC. All rights reserved. OSOM® is a registered trademark of Sekisui Diagnostics, LLC. Silaris™ and Because every result matters™ are trademarks of Sekisui Diagnostics, LLC. FastPack® is a registered trademark of Qualigen Inc.

RPC PROFILE

Usage matters Clinical product utilization allows hospitals to see the full picture of how products affect patient care and outcomes, as well as how various features of products can increase the cost of care without providing evidencebased value, says Amy Campbell, chief administrative officer, Yankee Alliance. Here are two examples.

• Patient cleansing. A provider uses benchmarking to get the best price for pre-packaged bathing products. However, based on clinical product utilization and peer benchmarking, the provider finds it is using a pre-packaged bath two to three times more often than other facilities around the country. By categorizing products the way they are clinically used, the provider views other options for patient cleansing, as well as how cleansing practices vary within the hospital, across the health system, and across the country. The provider also applies best-practices research to guide nursing practice to prevent hospital-acquired infections and maintain skin integrity while using the most cost-effective method for the patient.

• External patient warming (i.e., forced-air warming products for the OR). A provider gets the best price for warming products, but benchmarking shows that caregivers are using two products per patient when guidelines state that warming products are not needed for every procedure. Further, forced-air gowns often get in the way during surgery and are discarded, because the patient needs a new one in the post-op phase. Using Blue.Point, the provider sees how the increased usage and product mix affect total cost of care. Using peer benchmarking and clinical evidence, the provider gains insight into alternative practices and data-driven practice for cost savings and improved outcomes.

“Yankee Alliance members have a support team comprised of dedicated resources, contracting, analytics, and clinical subject matter experts that maximizes the value of the contract portfolio and uncovers hidden savings opportunities,” says Campbell.

“These are provided through a service bureau model, where Yankee proactively runs member data on a monthly basis to highlight opportunities and pushes this information out to the membership.” Yankee Alliance’s Member Services and Clinical teams assist with implementation.

In addition, Yankee Alliance uses Blue.Point (www.bluepointscs.com) to give health systems visibility into the products they use on their patients, and how they use them. It can help members (and non-Yankee subscribers) answer such questions as: • “How do my hospital’s product usage and clinical practices compare to other hospitals?”

• “What are the industry-accepted best practices and how do my hospital’s practices compare?”

• “How do we generate a pipeline of savings opportunities for our value analysis teams to work on?”

• “What is the step-by-step roadmap to implementing change?”

• “How do I track implementation progress over the short term and long term?”

8

In March 2018, Cathy Spinney – who has been with Yankee Alliance for 28 years – was named president and CEO. Under her leadership, Yankee Alliance continues to transform its technology platform and invest in the human resources required to assist its members implementing savings opportunities.

Says Campbell, the differentiators for Yankee Alliance are – and will continue to be – the following: • Voice. “As a member-owned organization, our members are at the center of everything we do and drive strategic decisions through our Board of Managers, Partners Advisory Committee and our departmental committees.”

• Service. “Providing members with inside account support, field resources, specialists (such as clinicians and pharmacists) and an analytical support team to turn data into actionable information to implement savings.”

•L everage. “Combined volume of over $4 billion, working together as an Alliance.”

June 2019 | The Journal of Healthcare Contracting

THE CATALYST ADVANCING HEALTH CARE Henry Schein has partnered with Medpod, a software solution that transforms health care delivery.

By transforming telemedicine with the most comprehensive scalable telediagnostics platform, Medpod connects groundbreaking software and medical devices, optimizes health care delivery and maximizes patient management throughout the continuum of care.

Medpod elevates the medical standard for higher quality care between remote provider and patient, regardless of their physical location — maximizing flexibility and opportunity for your practice.

Are you ready to navigate the future of telemedicine?

Let Henry Schein Medical and Medpod lead the way.

1.800.P.SCHEIN HenrySchein.com/Medpod DISCLAIMER: All product and company names are trademarks™ or registered® trademarks of their respective holders. The Medpod logo may not be reproduced by any means or in any form whatsoever without Medpod Inc.’s written permission. The Henry Schein logo is a registered trademark of HS TM, LLC, a Henry Schein subsidiary. The Henry Schein logo may not be reproduced by any means or in any form whatsoever without HS TM, LLC ‘s written permission. All rights reserved 2016-2019. © 2019 Medpod Inc. All Rights Reserved.

MODEL OF THE FUTURE

A Makeover at Cleveland Clinic How a supply chain team is changing the flow of information and products at one of the nation’s largest healthcare systems

Pohlman and his team are in the midst of changing the flow of information and products at one of the nation’s largest healthcare systems.

Cleveland Clinic consists of the main campus in Cleveland (1,400 beds, over 100 operating rooms and 60 buildings), 10 regional hospitals and more than 150 outpatient locations in northern Ohio.

Inventory Management Transformation What does industrial engineering have to do with supply chain management? Quite a bit.

Sometimes referred to as “optimizers,” industrial engineers enlist natural science, mathematics, computer engineering and other skills in an effort to improve or simplify systems, which could be manufacturing, customer service, supply chain, etc.

They plan, they conduct simulations, they problem-solve. Then they continually educate the people on their roles in those systems.

Steve Pohlman has a degree in industrial engineering (as well as an MBA).

Prior to beginning his career in healthcare supply chain in 1997, he worked in manufacturing in the auto and welding industries. Is it any surprise, then, that he is transforming processes at Cleveland Clinic, where he serves as senior director of materials management?

10

The initiative – Inventory Management Transformation (IMT) – revolves around three components: 1) Helping nurses and clinical staff spend more time at the bedside by 2) centralizing supply chain data, inventory and decision-making, so that 3) onsite materials teams can devote their time servicing the needs of the hospital staff. It’s a chain, or circle, of support: A central team provides support to onsite materials teams, who in turn support caregivers at the bedside.

June 2019 | The Journal of Healthcare Contracting

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

A 28-year tradition of excellence.

Product breadth, supply chain efficiency, and total cost savings from a company that places YOU first! www.dukal.com | 1-800-243-0741

MODEL OF THE FUTURE

IMT begins with data collection. Cleveland Clinic is implementing RFID technology for implantable devices and high-dollar supplies, and a two-bin Kanban system for higher-volume, lower-dollar items.

“We started with [implantables] because that is where we felt we were at the greatest risk for product expiry and inventory loss,” says Pohlman. At press time, the system was live at five of the health system’s hospitals, with implementation at the main facility expected by the end of summer. “We have been able to greatly reduce the clinical and non-clinical hours spent on expiry checks,” he points out. The system creates a safer environment for patients (zero serious safety events have occurred due to expired supplies), and it gives the sourcing team utilization data to negotiate more effectively with vendors.

Perhaps most important, Pohlman calculates that at press time, 22,000 hours had been repurposed back to the clinical staff to take care of patients instead of manage supplies.

Rollout of the system to all hospitals should be completed by the end of 2019. Already at press time, 70,000 items had been RFID-tagged.

The next phase of IMT will be implementation of a third-partylogistics model for the storage and distribution of implantables and high-dollar items. Rather than asking vendors to ship implantables di-

“ We learn about [nursing’s] work, and they learn from us. It’s about understanding what we need from each other.” rectly to the hospitals via overnight delivery services, Cleveland Clinic will direct vendors to ship them to its med/surg distributor. There, each item will be RFID-tagged, so Cleveland Clinic’s central materials team can monitor expiry and manage disposition as needed. The items will then be supplied to the facilities on a just-in-time basis.

Center of Excellence An industrial engineer would never transform a system without creating an infrastructure to support its rollout and sustain the system day after day, year after year. For IMT, that infrastructure rests on the Center of Excellence, or COE. Comprising 10 project managers, the COE is standardizing how inventory is managed across the enterprise, says Pohlman. That involves replacing seven different inventory systems – which do not interface with each other – with one. That work is being undertaken.

Simultaneously, the COE is redesigning supply chain workflow, training people on it, and developing standard policies and procedures. In the

12

Steve Pohlman

future, the COE will serve as a customer support center for the hospital materials leaders by monitoring inventory levels and utilization, providing expiry scorecards and technical support, and training new employees.

“Our enterprise will likely continue to expand and do construction projects,” says Pohlman. “The goal of the inventory team is to be involved in the design of any space and workflow that involves supply usage early in the process.”

Transforming inventory for an enterprise as large and complex as Cleveland Clinic has been challenging, admits Pohlman. “Each hospital brings its own set of challenges. IMT is clearly not a cookie-cutter approach.”

But the most surprising result thus far is how much the project has strengthened supply chain’s relationship with nursing, he says. As each has gotten to know each other’s processes and needs, trust and cooperation has grown.

In fact, after the initial implementation at each facility, “the nurses don’t want us to leave, because we made their job so much easier.

“We learn about their work, and they learn from us. It’s about understanding what we need from each other.”

June 2019 | The Journal of Healthcare Contracting

WELCH WELCH ALLYN ALLYN AND AND HILLROM HILLROM We’re We’re unifying unifying our our brands brands to to advance advance connected connected care. care.

JOIN OUR NEXT STEP FORWARD JOIN OUR NEXT STEP FORWARD AT WWW.HILLROM.COM. AT WWW.HILLROM.COM. © 2019 Hill-Rom Services, Inc. © 2019 Hill-Rom Services, Inc.

MC16138 MC16138

TRENDS

Protecting the Channel The Grey market: Financial issue. Patient safety issue.

By April 2018, BD was so concerned about the potential patient-safety impact from product diversion and the grey market that the company put into place a full-time Channel Protection Team to identify and address grey market activity. The effort has paid off, as the amount of diverted BD product has declined.

“The Channel Team has taken an aggressive approach to seeking out and shutting down diverters, proactively identifying fraudulent accounts and

14

unauthorized resellers, as well as pursuing legal action against grey market participants,” says Jim Berdela, channel development and marketing vice president.

And with good reason: Products sold on the grey market are vulnerable to a multitude of patient safety issues.

Grey market commerce denies companies the ability to track an item’s end user or distributor – a significant liability in the event of a recall, Berdela points out. Additionally, without a proper chain of custody, the quality and sterility of a product

June 2019 | The Journal of Healthcare Contracting

can no longer be assured. “From a business perspective, companies face data distortion around purchasing trends, and loss of lineof-sight into who the ‘real’ customers are, and financial damage.”

What is the grey market?

Diverted products can enter the grey market from both inside and outside the U.S. “For example, a U.S. manufacturer sells its product to a supplier outside the U.S. for the sole purpose of servicing a different country or region (e.g. Latin America),” says Berdela. “The product is sold to this supplier, but after the sale, all or much of it is fraudulently diverted from the region, unbeknownst to the manufacturer, and resold back into the U.S.” Richard Bergner, chief operating officer, Integritet Global Consulting & Investigations in Miami, Florida, points out that domestic diversion in the U.S. can occur when products are sold at special pricing for home healthcare, Medicare, group pricing volume or other incentives. “These products can also be diverted, which usually involves falsified sales tracings and in some cases, fraud,” says Bergner, who since 2004 has been investigating healthcare diversion.

“In other cases, we have seen cargo thefts where trucks are stolen. In yet other cases, we have seen multi-million-dollar thefts occurring at hospitals, distributors, wholesalers, manufacturers and others. These are not huge single hit ‘heists,’ but instead are daily thefts, which lead to losses in the millions of dollars over short periods of time – with the products making their way right back into the supply chain.”

The desire for the lowest-price option on the part of purchasers fuels the secondary market, adds Bergner. Manufacturers inadvertently fuel the problem with varying global cost structures to penetrate emerging

The Journal of Healthcare Contracting | June 2019

markets and improve healthcare for patients globally. “Savvy traders exploit these opportunities, which means products intended for a particular market never make it to those patients.”

Given that the grey market is “a shadow supply chain,” assigning a dollar value to it is difficult. Bergner estimates it is a “multi-billiondollar problem for manufacturers, [which] results in lost sales, strained customer relationships, poor forecasting and in some cases, markets desperately in need of supplies underserved.

“Worst of all, it creates an illicit supply chain which fuels cargo theft, counterfeiting, and other criminal activity. This channel can lead to improperly handled, misbranded, or counterfeit products being sold to healthcare providers, putting patients at risk.”

“ This channel can lead to improperly handled, misbranded, or counterfeit products being sold to healthcare providers, putting patients at risk.”

– Richard Bergner

Online commerce The growth of online commerce may be exacerbating the problem.

“Heavily trafficked e-commerce sites that specialize in marketplace sales provide easy access to outlets selling grey market product,” says Berdela. “Many online resellers using these retail sites’ third-party marketplaces are not authorized medical distributors, and it is difficult to know how they source the products they sell.”

Says Bergner, “Third party market sellers can set up a storefront with little or no inventory, so there is no barrier to entry. Illicit products can be shipped to the online marketplace, get comingled with other inventories and fulfilled by that marketplace, so a reputable distributor could have their orders fulfilled with grey goods or worse.”

Online auction sites are another concern.

“Hospitals, clinics, surgery centers and even doctors are buying these products online to cut costs, improve margins, and sometimes to keep a struggling practice from failing,” says Bergner.

15

TRENDS

Meeting the challenge Although it is not illegal to buy product from the grey market, buyers should be aware of possible illegal or criminal activity going on behind the scenes, says Bergner. “Purchasing product from the grey market only encourages more such behindthe-scenes illegal activity.”

In March 2019, the FDA Office of Criminal Investigations arrested four individuals accused of fraudulently diverting infant baby formula into the U.S. market that was contractually meant for sale into South America, Bergner points out. The indictment by the FDA included a requested judgment in excess of $120 million and jail time for the indicted individuals. The FDA got involved with this case due to the combination of fraudulent –Jim Berdela diversion and the potential public safety risk, he says. While the case focused on baby formula, the group was also trading in medical devices.

BD’s Channel Protection Team “has made significant progress in implementing proactive and preventative measures to identify diversion, including educating and training our sales teams to recognize a fraudulent account or unauthorized reseller, data mining, using red-flag reports based on parameters and algorithms, and limiting access to U.S. products outside the country,” says Berdela. “BD also takes legal action against diverters by holding grey market suppliers accountable for impairing legitimate businesses, raising questions about brand authenticity and most important, compromising patient safety.”

In 2018, the company discovered a U.S.-based distributor submitting fraudulent rebates, that is, rebates submitted on sales that never took

Without a proper chain of custody, the quality and sterility of a product can no longer be assured.

16

place, and diverting product purchased from BD into the grey market, he continues. BD initiated litigation and was awarded a multi-million-dollar judgment. Such action was taken to help ensure a safe and secure supply chain for its customers and their patients, says Berdela.

Attacking grey market product sales is a win for the entire healthcare supply chain, from manufacturer to patient, adds Bergner. “You can prevent risk to patients and improve the bottom line at the same time,” he says. Basic approaches include: • Conducting proper due diligence on new or even existing customers or companies of interest.

• Evaluating shipments versus consumption for markets or geographies where diversion is possible.

• Requiring proof of performance beyond simple assurances that the products went where they were supposed to go.

• Conducting formal or informal market surveys or reviews. These can be done by company personnel or third parties.

• Developing and maintaining a program to address and confront grey market activity and build it into day-to-day business.

• Educating internal and external partners on the risks of the grey market and this illicit supply chain.

• Partnering with customers and listening to what they are seeing out there, and then reacting to it.

June 2019 | The Journal of Healthcare Contracting

Please join us for the ANAE Annual Conference July 11-12 in Dallas, Texas The Association of National Account Executives Annual Conference provides an opportunity for ANAE members and prospective members to network with their peers and customers, while hearing from leading supply chain executives and GPOs on working successfully with IDNS.

This year we are nominating The National Account Executive of the Year and the winner will be presented at this conference! This award is given to the National Account Executive that has made a major impact within their company, the IDN/GPO/RPC Contracting market and have shown exemplary levels of ethics and leadership skills throughout their career.

Confirmed Speakers:

» Traci Bernard, President, Texas Health Harris Southlake Hospital » Dee Donatelli, Principal, Dee Donatelli Consulting LLC » Barbara Strain, Director of Value Management, University of Virginia Health System

» Ed Hardin, Vice President Supply Chain, Froedtert Health System » Jeff Cohen, EVP, Public Affairs, Federation

REGISTRATION: Early Bird Special ends June 11: $1,430 General Registration: $1,530 ANAE Members: $1,161 (Savings of $369)

» Pam Bryant, Senior Vice President Supply Chain Management, Parkland Hospital and Health Services

» Todd Laidlaw, Vice President Business Development, Medline Industries

» Sue Casey, VP, Strategic Supplier Engagement, Supply Chain Services, Premier, Inc.

» Vizient Aggregation Group » Sandy Wise, System Director, Baylor Scott & White Health

HOTEL: Dallas/Fort Worth Airport Marriott 8440 Freeport Parkway Irving, TX 75063

SPECIAL GROUP RATE: Buy 3, get the 4th one free!

For more information and registration visit: www.jhconline.com/events

Steady Progress The infection prevention trends look encouraging, but there’s still work to be done

18

June 2019 | The Journal of Healthcare Contracting

Each day, approximately one in 31 U.S. patients contracts at least one infection related to his or her hospital care, reports the Centers for Disease Control and Prevention. That might not sound like great news. But it does signal progress.

“Overall, there is a lot to be happy about,” says Keith Kaye, M.D., MPH, FIDSA, FSHEA, professor of medicine in the Division of Infectious Diseases at the University of Michigan Medical School, referring to CDC’s recently released “2017 National and State HealthcareAssociated Infections (HAI) Progress Report.”

“Pretty much all device-associated and MDRO [multidrug-resistant organism] metrics are improved from 2016 to 2017,” says Kaye, who is past president of the board of trustees of the Society for Healthcare Epidemiology of America, or SHEA. “This improvement occurred on top of notable progress that had already been made prior to 2016.”

According to the CDC, nationally, between 2016 and 2017, acute care hospitals experienced: •A bout 9 percent statistically significant decrease in central-line-associated bloodstream infections (CLABSIs). (Largest decrease – 10 percent – occurred in wards.)

•A bout 5 percent statistically significant decrease in catheter-associated urinary tract infections (CAUTIs). (Largest decrease – 8 percent – occurred in ICUs.) •A bout 3 percent statistically significant decrease in ventilator-associated events.

• About 8 percent statistically significant decrease in methicillin-resistant Staphylococcus aureus (MRSA) bacteremia.

•A bout 13 percent statistically significant decrease in C. difficile infections.

• About 1 percent statistically significant decrease in surgical site infections (SSIs) related to 10 select procedures tracked between 2016 and 2017. (That said, no significant changes in abdominal hysterectomy SSIs or colon surgery SSIs.)

The Journal of Healthcare Contracting | June 2019

19

and

PROTECT YOUR PATIENTS, STAFF, AND FACILITY

©2019 PDI

PDI04179195

NEW! Next-generation Disinfectant

KILLS

R

MS

OO

IS

MIC

54

RGAN

ACCELOQUAT™ formulation: Innovation against infection You’re a heroic infection fighter. Choose the disinfectant that delivers SPEED—a true 1-minute bactericidal, fungicidal, virucidal, and tuberculocidal—and POWER, destroying 54 microorganisms, including 17 Multi-Drug Resistant Organisms like MRSA, CRE, and VRE. Call on the SPEED and POWER of Prime at pdihc.com/Prime

Spray format available!

PATIENT CARE

INTERVENTIONAL CARE

ENVIRONMENT OF CARE

INFECTION PREVENTION Compared to the 2015 baseline standardized infection ratio (or SIR, a comparison of the number of actual infections in a facility and the number of infections that were “predicted” to have occurred based on previous years of reported data): • Forty-one states performed better on at least two infection types. (Of these, 37 performed better on at least three infection types, and 23 performed better on at least four).

• Five states performed worse on at least two infection types.

Compared to the 2017 national SIR: • Twenty-four states performed better on at least two infection types. (Of these, 14 states performed better on at least three infection types, and three performed better on at least four.)

• Twenty-seven states performed worse on at least two infection types.

the Association for Professionals in Infection Control and Epidemiology (APIC), agrees that the Progress Report shows encouraging trends. Even so, much remains to be done, she says.

“It is surprising to see that no significant changes were detected in reducing colon surgery surgical site infections in acute care settings, as many infection prevention programs target these procedures to reduce the risk of infection associated with them. The numbers suggest there is still more room for improvement.”

“We can do better,” adds Kaye. “Surgical site infections are one of the most common healthcare-acquired infections, and continued focus on optimizing SSI prevention is called for.” SHEA published “Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update” to provide recommended strategies based on available scientific evidence and guidance, he says.

Progress, not perfection “I was pleasantly surprised by the continued sharp and significant decreases in CLABSI, MRSA bacteremia and C. difficile,” says Kaye. “De“Genuinely creases approached or exceeded 10 percent for each embracing a of these measures. These are culture of safety large, impressive decreases, and making particularly when consideryour institution ing that these occurred in the a high-reliability setting of notable improveorganization are ments leading up to 2016.” critical in the “We are very encouraged journey towards to see steady progress,” says reducing HAIs.” Arjun Srinivasan, M.D., as– Keith Kaye sociate director for healthcare-associated infection prevention programs, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC. “It’s a reflection of the hard work that folks in hospitals are doing day in and day out to follow CDC recommendations and best practices, to make sure they are delivering the best care.”

Room for improvement Marie H. Wilson, RN, CIC, infection preventionist at Methodist Dallas Medical Center and a spokesperson for

22

Indeed, progress in infection prevention is never a straight line. For example, CDC reports that although U.S. rates of hospital-onset MRSA dropped 17 percent each year between 2005 and 2013, progress against methicillin-susceptible staph (MSSA) may be rising in communities, and progress against MRSA has slowed in hospitals.

And “zero HAIs” may be an impossible dream, if for no other reason than new challenges continually arise.

For example, healthcare facilities in several countries – including the United States – have reported that a type of drug-resistant yeast called Candida auris has been causing severe illness in hospitalized patients, reports CDC. But that doesn’t deter infection prevention professionals from seeking continuous improvement.

“I am not certain that ‘zero HAIs’ is always obtainable, due to severity-of-illness issues that some patients experience,” says Kaye. “However, in my opinion, more important than reaching zero, is to make certain that all preventive processes are in place and are being utilized fully so that infection prevention is optimized.” These processes range from hand hygiene to limiting unnecessary indwelling devices, managing indwelling devices with appropriate hygiene, avoiding unnecessary antibiotics and optimizing the environmental hygiene of a hospital, he says.

June 2019 | The Journal of Healthcare Contracting

Inpatient infections Among hospital inpatients, healthcare-associated infections (HAIs) lead to the loss of tens of thousands of lives and cost the U.S. healthcare system billions of dollars each year.

These factors raise the risk of HAIs: • Catheters (bloodstream, endotracheal, and urinary).

• Surgery.

• Injections.

• Healthcare settings that aren’t properly cleaned and disinfected.

• Communicable diseases passing between patients and healthcare workers.

• Overuse or improper use of antibiotics.

Common HAIs patients get in hospitals include: • Central-line associated bloodstream infections.

• Clostridium difficile.

• Pneumonia.

• Methicillin-resistant Staphylococcus aureus (MRSA).

• Surgical site infections.

• Urinary tract infections.

• Catheter-associated urinary tract infections.

Source: Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services (https://health.gov/hcq/prevent-hai.asp)

“The biggest barriers to implementing and complying with these processes include limited infection prevention resources and competing issues that face the hospital. Genuinely embracing a culture of safety and making your institution a high-reliability organization are critical in the journey towards reducing HAIs and improving the safety of patients.”

Make the right thing easy “This is not a one-and-done proposition,” says Srinivasan.

“These are infections that require constant diligence and activity. If we take our eye off the ball, we can run into a situation where we stop making progress.”

Patients are sicker than they’ve ever been, he says. “Providing care is complex, and the more complex it is, the more difficult it is to remember all the things that need to be done.

To counter that, a lot of our focus at CDC has been to figure out how we can make the safe practice the easy thing to do.”

Example: Providers may forget to wash their hands before and after each interaction with a patient. “Here’s a simple fix: Mount an alcohol-based hand dispenser outside every room,” says Srinivasan. “It’s easy to access the dispenser, and it’s a visible reminder to wash your hands.”

The Journal of Healthcare Contracting | June 2019

Another key to infection prevention is antibiotic stewardship, that is, prescribing antibiotics only when they are needed, and making sure regimens are properly adhered to.

“It’s incredibly important,” says Srinivasan. “We know that the biggest infection type where improved antibiotic use can play a role is C diff, which is a problem in nursing homes and hospitals. It’s a major area of focus at CDC, and we are thinking about the best way to deliver best practices across the spectrum of healthcare.

“There is an evolving understanding of how we deliver healthcare,” he adds. “In the past, nurses played their role, and physicians played their role, etc. We’re increasingly understanding that healthcare is a team sport. For example with antibiotics, the physician might be the one writing the order, but the pharmacist is the one who dispenses it, and the nurse is the one who administers it. Each one plays an equally important role.”

Work smarter, closer As important as antibiotics are, experts agree that greater success against healthcare-acquired infections rests with better data, better processes and close working relationships among provider staff.

23

INFECTION PREVENTION More than 21,000 hospitals and other healthcare facilities provide data to the CDC’s National Healthcare Safety Network (NHSN), which in turn is used for national- and state-level analyses, and for targeted prevention initiatives by healthcare facilities, states, regions, quality groups, and national public health agencies, including CDC. Providers, in turn, can use that data to track and compare their antibiotic usage and infection rates with other facilities.

“Reaching ‘zero’ requires sustainable collaboration among an interprofessional team, including those in the acute care setting and beyond,” says Wilson. “As our patients come to us sicker than ever, our challenges to keep them infectionfree will continue to increase.

“Successful health systems support collaborative environments among care partners, monitor leading measures, and respond to infection prevention risks with calculated and evidence-based interventions.”

For further information: The 2017 National and State Healthcare-Associated Infections (HAI) Progress Report provides a summary of select HAIs across four healthcare settings; acute care hospitals (ACHs), critical access hospitals (CAHs), inpatient rehabilitation facilities (IRFs) and long-term acute care hospitals (LTACHs). (https://www.cdc.gov/hai/data/portal/progress-report.html) Vital Signs, Centers for Disease Control and Prevention, March 2019, https://www.cdc.gov/vitalsigns/staph/index.html

A new threat: Candida auris The Centers for Disease Control and Prevention has advised healthcare providers to watch for a type of yeast – Candida auris – which has been causing severe illness in hospitalized patients. What makes C. auris so threatening is that it is difficult to identify, and it does not respond to commonly used antifungal drugs.

Limited data suggest that the risk factors for Candida auris infections are generally similar to risk factors for other types of Candida infections, according to CDC. These risk factors include recent surgery, diabetes, broad-spectrum antibiotic and antifungal use.

People who have recently spent time in nursing homes and have lines and tubes that go into their body (such as breathing tubes, feeding tubes and central venous catheters) seem to be at highest risk for C. auris infection. Infections have been found in patients of all ages, from preterm infants to the elderly.

C. auris has caused bloodstream infections, wound infections, and ear infections. It also has been isolated from respiratory and urine specimens, but it is unclear if it causes infections in the lung or bladder. CDC

24

reports that it doesn’t know if patients with invasive C. auris infection are more likely to die than patients with other invasive Candida infections. Based on information from a limited number of patients, 30% to 60% of people with C. auris infections have died.

However, many of these people had other serious illnesses that also increased their risk of death.

C. auris is harder to identify from cultures than other, more common types of Candida. For example, it can be confused with other types of yeasts, particularly Candida haemulonii. That’s why special laboratory tests are needed to identify it.

Most C. auris infections are treatable with a class of antifungal drugs called echinocandins, according to CDC. However, some C. auris infections have been resistant to all three main classes of antifungal medications, making them more difficult to treat. In this situation, multiple classes of antifungals at high doses may be required to treat the infection.

For more information, see “General Information about Candida auris,” https://www.cdc.gov/fungal/ candida-auris/candida-auris-qanda.html

June 2019 | The Journal of Healthcare Contracting

Water works Everyone knows that good hand hygiene – including hand washing and donning gloves – is important in preventing infections in healthcare settings. So is the infrastructure that supports it – sinks, faucets and soap and alcohol rub dispensers.

Here are some things you might not know about water and related topics, as they pertain to healthcareacquired infections.

• The location of sinks is more influential than the number of sinks. One study found that each additional meter between the patient’s immediate surroundings and the nearest sink decreased the likelihood of handwashing by 10 percent.

•P athogens can be spread by water splashed from sinks, so water pressure should be optimized and flow should be offset from the drain.

• Sinks designated for handwashing, and not for patient use, can improve hygiene, some studies show.

• It’s true that valves in faucets that automatically turn on and off by themselves can reduce transmission of pathogens by negating the need for users to touch the handle.

But they also have low flow, tepid temperature and internal components (valves) that may harbor biofilm, which can contribute to microbial amplification.

•P aper towels are preferable to warm-air blowers for drying hands, because the towels can be used to turn off the faucet after use and the blowers may spread pathogens. But be careful: Pathogens can be spread by contaminated towel dispensers.

• Alcohol-based hand rub dispensers have been shown to improve hand hygiene compliance.

The optimal location appears to be just outside the doorways to patient rooms. In that location, the dispenser is highly visible and is on the route of the caregiver; the action of entering the room is a trigger for the caregiver to perform hand hygiene.

• Dispensers immediately near or on patient beds also help compliance.

• The design of dispensers is important: A bright color and a design that differentiates the hand rub dispenser from soap dispensers improve usage.

• Plumbing in a healthcare facility can house pathogens. In fact, completely eliminating those pathogens is unlikely. A multidisciplinary water management team should be appointed with the authority to implement water decisions.

These include mapping the water system; analyzing hazards; developing mitigation strategies; establishing metrics; enacting policies that identify hazards; conducting surveillance for disease caused by waterborne pathogens (e.g., pneumonia, bloodstream infections, surgical site infections, meningitis, gastroenteritis and urinary tract infections); and developing a strategy for replacement of current higher-risk premise plumbing problem areas.

• One more thing about water: Those beautiful, soothing, in-hospital water features – water walls, reflecting pools, fountains? Pretty to look at, but avoid them. They represent unacceptable risk in hospitals serving immunocompromised patients, even with standard maintenance and sanitizing methods.

Source: “Using the Health Care Physical Environment to Prevent and Control Infection,” a joint project prepared for the Centers for Disease Control and Prevention by the American Society for Health Care Engineering and several other organizations. (http://www.ashe.org/resources/pdfs/cdc/CDCfullbookDIGITAL.pdf )

The Journal of Healthcare Contracting | June 2019

25

TRENDS

MRSA: The bug all of bugs?

FAQs about methicillin-resistant Staphylococcus aureus, put together by the editors of the Journal of Healthcare Contracting, based on information from the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, and the World Health Organization.

Q: What is MRSA? A: Methicillin-resistant Staphylococcus aureus is a staph infection. Staph is a type of bacteria often found on human skin and on surfaces and objects that touch the skin. While the germ does not always harm people, it can get into the bloodstream and cause serious infections, which can lead to sepsis or death.

Q: How does one get it?

A: The risk for serious staph infection is greatest when people stay in healthcare facilities or have surgery, when medical devices are placed in their body, when they inject drugs, or when they come into close contact with someone who has staph. To reduce the spread of staph in the community, everyone should keep

26

their hands clean, cover wounds, and avoid sharing items that contact skin, like towels, razors, and needles.

Q: How serious is MRSA? A: Serious. More than 119,000 people suffered from bloodstream staph infections in the United States in 2017 – and nearly 20,000 died. (This new data from the Centers for Disease Control and Prevention reflect rates for

June 2019 | The Journal of Healthcare Contracting

70% 70%

Necessary Necessary Necessa ry Necessary Prescriptions Prescriptions Prescriptions

At At least Atleast least

30% 30% 30%

Unnecessary Unnecessary Unnecessary Prescriptions Prescriptions Prescriptions

(Still (Still(Still need need need improve to improve to improve selection, drugdrug selection, selection, dose and duration) dose dose andand and duration) duration)

2

2 22 2 ntsts ts In IInnU.S m eentmen rmtm U.S U.S. Do a p t p ear par . Do . Docto r’s D p y c O ctorc’stor’sO megregnecgnyenDcey De s andd Em OfficOffeficsfiecan er esdan EmdeErm

PREVENT PREVENT PREVENT the development and spread of infections,

the the development development and and spread spread ofof infections, infections, including antimicrobial-resistant bacteria. including including antimicrobial-resistant antimicrobial-resistant bacteria.

Preventing infection is the first stepbacteria. to Preventing Preventing is the is the first first step step to to being a good steward infection of infection antimicrobials.

Prudent infection being being a good a good steward steward of of antimicrobials. antimicrobials.

Prudent Prudent infection infection prevention programs include hand hygiene products, injection 2 prevention prevention programs programs include include hand hand hygiene hygiene products, products, injection injection equipment, and personal protective equipment.

Henry Schein 2 2 equipment, equipment, and and personal personal protective protective equipment. equipment.

Henry Henry Schein Schein has the infection prevention supplies you need, from gloves to has has the the infection infection prevention prevention supplies supplies you you need, need, from from gloves gloves toto soaps,disinfectants, disinfectants, vaccines, and more. vaccines, and more. antimicrobial soaps, antimicrobial antimicrobial soaps, soaps, disinfectants, disinfectants, vaccines, vaccines, and and more. more.

TREAT

the condition with a plan that avoids TREAT TREAT

inappropriate and antibiotics. the the condition condition with with a plan aunnecessary plan that that avoids avoids Antimicrobial stewardship interventions— inappropriate inappropriate and and unnecessary unnecessary antibiotics. antibiotics. deliveringAntimicrobial the right antibiotic or antiviral, at the right dose, at Antimicrobial stewardship stewardship interventions— interventions— the right time, and for the right duration—improve individual delivering delivering the the right right antibiotic antibiotic oror antiviral, antiviral, at at the the right right dose, dose, at at patient outcomes, reduce the overall burden of antibiotic the the right right time, time, and and forfor the the right right duration—improve duration—improve individual individual 5 resistance, and reduce save health care dollars. patient patient outcomes, outcomes, reduce the the overall overall burden burden of of antibiotic antibiotic

DIAGNOSE DIAGNOSE DIAGNOSE quickly and accurately to identify the source

quickly quickly and and accurately accurately toto identify identify the the source source of the infection. of of the the infection. infection.

An inaccurate, incomplete, or late diagnosis AnAn inaccurate, inaccurate, incomplete, oror late late diagnosis diagnosis could lead to the prescription ofincomplete, unnecessary antibiotics, could could lead lead to to the the prescription prescription of of unnecessary unnecessary antibiotics, antibiotics, accelerating the rate at which bacteria become resistant and accelerating accelerating the the rate at at which which bacteria bacteria become become resistant resistant and and putting patients atrate risk for allergic reactions or Clostridium 3 patients putting putting at testing at risk risk forfor allergic allergic reactions reactions or Clostridium Clostridium .patients Rapid lab — especially at theor molecular difficile.

3 3 4 Rapid Rapid lab lab testing testing —— especially especially atfrom at the the molecular difficile. difficile.

Choose a molecular range of level—ensures confident results.

4 4 level—ensures level—ensures confident confident results. results.

Choose Choose from from a range a range of of readers and molecular diagnostics that meet the FDA’s recent readers readers and and molecular molecular diagnostics diagnostics that that meet meet the the FDA’s FDA’s recent recent flu reclassification requirements. fluflu reclassification reclassification requirements. requirements.

1. https://Professional-Practice/Practice-Resources/Antimicrobial-Stewardship https://Professional-Practice/Practice-Resources/Antimicrobial-Stewardship 2. https://www.cdc.gov/infectioncontrol/pdf/outpatient/guide.pdf https://www.cdc.gov/infectioncontrol/pdf/outpatient/guide.pdf 1. https://Professional-Practice/Practice-Resources/Antimicrobial-Stewardship 1. https://Professional-Practice/Practice-Resources/Antimicrobial-Stewardship 3. https://www.cdc.gov/media/releases/2016/p0503-unnecessary-prescriptions.html https://www.cdc.gov/media/releases/2016/p0503-unnecessary-prescriptions.html 2. https://www.cdc.gov/infectioncontrol/pdf/outpatient/guide.pdf 2. https://www.cdc.gov/infectioncontrol/pdf/outpatient/guide.pdf 4. https://www.cdc.gov/mmwr/volumes/65/rr/rr6506a1.htm https://www.cdc.gov/mmwr/volumes/65/rr/rr6506a1.htm 3. https://www.cdc.gov/media/releases/2016/p0503-unnecessary-prescriptions.html 3. https://www.cdc.gov/media/releases/2016/p0503-unnecessary-prescriptions.html 5. https://www.cdc.gov/getsmart/healthcare/evidence.html https://www.cdc.gov/getsmart/healthcare/evidence.html

4. https://www.cdc.gov/mmwr/volumes/65/rr/rr6506a1.htm 4. https://www.cdc.gov/mmwr/volumes/65/rr/rr6506a1.htm 5. https://www.cdc.gov/getsmart/healthcare/evidence.html 5. https://www.cdc.gov/getsmart/healthcare/evidence.html

5 5 resistance, resistance, and and save save health health care care dollars. dollars.

Learn more at www.henryschein.com/asp

Learn Learnmore moreatatwww.henryschein.com/asp www.henryschein.com/asp

TRENDS

The U.S. Department of Veterans Affairs medical centers reduced staph infections by 43 percent between 2005 and 2017 by implementing a multifaceted MRSA prevention program. The program included MRSA screening, use of Contact Precautions, and an increased emphasis on hand hygiene and other infection prevention strategies. all Staphylococcus aureus infections – methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA).

Q: Just how resistant to antibiotics is MRSA? A: Here’s a clue: Many refer to MRSA as a “superbug.” That can’t be good.

Q: Can you be more specific?

A: A 2015 study, published in the Journal of Global Infectious Diseases, reports that more than 95 percent MRSA worldwide do not respond to first-line antibiotics, i.e., amoxicillin, TMP-SMX, or erythromycin.

Several studies have reported MRSA resistance to newer antimicrobial agents like linezolid, vancomycin, teicoplanin, and daptomycin. Pandrug-resistance – i.e., resistance to all antibiotics and drugs in present use – cannot be ruled out, noted the researchers.

Q: Sounds ominous.

A: In 2014, the World Health Organization issued a report, “Antimicrobial resistance: Global report on surveillance 2014,” in which researchers wrote, “A post-antibiotic era – in which common infections and minor injuries can kill – far from being an apocalyptic fantasy, is instead a very real possibility for the 21st Century.”

Q: Is there any good news about MRSA? A: Yes. MRSA bloodstream infections in healthcare settings decreased in the United States by approximately 17 percent each year between 2005 and 2012, according to electronic health record data from more than 400 acute care hospitals and population-based surveillance data from CDC’s Emerging Infections Program. But …

Q: But what?

A: These reductions have recently started to stall. The CDC report showed an almost 4 percent increase in MSSA infections that started outside of a healthcare setting each year from 2012 to 2017. The rise

28

in staph infections in the community may be linked to the opioid crisis. As reported by CDC last year, 9 percent of all serious staph infections in 2016 occurred among people who inject drugs – up from 4 percent in 2011.

To decrease staph infections in people who inject drugs, healthcare providers should link patients to drug-addiction treatment services and provide information on safe injection practices, wound care, and how to recognize early signs of infection.

Q: Are hospitals having any success dealing with MRSA? A: The U.S. Department of Veterans Affairs medical centers reduced staph infections by 43 percent between 2005 and 2017 by implementing a multifaceted MRSA prevention program.

The program included MRSA screening, use of Contact Precautions, and an increased emphasis on hand hygiene and other infection prevention strategies.

Q: “Contact precautions?”

A: As defined by CDC, Contact Precautions are: • Whenever possible, patients with MRSA will have a single room or will share a room only with someone else who also has MRSA. •H ealthcare providers will put on gloves and wear a gown over their clothing while taking care of patients with MRSA.

June 2019 | The Journal of Healthcare Contracting

• Visitors may also be asked to wear a gown and gloves.

• When leaving the room, hospital providers and visitors remove their gown and gloves and clean their hands.

• Patients on Contact Precautions are asked to stay in their hospital rooms as much as possible. They should not go to common areas, such as the gift shop or cafeteria. They may go to other areas of the hospital for treatments and tests.

Q: In February, the Agency for Healthcare Research and Quality (AHRQ) reported on research about reductions in post-hospital MRSA infections. What’s that about?

A: The study – known as Project CLEAR (Changing Lives by Eradicating Antibiotic Resistance) – was published February 14 by the New England Journal of Medicine, and included more than 2,000 patients with MRSA who were discharged from Southern California hospitals between 2011 and 2014. Patients in one group received an educational binder with recommendations for preventing infections via personal hygiene, laundry, and household cleaning. A second group received the same educational materials, but for six months also took steps to remove MRSA from their skin and noses with chlorhexidine antiseptic for bathing, chlorhexidine mouthwash, and the nasal antibiotic ointment mupirocin. Participants in the second group who followed the treatment completely had a 44 percent reduction in MRSA infections and a 40 percent reduction in all infections.

were published in The Lancet, involved about 330,000 adult patients in non-intensive-care units in the HCA Healthcare system. The trial evaluated whether daily bathing with the antiseptic soap chlorhexidine (CHG) – and in those patients with MRSA, adding the nasal antibiotic mupirocin – more effectively reduced hospital-acquired bacterial infections than bathing with ordinary soap and water. While no statistically significant difference between the two intervention groups was seen within the population overall, the researchers did find that one subset of patients – those with medical devices (e.g., central venous catheters or lumbar drains) – experienced a substantial benefit if they received the CHG/mupirocin intervention.

Among that subset of patients, investigators recorded a 30 percent decrease in bloodstream infections and a nearly 40 percent decrease in antibiotic-resistant bacteria, including MRSA and vancomycinresistant enterococcus (VRE), compared to rates seen in similar patients in the standard bathing arm of the trial.

Q: One month later, in March, the National Institutes of Health reported on another study regarding MRSA among hospital patients. What happened?

A: The ABATE (Active Bathing to Eliminate) Infection trial, the results of which

Q: Are patients with medical devices, such as central venous catheters or lumbar drains, especially susceptible to MRSA? A: Yes. In the ABATE trial, although they represented only 12 percent of the total non-ICU patient population, patients such as these accounted for 37 percent of MRSA and VRE clinical cultures and more than half of all bloodstream infections.

The Journal of Healthcare Contracting | June 2019

More than 119,000 people suffered from bloodstream staph infections in the United States in 2017 – and nearly 20,000 died.

29

SPONSORED: MCKESSON

These were the central themes that emerged during two Supply Chain Leadership Forums that McKesson hosted at the 2019 Spring IDN Summit. Healthcare supply chain leaders from across the U.S. discussed their non-acute care strategies, the challenges they face and ideas for successful supply management throughout the continuum of care.

Changing market dynamics

Culture Clash: Supply Chain Leaders Discuss Challenges, Opportunities in the Non-Acute Space Changing market dynamics drive need for greater operational efficiency, visibility and control in supply management beyond the four walls of the hospital While healthcare supply chain professionals have successfully tackled supply challenges in acute-care environments, driving product standardization and contract compliance, and harnessing data and analytics for strategic decisionmaking, the non-acute care space in many ways remains largely up-tapped. This dynamic and diverse collection of care settings – from physician offices to longterm care facilities – have traditionally managed supplies independently through manual processes and disparate systems that restrict visibility and control.

Today, as healthcare organizations increasingly bring non-acute facilities under their corporate umbrellas, they expect their supply chain teams to assume responsibility over this space. But supply chain professionals are quickly realizing that the best practices, processes and technologies they have successfully used within the four walls of hospitals do not apply to the vastly different world of non-acute care.

From a change management perspective, they are also finding that non-acute care clinicians are often unwilling to relinquish control over supply management in fear they will no longer have the supplies they need when they need them.

This culture clash is leading supply chain professionals to question how they can possibly meet the expectation of system-wide supply management, and achieve efficiency and cost savings goals, when they are unable to successfully marry these two vastly different worlds.

30

According to a recent survey conducted by the Health Industry Distributors Association, 71 percent of health systems plan to increase their community footprint by acquiring non-hospital facilities.1 Along with that comes the need for more sophisticated supply chain processes to address the nonacute space. But in many cases, supply chain is engaged too late in the merger and acquisition (M&A) process: “ One of our biggest challenges is being ahead of the growth,” said an executive director of supply chain for a health system in the Northwestern U.S. “We have 300 non-acute care facilities and quite a few of those are small.

Our health system goes out, buys these practices and then expects us to figure out how to make them into a business. Often we are on the backend and have to get caught up on how we can integrate physicians in these groups.”

Culture and change management Acute and non-acute care supply channels have grown up alongside each other over the years with very little overlap, resulting in vastly different cultures among stakeholders – and diverse views of supply management. Those non-acute clinicians that have built their own practices and have managed every aspect of them, including supply

June 2019 | The Journal of Healthcare Contracting

management, can be resistant to allowing their acquirer’s supply chain team to intervene.

“The greatest challenge is culture change,” said the system vice president for a health system in the Southeastern U.S. “They (physicians) are unwilling to let go because they are used to doing their own thing.”

Greg Colizzi, vice president of health systems marketing, McKesson, who led the forums, presented a magazine article from 1968 on the rising cost of healthcare, and the desire to push care outside of the hospital and into non-acute settings. The article, published 51 years ago, addressed many of the same issues health systems are still facing today, including the need to disengage clinicians from day-today clerical activities. Colizzi addressed the forum participants saying: “ Culture is a part of your responsibility that many people overlook but it can have a tremendous impact on your ability to get things done. In the non-acute space, you need to develop a value proposition, so clinicians understand how they will benefit from supply chain involvement.”

Greatest waste is not supply cost, it’s time Forum participants discussed how the opportunities for improvements and savings on the nonacute side have less to do with product cost, and more about driving greater operational efficiency and staff productivity. The responsibility for supply management outside of the hospital has fallen on clinicians who have no formal supply chain training. When supply chain professionals assume responsibility for supply management in the non-acute space, it frees up clinicians’ time to focus on patients. It also opens the door for supply chain to drive cost-savings initiatives around contracting and standardization.

Those in the forum added that supply standardization in the non-acute space presents the opportunity to not only cut costs but also

The Journal of Healthcare Contracting | June 2019

support patient care. The vice president of supply chain for a health system in the Mid-Atlantic region with 150 non-acute facilities, including five nursing homes, explained how product choices on the non-acute side can financially impact the overall health system when patients are readmitted to the hospital for unreimbursed conditions. He stated: “ The biggest challenge we are facing on the non-acute side is managing the total cost of care. We have been picking up a lot of physician practices that are using different products and technologies, which can often cause problems for the acute care facilities, such as rates of readmissions.”

The challenge of contracting As supply chain peels back the layers of the non-acute care facilities their organizations have acquired, they typically discover that contracting arrangements – both group purchasing organization (GPO) and local contracts – are quite different from those in the acute space. Forum participants spoke of the challenges of different pricing for the same products based on class of trade, and the opportunity to generate organization-wide savings by negotiating a single price for a product regardless of care setting.

They have also found contract compliance is far lower on the non-acute sides of their businesses. While 80+ percent compliance is typical among hospitals, in non-acute care the average is between 40-50 percent. This too represents an area where supply chain professionals can make a significant impact, if they can overcome long-held beliefs, practices and processes in the non-acute space. One supply chain leader stated: “ We have embarked on a journey to determine how we can ensure the pricing we negotiate is getting all the way through to non-acute. Each time we acquire a new facility, we bring in their bad habits and they are not excited about changing. We are having a tough time just getting the non-acute care organizations to even understand why we track their utilization of anything.”

The need for technology and data Those supply chain leaders in attendance acknowledged that in order for them to help improve operational, clinical and financial outcomes in the non-acute care environment, they need the level of sophistication, visibility and control they currently have in the acute care space.

This cannot be achieved through the manual processes, disconnected information technology (IT) systems and disparate data that supply chain professionals today encounter outside of the hospital. The only way for health systems to align the supply chains of their non-acute acquisitions with their broader operations is to utilize technology designed specifically for the needs of each care setting, automates processes, generates data for advanced analytics and data-driven decision-making, and integrates with the health systems ERP.

31

SPONSORED: MCKESSON

“When managing 200+ non-acute sites the savings opportunity isn’t related to the ‘price at the pump’ but rather in how we use the products,” said one forum participant. “What we need is a program that enables us to aggregate all of those sites so we can look at products, how we use them and establish a best practice model for savings.”

Colizzi pointed out that while the non-acute environment can benefit from some of the best practices applied in the acute space, such as process automation and standardization, it is not so simple as extending supply chain practices out from the hospital, stating: “ W hile supply chain encounters some variation among departments within a hospital, the differences vary widely from one non-acute facility to another, even within the same category of facility. You need to figure out the right model for

each individual non-acute care setting because they all have unique requirements. There is no one size fits all approach.”

Each year McKesson hosts a number of Supply Chain Leadership Forums to help leaders connect with others who are either building or in the process of implementing their non-acute strategy. If you are interested in participating in a future Forum, please provide your contract information to the McKesson health systems marketing team at mms.healthsystems@mckesson.com.

1. T he Quest for Price Parity: How to Align Hospital and Non-Hospital Location’s Cost Containment Strategies, Decision Resources Group, https://www.healthcarebusinessinsights.com/blog/supply-chain/quest-price-parity-align-hospital-non-hospital-locations-cost-containment-strategies/

There is no “one size fits all” solution for non-acute If the management of supplies within the four walls of a hospital seems challenging, with the wide range of clinical departments and stakeholders, then assuming control over the non-acute supply chain, where each standalone facility has its own teams, processes, formularies and contracts, appears impossible.

Yet successful supply chain management in the non-acute space is achievable and can yield significant savings in terms of greater process efficiency and standardization. Before a supply chain team can implement a strategy, it must first understand the unique needs of each facility. Below are some general guidelines on challenges in supply management for five categories of non-acute care.

Ambulatory Surgery Centers • High supply volume • Limited storage space • Predictable utilization • Low unit of measure • Frequent deliveries • Need for consignment inventory management Physician Practices • Low supply volume • Small units of measure (UOM) • L ow supply spend but high labor costs • Variety of specialty products (e.g. Med/Surg, lab, Rx, office supplies)

Urgent Care • Wide breadth of services (from routine care to emergencies) • Broad spectrum of supplies (from bandages to imaging equipment) • Unpredictable utilization and volumes Laboratory • Involved in 70% of medical decisions • Unique needs such as sequestration, cold chain • Fragmented distribution

Home and Long-Term Care • Wide reach – all the way through to a patient’s home • Complex inventory tracking requirements • Clinicians heavily involved in supply management • High hospital readmission rates • Revenue leakage from low product/charge capture • Tremendous opportunity for supply chain as more care is delivered in the community

*The Impact of Diagnostics on Healthcare Outcomes, Health Industry Distributors Association.

32

June 2019 | The Journal of Healthcare Contracting

The non-acute continuum is complicated.

We’ve got your roadmap.

Did you know 34% of health system leaders say that aligning

McKesson can help

their non-acute supply chain is their biggest challenge?*

you take control of:

Supply chain leaders are challenged with balancing the many needs of their non-acute facilities — from surgery centers to doctors’ offices to long-term care facilities and even to patients’ homes. McKesson can help you implement comprehensive strategies that drive out costs and provide better care across the non-acute continuum.

McKesson.com/TakeControl Medical-Surgical. Pharmaceutical. Lab. Equipment. © 2019 McKesson Medical-Surgical Inc. All rights reserved. *HIDA Hospital And Health System Provider Survey, June 2018.

Read our article in this month’s issue to learn how you can implement a winning non-acute strategy.

• Operations • Analytics • Process Automation • Supply Cost Management • Visibility • Standardization • Post-Acute Care • Laboratory • Pharmaceuticals • Leading Change

TRENDS

A new kind of medical school for a new kind of doctor Kaiser Permanente School of Medicine to begin accepting applications in June The Kaiser Permanente School of Medicine was set to accept applications from prospective students in June 2019, with the intention of opening the doors to its first class in the summer of 2020. It will waive all tuition for the full four years of school for its first five classes.

“Our students will learn to critically examine factors that influence their patients’ health in their homes, workplaces, schools, and communities – and become effective health advocates for their patients,” said Mark Schuster, M.D., PhD, founding dean and CEO of the school, to be located in Pasadena, Calif.

The school intends to provide students with clinical experiences in Kaiser Permanente’s integrated healthcare system, starting at the beginning of their

34

first year. It will use a small-group, case-based medical curriculum designed to prepare future physicians to become collaborative, transformative leaders committed to prevention, fluent in data-driven care, and adept at addressing the needs of underserved patients and communities, according to Kaiser Permanente.

Kaiser Permanente says that the school’s senior leaders have built a curriculum that integrates the school’s three academic pillars: Foundational Science, Clinical Science, and Health Systems Science, a discipline that studies care delivery from structural, organizational and interpersonal perspectives, and includes topics such as population health, social inequality, and quality improvement. The core of the curriculum will consist of case-based learning, in which students in faculty-facilitated small groups combine knowledge from each of the three pillars and apply it to promoting health, understanding illness, and providing care.

Another feature of the school will be its Longitudinal Integrated Clerkship (LIC) model of clinical education. First-year students will work with primary care preceptors all year, giving them the opportunity to form relationships with patients and clinical mentors over time. Second-year students will continue in their primary care LICs and will also participate in LICs in obstetrics and gynecology, pediatrics, psychiatry, and surgery.

Third- and fourth-year clinical education will be dedicated to the students’ exploration of potential specialties and other areas of interest.

June 2019 | The Journal of Healthcare Contracting

INOMAX® (NITRIC OXIDE) GAS, FOR INHALATION

Because Every Moment Counts

INCLUD ALL ED * S ’ IT

IT

INOmax Total Care®

C

A complete system with comprehensive care is included in your INOmax Total Care contract at no extra cost.

When critical moments arise, INOmax Total Care is there to help ensure your patients are getting uninterrupted delivery of inhaled nitric oxide.

• Over 18 years on market with over 700,000 patients treated1 • Continued innovation for delivery system enhancements • Emergency deliveries of all INOmax Total Care components within hours† • Live, around-the-clock medical and technical support and training • Ongoing INOMAX® (nitric oxide) gas, for inhalation reimbursement assessment and assistance included in your INOMAX contract (Note: You are ultimately responsible for determining the appropriate reimbursement strategies and billing codes)

Indication INOMAX is indicated to improve oxygenation and reduce the need for extracorporeal membrane oxygenation in term and near-term (>34 weeks gestation) neonates with hypoxic respiratory failure associated with clinical or echocardiographic evidence of pulmonary hypertension in conjunction with ventilatory support and other appropriate agents.

Important Safety Information • INOMAX is contraindicated in the treatment of neonates dependent on right-to-left shunting of blood.

2017 EMERGENCY

DELIVERIES L INCL

1

UD ED

IT

CONTRACT

C

AL DRUG &’SDEVICE IT

2,700+ IN YOUR NO EXTRA COST

• In patients with pre-existing left ventricular dysfunction, INOMAX may increase pulmonary capillary wedge pressure leading to pulmonary edema.

• Monitor for PaO2, inspired NO2, and methemoglobin during INOMAX administration.

• INOMAX must be administered using a calibrated INOmax DSIR® Nitric Oxide Delivery System operated by trained personnel. Only validated ventilator systems should be used in conjunction with INOMAX.

• The most common adverse reaction is hypotension.

• Abrupt discontinuation of INOMAX may lead to increasing You are encouraged to report negative side effects pulmonary artery pressure and worsening oxygenation. of prescription drugs to the FDA. Visit MedWatch or • Methemoglobinemia and NO2 levels are dose dependent. call 1-800-FDA-1088.

Nitric oxide donor compounds may have an additive Please visit inomax.com/PI for Full Prescribing effect with INOMAX on the risk of developing Information. methemoglobinemia. Nitrogen dioxide may cause airway inflammation and damage to lung tissues.

Visit inomax.com/totalcare to find out more about what’s included in your contract. *INOmax Total Care is included at no extra cost to contracted INOMAX customers. †Emergency deliveries of various components are often made within 4 to 6 hours but may take up to 24 hours, depending on hospital location and/or circumstances.

Reference: 1. Data on file. Hampton, NJ: Mallinckrodt Pharmaceuticals.

Mallinckrodt, the “M” brand mark and the Mallinckrodt Pharmaceuticals logo are trademarks of a Mallinckrodt company. Other brands are trademarks of a Mallinckrodt company or their respective owners. © 2018 Mallinckrodt US-1800073 August 2018

INOmax®(nitric oxide gas)

Brief Summary of Prescribing Information INDICATIONS AND USAGE Treatment of Hypoxic Respiratory Failure INOmax® is indicated to improve oxygenation and reduce the need for extracorporeal membrane oxygenation in term and near-term (>34 weeks) neonates with hypoxic respiratory failure associated with clinical or echocardiographic evidence of pulmonary hypertension in conjunction with ventilator support and other appropriate agents.

CONTRAINDICATIONS INOmax is contraindicated in neonates dependent on right-to-left shunting of blood.

WARNINGS AND PRECAUTIONS Rebound Pulmonary Hypertension Syndrome following Abrupt Discontinuation Wean from INOmax. Abrupt discontinuation of INOmax may lead to worsening oxygenation and increasing pulmonary artery pressure, i.e., Rebound Pulmonary Hypertension Syndrome. Signs and symptoms of Rebound Pulmonary Hypertension Syndrome include hypoxemia, systemic hypotension, bradycardia, and decreased cardiac output. If Rebound Pulmonary Hypertension occurs, reinstate INOmax therapy immediately.

Hypoxemia from Methemoglobinemia Nitric oxide combines with hemoglobin to form methemoglobin, which does not transport oxygen. Methemoglobin levels increase with the dose of INOmax; it can take 8 hours or more before steadystate methemoglobin levels are attained. Monitor methemoglobin and adjust the dose of INOmax to optimize oxygenation.

If methemoglobin levels do not resolve with decrease in dose or discontinuation of INOmax, additional therapy may be warranted to treat methemoglobinemia.

Airway Injury from Nitrogen Dioxide Nitrogen dioxide (NO2) forms in gas mixtures containing NO and O2.

Nitrogen dioxide may cause airway inflammation and damage to lung tissues.

If there is an unexpected change in NO2 concentration, or if the NO2 concentration reaches 3 ppm when measured in the breathing circuit, then the delivery system should be assessed in accordance with the Nitric Oxide Delivery System O&M Manual troubleshooting section, and the NO2 analyzer should be recalibrated. The dose of INOmax and/or FiO2 should be adjusted as appropriate.

Worsening Heart Failure Patients with left ventricular dysfunction treated with INOmax may experience pulmonary edema, increased pulmonary capillary wedge pressure, worsening of left ventricular dysfunction, systemic hypotension, bradycardia and cardiac arrest. Discontinue INOmax while providing symptomatic care.

36

ADVERSE REACTIONS Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

The adverse reaction information from the clinical studies does, however, provide a basis for identifying the adverse events that appear to be related to drug use and for approximating rates.

Controlled studies have included 325 patients on INOmax doses of 5 to 80 ppm and 251 patients on placebo. Total mortality in the pooled trials was 11% on placebo and 9% on INOmax, a result adequate to exclude INOmax mortality being more than 40% worse than placebo.

In both the NINOS and CINRGI studies, the duration of hospitalization was similar in INOmax and placebo-treated groups.

From all controlled studies, at least 6 months of follow-up is available for 278 patients who received INOmax and 212 patients who received placebo. Among these patients, there was no evidence of an adverse effect of treatment on the need for rehospitalization, special medical services, pulmonary disease, or neurological sequelae.

In the NINOS study, treatment groups were similar with respect to the incidence and severity of intracranial hemorrhage, Grade IV hemorrhage, periventricular leukomalacia, cerebral infarction, seizures requiring anticonvulsant therapy, pulmonary hemorrhage, or gastrointestinal hemorrhage.

In CINRGI, the only adverse reaction (>2% higher incidence on INOmax than on placebo) was hypotension (14% vs. 11%).

Based upon post-marketing experience, accidental exposure to nitric oxide for inhalation in hospital staff has been associated with chest discomfort, dizziness, dry throat, dyspnea, and headache.

DRUG INTERACTIONS Nitric Oxide Donor Agents Nitric oxide donor agents such as prilocaine, sodium nitroprusside and nitroglycerine may increase the risk of developing methemoglobinemia.

OVERDOSAGE Overdosage with INOmax is manifest by elevations in methemoglobin and pulmonary toxicities associated with inspired NO2. Elevated NO2 may cause acute lung injury.

Elevations in methemoglobin reduce the oxygen delivery capacity of the circulation. In clinical studies, NO2 levels >3 ppm or methemoglobin levels >7% were treated by reducing the dose of, or discontinuing, INOmax.

Methemoglobinemia that does not resolve after reduction or discontinuation of therapy can be treated with intravenous vitamin C, intravenous methylene blue, or blood transfusion, based upon the clinical situation.

INOMAX® is a registered trademark of a Mallinckrodt Pharmaceuticals company. © 2018 Mallinckrodt. US-1800236 August 2018

June 2019 | The Journal of Healthcare Contracting

By David Forbes, HIDA Director, Healthcare Supply Chain Collaborative Getting the Most from Your Most Important Supplier

Pricing Accuracy in Practice One of my proudest achievements during my Mercy Health Services tenure was the level of collaboration achieved with our vendor partners. During the April Contract Administration Conference, I had the privilege to share the stage with Medline Industries President of Distributed Products Bill Abrams to discuss the 98.4% pricing accuracy rate earned by each team’s commitment to partnership, hard work, and focus.

Step one of this successful pricing accuracy program was simply deciding to tackle the issue. Both of us, Mercy and Medline, saw an efficiency improvement opportunity, and we decided to do better. Staff was dedicated on both sides to enrich and maintain master data (including part numbers, contract number and tier information, pricing, and units of measure) in a way that ensured each company’s systems matched. After a recent contract award and timed with its launch, my team provided Medline a data dump of all items procured through Medline; Medline then layered in what they had loaded as item-level attributes. After a couple of iterations, our organizations agreed to a single source of truth.

Since this initial data load, Mercy and Medline has met on a weekly basis to both pre-load all known future price changes and correct any price discrepancies in the moment. Contract eligibility discrepancies were often resolved by the Mercy and Medline staff calling manufacturers on the fly together; when this was not the case, Medline would hold discrepant invoices for up to 21 days to prevent unnecessary credit and rebills.

In order for this collaboration to be successful, Mercy had to work through a substantial system challenges, most notably a supply chain

HIDA PRIME VENDOR:

information system that experienced its most recent major update in 1994. Creativity and hard work supplemented the fact this system did not have data upload capabilities or the ability to load data prior to real-time. Discrete steps included leveraging macro software to get the data in and loading the initial source of truth in between orders and on a Saturday.

This was one trade partnership case study of many from my time at Mercy, and I am beyond excited to foster industry-wide collaboration in my new role with HIDA. A supply chain is only as efficient and effective as the various players are collaborative, and in the

unique economic and policy environment that is healthcare efficiency and effectiveness are paramount. Whether you are a provider, distributor, manufacturer, or GPO, we each have ownership in a process that leads to high quality, value-based patient care.

For more information about HIDA’s Supply Chain Collaborative designed to address and solve longstanding supply chain issues, don’t hesitate to reach out to me at forbes@hida.org.

About David David Forbes served as the Director, Value Analysis, and Director, Contracting Services, for Mercy, an IDN based in Baltimore, Maryland, after spending time in both supply chain consulting and residential home building. David will leverage this provider- and industry-based experience in his new role at HIDA as Program Director, Healthcare Supply Chain Collaborative, by focusing on the development of industry-level standards in contract administration, e-commerce, and supply chain visibility for the purpose of creating a more effective and efficient supply chain.

The Journal of Healthcare Contracting | June 2019

37

SPONSORED: HEALTH O METER® PROFESSIONAL SCALES

Is it Really Just a Bath Scale?

Quality healthcare doesn’t end just because a patient is at home.

Due to recent changes in Medicare reimbursement of patient weight scales and an increased focus on athome weight measurements, healthcare providers, IDNs and home health companies are seeking quality professional home care scales. Professional home care scales are needed for a variety of patients such as participants in physician monitored weight loss programs, patients with congestive heart failure or those with nutritional problems. Though these scales are intended for home use, patients still need a quality professional medical scale. Providers then require an educated sales representative to teach them about the importance of purchasing quality scales for their programs, which in some cases have thousands of participating patients – a huge earning opportunity for you.

38

June 2019 | The Journal of Healthcare Contracting

SPONSORED: HEALTH O METER® PROFESSIONAL SCALES

Inexpensive, retail-quality bathroom scales pose several potential problems for the user and in turn, pose problems for the provider of the scale. The simple, and usually poor design of these inexpensive scales is not suitable for use with the aging adult population or for home health use where precise and accurate weight measurements are critical.

Design elements such as the scale’s feet, placement of electronics, and size of the platform can affect both stability and accuracy. Feet that are small in diameter or height cannot adequately support or protect the scale. Accuracy is also affected with poorly designed feet and made worse if the scale’s electronics are placed below the bottom of the scale platform. The ideal professional home scale has large stable feet built into the scale with electronics located inside the platform. This design protects the scale from water damage and provides more accurate weight readings when used on carpet. In addition to well-designed feet, stability can be increased by the design of the scale’s platform. A wide platform allows patients to find a comfortable and secure stance to help maintain their balance. Platforms with a textured, non-slip surface can provide a stable foothold and traction.

Along with evaluating a scale’s design, healthcare providers need to consider the manufacturer of the scale. For optimum safety and accu-

A medical scale manufacturer has the knowledge and expertise to design a product that withstands the conditions of the scale’s intended use and provides additional benefits to the user.

racy, patients need a medical-grade professional home care scale from a manufacturer that specializes in healthcare products. Reputable medical scale suppliers are ISO 13485:2016 certified and manufacture their products in FDA-registered factories. ISO 13485 applies specifically to medical devices and assures the company operates under strict quality standards by means of a thorough quality management system. A medical scale manufacturer has the knowledge and expertise to design a product that withstands the conditions of the scale’s intended use and provides additional benefits to the user. Purchasing products from a reliable healthcare supplier can give the provider peace of mind when supplying the scales to their patients.

Whether the provider’s program needs 10 units or 10,000, Health o meter® Professional Scales provides the products and support that you and your customers need. Under the audited ISO management system, Health o meter® Professional home care scales undergo strict medical level quality testing at the company’s FDA-registered factories. The company also has the industry’s highest rated Customer Service with customer calls answered within 15 seconds, calls that you or your corporate headquarters do not have to field. And as the #1 Medical Scale brand in the U.S., Health o meter® Professional Scales understands how to design professional home care scales with the best features producing optimal functionality.

Talk to your accounts about their needs for professional home care scales and explain the importance of providing a quality, medicalgrade scale for their patients. When choosing the right brand for their at-home patient scale programs, choose the brand that makes it weigh easier for you, the provider, and the patient, Health o meter® Professional Scales.

Visit www.homscales.com or call 1-800-815-6615.

40

June 2019 | The Journal of Healthcare Contracting

HSCA

Meet the President The Healthcare Supply Chain Association introduced its new president and CEO this spring. She is national healthcare expert Khatereh Calleja.

Calleja joins HSCA from AdvaMed, the world’s largest association representing manufacturers of medical devices, diagnostic products, and medical information systems, where she served as senior vice president of technology and regulatory affairs.

“Khatereh has been at the “The value that forefront of some of the most GPOs deliver to critical healthcare debates in providers, Medicare Washington, and her profound and Medicaid, knowledge of health policy, her passion for communicating about and taxpayers is the value of the supply chain, and indispensable in her reputation as a bridge-builder today’s evolving in Washington will help drive our healthcare advocacy on behalf of the supply landscape.” chain and the providers and pa– Khatereh Calleja tients we serve,” said Lee Perlman,

The Journal of Healthcare Contracting | June 2019

GNYHA Ventures president and HSCA board chair. “The entire supply chain will benefit from Khatereh’s leadership, forward-looking vision, and deep healthcare expertise, and we are thrilled that Khatereh has chosen to begin the next chapter of her outstanding career as the head of HSCA.” “The value that GPOs deliver to providers, Medicare and Medicaid, and taxpayers is indispensable in today’s evolving healthcare landscape,” said Calleja. “I look forward to being a strong voice for the healthcare supply chain in Washington and serving as a resource to policymakers and partner to all supply chain stakeholders.”

While at AdvaMed, Calleja led a wide range of policy and legal-regulatory priorities focusing on Congress, the Department of Health and Human Services, the U.S. Food and Drug Administration, the Federal Trade Commission, and the administration. Prior to AdvaMed, she established and led the Washington office of the American Society of Plastic Surgeons. She also previously directed legislative and regulatory affairs outreach activities at the American Academy of Otolaryngology and has worked closely with Congressional committees and regulatory agencies in several capacities. She is a graduate of Emory University and the Villanova University School of Law. Outgoing HSCA President and CEO Todd Ebert, R.Ph., is retiring and moving back to St. Louis after a distinguished career in healthcare spanning more than four decades.

“Todd Ebert has been a leading and deeply respected voice in healthcare throughout his 40+ year career – first as a pharmacist, then as the CEO of a leading group purchasing organization, and ultimately as President and CEO of HSCA,” said Perlman. “We are grateful to Todd for his leadership, service to the industry, and friendship, and for all he has done to move the organization and the industry at large forward.”

41

Send all upcoming events to Graham Garrison, managing editor, at ggarrison@sharemovingmedia.com

CALENDAR

AHRMM AHRMM Conference & Exhibition July 28-31, 2019 San Diego, Calif.

GHX Supply Chain Summit April 27 – 29, 2020 Gaylord National National Harbor, Md.

Health Connect Partners Fall ’19 Hospital Supply Chain Conference September 23-25, 2019 Kansas City, Mo. Spring ’20 Hospital Supply Chain Conference March 16-18, 2020 New Orleans, La.

HealthTrust HealthTrust University Conference August 12-14, 2019 Nashville, Tenn.

Intalere Elevate 2019 May 13-16, 2019 Gaylord Rockies Denver, Colo.

Premier Breakthroughs Conference & Exhibition June 18-21, 2019 Nashville, Tenn.

Share Moving Media IDN Insights East May 16-17, 2019 Nashville, Tenn.

National Accounts Summit November 14-15, 2019 Atlanta, Ga.

Vizient Vizient Fall Connections Summit September 16-20, 2019 The Wynn, Las Vegas, Nevada

IDN Summit Fall IDN Summit & Reverse Expo September 9-11, 2019 JW Marriott Desert Ridge Resort and Spa Phoenix, Ariz.

Spring IDN Summit & Reverse Expo April 27-29, 2020 Omni Orlando Resort at ChampionsGate Orlando, Fla.

42

June 2019 | The Journal of Healthcare Contracting

CALENDAR

HealthTrust to celebrate platinum anniversary at HTU19 HealthTrust will host its annual membership conference, HealthTrust University (HTU), back home where it all started 20 years ago – Nashville, Tennessee. More than 4,000 members, exhibitors, board advisors, speakers and staff are expected to attend HTU and its Vendor Fair, Aug. 12–14 at the Gaylord Opryland Resort & Convention Center.

Dozens of general and education sessions are planned, allowing executives and health professionals in nursing, pharmacy and supply chain opportunities to earn continuing education credits. Among the keynotes will be John “Jocko” Willink, former Navy SEAL and CEO & co-founder of Echelon Front; and Sekou Andrews, creator of Poetic Voice. Headline entertainers Vince Gill, Jeffrey Steele and others will add excitement each evening as HealthTrust celebrates its platinum anniversary in the Music City.

The Journal of Healthcare Contracting | June 2019

A highlight of HTU each year is CEO Ed Jones recognizing members for excellence across a number of supply chain dimensions. Jones will present HealthTrust’s highest honor – a Member Recognition Award – to a number of member organizations. Chief Medical Officer John J. Young, MD, will award the annual HealthTrust Innovation Grant. And COO Michael Berryhill will recognize supplier excellence as well as announce the Supplier of the Year.

43

PEOPLE

Bringing the Energee!

Teamwork and leadership on an NBA dance team Lisa Fohey, supply chain director of deployment readiness for Advocate Aurora Health in Milwaukee, insists she’s not an athlete in the traditional sense of the word. Yes, she played soccer and ran cross country in high school.

But she was always JV. “I won just one race, and that was because I was the only runner,” she recalls.

But she loves to be active. For example, in 1983, a friend opened an aerobics studio in Milwaukee and taught her how to be an instructor. “It was a match made in heaven,” says Fohey, who still teaches a couple of classes today. It was at that aerobics studio in 1990 that she learned about auditions for the Energee!

44

Dance Team, which, at the time, was the official dance team of the NBA Milwaukee Bucks.

She was 27 and had never been trained as a dancer (though her mother has a photo of her daughter with 11 other three-year-olds in tutus, no two of whom are doing the same thing). But she thought learning hiphop might be a blast. So she went to a couple of practice sessions before auditioning for the team one evening at the Italian Community Center in Milwaukee.

She recalls being “nervous as all heck” that evening, and fairly certain she wouldn’t make the team. But the atmosphere during the tryout was

June 2019 | The Journal of Healthcare Contracting

Change Your Vue Introducing the next generation of Ultrasound Gel Innovative and Ergonomic Packaging The patented FlexPac® is designed for ease of use and functionality. The flexible packaging reduces gel waste by up to 14% over traditional packaging and lessens Co2 emissions.

Sustainable and Natural Gel

EcoVue® is the most environmentally-friendly gel on the market—it is produced from 97.8% natural ingredients. There are no dyes in the gel.

Paraben & Propylene Glycol Free

EcoVue® has no parabens and is propylene glycol free—a key cause of probe delamination which can lead to costly replacements.

Acoustic Velocity

EcoVue® allows acoustic velocity to remain constant when heated to 40⁰C. Heat has little to no effect on gel performance.

Optimal Viscosity

EcoVue® gel is the optimal viscosity and appropriate for use in any procedure where ultrasound gel is required or recommended.

Safety

EcoVue® complies with the FDA recommendation to avoid refilling ultrasound gel containers—a practice that has been linked to crosscontamination in healthcare environments. All EcoVue® products have tamper evident mechanisms where required.

Post-Procedure Care

Ergonomically designed for ease-of-use, the eco-friendly FlexPac® creates higher product-topackage ratio reducing waste and improving sustainability. Designed with patient safety in mind, our non-refillable & single use products will forever Change Your Vue of ultrasound gel.

EcoVue.com

EcoVue® gel provides for a quick and easy cleanup and leaves no sticky residue.

Health Safety

EcoVue® is FDA approved and is California Prop65 compliant. EcoVue® offers a Kosher and Halal religious certification for quality.

Made in the USA EcoVue® is made with domestically sourced ingredients and manufactured in York, PA

PEOPLE

collegial. “We were all there to have a great time,” she says of the women who were auditioning. To her surprise, she was admitted to the team for the 1990-1991 basketball season, and danced through 1993. (She served as the team’s personal trainer and assistant coach for several years after that.)

It was a great time to be on the Energee! Team, she says. For one thing, the team was only in its second year, so expectations on the part of fans were still moderate. Yet at the same time, the basketball industry was waking up to the fact that games had to be more than games.

The quality of entertainment for fans – and ways to engage them – was beginning to come into play.

For the Bucks, that meant introducing Streetlife (a band), Bango

“She was looking at what our arms were doing, what our legs were doing. It was kind of like artwork.” (the mascot) and of course, Energee! (They were to be followed

by Hoop Troop, Juniorgee!, Seniorgee!, Flashmobs, Rim Rockers, Street Dancing team, a drumline and full production professional half time shows.)

Work/life balance Being an Energee! Dancer was a challenge for Fohey’s work/life balance. She had a full-time day job as a logistics manager at Children’s Hospital in Milwaukee in addition to her aerobics gig. Energee! practice consumed up to eight hours a week. Add to that many hours of practice on her own. Because she wasn’t a trained dancer, Fohey got permission to videotape routines so she could study them at home.

Occasionally she would sit on the sidelines during practice and take notes, then go to the aerobics studio for some practice time.

“It was absolutely a labor of love.”

Come game day, she and teammates would arrive a couple of hours early, learn the music, walk through their routines, and run through anything that needed fine-tuning. Dressed, with makeup applied and hair

46

done, the women would wait in the tunnel to be called to the floor for their particular timeouts. “Some of us were nervous, others didn’t seem fazed at all,” she recalls. “I think it was just excited anticipation.”

Perhaps the coolest part of game days were the routines the team performed in the fourth quarter. As opposed to the earlier timeouts, the women were never sure what they were going to do when they came out onto the floor. The music would come on, the dancers would train their eyes on the leader, who would call the formation and routine using hand and arm signals.

“I really appreciate the things I learned from the coaches and choreographer,” she recalls. Director Lois Wagner Koepke had the ability to visualize the choreography from floor level as well as the top seats. “She was looking at what our arms were doing, what our legs were doing. It was kind of like artwork,” says Fohey.

Fohey still gets together with dance team alumni. Perhaps not surprisingly, quite a few of them have daughters of their own who dance or participate in gymnastics or general fitness activities.

Her friendships are just one thing she carries with her from Energee!. Another is her appreciation for strong leadership, such as the kind she experienced on the dance team. And closely related to that: Teamwork.

“We offered each other a lot of encouragement,” she says. “We wanted everyone to be able to do the routine as well as the next person.” She likens the dance team to a fighter jet formation. “We always had to be looking side to side, to the people next to us.

“I’m lucky that I have had a couple of really empowering experiences,” going all the way back to Girl Scouts. “I really value the friends I’ve made and the camaraderie.” And she enjoys hearing and reading their success stories.

“Motivating and inspiring.”

June 2019 | The Journal of Healthcare Contracting

DEDICATION makes all the difference.

Partnering with Terumo brings our expertise and care to you, your clients and ultimately where it matters most.

Our SurGuard®3 safety hypodermic needle offers some very convincing benefits.

Decrease healthcare costs: 20%* less expensive than the leading hinged safety hypodermic product.

Standardize operations: A broad range of product sizes and three modes to meet every clinician’s style make it simpler to standardize with Terumo.

Improve patient outcomes: Patients benefit from a more comfortable injection, as our needles are 10%* sharper than the market leader.

Increase OSHA compliance and reduce liability: Safety mechanism includes a lock for both the needle and hub, and is designed to minimize the ability to be removed.

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-0325-11152017. *Data on file. Terumo Medical Products, April 2016.

VENDOR CREDENTIALING

Next Steps An industrywide consortium took a big step this winter in its quest to bring uniformity to the vendor credentialing process.

In January, the Consortium for Universal Healthcare Credentialing (C4UHC) successfully completed the process of certification to develop ANSI (American National Standards Institute) standards for healthcare supplier credentialing through NEMA, an ANSI-standards-setting body.

ANSI is the U.S. leader for standards development, says Dennis Orthman, consulting director for C4UHC. “Standards are only certified by ANSI if very specific criteria and processes are followed in their creation,” he says.

“As required by ANSI, the Consortium’s standards development process involved all stakeholder groups in an open and transparent discussion. Formal votes were taken, and consensus was reached. In the case of ANSI/ “Virtually every piece NEMA SC1 2019 Standards for Supof medical equipment plier Credentialing in Healthcare, over – and the hospital 45 different stakeholder entities were involved, including healthcare providelectrical systems they ers, suppliers, distributors, and others. are plugged in to – used “The Consortium could not be hapin the delivery of care of pier with what has been accomplished, the patient conforms to and the process used to get there.”

NEMA is the association of elecANSI/NEMA standards. trical equipment and medical imaging This enhances the ease of manufacturers, and is one of numeruse and promotes safety, ous standard-setting bodies that are among other things.” part of ANSI. Its connection to vendor credentialing is a natural one.

– Dennis Orthman, consulting director, C4UHC “Many healthcare providers and suppliers already conform to ANSI/ NEMA standards, so there should be some familiarity for credentialing,’ says Orthman. “Virtually every piece of medical equipment – and the hospital electrical systems they are plugged in to – used in the delivery of care of the patient conforms to ANSI/NEMA standards. This enhances the ease of use and promotes safety, among other things. If every piece of equipment had a different plug and did not have to meet fire and electrical safety minimums, think what that would mean to everyone?

“We would like supplier credentialing to look more like standardized and interoperable electrical components versus [its current state].”

48

Reps’ personal information protected Adopting the ANSI standards will minimize the exposure of personal and sensitive information from suppliers’ employees, according to the Consortium.

The adoption of ANSI standards require suppliers to work with their providers of background checks and other information to ensure that they also meet the ANSI/NEMA SC1 2019 standard, explains Orthman. Suppliers then can communicate that their employee has met the requirement to the ANSI/NEMA SC1 standard with no need to send source documentation, personal information, or sensitive health information, minimizing the exposure of personal information.

“Adherence to the standard protects not only the individuals, but any entity that comes in contact with the information, thus reducing the risk of exposure or the inappropriate use of the information,” he says. “As with other standards, audits will be conducted to ensure that the organization is conforming to the standard, or they will no longer be allowed to state that they are compliant to ANSI standards.

“The next steps are to include additional stakeholders in the continuum of supplier credentialing to show the true value of standardized and interoperable credentialing. Ultimately this will benefit us all, either in our professional roles, or as patients.”

The Consortium for Universal Healthcare Credentialing is the successor organization to the Coalition for Best Practices in Healthcare Industry Representatives, which, beginning in 2012, has worked to develop best practices for vendor credentialing. For more information, go to www.c4uhc.org

June 2019 | The Journal of Healthcare Contracting

NEWS

Industry News Number of employed physicians outnumber self-employed in US for first time, new AMA study shows The number of employed physicians exceeds self-employed physicians for the first time in the U.S., according to an American Medical Association (AMA) study. The study found that 47.4% of all patient care physicians in 2018 were employed physicians. That’s a 6 percentage point increase compared to 2012. It also found that 45.9% of all patient care physicians in 2018 were self-employed physicians, down 7 percentage points compared to 53.2% in 2012. The AMA noted that the number of self-employed physicians also declined nearly continuously between the early 1980s and the mid-1990s. Therefore, the findings represent the continuation of a longer-term trend, and “caution should be taken in assuming current trends will continue indefinitely,” the AMA said.

Additionally, the survey showed: • 54% of patient care physicians worked in physicianowned practices in 2018 as an owner, employee or contractor, down from 60.1% in 2012

The Journal of Healthcare Contracting | June 2019

• 8% of all patient care physicians worked directly for a hospital in 2018, up from 5.6% in 2012 • 26.7% of patient care physicians worked in hospitalowned practices in 2018, up from 23.4% in 2012 • Younger physicians and female physicians were more likely to be employed physicians in 2018 compared to 2012

Cardinal Health survey finds supply chain tasks causing stress for clinicians, impacting patient care Clinicians report spending more than twice the amount of time they would like to on supply chain-related tasks, and as a result have less time with patients and increased stress levels, according to the fourth annual Cardinal Health Hospital Supply Chain Survey. Additionally, 25% of those managing supply chains – along with 20% of clinicians – say that supply chain tasks “stress them out.” The survey, which included hospital supply chain decision makers as well as clinicians, showed two out of three (67%) respondents have observed clinical staff frustration caused by supply-related issues, including:

49

NEWS

• Missing supplies: 74% of frontline providers say looking for supplies that should be at hand (but aren’t) has the most negative impact on their workplace productivity, and 84% of department managers say the same • Manual tasks: 49% of frontline providers report manually counting and tracking supplies with 46% of frontline providers saying this has a “very” or “somewhat” negative impact on their workplace productivity • Utilization: 70% of respondents noted wasting and overutilization of supplies as a significant or somewhat significant problem within the organization, with a higher percentage among department managers (81%)

Premier Inc promotes Michael J. Alkire, Craig S. McKasson to new leadership roles Premier Inc (Charlotte, NC) named Michael J. Alkire its new president and Craig S. McKasson its new chief administrative officer, effective immediately. Alkire has been COO of Premier since 2013. His promotion is in recognition of the expansion of his role to include oversight of Premier’s two evolving segment strategies in Performance Services and Supply Chain Services, as well as his existing oversight of overall business operations. In addition to serving as chief administrative officer, McKasson will retain his role as SVP, CFO, and treasurer of Premier, as he has since 2013. McKasson’s promotion is in recognition of the expansion of his role to include oversight of corporate development, enterprise project management and corporate technology.

Alkire and McKasson will each report directly to Susan DeVore, who will continue serving as Premier’s Chief Executive Officer (CEO) and director of the company.

“Michael Alkire and Craig McKasson are proven, effective stewards of Premier’s business operations, and are integral to the company and our evolving strategies,” said DeVore, Premier CEO. “Expanding their roles will enable them to oversee day-to-day strategic operations, while I focus on the long-term growth vision of the company together with our Board of Directors.”

Three Michigan health systems to build shared laundry facility Henry Ford Health System (Detroit, MI), Michigan Medicine (Ann Arbor), and St. Joseph Mercy Health System

50

(Livonia, MI) formed a joint venture to establish a $48 million medical laundry service facility in Detroit. The 105,000-square-foot facility, to be completed by spring 2020, will be designed to accommodate 78 million pounds of healthcare linens every year for all three health systems.

It will include automated technology, use environmentallyfriendly products, and have about 180 employees, most of whom will be new hires. The laundry facility will be owned and operated by the Metropolitan Detroit Area Hospital Service, a nonprofit of which all three health systems are a part.

“This is a win-win for Henry Ford, Michigan Medicine and St. Joe’s, the city of Detroit and state of Michigan,” says Bob Riney, Henry Ford’s president of Healthcare Operations and chief operating officer. “By sharing a centralized laundry service, our partnership demonstrates how health care institutions can work together to achieve efficiencies and spur economic renewal. We’re committed to doing our part to continue to reinvest in Detroit and the communities we serve throughout southeast Michigan.”

Yale New Haven Hospital announces $838M project Yale New Haven Hospital (New Haven, CT) announced a $838 million project that will include two new patient facilities on its Saint Raphael campus (New Haven) and “focus on innovation in the neurosciences.” The new 505,000 square-foot project will feature 204 inpatient beds for patients seeking care for a host of issues, from movement disorders to neuro-regeneration. The project will also allow Yale New Haven to decant portions of the existing East Pavilion, which was built in 1953 and includes more than 300 patient beds. An existing parking garage on Orchard Street will be extended to George Street to accommodate patients and a new 200-space underground garage will support the facility. The hospital has pledged its ongoing support to City of New Haven in conjunction with the project. Yale New Haven has agreed to work with the City “to drive better quality health outcomes for City employees at lower costs.” The hospital has agreed to a one-time voluntary bridge payment of $3 million in addition to its ongoing support. Yale New Haven has also agreed to pre-pay $8.9 million in building fees associated with the project.

June 2019 | The Journal of Healthcare Contracting

Better data.

Better workflows.

Better care.

At Midmark, we use true real-time and retrospective operational data to help you set benchmarks and make meaningful adjustments to clinical processes.

And through our evidence-based ecosystem design approach, technology connects with equipment and your EMR system to improve the clinical care environment at the point of care and beyond.

Learn more at: midmark.com/JHCjun

Š 2019 Midmark Corporation, Miamisburg, Ohio USA

At HealthTrust, we use science supported by data. Others may claim big data. But they can’t duplicate our experience and insight in guiding informed decision-making that supports improved care and lowered cost.

Let us help you amplify your voice and turn data into action.

Empower your conversations healthtrustpg.com/amplify