JHC June 2020

Providing Insight, Understanding and Community

June 2020 • Vol.16 • No.3

Catalyst for change Successful healthcare leaders require a new set of skills to succeed in a new era.

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CONTENTS »» JUNE 2020 The Journal of Healthcare Contracting is published bi-monthly

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Catalyst for change

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Editorial Staff Editor Graham Garrison ggarrison@sharemovingmedia.com

Successful healthcare leaders require a new set of skills to succeed in a new era.

Managing Editor Daniel Beaird dbeaird@sharemovingmedia.com

Feature

10

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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 2020 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.

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2 Publisher’s Letter: Three Themes 4 Reflection and renewal

Understanding what we have been going through, how we will get through it, and what steps we need to take to prepare for the next crisis.

8 What happens next

One expert discusses how we arrived at the crises that surfaced amid the COVID-19 pandemic, and what the road ahead may look like.

15 Navigating the journey

Ed Hardin helps guide students and young professionals through their potential careers

22 On the other side of the curve

With a continued reduction in COVID-19 cases, one health system was busy mapping out next steps to resuming elective surgeries and procedures

26 Resuming elective surgeries: A roadmap

contributing authors.

The Journal of Healthcare Contracting | June 2020

28 Resourceful and tenacious

Challenges abound, but so do solutions, amid the COVID-19 pandemic

34 Rallying around the caregivers

Distributors are working tirelessly to ensure product gets to providers.

36 Infectious disease expert: Infection preventionists are “essential” to the COVID-19 response 38 Pandemic sourcing checklist

Ten questions to screen potential healthcare supply sources … and avoid fraudulent brokers

42 Under duress

How to make decisions in a crisis

44 Into the line of fire

Tracing the footsteps of heroes

45 Calendar 46 Contracting News & Notes

Recent headlines and trends to keep an eye on

1

PUBLISHER’S LETTER

John Pritchard

Three Themes There are many new terms that have popped up within the last few months that I wish I’d never heard: ʯ COVID-19 ʯ New normal ʯ PPE shortages ʯ Antibodies ʯ Coronavirus ʯ Zoom ʯ Testing I am a self-diagnosed news junkie, but I’ve had enough. It’s all I can do to watch anything on television. I still read two newspapers a day, but even that is hard for me to do lately.

I worry about the headlines as we continue into this new space with COVID-19. I worry we will have finger pointing at what could we have done, what we should have done, and what we didn’t do.

Honestly, that’s all too simple. I refuse to be pulled into those conversations. Instead, I will share with you three themes that will help our U.S. healthcare supply chain going forward to be in the best shape it can be to serve our nation’s patients:

1. The way hospitals’ demand plan for product doesn’t work and will have to change. We will see a best-in-class model emerge that is data driven, and hospitals will be within best practices or they will be outside of best practices.

2. Responsible sourcing in the future will be the new standard. Hospitals will have visibility of their supplier’s supply chain, including all the supplier’s raw materials, work-in-progress, finished goods, and in-transit inventory.

3. Distribution will be coveted again as a vital and valuable link in the supply chain. The days of commoditizing distributors are over!

You will see more of these themes from us in this new space. Stay safe, be well and thank you for all you do!

Thank you for reading this issue of The Journal of Healthcare Contracting!

2

June 2020 | The Journal of Healthcare Contracting

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SUPPLY CHAIN

BY DEE DONATELLI

Reflection and renewal Understanding what we have been going through, how we will get through it, and what steps we need to take to prepare for the next crisis.

I do not imagine that I’m alone in the fact that much time over the past few

Let’s break the past several months

months has been spent in reflection. The massive amount of information and inaccu-

down into phases and then project what

racy of the information being reported has been overwhelming and confusing; specifi-

might come next.

cally, as it relates to the healthcare supply chain. I am fearful that finger pointing may

4

result as we begin to reflect upon the process by which we source, procure and manage

Phase I: Prepare. Most partners, both

inventory. Most importantly, I hope that we have learned from this crisis and are willing

providers and suppliers, activated an

to renew our partnerships in a more innovative and improved approach to manage our

emergency preparedness of some sort.

supply chains.

We began to increase inventory levels as

June 2020 | The Journal of Healthcare Contracting

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SUPPLY CHAIN

the market allowed and, in some cases,

before experienced. We have little-to-no

imagine that when we can all come to-

might have begun to “hoard.” Suppliers be-

visibility upstream for availability, nor

gether at a conference or meeting, we will

gan to ration supplies based upon customer

downstream for demand. We are expected

be reflecting on this crisis for years.

status, contracts and relationships. Provid-

to make available supplies that we have

ers began to lock down or more closely

limitations in how to source nor any way

monitor specific PAR levels, locations and

to know when they may become available.

Revise our processes

allocation of request by departments.

We are woefully ill-prepared to sustain this

So, at these future meetings, rather than

level of support yet relied upon to do so.

finger pointing and talking about all the issues, problems, and shortages, we must

Phase II: Frenzy. This may seem insulting, but a frenzy is defined as an intense,

Phase IV: Reactivate. When stay-at-

spend the valuable time together to revise

often wild, state that is disorderly or

home directives and quarantines are lifted,

our processes for the future. Through les-

agitated; a period of great energy and

we will need to think about the reactivation

sons we have learned, we need to provide

activity. As I search for a descriptor for

of our regular healthcare delivery system.

greater visibility into the healthcare supply

the activities that supply chain endured

Specifically, return to the new normal in

chain. How do we bring suppliers and

during the height of the crisis, this defini-

our hospitals and care facilities. How do

providers together in true collaboration to

tion seems to be appropriate. Providers

we clean, restock, reconfigure (back to the

improve? We will need massive postmortem analysis, new playbooks and policies, and enhanced procedures for the entire

With the continuation of intense projected needs and unknown timelines we move into a state of sustaining a pace we have no way to understand or predict.

supply chain – providers and suppliers.

We must work together as a healthcare continuum rather than individually. We discovered what does not work, so now we must renew and focus on what did work and what can be improved upon so the next time – and there will be a

and distributors were sourcing supplies

original designed state) departments? We

next time – we will be stronger, smarter

from new and even unknown suppliers,

will need to return the overstock of beds,

and nimbler to achieve a healthier supply

breaking traditional rules and histori-

oxygen cylinders, ventilators, room divid-

chain for our clinicians and patients.

cal barriers of acquisition. All through

ers, tents, trailers and excess emergency

limited visibility. Manufacturers began to

technologies; all while continuing to

crisis, supply chain is the backbone of

break down barriers to increase or modify

source and procure still limited supplies.

healthcare. We have a responsibility to

production at unheard-of rates.

We will likely be very conservative in

reflect upon and renew our profession,

this phase of activities as we “will never

partnerships and dedication to improve

Phase III: Support. With the con-

want to go through this scramble again.”

the process for our future. There has

tinuation of intense projected needs and

So what do we keep, store or rethink

never been a better time for supply chain

unknown timelines we move into a state

regarding stock levels (JIT), sourcing and

to promote our importance and sell the

of sustaining a pace we have no way to un-

procurement processes?

improvements we will make through the

derstand or predict. We call upon our basic

As we have learned through this

refection and renewal that we have an op-

supply chain management skills and adapt

Phase V: Renew. I am confident we will

portunity to achieve. The time is now, and

them to daily practices that we have never

come out of this pandemic renewed. I

I sincerely hope we seize the moment.

Dee Donatelli, RN, BSN, MBA, is vice president of professional services, TractManager, and principal of Dee Donatelli Consulting, LLC. She currently serves as chair of the Association for Healthcare Resource and Materials Management (AHRMM) board, is a 2015 Bellwether inductee and serving on Bellwether Board. She is past president of AHVAP.

6

June 2020 | The Journal of Healthcare Contracting

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EXECUTIVE INTERVIEW

What happens next One expert discusses how we arrived at the crises that surfaced amid the COVID-19 pandemic, and what the road ahead may look like.

In many ways, the COVID-19 pandemic was “the perfect storm” for the U.S.

low number of beds, “because we put

healthcare supply chain, said Dr. Eugene Schneller, a professor of supply chain man-

so much into outpatient surgical centers

agement at the University of Arizona State’s W. P. Carey School of Business, and the

and other settings.”

principal at Health Care Sector Advances.

Second, the U.S. has made an unrelentless push towards lowering costs.

“One of the things we’ve done is push

8

“If you think about the last decade

And by doing that we turn out to be one

lean,” said Schneller. “Lean means that

to two decades in healthcare, the mergers

of the countries at the tail of the curve

we have relatively few products. We’ve

and acquisitions, the changes in technol-

of number of beds per thousand, with

pushed all of the distribution of those

ogy, a number of things have happened,”

one of the fewest.” While Japan, North

products over to our traditional distribu-

he said. “Number one, we pushed as

Korea and others are leaders in this

tors. And they then are looking at their

much as we could outside of the hospital.

area, the United States has a relatively

inventories and those inventories they’ve

June 2020 | The Journal of Healthcare Contracting

become more lean to in terms of how

look forward at this point, a month,

they manage those.”

two months and really worry a lot about

Department of Defense grant, Schneller

what’s going to happen.”

led a team that faced the same kinds of

Thus the perfect storm – reduc-

As the principal investigator on a large

tion in beds, outsourced products, and a

issues of maintaining large stores for

move toward lean. Also add the impact

emergencies. “But they understood that you need to be able to rotate stock,” he

not thinking ahead about how those big

Our obsession with cost ultimately cost us

organizations can respond collectively, we

“We’ve had this cost obsession,” said

piration dates on them. And if you can’t

have found ourselves in big trouble.”

Schneller, “and it’s really let lead to lean

move stock around very quickly, those

taking over all of our thinking.”

national repositories aren’t going to serve

of mergers and acquisitions. “Really, by

In a podcast recorded in mid-April 2020 during the COVID-19 shelter-in-

Lean can be wonderful in that it looks

said. “Various products basically have ex-

the purpose.”

place order, Dr. Schneller discussed the

at and deals with the issue of demand,

immediate and long-term implications

and it means that we can predict demand.

COVID-19 pandemic is we need a much

from the pandemic on the U.S. healthcare

“But one of the things we found out is

better interface between our public

supply chain with The Journal of Healthcare

we’re not very good at predicting demand

health supply chain and our everyday

Contracting Publisher John Pritchard.

for a pandemic.”

hospital supply chain, Schneller said.

What will happen in the second wave of disruption?

As companies domestically as well as in China, India, and around the world find themselves economically challenged, what will the impact be to the U.S. healthcare supply chain?

Schneller described the U.S. healthcare supply chain as one of the most resourcedependent supply chains that exists across

One of the realizations of the

Tier two and tier three suppliers – those who are making compounds that go into pharmaceuticals, parts that go into high tech or low tech devices – are very economically challenged due to COVID-19.

industries. “And hospitals are probably the most highly dependent on other “And we need to think about how to

think of,” he said. “They make almost

Linking public health with the everyday supply chain

nothing of what they use.”

There has been a huge separation of

we finance the fire department because

resources than any other industry you can

finance that,” he said. “Think about this;

planning for public health versus planning

we hope no houses will catch fire, but

those who are making compounds that

for everyday health in the United States,

they’re on standby. We need to know

go into pharmaceuticals, parts that go

Schneller said. This came to a head with

how to understand how to fund standby

into high tech or low tech devices – are

the national stores for pandemics. “We

in the supply chain, and we need to be

very economically challenged due to CO-

didn’t manage them very well,” he said.

able to divert some funding to do that.

VID-19. Some may go out of business.

There were products in warehouses for

I’m not sure if the national level is the

“I think that the hospitals will begin to

long periods of time that weren’t inspect-

only level to do it.”

see shortages in those devices, as well

ed and checked properly, or had expired.

as in the parts that are needed to repair

For instance, ventilators had parts that

visit: www.nationalaccountexecutives.

devices when they become inopera-

needed to be maintained or inspected,

com/2020/04/national-accounts-today-

tive,” said Schneller. “So I am trying to

such as plastic tubing.

episode-8-dr-eugene-schneller.

Tier two and tier three suppliers –

The Journal of Healthcare Contracting | June 2020

To listen to the full podcast,

9

10

June 2020 | The Journal of Healthcare Contracting

BY GRAHAM GARRISON

Catalyst for change Successful healthcare leaders require a new set of skills to succeed in a new era.

The University of Tennessee Haslam’s Executive MBA for Healthcare Leadership aims to develop professionals who can lead these transitions.

The world is not slowing down. But with the right training and mindset, to-

online model, students attend four in-

day’s healthcare leaders may master the ability to drive change in “one of the most

person residencies during the year, com-

complex sectors of our economy,” said Jim Rosenberg, director, Executive MBA for

plete bi-weekly online distance learning

Healthcare Leadership for the Haslam College of Business, University of Tennessee.

sessions, and tackle applied homework assignments. In addition, each student completes an organizational action project (OAP) to apply new concepts to

ment of healthcare today, organiza-

Building solutions across the health sector

tions are under tremendous pressure to

UT’s Executive MBA for Healthcare

senior leadership of their organization.

reinvent themselves,” said Rosenberg.

Leadership specializes in developing

Students spend the entire year analyzing

“There is much experimentation and

leadership for administrators, nurses, phy-

an issue facing their organization and

change as healthcare leaders react to

sicians and other healthcare professionals.

work closely with an assigned advisor to

new payment models, risk sharing

The program builds on Haslam’s centers

craft and implement solutions (see ac-

models, customer satisfaction measures,

of excellence in supply chain manage-

companying sidebar).

expectations, and more. It is imperative

ment, Lean for healthcare, healthcare

we invest in the knowledge and capa-

finance, and more. “We work with leaders

the college’s Executive MBA programs,

bilities of these leaders who are driving

across the health sector who are building

have realized an average ROI for their

change in one of the most complex

solutions for the next chapter in health-

organizations of over $6.5 million, said

sectors of our economy.”

care service: a renewed era of affordable,

Rosenberg. “This thesis-like undertak-

accessible, equitable, and excellent care.”

ing is representative of the immediate

“In the rapidly changing environ-

As the healthcare industry continues

a strategic project developed with the

These projects, used in many of

to face challenges that demand increased

The Haslam EMBA-HL program’s

efficiency and quality of care, the need to

applied approach introduces new ideas

a time when healthcare is facing unprec-

combine healthcare industry knowledge

and challenges participants to put them to

edented changes, the OAP is a real-world

with broad strategic business founda-

work immediately, with the full support

investment that far exceeds the cost of

tions has never been greater. The Haslam

of expert faculty. “Participants grow per-

the program.”

College Executive MBA for Healthcare

sonally, see immediate movement on their

Leadership program is designed to meet

initiatives, and walk away with new capa-

alized leadership development curricu-

that need.

bilities that will support them throughout

lum, guided by structured assessments

their careers,” said Rosenberg.

and individual coaching. “We offer

“The Haslam EMBA-HL program is

application offered by this program. In

Students also participate in a person-

a catalyst for these healthcare leaders and

The Executive MBA for Healthcare

their organizations to successfully imple-

Leadership is a highly-applied, one-year

skills and evaluate personal leadership

ment change and deliver the next era of

degree program for experienced profes-

style allowing students to refine skills

healthcare,” said Rosenberg.

sionals. In this hybrid in-person and

while learning the business of healthcare.

The Journal of Healthcare Contracting | June 2020

meaningful course content on leadership

11

SUPPLY CHAIN U

across the health sector.

The healthcare environment today is changing dramatically, and at a rapid pace. Professionals across the sector are working to transition from a system designed for acute care; dependent on cross-subsidies for many patient populations; and with few mechanisms for cost control.

Critical competencies

The Executive MBA for Healthcare Lead-

including value-based payments, industry

The healthcare environment today is

ership curriculum is focused on building

consolidation, pricing and contracting

changing dramatically, and at a rapid pace.

six critical competencies for healthcare

transparency, and healthcare consumerism;

Professionals across the sector are working

leadership and transformation:

and direct application by students,” said

Our graduates become healthcare leaders who can drive innovation and change in their organizations.”

“In all, students complete 45 credit hours in an accredited program,” said Rosenberg. The program model has been used by the college since 1994 and has supported the education of over 800 senior level healthcare graduates from

to transition from a system designed for acute care; dependent on cross-subsidies for many patient populations; and with few mechanisms for cost control. “The next era in healthcare is driven by a renewed focus on affordability and population health outcomes, which demands new attention to wellness, prevention, and chronic care,”

ʯ ʯ ʯ ʯ

Consumer centric thinking

Rosenberg. “This combination of concepts,

Business model innovation

cases, and application transforms the think-

Healthcare policy influence

ing and capabilities of students to lead and

Systems thinking and

transform the next era in healthcare.”

operational excellence

In addition to delivering the curricu-

ʯ Data and technology facility ʯ Change leadership and

lar needs of today’s healthcare professionals, Rosenberg said the learning

self-development.

model is designed to provide intense,

said Rosenberg. “Leaders must simultaneously improve equity in care, expand ac-

applied, and relevant opportunities for “The program weaves together core

learning that allows students to gain

cess, and contain costs without sacrificing

MBA skills; leading-edge cases, speakers,

information quickly and apply it immedi-

quality of care.”

and practices focused on key challenges

ately within their organizations.

A rare opportunity

High marks

Several U.S. universities offer healthcarefocused Executive MBA programs.

The Haslam College of Business executive education programs are recognized as among the best in the world, ranked #20 globally (Financial Times 2019). The Executive MBA is ranked #1 for relevance by participating executives (Economist 2018).

Organizations that have participated include: ʯ Amedisys ʯ Northwestern ʯ Cigna Medicine ʯ Covenant Health ʯ Medtronic ʯ Pathways ʯ Anthem ʯ TeamHealth ʯ Centene ʯ UT Medical Center ʯ LifePoint Health

“What sets apart the Haslam Executive MBA for Healthcare Leadership is the core focus on preparing leaders to transform the industry by integrating business

ʯ Kindred Healthcare ʯ American College ʯ

of Cardiology Sutter Health

concepts to build creative solutions,” said Rosenberg. “Each cohort brings together highly experienced leaders from across the healthcare sector including providers, payers, and suppliers.”

This provides a rare opportunity for deep exploration, collaboration, and

12

June 2020 | The Journal of Healthcare Contracting

A big thank you We are truly inspired by your selfless courage and unwavering commitment to your hospitals, healthcare facilities and organizations during this COVID-19 pandemic.

At Health Connect Partners, our goal is to connect providers and suppliers through educational meetings and conferences. Our mission is to provide the best in healthcare education and networking.

We realize that the need for connection in our healthcare communities has never been greater, even though being in the same place is not possible right now.

For our first ever Virtual Conferences held this spring, we facilitated those same one-one-one interactions our attendees have come to expect during our signature Reverse Expo, with no travel required.

Thank you to all who participated in our inaugural Virtual Conferences, and thank you to the Educational Advisory Board for their continued support.

We are beyond grateful to all of you for your understanding and willingness to make the Virtual CoNNection possible.

Together we will always make a difference.

For more information visit www.hlthcp.com

SUPPLY CHAIN U

“ The next era in healthcare is driven by a renewed focus on affordability and population health outcomes, which demands new attention to wellness, prevention, and chronic care.” ʱ Jim Rosenberg, director, Executive MBA for Healthcare Leadership for the Haslam College of Business, University of Tennessee

understanding across silos in the industry.

to handle adversity,” said Rick Smith, vice

“Haslam’s EMBA-HL is the only acceler-

president of operations - South Region,

ated one-year program allowing for quick

Pathways by Molina, an alum of the

adoption of leadership skills and business

program. “Led by innovative faculty who

acumen,” said Rosenberg. Students make

possess global experience, this program

an immediate impact on their organiza-

provides life-changing value to ensure you

tion through applied assignments to

have the skills needed to maximize your

advance their work and improve delivery

leadership potential.”

of care. The unique curriculum is driven

“We have over 20 years of experience

by a faculty with deep experience in the

leading healthcare executive education

healthcare, finance, operations, and strate-

programs,” said Rosenberg. “Participants

gic management sectors and dedicated to

grow personally, see immediate move-

student success.

ment on their initiatives, and walk away

“The greatest asset to success is

with new capabilities that will support

investing in yourself and being equipped

them throughout their careers.”

Organization Action Project A key component of the Haslam EMBA-HL program is the Organizational Action Project (OAP). Each student is required to complete an OAP to apply new concepts to a strategic project developed with the senior leadership of their organization. Students spend the entire year analyzing an issue facing their organization and work closely with an assigned advisor to craft and implement solutions.

“The Organizational Action Project (OAP) was one of the highlights of the program,” said Jason Fugleberg RN, BSN, MBA, CENP, chief nursing officer, Brigham City Community Hospital. “The OAP allowed me to leverage the knowledge of faculty mentors and apply concepts learned throughout the academic year to a company initiative with a real financial return. The financial benefit of my OAP was more than $5 million. This project was a game changer for our hospital.”

Other examples include: Implementing a remote-order-entry pharmacy service.

The senior vice president of pharmacy for a hospital system with more than 42,000 employees and 100 hospitals worked with Randy Bradley, assistant professor of information systems and supply chain management at Haslam, to propose a proof-of-concept program for implementing a remote-or-

der-entry pharmacy service for after-hours order review in 10 hospitals. Although the proposal emphasized pharmacy job satisfaction, its ultimate significance was in the improvement of patient care and safety. The fiscal goal of the proposal was to break even on cost through savings generated by reduced pharmacist and nurse turnover. Initial conservative estimates showed these savings covered 43% to 88% of the service cost. Through data tracking, the proposal was able to show a break-even program and patient care was advanced at the same time.

Growing a toxicology laboratory into a marketplace force. The vice president of business operations for a forensic toxicology laboratory with 30 employees in Nashville sought to grow her company into a competitive marketplace force.

The lab, which specializes in sports organizations, medical examiners, crime labs, physicians and pain management clinics, was struggling financially at the time. Its leadership team was very serious about return on investment – requiring at least $10 for every dollar invested into its vice president’s Executive MBA program. That return on education investment ultimately capped out at more than $2,000 per dollar spent, and the business now boasts approximately 280 people.

To learn more about recent OAPs implemented by EMBA-HL students visit: https://haslam.utk.edu/healthcare-emba/oap

14

June 2020 | The Journal of Healthcare Contracting

BY GRAHAM GARRISON

Navigating the journey Ed Hardin helps guide students and young professionals through their potential careers

Everyone wants to play the hero. But every hero needs a guide to navigate

engagements related to his profession.

the journey.

Over time, as he started to do more of

That’s precisely the role that Ed Hardin, vice president, supply chain, Froedtert Health, has set out to play for many students and young professionals.

those, he said he got more comfortable.

Then about seven years ago, Hardin began formally as an educator, and has taught in a college university setting ever

For almost 30 years, Hardin has

impression upon me. They reinforced

since. He was a guest lecturer for a time,

gravitated toward involvement in the lives

the importance of actively taking people

then became an adjunct where he taught

of young people, whether it be profes-

under your wing and helping them along.”

full courses. “I’ve enjoyed that work,”

sionally, through education, or community

he said.

service. “A lot of it stemmed from the

Hardin said he realized pretty quickly

fact that quite a few people during my

Pay it forward

that mentoring and coaching could serve

career early on before I turned 30 were

About 10 years ago, when Hardin began

others, as well as himself, by just simply

really strong mentors. Most of those guys

his membership and involvement in

learning from young people. “I also real-

are retired today, but they really left an

AHRMM, he also began to do speaking

ized that it actually became a great source

The Journal of Healthcare Contracting | June 2020

15

SUPPLY CHAIN U

of talent development,” he said. “In my

believe that resonates with young people.

continues to receive treatment. “I’ve still

shop, we have probably half of my per-

They have a different mindset around in-

got a long journey ahead of me, but the

sonnel are under 35.”

novation, and a different mindset around

chemo, and the good Lord are doing their

collaboration and working together.”

thing, and I’m doing pretty well. I’m still

Hardin said educating has provided a great opportunity to bring people into

Hardin said those under 35 years of

able to work. It gives me purpose, and

healthcare from different focus areas.

age value purpose in their work lives and

something else to think about. So it’s been

Many of them, either IT, finance, or

getting along well with others. “They want

a real blessing.”

supply chain for general industry, get

to work for organizations with a soul,” he

interested in healthcare as a result of the

said. “They want to talk about what we

courses. Hardin said he’s hired seven or

can do as a supply chain to not just move

The value for supply chain

eight former students in roles where he’s

product but to do good in this world.”

Hardin said bringing young profession-

worked. “I have a pretty good affinity for

One of his students has gone on to

als into healthcare positions benefits the

young people, enjoy working with them,

become a manager for sourcing. Most

individuals and the organizations willing

and enjoy bringing on talent. My getting

of them have been entry level roles, but

to invest in them. Supply chain teams

involved and practicing this has made

very good, stable roles. Hardin said many

could benefit from hiring young profes-

it easier over time to get better at it. It's

young professionals are coming to realize

sionals who perhaps don’t have experi-

been rewarding, fun, and energizing – and

that healthcare is a stable industry with

ence in healthcare but have other skillsets.

all because I've been intentional and tena-

typically not a lot of layoffs like other

By and large, supply chain in particular

cious about it, and I’ve really seen a lot of

segments of the economy. A handful of

has been plagued by some very “provin-

good outcomes.”

students he would eventually help get hired

cial” thinking over the years, he said. “We tend to promote people who have been

Hardin said bringing young professionals into healthcare positions benefits the individuals and the organizations willing to invest in them.

Supply chain teams could benefit from hiring young professionals who perhaps don’t have experience in healthcare but have other skillsets.

in positions for long time, who may have only had a healthcare background, and may have only worked in that organization,” he said. “I think diversity is super important. I'm not saying that I'd want to hire everyone from the outside. That's not it at all. But I think the mix of different skillsets, and experiences, as well as youth, is really good for an organization.”

Hardin said the three departments that he’s managed since he got back into the provider world benefited from transitioning from being very provincial

Topics that resonate

in healthcare started in another industry

and traditional to recognizing that there’s

Hardin said he has gravitated toward

before coming back to Hardin. “They got

value in people who may have worked in

teaching and lecturing on three topics in a

their degree and within a year had reached

other industries, and certainly people who

general setting – innovation, collaboration

out and said, ‘You know what, this isn't

are young, and very eager, and capable of

and values. “I’ve been very drawn to

working for me. And I think I'd like to

working hard. There’s strength in that.

innovation and unique solutions, as well

come to work in healthcare.’”

as collaboration, not just with kind of col-

16

Hardin was expected to teach at Mar-

laboration within my organization, but also

quette University this spring, but he has

Mentorship

with vendors and other hospital organiza-

taken a break. In November 2019 he was

The education doesn’t stop at the end of

tions doing things together,” he said. “I

diagnosed with stage four cancer, so he

a course. Hardin said he has traditionally

June 2020 | The Journal of Healthcare Contracting

taken on one to two mentees at any given

A boost to collaboration

his work with young people. “A lot of

time where he’s worked. Upon joining an

When young professionals are brought on

that has been formulated, and developed

organization as the new leader and peri-

board, Hardin said organizations will see

as a result of just working with young

odically in his communications with staff,

improvements in collaboration. “By my

people, and watching them work, and

he offers to be a mentor. “Not surpris-

very nature, I try to play nice in the sand-

realizing that some of the paradigms

ingly, few take me up on this offer, but

box, but younger people, I think, are bet-

that I might have carried going into

that’s perfectly fine,” he said.

ter at it. They see the value in being able

this industry I put aside, and realized I

It can be hard work. Hardin meets

to do that. I think they’re less competitive

can probably accomplish a lot more by

once a month with his mentees. They do

in an unhealthy sense. It’s not that they’re

intentionally, actively playing nicer in the

all the heavy lifting in terms of finding

uncompetitive, but they frown upon some

sandbox, and inviting people into that

time on Hardin’s calendar. At the end of

of the unhealthy aspects of competition.”

sandbox, so to speak. And I've learned a

each one-hour session, Hardin provides

Hardin said he is probably known in

lot of that just simply from working with

them a bit of homework. A few months

the industry for advocating collaboration

young people. I think they’re very, very

into the relationship, Hardin and his men-

among stakeholders. He credits that to

good at that.”

tee mutually agree on a book to jointly read and discuss together. “During our sessions we discuss everything under the sun; much of it professional, but also personal.”

About Froedtert Health

The split between those that work in

The Froedtert & the Medical College of Wisconsin regional health network is a part-

Hardin’s shop and those in other depart-

nership between Froedtert Health and the Medical College of Wisconsin. Its health

ments that he mentors is about 50-50,

network includes five hospitals, more than 1,700 physicians and nearly 40 health

he said. “With those that work within

centers and clinics. The health system operates eastern Wisconsin’s only academic

my shop, I get involved to a reasonable

medical center and adult Level I Trauma Center at Froedtert Hospital, Milwaukee.

degree in identifying and supporting

It is an internationally recognized training and research center engaged in thou-

where I believe they can best advance in

sands of clinical trials and studies.

our organization.”

The Journal of Healthcare Contracting | June 2020

17

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Specialty pharmaceuticals for non-acute – building a better model Specialty pharmaceuticals are expensive, require special handling and are growing in usage.

What is the best way to manage these drugs?

Specialty pharmaceuticals can cause supply chain challenges “Specialized care – including the administration of specialty pharmaceuticals – is rapidly moving out of the hospital and into non-acute settings,” says Ann Gapper, senior director, Rx category management at McKesson. “Patients prefer the convenience of outpatient settings, and payers like the lower costs incurred there.”

However, getting specialty drugs to nonacute locations, such as physicians’ offices, isn’t easy. It can cause your supply chain and pharmacy leaders a lot of headaches.

Traditionally, health systems have either worked with numerous manufacturers or a specialty distributor to source their drugs.

But managing orders from multiple suppliSpecialty drugs are more in demand now than ever. Want proof? While watch-

ers takes time and manpower, says Patrick

ing your favorite TV show this week, count the number of times you hear, “Ask your doc-

Baranek, senior manager, pharmaceuticals at

tor if BLANK is right for you” during a commercial break. These medications, sometimes

McKesson. “Supply chain may be servicing a

called specialty pharmaceuticals, are being used to treat conditions like Crohn’s disease,

network of 100-, 200- or even 500-physician

non-Hodgkin’s Lymphoma, leukemia, multiple sclerosis, and infections resulting from anti-

offices. Individual orders are placed either

cancer drug treatments, as well as more common conditions, including high cholesterol

over the phone to a variety of manufacturers

and hepatitis C. These specialized medications, which were once only given by specialists,

or by logging onto separate websites.”

are now being administered in physician offices and are being requested by patients.

Specialty pharmaceuticals present unique distribution challenges too, adds Jon Pildis, vice president, materials

18

But achieving better patient outcomes

require climate-controlled storage and spe-

management at McKesson. “You’re mov-

rests on something far more straightforward

cial handling. For these reasons and more,

ing vials that are worth hundreds, and in

than molecular research – supply chain

specialty pharmaceuticals represent one

some cases, tens of thousands of dollars.

management. Often administered by injec-

more opportunity for supply chain profes-

That high value means that you have to

tion or infusion, specialty pharmaceuticals

sionals to use their expertise in managing

be very careful with your processes.”

can be very expensive. And they’re highly

high-dollar, temperature sensitive products

regulated. Many specialty pharmaceuticals

while controlling costs.

Specialty pharmaceuticals also need to be in a temperature-controlled

June 2020 | The Journal of Healthcare Contracting

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environment to meet regulatory requirements, whether it’s refrigeration or frozen storage, he adds. Specialty drugs can be very challenging to correctly manage.

Simplify your pharmaceutical supply chain To meet the growing demand for specialty pharmaceuticals in the outpatient setting, supply chain and pharmacy

Quick quiz: What’s a biosimilar?

As supply chain finds itself increasingly involved in specialty pharmaceuticals, you’ll start hearing a lot about “biosimilars.” What are they?

While they are not the same as generic equivalents, biosimilars are highly similar to – and have no clinically meaningful differences from – existing, FDAapproved reference biologics. They are a rapidly growing treatment option for physicians treating advanced diseases, with more than 20 unique biosimilars expected to enter the U.S. healthcare market over the next decade.

leaders should consider simplifying their procurement processes by ordering these drugs through one supply chain expert. From a logistics perspective, using a distributor that handles specialty pharmaceuticals and traditional pharmaceutical offerings and med/surg supplies

Clinicians are finding that biosimilars: ʯ Expand treatment options for complex diseases. ʯ Offer substantial cost-savings on expensive therapies. ʯ Are FDA-approved, safe and effective treatments. ʯ Come with support from FDA and other leading medical advisory organizations.

and equipment can pay off and lead to better supply chain performance for its procurement team.

“When expanding your clinical offerings to providing specialty drugs at your non-acute sites, you should consider how

distribution experience.

alleviate headaches,” he says.

We take these specialized,

“If you think about a health system that has already

high-value drugs, and run

you will handle these drugs,” says Pildis.

set up an account with a distributor like McKesson,

them through our logistics

“By supplying specialty pharmaceuticals

specialty drugs are one more product that can be

network, and get product

directly to alternate site locations, you

added to their orders, shipments and invoices,” says

to customers in an

will be sparing the health system’s supply

Gapper. “They can order directly from us and receive

efficient way.”

chain team from receiving, storing and

the product next-day with

physically moving them. What’s more,

high service levels. Plus,

being asked to tackle many

they can take advantage of

challenges facing health-

all the technology already

care – managing specialty

in place with us.”

pharmaceuticals shouldn’t

receiving specialty pharmaceuticals on a just-in-time basis helps clinics minimize on-hand inventory too. This reduces the financial burden on the non-acute staff.”

McKesson offers supply chain managers the ability to order specialty pharmaceuticals via electronic data interchange (EDI) or use punch out, says Baranek.

Supply chain managers will have a seamless connection and 24/7 access to their data with a business analytics tool. By accessing their non-acute data, supply chain managers understand where their spend is going, and see opportunities for

20

standardization and formulary management. “That helps

‘You’re moving specialty pharmaceutical vials that are worth hundreds, and in some cases, tens of thousands of dollars. That high value means that you have to be very careful with the way you manage your pharmaceutical supply chain.’

As a corporation,

Supply chain leaders are

be one of those. Look for

McKesson is one of the

a solution that provides

largest pharmaceutical

access to a broad product

distributors in the United

portfolio, an operational

States. “We work with

model that provides confi-

most manufacturers to

dence that the quality and

expand access to these

regulatory requirements are

life-saving drugs that treat

being met, and the simplic-

a variety of chronic con-

ity of integration with

ditions,” says Pildis. “We

existing processes. Same

leverage our non-acute

products, better model!

June 2020 | The Journal of Healthcare Contracting

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COVID-19

On the other side of the curve With a continued reduction in COVID-19 cases, one health system was busy mapping out next steps to resuming elective surgeries and procedures

At its high point, Ochsner Health was located in one of the nation’s COVID-19

concerns. Many people with medical issues

hotspots. The New Orleans-based health system had confirmed inpatient cases that

were fearful to leave their house. “That

reached into the mid-800s.

has significant implications,” said Thomas.

“We’ve heard of people who have had strokes who delayed care out of fear. Minor

But there were positive signs by

heart attacks as delayed care. People with

mid-April. On April 17, the number of

broken hips that have delayed care for mul-

inpatient COVID-19 cases had lowered

tiple days. That is not a good situation.”

to 573. Another positive trend was more

Dr. Robert Hart, chief medical of-

people being discharged home who were

ficer, Ochsner Health, said ER physicians

COVID positive. Ochsner discharged its

had seen cases where a patient with a

1,500th COVID patient by April 20, just

heart attack stayed at home a few days

over one month after Ochsner admitted

rather than coming in for treatment. On

its first COVID-19 patient on March 9.

the surgery side when the stay-at-home

More patients were coming off ventilators and fewer were having to go on them.

Warner Thomas, president and CEO

order was in place, Ochsner was only perbut these patients still need care. Cancer

forming emergency surgeries. “There are

surgery, heart surgeries and other things

some tiers of surgeries we laid out that

of Ochsner Health, said the health system

have been delayed, so it’s time to get back

could be put off and some that couldn’t,”

was working with local and state officials

to taking care of folks.”

Hart said. “We’ve got to begin consider-

on how to open back up some of its op-

ing getting people back on the schedule to

erations. “We’re working towards getting

get them taken care of before we wind up

ready to get back to do other surgeries

Delay of care

or procedures that we’ve had to delay,”

Thomas said one of the fears from a public

he told media members in a conference

health perspective is there were people de-

right precautions in its ERs and clinics

call. “We delayed them during the peak,

laying their medical care due to COVID-19

by temperature checking everyone that

doing more harm than good out of this.”

Thomas said Ochsner was taking the

Dynamic Ventilator Reserve Program Ochsner Health was participating in the Dynamic Ventilator Reserve Program that has been put together by the COVID Task Force at the White House in conjunction with the American Hospital Association.

The Dynamic Ventilator Reserve Program is “a collaborative voluntary effort led by a group of U.S. hospitals and health systems that has created an online inventory of

22

ventilators and associated supplies, such as tubing and filters, to support the overall needs of combatting the COVID-19 pandemic,” according to the AHA. “Hospitals and health systems will input into the database available equipment that they are able to lend to others in the country. Providers are then able to access this virtual inventory as their need for ventilators increases.”

June 2020 | The Journal of Healthcare Contracting

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COVID-19

comes into the organization, whether

and employees. By mid-April, the health

patient or employee. If anyone has a fever

system had tested over 23,000 people

you are going to be tested, whether you

they are getting tested appropriately and

for COVID-19, with more than 7,000

come in to be admitted, or have a proce-

sent home. Ochsner had the appropriate

confirmed cases – about one-third of

dure,” said Hart. “If you go to one of our

amounts of PPE for healthcare personnel,

Louisiana’s COVID-19 cases. Ochsner

infusion centers you are going to be tested.

and patients were given masks, he said.

had ramped up to conducting 1,300-1,400

For instance, if we give you chemotherapy

tests a day, either same-day tests or point-

or infusion that may compromise your

of-care testing.

immune system, we want to know first

“It’s important we don’t see ongoing delay of care, because frankly that’s going to create a bigger medical issue for folks going

Thomas said patients being admitted

“If you come into one of our facilities

whether you are positive or not. Because

forward,” said Thomas. “We worry about

into the ER for any reason were being

it may be something we want to put off a

the escalation of chronic disease or the

tested for COVID. People having surger-

couple of weeks for your safety.”

delay of care that need to be dealt with.”

ies were being tested proactively. “We’re

Ochsner started antibody testing the

making sure to test and screen people as

week of April 20. The initial focus was

they come in,” he said. The rate of testing

antibody testing for the frontline caregiv-

Testing

was only going to increase as the health

ers such as critical care and ED staff who

Testing for COVID had become a routine

system worked to begin surgeries and

have been working around COVID-19

part of the screening process for patients

procedures that had been postponed.

cases since at least early March. “There

Telehealth takes off Ochsner Health’s telemedicine platform, Ochsner Anywhere Care, is seeing record numbers of enrollments and visits since the COVID-19 outbreak in Louisiana, according to the health system. Patients are able to see a provider on-demand, receive assessment and appropriate treatment, all from the comfort and safety of home.

In March 2020, urgent care on-demand and behavioral health scheduled appointments increased 852% in enrollments and 933% in virtual visits over February 2020, Ochsner reported in a release. The trend was continuing in April, with daily virtual visits growing significantly. Key highlights include: ʯ March 2020 Ochsner Anywhere Care enrollments: 10,084 (February 2020: 1,059) ʯ March 2020 Ochsner Anywhere Care virtual visits: 3,616 (February 2020: 350) ʯ April 2, 2020 Ochsner Anywhere Care virtual visits: 2,700 (March 2, 2020: 39) “It is reassuring and evident that those in need of nonemergent medical care are heeding the advice of local, state and federal officials during the COVID-19 outbreak and are sheltering-in-place, leaving only for essential er-

24

rands,” said David Houghton, MD, MPH, medical director of Ochsner Anywhere Care. “Telemedicine has made it possible to safely and effectively treat illnesses from home and we are seeing thousands of patients choose Ochsner for their virtual healthcare needs.”

Ochsner Health was one of the initial six healthcare providers approved by the Federal Communications Commission’s Wireline Competition Bureau approved for its COVID-19 Telehealth Program. Healthcare providers in some of the hardest hit areas like New York could use this $3.23 million in funding to provide telehealth services during the coronavirus pandemic. As part of the recently enacted CARES Act, Congress appropriated $200 million for the FCC to support health care providers’ use of telehealth services during this national emergency “This is changing the landscape around virtual care,” said Hart. “Not only with patients, but physicians are realizing how effective they can be with certain types of virtual care. I think this is going to be something that does not go away when COVID-19 is gone. It’s going to be something that not only the physicians, but patients will be looking at – how does this continue going forward in some fashion that everyone finds useful.”

June 2020 | The Journal of Healthcare Contracting

Washington State Hospital Association to citizens: Don’t delay routine care Hospitals across Washington were urging citizens to seek timely medical care for non-COVID-related health issues, including care for new or chronic health conditions.

Hospitals and health care providers across the state were reporting abnormally low volumes of patients seeking routine medical care, according to the Washington State Hospital Association. But patients who have arrived at the hospital seeking care have been more severely ill. People are waiting to seek medical attention – and endangering themselves as a result.

“Life is on pause right now, but your health care needs are not,” WSHA President and CEO Cassie Sauer said. “Do not delay needed care – you could get worse. Hospitals and clinics are prepared to safely provide services and you should get care when you need it.”

Health care conditions that are left untreated can worsen, making them more difficult to treat, or even become life threatening, the WSHA said. Many providers are offering virtual appointments, allowing patients to see

their providers at home and determine if a physical visit to a hospital or clinic is necessary.

Pennsylvania: Elective surgeries can resume if guidelines followed The Pennsylvania Department of Health announced in late April that healthcare facilities could continue with elective procedures, as long as certain guidelines are followed. There are three main criteria facilities must meet before elective procedures can resume: ʯ First, facilities should make sure there is enough PPE in the event of a surge in COVID-19 cases. ʯ Second, facilities should be able to treat patients without having to resort to drastic measures like prioritizing patient care if there is another surge. ʯ Third, facilities should make sure there is enough trained and educated staff to handle elective procedures, as well as a potential surge in hospital patients.

is a sense now with people this was sim-

right conversation with folks coming in

organization’s revenue. Thomas reported

mering in our community in New Orleans

and talking through that.”

clinics, outpatient procedures and imaging

prior to Mardi Gras,” said Hart. “We may

Fortunately, the health system has

were down 60-70%. “It’s had a major

find out that a lot of people who could

not had to lay off or furloughed anyone,

impact on our revenue both at the end of

well have antibodies to COVID-19 not

Thomas said. “We’ve redeployed a lot of

March and the month of April.” Thomas

even realize they were exposed along the

people, taken folks that were less busy

said Ochsner was putting into place

way.” From there, testing would expand

and moved them to other areas.”

some expense reduction items, “things

to other inpatient areas, procedural areas, and into clinics.

Many Ochsner employees in areas less

we think we can put off, programs we

busy were taking their paid vacation during

can stop temporarily, hiring we will stop

April and May. “We’re doing that for a couple

temporarily in some of our areas,” he

of reasons,” said Thomas. “No. 1, because

said. “Certainly not in our clinic areas but

Financial impact

we have time for them to do it; we don’t have

other areas.”

Thomas said during the peak of the

as many patients. We also think in the second

While the organization was still evalu-

COVID-19 cases, Ochsner had delayed

part of the year, we are going to have to be

ating the extent of the economic impact,

well over 6,000 surgeries and procedures.

catching up with these 6,000-plus surgeries

a lot of it would depend on how quickly

“We’ll be in contact with those patients

and procedures, visits. We want people

people come back for medical care and

to get them scheduled soon,” he said.

ready to go in the second part of the year.”

what that looks like over the next couple

“We know many of those procedures need to be done. We’ll be having the

Indeed, the elimination of voluntary procedures has had a major impact on the

The Journal of Healthcare Contracting | June 2020

of months, Thomas said. “We’re going to be watching that carefully.”

25

COVID-19

Resuming elective surgeries: A roadmap 3. Personal Protective Equipment Principle: Facilities should not resume elective surgical procedures until they have adequate PPE and medical surgical supplies appropriate to the number and type of procedures to be performed.

4. Case Prioritization and Scheduling Principle: Facilities should establish a prioritization policy committee consisting of surgery, anesthesia and nursing leadership to develop a prioritization In response to the COVID-19 pandemic, the Centers for Medicare and

strategy appropriate to the immediate

Medicaid Services (CMS), the U.S. Surgeon General and many medical specialties

patient needs.

recommended interim cancelation of elective surgical procedures.

5. Post-COVID-19 Issues for the Five Phases of Surgical Care However, “when the first wave of this pandemic is behind us, the pent-up pa-

Principle: Facilities should adopt

1. Timing for Reopening

policies addressing care issues specific

of Elective Surgery

tient demand for surgical and procedural

Principle: There should be a sustained

to COVID-19 and the postponement of

care may be immense, and health care

reduction in the rate of new COVID-19

surgical scheduling.

organizations, physicians and nurses must

cases in the relevant geographic area for

be prepared to meet this demand,” The

at least 14 days, and the facility shall have

6. Collection and Management of Data

American College of Surgeons, American

appropriate number of intensive care

Principle: Facilities should reevaluate and

Society of Anesthesiologists, Associa-

unit (ICU) and non-ICU beds, personal

reassess policies and procedures frequently,

tion of periOperative Registered Nurses,

protective equipment (PPE), ventilators

based on COVID-19 related data, resourc-

American Hospital Association said a

and trained staff to treat all non-elective

es, testing and other clinical information.

joint statement.

patients without resorting to a crisis stan-

Facility readiness to resume elective

dard of care.

7. COVID-related Safety and Risk Miti-

In “Roadmap for Resuming Elective

2. COVID-19 Testing Within a Facility

Principle: Facilities should have and

Surgery after COVID-19 Pandemic,” the

Principle: Facilities should use avail-

implement a social distancing policy

organizations created a list of principles

able testing to protect staff and patient

for staff, patients and patient visitors in

and considerations to guide physicians,

safety whenever possible and should

non-restricted areas in the facility which

nurses and local facilities in their resump-

implement a policy addressing require-

meets then-current local and national

tion of care in operating rooms and all

ments and frequency for patient and

recommendations for community

procedural areas.

staff testing.

isolation practices.

surgery will vary by geographic location.

26

gation surrounding Second Wave

June 2020 | The Journal of Healthcare Contracting

We’re thinking of you.

We know that many things have changed, your jobs, your workplaces, and your lives have changed. We want you to know we appreciate all you do as the country works through this pandemic, and just want to say‌

Thank you.

www.EcoVue.com

COVID-19

Resourceful and tenacious Challenges abound, but so do solutions, amid the COVID-19 pandemic

Editor’s note: In the following interview, Ed Hardin, vice president, supply chain, Froedtert Health, provided insights into how his health system has responded to the COVID-19 pandemic.

The Journal of Healthcare Contracting (JHC): Can you discuss your organization’s response to COVID-19?

Ed Hardin: I got involved in the first weeks of my organization’s reaction to COVID-19 in an effort to prepare the organization for increased demands of affected patients. We then moved into an Enterprise Incident Command approach, which directly involves more than 50 and many more indirectly. It’s part of the Hospital Incident Command and a pretty standard and approved way of addressing disasters, and crises. It’s not too unlike what first responders do during natural disasters.

We have a number of different sections within that governance. One of them is called the Logistics Section, and I’m the section chief. Within that, our responsibility is basically providing resources where there is a need. It’s not just supplies; it’s HR related, IT related, and training related. It involves a host of things. My world had been primarily supplies and equipment, but this is far

Ed Hardin

broader. Most hospitals actually, I believe, are functioning this way – the big ones for

28

sure. I’m real proud of our organization

Hardin: It’s in large part a different and

hose, but it’s a close organization – par-

for what we’re doing.

very intensive type of project manage-

ticularly at the leadership level, we enjoy

ment, I was trained in project management

and respect and one another. So, it's made

JHC: How do you approach

in the early 2000s but never had to apply

easier by that but it’s definitely a different

this situation compared to

this learning in such a critical way. We’re all

dynamic. People’s titles go away. It’s really

the regular supply chain work?

learning and kind of drinking from a fire

what you know. So, it’s interesting work.

June 2020 | The Journal of Healthcare Contracting

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COVID-19

JHC: How are you navigating

I would tell you that my sense is,

leader need to be a part of it. Because

supply disruptions or shortages?

because of our academic affiliation,

if you’re on the outside, you’re probably

Hardin: As of right now (early April),

that the community seems to be pretty

going to get inundated with requests

I feel pretty comfortable where we’re

engaged with us. Milwaukee in general

that aren’t really put into proper context.

at, but the situation is very fluid. Unlike

is a very, very generous city. The state

You’re just simply going to be in reaction

California and New York, we’ve had time

is a very generous state, and so that’s

mode. But be a part of it, be actively a

to prepare (in Milwaukee). And so, we’ve

demonstrated in the type of gracious

part of it.

become quite the resourceful group. Our

support that people are giving our

regular suppliers are reliable in the sense

hospital. I hear the same for the other

on steroids, right? I think that being

that we’re getting supplies from them,

hospitals. Our cup runneth over, so to

resourceful and tenacious involves some

but we’re all on allocation. We’re not get-

speak, at Froedtert Health in terms of

level of risk. And I can tell you that your

ting what we would want, we’re getting

what the community is doing. Again, we

typical suppliers aren’t going to meet

what they can give us. That means that a

haven’t had a big surge of patients, so it

your needs, and therefore you’re going

lot of our purchases in the last three to

remains to be seen, but I'm feeling pretty

to have to be tenacious, resourceful. It’s

four weeks have been on allocation.

comfortable right now.

oftentimes up to the CFO or the CEO,

This situation is project management

but unless you’re willing to wade into the international supply chain market, I

We’ve hit a lot of bumps in the road, but we’ve been resourceful and tenacious. I think those are the two words of the day – resourceful and tenacious. Many of us are working around the clock to see to it that these things happen.

think it’s going to be tough, because the local guys, your regular suppliers, can’t supply. Incidentally, most of the suppliers – and by suppliers in this reference I mean companies that are coming your way and wanting to help you buy masks, and gowns, and other PPE – nearly all of them got into this business two months ago.

Now they’re in it, and some are unsavory. I think that’s part of the risk that you share, but you’re going to have

Dollar wise, probably pretty high,

30

JHC: What suggestions would

to really sort through it, roll up your

we’re working with suppliers that we

you give to other supply chain

sleeves and vet these guys. We have been

normally don’t do business with. In some

teams on how to stay sane

fortunate that most of the work we’ve

cases, we’re having to deal directly with

during a crisis like this?

done has been with companies that have

the manufacturers in China. So we are

Hardin: I’ve been pretty healthy, de-

not been in this business before, but

covering new ground for our organiza-

spite my health situation (Hardin was

came to us at the recommendation of

tion. I think we’re doing a pretty decent

diagnosed with stage four cancer in

very respected leaders at our medical

job, given our experience in this space.

November 2019), but I was near my wits

school or within our health system. That

We’ve hit a lot of bumps in the

end until we implemented the Enterprise

is the kind of a level of vetting that puts

road, but we’ve been resourceful and

Incident Command. While the situation

my mind at ease. But yeah, this is about

tenacious. I think those are the two

can be frustrating because you’re having

being resourceful, tenacious, and having

words of the day – resourceful and

to learn something new, I think that this

a willingness to take risks. And I know it

tenacious. Many of us are working

actually helps us. My advice is that if

makes us feel uncomfortable, but organi-

around the clock to see to it that

your organization has an Incident Com-

zations are going to have a difficult time

these things happen.

mand Operation, you as a supply chain

if they’re not willing to do that.

June 2020 | The Journal of Healthcare Contracting

SPONSORED

ENCOMPASS GROUP

Pulling Together How Encompass Group stepped up to fill a need during the COVID-19 crisis

As the cases of COVID-19 spiked across the United States, John Wood and the

up again domestically or in this hemi-

team at Encompass Group were like a lot of companies – they wanted to help in any

sphere if the need arose.”

way they could. Fortunately, as a leading manufacturer and marketer of textiles, apparel,

Within three days, Encompass Group

therapeutic support services, and single-use medical products, they had the ability to do

began the process to start suppling PPE.

just that.

“But we did have a few challenges that we needed to face.”

Wood spoke about those challenges,

“A friend at Vizient and I were talking

Wood, CEO of Encompass Group,

and other ways in which the organization

and I told him, ‘It might be a crazy idea,

recounted in a recent podcast with John

is helping America’s frontline caregivers

but Encompass has a 510(K), and in the

Pritchard, publisher of The Journal of

amid the COVID-19 pandemic, during

past had been a manufacturer of PPE,”

Healthcare Contracting. “We could set that

the podcast.

The Journal of Healthcare Contracting | June 2020

31

SPONSORED

ENCOMPASS GROUP

The PPE process

C. Love and GLO Good Foundation

healthcare workers. Indeed, in healthcare,

The first step toward producing the PPE

Co-Founder Dr. Jonathan B. Levine.

the line between partners and competi-

supplies involved validating with the FDA

The episode featured footage including

tors had become blurry on a normal day.

that the changes Encompass would make

jackets being packed and shipped out by

The current crisis has only enhanced

were going to be acceptable. The FDA

Encompass Group.

collaboration among industry stakehold-

had set up a portal where people could

ers. “Everybody’s working together,” said

Encompass Group was also the

start applying to manufacture this type of

source of 10,000 scrub units being

Wood. “It’s been a positive thing to see

product domestically, “but there was quite

donated by Jockey International to the

how everybody’s pulling together to come

a backlog there,” said Wood.

healthcare staff at the Jacob K. Javits

up with a solution.”

Wood had a conversation with another business partner, Jockey Interna-

Convention Center in New York City.

“I think we’ve all seen on the news

To listen to the podcast, visit: www.jhconline.com/podcast-encompass-

tional. Wood told the COO about what

where healthcare workers were com-

group-steps-up-to-fill-need-during-covid-

Encompass was doing and two days

ing home and changing in their garage

19-crisis.html.

later he had used some of their connections to get in touch with the task force led by Vice President Mike Pence. Just like that, “we were on the phone with the FDA,” Wood said. “We described what we were doing and we were approved within an hour.”

Within four weeks, Encompass went from idea, to procuring the necessary equipment and raw materials, to producing and shipping PPE.

SHARE donation

The Encompass Group SHARE donation was part of tens of thousands of pieces of protective gear conveyed from private and corporate donors to hospital healthcare staff in over a dozen hard-hit states.

On April 8, as the first of many efforts to respond to the national emergency to combat COVID-19, Encompass Group

because they don’t want to bring things

announced a direct corporate donation

into their home,” said Wood. “They are

through SHARE, a national call-to-action

having to do laundry every other night

program established by the Society of

so they can keep up with the workload.

Nurse Scientists Innovators Entrepre-

For them to have at least one more set of

neurs & Leaders (SONSIEL) in partner-

scrubs, hopefully that helps a little bit in

ship with the GLO Good Foundation.

the things that they’re facing.”

The Encompass Group SHARE donation was part of tens of thousands of pieces

32

of protective gear conveyed from private

Working together

and corporate donors to hospital health-

With the challenge before the U.S.

care staff in over a dozen hard-hit states.

healthcare sector, Wood said the team

ABC News Nightline featured

at Encompass Group feels fortunate to

SHARE program activity with SON-

be able to continue to work and contrib-

SIEL President & Co-Founder Rebecca

ute to meeting the needs of America’s

June 2020 | The Journal of Healthcare Contracting

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COVID-19

Rallying around the caregivers Distributors are working tirelessly to ensure product gets to providers.

of product across a wider group of essential purchasers. This is accomplished by placing temporary limits on the quantities any particular purchasing entity can purchase at any given time. It is commonly based on historical demand. Looking back over a defined period of time, distributors would then make that amount of product available to customers.

There were several reasons for this.

“One is to make sure that it’s a signal so customers understand there’s a potential supply issue, that the historical amount of supply that’s been available may not be available in the future,” Eliasek said.

“It’s a signal to our customers to conserve and to make sure that when they’re using these products that they need to be using The warning bells began to go off in January. Back in January when COVID-19 started to build, there was an impact to the production of personal protective equip-

them effectively.”

Allocation is also a way for distribu-

ment (masks, gowns, face shields, gloves products), because a high percentage of those

tors to maintain the supply chain and

products are made in China. McKesson anticipated the product disruptions that would

have product available for customers

happen as a result of the situation in China and began to plan accordingly.

when they need it. “A lot of our customers don’t have a lot of space within their facilities,” said Eliasek. “Their facilities

“It’s a relatively long supply chain and

to how McKesson and other large

are dedicated to caring for patients, and

it takes some time for those products

national distributors are working with

so they might have a small supply closet

to be made and then get to the United

the government to get products into the

or they might keep products in a cabinet

States,” said Joan Eliasek, senior vice

hands of providers.

somewhere. They don’t have space to put

president of Customer Experience for

weeks’ worth of product. They rely on

McKesson. “So we knew then that there

them in our distribution centers. And so

Healthcare Contracting, Eliasek discussed

Once it was determined that product

product won’t be available, we use this

McKesson’s efforts to support caregivers

supply would be disrupted due to condi-

allocation methodology, which is not per-

and communities during the pandemic.

tions in China, distributors were forced to

fect but does help us maintain products

Topics ranged from allocation of med-

employ allocation strategies. Allocation is

so that our customers will have it as they

surg products and why that’s happening

a methodology to spread a limited supply

continue to use it.”

In a podcast hosted by The Journal of

34

us to maintain those products and keep

Maintaining supply amid a pandemic

would potentially be a shortage of supply.”

when we see that there’s a possibility that

June 2020 | The Journal of Healthcare Contracting

Another reason distributors use al-

dock, but don’t go inside the facilities to

before, there are certainly new sources of

location is to ensure products don’t get

limit the exposure they have to particular

these supplies that are becoming avail-

shipped to an e-commerce provider or re-

patients. There are new cleaning proce-

able,” she said. “And so I feel confident

seller looking to profit on the opportunity

dures for McKesson trucks, and PPE

that over time we’ll be able to have more

that’s created when demand increases.

equipment is being issued to drivers such

product available and be able to meet the

as wipes and gloves.

customers’ needs.”

At the warehouses, workers have

Eliasek said she received an email from

Collaboration and adaptation

their temperature checked as they start a

one of McKesson’s inside sales reps that

Eliasek said one of the positive develop-

shift, follow social distancing guidelines

illustrated the commitment distribution

ments amid the pandemic has been see-

and wear masks and gloves. They also

has in response to COVID-19. The rep

ing how distributors are working directly

have been asked to self-monitor their

was shopping at a grocery store next door

with the White House and FEMA. “All

temperature to help identify anyone who

to one of McKesson’s customers when

of the key distributors in the industry

has a high temperature isn’t in the facility

a McKesson truck pulled up. Without

are working very closely with FEMA,”

and potentially coming into contact with

revealing he worked for McKesson, the rep

said Eliasek. This includes daily calls so

anyone in the building, said Eliasek. “So

told the driver he appreciated what he was

that FEMA officials better understand

there are a lot of things that we’ve put in

doing. “I’m not the hero here,” the driver

the supply chain, the product that’s

place to make sure that those folks are

responded. “These healthcare providers

available, and ensuring products get to

safe. And we have a fair amount of train-

are the heroes. I would work 24 hours

areas deemed COVID-19 hotspots. In

ing to help them understand what needs

a day if they asked me to because it’s so

those areas, distributors are coordinat-

to be done, and really all of that has been

important that these products get to these

ing with FEMA, as well as government

driven by CDC recommendations.”

end users so they can do their jobs.”

agencies such as state and local departments of health.

Within their own internal organizations, distributors have had to adjust to a new reality. At McKesson, all officebased employees with the exception of a few running operations are working from home. McKesson made investments in technology and systems for its customer service reps to be able to field calls from customers remotely rather than a call center. Reps are using “safe

“ While the demand is much, much higher than before, there are certainly new sources of these supplies that are becoming available. And so I feel confident that over time we’ll be able to have more product available and be able to meet the customers’ needs.” ʱ Joan Eliasek, senior vice president of Customer Experience for McKesson

zone protocols” where they do as much as they can from home unless they need to resolve a specific issue onsite

Committed to the providers

for customers.

Despite the challenging environment,

one at McKesson feels, “that we will do

there are reasons for optimism. Eliasek

whatever we can to make sure that these

to protect employees at its distribution

said the McKesson team is working tire-

providers have what they need. We’d love

centers. For instance, historically private

lessly to find product and to make sure

to be able to give them everything and

fleet drivers may have gone into a facility

the integrity of the supply chain is in

we’re trying really hard to get it more

to deliver product or put the product

place. Conditions in China are improving

of the product and get it available, and

away in a storeroom. With a new safe

with more product flowing out. “While

we’re starting to see a light at the end of

zone delivery policy, drivers come to the

the demand is much, much higher than

the tunnel as far as that’s concerned.”

McKesson also put measures in place

The Journal of Healthcare Contracting | June 2020

Eliasek said that’s a sentiment every-

35

FRONT AND CENTER

Infectious disease expert: Infection preventionists are “essential” to the COVID-19 response Almost overnight, infection disease experts in the United States went from

equipment appropriately and safely. “It is

obscurity to sought after sources. In some cases, such as Anthony S. Fauci, MD,

also important for IPs to work with hos-

director of the National Institute of Allergy and Infectious Diseases, they’ve become

pital leadership to help deliver consistent

household names.

and clear messaging to healthcare workers and patients. With social media and the internet many ‘urban health legends’ can

So too, has the spotlight shifted

a challenge. “We are not working in a con-

rapidly emerge and it is important to mes-

at IDNs and hospitals on the role of

trolled environment – and in many cases,

sage clearly and consistently.”

infection preventionist.

we have to make important decisions

Keith Kaye MD, professor of medicine, division of Infectious Diseases, University of Michigan Medical School, and

based on little data and rapidly emerging

Learning, and looking ahead

science,” he said.

The basics of IP, and adherence to

Our healthcare system will need to be less

past president of Society for Healthcare

those basics, remain critically important.

reliant on single use infection prevention

Epidemiology of America, said in the fight

Examples of critical IP basics include

items (like n95 masks) in the future, Kaye

against COVID-19, infection prevention-

hand hygiene, appropriate use of airborne,

said. “We will need to have reprocessing

ists, or “IPs” are involved in all essential

droplet and contact precautions, and

alternatives clearly worked out. Hospitals

components for preparation and response.

making certain that healthcare workers are

will also have to consider stockpiling

They are involved in key decision making

aware of how to don and doff protective

more PPE and avoid ‘just in time’ order-

and planning with regards to issues ranging

ing of supplies.”

from PPE supply and use, methods to

We also are too reliant on China for

perform urgent surgery and procedures

many of medical supplies, “and when they

safely, and when necessary, helping to

are dealing with their own pandemic issues,

optimize infection control in field hospitals

our supply chain can be hugely impacted.”

and temporary structures built to manage

Kaye said as much as we tried to learn

overflow of COVID patients. “They are

and prepare after SARS and H1N1, we

also very important with regards to helping

clearly were not prepared for this pan-

with the messaging to patients, the public

demic. “We have faced critical challenges

and healthcare workers.”

with regards to PPE supply, ventilator availability, surge capacity of hospitals, and testing methodologies and supplies.

36

Infection prevention in hot spots

Also, public health in some areas was

For many hospitals and health systems

completely overwhelmed even in the early

within what are considered hotspots for

stages of the pandemic – we need to com-

COVID-19 cases, maintaining proper infec-

mit to a stronger public health infrastruc-

tion prevention amid a crisis is undoubtedly

ture as a country moving forward.”

June 2020 | The Journal of Healthcare Contracting

Infection risks are everywhere.

So are we.

Innovation against infection.

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PATIENT CARE

INTERVENTIONAL CARE

ENVIRONMENT OF CARE

PRIME DISTRIBUTOR

PROVIDED BY THE HEALTH INDUSTRY DISTRIBUTORS ASSOCIATION

Pandemic sourcing checklist Ten questions to screen potential healthcare supply sources … and avoid fraudulent brokers

Since COVID-19 invaded the United States, the healthcare supply chain has

proof of the current location of

faced a dramatic increase in demand for medical supplies.

the inventory?

4. Can you offer references?

5. Can you provide a sample?

This situation is ripe for abuse by

6. Can you provide a copy of your

fraudulent brokers – individuals or busi-

quality manual?

nesses armed with little knowledge of the

7. Can you provide the company’s

healthcare industry and its stringent quality

W-9 and/or business license?

requirements – who dive into what they see

8. Can you provide a financial

as an opportunity-rich market. The goal of

snapshot, including a recent

these brokers is to facilitate deals between

income statement?

sellers and buyers in the unofficial “gray

9. Can you provide proof of

market.” Brokers do not take ownership of

510(k) clearance?

products. Industry acceptable transportation

10. Can you provide product cut

controls are not guaranteed, increasing

sheets?

the risk for lost or damaged shipments.

Brokers are focused on individual transac-

A request for advance payment

tions, not long-term business relationships

should raise a bright red flag. There

with either the buyer or the seller. A bro-

Agency’s (FEMA) recent efforts to screen

have been multiple reports in which the

kered transaction is ripe for price-gouging,

1,000 new supply offers resulted in only a

broker vanishes after receiving the funds

especially in times of high demand.

handful of viable purchases.

they say are needed for the purchase.

The media has reported multiple

So how can you understand the differ-

accounts where during the COVID-19

ence between a fraudulent broker and a

the physical items before paying for the

pandemic, brokers have profiteered from

professional, qualified distributor?

shipment. It also will allow you to verify

delivering high-priced, substandard or

the quality of the supplies.

counterfeit medical supplies, or simply

The 10 questions below can help buyers

disappeared with the money without mak-

spot warning signs before any payment is

ated by COVID-19, distributors have

ing a delivery at all.

made. Reliable distributors will be able to

been working diligently to identify new

provide rapid and verifiable responses to

PPE sources. Their goal is, as it always

vetting questions, brokers will not.

has been, to provide quality medi-

In contrast, established healthcare distributors typically serve as a single trusted source through which providers buy a

1. Are you able to demonstrate

To meet the increased demand cre-

cal supplies quickly and efficiently to

full range of medical products critical

proof of product registration

healthcare providers on the frontlines

to everyday operations. They are known

with the Food and Drug

of this pandemic.

to the nation’s hospitals, nursing homes,

Administration (FDA)?

physician practices, home health organizations, and other healthcare providers.

Vetting a supplier is not a simple process.

Even the Federal Emergency Management

38

Do not be shy about requiring access to

More information on sourcing offers

2. How long have you or your source manufactured medical supplies?

3. Can you provide current

for PPE from unknown sources can be found by visiting the Health Industry Distributors Association’s COVID-19 Resource

inventory levels and photographic

Center, HIDA.org/coronavirus.

June 2020 | The Journal of Healthcare Contracting

SPONSORED

OLYMPUS

Purchasing departments said “prove it.”

With our Endocuff-assisted colonoscopy device, we took the challenge and we are glad we did

BY BETH WALL, DIRECTOR OF HEALTH ECONOMICS AND REIMBURSEMENT, RN, MS, OLYMPUS

in a statistically significant and clinically relevant improvement in ADR, as compared with unassisted colonoscopy, due to its design, which maximizes visualization of the mucosa. For each 1% increase in ADR, there is a 3% reduction in the risk of interval colorectal cancer (CRC).1 ADR is shown through meta-analysis to be 14% higher with Endocuff-assisted colonoscopy compared to standard colonoscopy (29.8% vs. 25.8%).2, 3, 4 But with all its clinical advantages, the Endocuff would still add a cost for each case, one that the healthcare provider or payor would have to absorb.

What our stakeholders needed, from payors to hospital purchasing depart“Prove it.” Hospital purchasing departments have good reason to ask medical

ments to physicians who wanted to make

device companies to provide proof that investments into new technologies will make

a case for using Endocuff, is proof of

good sense. But what and how should medical device companies be presenting such

return on investment. We had a strong

proof to their potential customers?

theory, based on reasonable assumptions, that cost savings and health benefits could

At Olympus, we recently had an op-

detection rate (ADR), one of the most im-

be reflected in terms of the patient’s

portunity to show the economic value of an

portant indicators for prevention of inter-

ability to avoid CRC and the associated

investment in our ENDOCUFF VISION

val colorectal cancer (defined as cancer that

medical and cancer treatment costs. It was

(Endocuff) technology – and the response

recurs between colonoscopy screenings).

on us to make the case.

from hospitals and other stakeholders

40

The Endocuff device attaches to the

has encouraged us to pursue additional

distal end of a colonoscope, with multiple

economic value research for other products

flexible “arms” that fold within the prod-

from many of our medical business units.

uct during intubation and forward move-

First, we engaged a third-party researcher

ment and open out when drawn backward,

We identified the researchers at Guide-

thereby flattening the bowel folds and

house, and a team led by Tiffany Yu,

What we set out to prove

controlling the field of view. Olympus En-

whose experience in evidence develop-

We knew from clinical data that our

docuff received FDA 510(k) clearance in

ment across a variety of indications has

product, the Endocuff, improved adenoma

2016 for the claim that the device results

been shown to inform reimbursement

June 2020 | The Journal of Healthcare Contracting

guidelines6, 7, 8 that have been set to gauge

health economics and outcomes research

Third, we used economic modeling to assist in generating findings and the clinical study results were the starting point

(HEOR) and a proven record of rigorous

To hasten patient benefit, it is useful to

screening, treatment and outcomes for

research, as well as presentation experi-

rely on models. Yu had identified the Mar-

the average screening patient, beginning

ence at professional society conferences.

kov model, with its origins based in gam-

at age 50 over a lifetime — and com-

ing theory, as an ideal tool for this analysis.

pared these to patients screened with

It is important to note that the model

Endocuff-assisted colonoscopy.

and adoption discussions for payor and provider decision makers. We were interested in a partner with expertise in

the effectiveness of new innovations applied to healthcare. The model built for this economic study looked at CRC

Second, we educated ourselves on the baseline: particularly WTP

used clinical trial data, based on real world evidence, for its extrapolations. Starting

through health states representing

The medical community’s work toward

with the multiple clinical studies that had

screening (no CRC diagnosis), CRC

a “willingness to pay” (WTP) model has

CRC screening patients were tracked

diagnosis, metastasis, remission and

been a useful one. Between NICE, which is based in the U.K., and the analysis of health policy experts in the U.S., the thrust of such analysis has been to review the impact of quality adjusted life years (QALY) of patients with the use of the device.

In the case of Endocuff, facilities understand that while there could be a benefit to the device, it is not necessarily one that is measurable with each individual patient, as in the cases of patients

We were interested in a partner with expertise in health economics and outcomes research (HEOR) and a proven record of rigorous research, as well as presentation experience at professional society conferences.

death. Probabilities of transitioning between health states were applied annually. Patient outcomes included CRC incidence, CRC-related death, life years and QALY. Three stakeholder perspectives were evaluated: the device purchaser, the health plan, and the fully integrated accountable care organization (ACO) responsible for both device and medical costs. These perspectives were consid-

with no adenoma detected. Given such

ered separately and together. Lifetime

uncertainties, it is necessary to measure

Endocuff device costs were considered

the cost over the entire patient population

showed that use of Endocuff during

for the device purchaser; and lifetime

and analyze the benefits.

colonoscopy resulted in higher ADR, she

medical costs were considered for the

could then draw models over time.

health plan. The fully integrated ACO

Over time, as reflected in meta-analysis , 5

the WTP per QALY threshold in the U.S. is at $50,000.

This model was developed in compliance and accordance with international

was assumed to be responsible for device and medical costs.

To view more on this article visit: www.jhconline.com/olympus-endocuff-vision-technology-proves-its-worth.html orley DA, Jensen CD, Marks AR, et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med. 2014;370.

C Chin M, Karnes W, Jamal MM, et al. Use of the Endocuff® during routine colonoscopy examination improves adenoma detection: meta-analysis. World J Gastroenterol.

2016;22(43):9642–9649. doi:10.3748/wjg.v22.i43.9642 Hepatol. 2017; 16(8):1209–1219.

3 Patil R, Ona MA, Ofori E, Reddy M. Endocuff®-assisted colonoscopy-A novel accessory in improving adenoma detection rate: a review of the literature. Clin Endosc.

2016;49(6):533–538. doi:10.5946/ce.2016.032.

4 Facciorusso A, Del Prete V, Buccino RV, et al. Comparative efficacy of colonoscope distal attachment devices in increasing rates of adenoma detection: a network meta-analysis.

Clin Gastroenterol.

5 Neumann P, Cohen J, Weinstein M. Updating Cost-Effectiveness — The Curious Resilience of the $50,000-per-QALY Threshold. N Engl J Med 2014; 371:796-797. DOI: 10.1056/ NEJMp1405158 .

6 Caro JJ, Briggs AH, Siebert U, Kuntz KM. Modeling good research practices–overview: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force–1. Value Health. 2012;15(6):796–803. doi:10.1016/j.jval.2012.06.012.

7 Eddy DM, Hollingworth W, Caro JJ, Tsevat J, McDonald KM, Wong JB. Model transparency and validation: a report of the ISPORSMDM Modeling Good Research Practices Task Force–7. Value Health. 2012;15(6):843–850. 21.

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The Journal of Healthcare Contracting | June 2020

41

LEADERSHIP

BY LISA EARLE MCLEOD

Under duress How to make decisions in a crisis

“In every deliberation, we must consider the impact on the seventh generation…

clients to make decisions during a time of

even if it requires having skin as thick as the bark of a pine.”

uncertainty, plus a fourth question for all

The seventh generation principle comes from the Native American culture, where

of us to ponder.

it was used to make decisions large and small. Putting yourself in the position of future generations provides a frame that helps you do the right thing.

1. W ho does your organization serve?

In a crisis, leadership decisions have outsize impact and importance. We’ve

As I reflect upon where we are and

42

We’re in a defining moment. Whether

seen what happens when leaders focus

where we might do good, I find myself

you are in public service or the private

on short-term quarterly capitalism. It

thinking deeply about leadership; the type

sector, the decisions you make today will

erodes morale and creates a transac-

of leadership that got us here, and the

define you for years to come. Here are

tional relationship with employees and

type of leadership we need going forward.

three frames I’m using with my leadership

customers. During a crisis, focusing on

June 2020 | The Journal of Healthcare Contracting

short-term earnings will erode reputa-

4. How can you express empathy?

tion and trust overnight.

Any teacher or parent will tell you that

2. If you were an employee, what would you want your leader to do?

Leaders are being called upon to make tough decisions. Many have watched

5. Who does our government mean to serve?

empathy is a hard skill to teach. The ability

Does our government exist to reward

to lean into and understand the feelings of

our top producers? Or is the purpose of

another is crucial for leaders, and it’s criti-

government to serve the least among us?

cal for successful personal relationships.

My spiritual beliefs tell me it’s the latter.

Lately I’m thinking about the impact

A question I often ask myself is, how

their business evaporate overnight.

empathy (or lack of it) has on our collec-

would I want my children treated if they

Financial decisions and health decisions

tive spirit. I’ve worked with organizations

had been born poor? It’s only by accident

have suddenly become comingled. Lead-

where empathy is in short supply. At first,

of birth that I was born to a college edu-

ers will do well to consider, if I were in

it coarsens the culture, then eventually

cated couple with good jobs and a hard

the shoes of the lowest level employee

it poisons it, as people turn against each

work ethic. I didn’t create that for myself,

in my organization, what would I want

other. When leaders lack empathy, it’s

any more than my children chose their

my leader to do? What safety precau-

contagious. People double down on their

parents. What kind of world do we want

tions would I want them to take? What

own agendas as a way to self-protect.

to provide for less fortunate children?

financial measures would best serve the

When everyone is focused on short-term

team? To make it even more personal,

self-interest, organizational failure follows.

As I think about our future, I find myself thinking deeply about wisdom of the

here’s a question I’ve used in challenging situations: If one of the people in question were my child, how would I want their leader to handle this?

3. How do we want to be remembered by our customers?

You don’t have to give away the store.

You do want to think long and hard about how your customers are doing to look at your actions. One of our clients in retail made the decision to

Any teacher or parent will tell you that empathy is a hard skill to teach. The ability to lean into and understand the feelings of another is crucial for leaders, and it’s critical for successful personal relationships.

close, another in healthcare made the decisions to stay open, others, like some of our banking clients, are doing

As I work with our clients to help

7th generation principle. As Oren Lyons,

a hybrid. The lens they are using is,

them make good decisions, I continue to

Chief of the Onondaga Nation writes:

what’s best for our customers? Notice,

be impressed by their deep-seeded desire

“We are looking ahead, as is one of the

there’s a nuance to that. It’s not, what

to do the right thing. As we’ve seen many

first mandates given us as chiefs, to make

do our customers want? They may

times before, when things are at their

sure and to make every decision that we

want your restaurant to stay open. It’s

worst, people are often at their best.

make relate to the welfare and well-being

about asking, what’s best for people

Lastly, here’s a question I was thinking

and how do we want them to remember

about before this crisis that I find myself

our actions?

asking even more urgently today.

of the seventh generation to come.”

When they look back in time, what will the seventh generation think about us?

Lisa Earle McLeod is a leading authority on sales leadership and the author of four provocative books including the bestseller, “Selling with Noble Purpose.” Companies like Apple, Kimberly-Clark and Pfizer hire her to help them create passionate, purposedriven sales organization. Her NSP is to help leaders drive revenue and do work that makes them proud.

The Journal of Healthcare Contracting | April 2020

43

PEOPLE

TOM ROBERTSON, EXECUTIVE DIRECTOR, VIZIENT RESEARCH INSTITUTE

Into the line of fire Tracing the footsteps of heroes

Heroes come in all shapes and sizes. The dictionary defines a hero as a person

families of their own, who worry about

who is admired for courage, outstanding achievements or noble qualities. Common

them and about whom they worry, but

synonyms for the adjective heroic are bold, courageous and valiant.

who put it on the line every day in spite of being tired, in spite of being scared.

Healers. Caregivers. Sources of comfort.

When I think of heroes, my mind

Ports in the storm.

tends to focus on courage, and more

Ordinary folks who we might see at the

Heroes.

specifically on courage in the face of im-

grocery store, or whose car we park next

Before the international outbreak of

minent personal danger. People like Audie

to at our kids’ soccer games, who lay it

the virus, I had just begun reading a book

Murphy, the most decorated soldier of

all on the line for the rest of us when

about an obscure Polish resistance agent

World War II, or Eddie Rickenbacker, the

disasters strike.

named Witold Pilecki, who got himself

greatest American flying ace of World I,

44

in response to emergency distress calls.

There are heroes among us as we face

incarcerated in the concentration camp

or the Tuskegee Airmen, who overcame

this global outbreak of the COVID-19

at Auschwitz on purpose. To establish a

prejudice and social barriers to put their

virus. Doctors, nurses and lab technicians

bridge to the outside. To get word to the

lives at risk as fighter pilots.

standing in the doorways as patients are

world from inside the barbed wire. The

We lost more than 400 first respond-

wheeled in. Patient transporters, dietary

title of the book says it all in two simple

ers at ground zero on 9/11 – firefighters,

staff who bring meals, and maintenance

words: The Volunteer.

police officers and emergency medical

staff who sterilize treatment spaces

technicians who were last seen running

before patients arrive and after they leave.

of the fight ... to the caregivers and first

into buildings just before they collapsed.

Long-term care staff who protect the vul-

responders who run into the line of fire

Coast Guard rescue crews who head out

nerable elderly, and ICU staff who care

not away from it ... to the heroes, we say,

of safe harbors into treacherous seas

for the most desperately ill. All folks with

thank you.

To the volunteers on the frontlines

June 2020 | The Journal of Healthcare Contracting

CALENDAR

Due to COVID-19 restrictions at press time some dates and locations may change.

Calendar of events Association for Health Care Resource & Materials Management (AHRMM) AHRMM20 Conference and Exhibition September 2020 Virtual Event (more to come)

Premier Breakthroughs Conference June 15-18, 2021 Washington, DC

Federation of American Hospitals 2021 FAH Conference and Business Exposition March 7-9, 2021 Washington Hilton Hotel Washington, DC

Share Moving Media National Accounts Summit November 4-5, 2020 Atlanta, GA

Health Connect Partners Fall ’20 Hospital Supply Chain Conference September 30 - October 2, 2020 Kansas City, MO

Consolidated Service Center Forum November 3, 2020 Atlanta, GA IDN Insights East December 9-10, 2020 Philadelphia, PA

IDN Summit Fall IDN Summit & Reverse Expo August 24-26, 2020 JW Marriott Desert Ridge Resort and Spa Phoenix, AZ Spring IDN Summit & Reverse Expo April 12-14, 2021 Omni Orlando Resort at ChampionsGate Orlando, FL

SEND ALL UPCOMING EVENTS TO DANIEL BEAIRD, MANAGING EDITOR: DBEAIRD@SHAREMOVINGMEDIA.COM

The Journal of Healthcare Contracting | June 2020

45

NEWS

Contracting News & Notes Recent headlines and trends to keep an eye on

Piedmont Atlanta Hospital opened tower four months early for coronavirus

hospitals the telehealth resource centers

wrote Congress this week asking for fa-

nearly $165 million to combat COV-

cilities and providers responding in good

ID-19. Funds will go to 1,779 small rural

faith to be shielded from unwarranted

Piedmont Atlanta Hospital’s Marcus

hospitals and 14 HRSA-funded telehealth

liability during the pandemic. Not every

Tower is opening four months early,

resource centers. The funds target smaller,

state has acted on executive orders or

on April 13, to help treat the surge

rural hospitals and is separate from the

enacted legislation to support their health-

of coronavirus patients expected this

CARES Act. Approximately $30 billion in

care facilities and professionals, so these

month. The early opening will add three

the CARES Act was recently distributed

organizations are asking for a federal

ICU and acute nursing units to Atlanta’s

to hospitals nationwide.

legislative approach to ensure a consistent

capacity. It will add 132 beds, with 64

level of protection is available for every

designated as critically needed ICU beds.

facility and provider. The organizations representing these hospitals and health

Aug. 1 but accelerated its work schedule

AHA says hospitals stand to lose $200B by end of June

and deliveries of equipment to make it

The American Hospital Association

possible to open early.

(AHA) has released a report stating that

ʯ America’s Essential Hospitals ʯ American Hospital Association ʯ Association of American

The 16-story tower was set to open on

systems include:

America’s hospitals and health systems stand to lose $202.6 billion by the end of

Hospitals receive $30B in CARES Act by direct deposit

June, during the four-month period of the

CMS has announced the release of $30

port attempts to quantify the effects of the

billion of the $100 billion earmarked for

outbreak over the short-term, including:

hospitals in the CARES Act. The money is separate from the $34 billion in advance payment loans to providers announced last week. CMS later increased the amount in the Accelerated and Advance Payment Program (AAPP) to $51 billion.

The CARES Act funds began being distributed via direct deposit on April 10.

coronavirus outbreak in the U.S. The re-

ʯ The effect of COVID-19 hospitalizations on hospital costs

ʯ The effect of cancelled and forgone services, caused by COVID-19, on

Medical Colleges

ʯ Catholic Health Association of the United States

ʯ Children’s Hospital Association ʯ Federation of American Hospitals ʯ National Association for Behavioral Healthcare

ʯ Premier Healthcare Alliance ʯ Vizient, Inc.

hospital revenue

ʯ The additional costs associated with purchasing needed PPE

ʯ The costs of the additional support

Premier, America’s Physician Groups recommend APMs for CMS

All facilities and providers that received

some hospitals are providing to

Premier Inc. (Charlotte, NC) and

Medicare fee-for-service reimbursements

their workers.

America’s Physician Groups have recommended ways CMS can provide

in 2019 are eligible for the distribution.

alternative payment models (APMs)

46

for financial stability during the CO-

HHS awards close to $165M to rural hospitals, telehealth centers

Groups representing America’s hospitals, health systems seek liability protection

HHS, through the Health Resources and

Multiple organizations representing

urged CMS Administrator Seema

Services Administration, is awarding rural

America’s hospitals and health systems

Verma to:

VID-19 pandemic and also preserve the future of the models. The groups

June 2020 | The Journal of Healthcare Contracting

ʯ Allow organizations in APMs to move to no downside financial

FAIR Health: Impact of COVID-19 on hospitals, health systems

CMS offers some financial shelter to Medicare ACOs

risk with modified upside risk,

FAIR Health, a national, independent

After nearly three-fifths of Medicare

recognizing that losing the

nonprofit organization, has shared findings

ACOs indicated they would drop out

opportunity to achieve full shared

on COVID-19 in its health brief, Illuminat-

without more help pertaining to CO-

savings would only compound

ing the Impact of COVID-19 on Hospitals

VID-19, CMS offered some financial

the financial hardships they are

and Health Systems: A Comparative Study of

shelter. An interim rule on April 30

experiencing due to COVID-19

Revenue and Utilization. Findings include:

requirements during the public health

ʯ Implement extreme and

ʯ In general, there was an association

emergency for participants in the Medi-

uncontrollable circumstances

between larger hospital size and

care Shared Savings Program (MSSP),

models across all CMS Innovation

greater impact from COVID-19.

in which 517 organizations treat more

Center models, allowing model

Nationally, in large facilities (over 250

than 11 million beneficiaries. These

participants to maintain their

beds), average per-facility revenues

changes may affect the 160 ACOs

current status

based on estimated in-network

that have agreements ending Dec. 31.

amounts declined from $4.5 million

They include:

ʯ Provide an opportunity for entities to enter the Medicare Shared Savings

in the first quarter of 2019 to $4.2

Program and Direct Contracting for

million in the first quarter of 2020.

a Jan. 1, 2021, start date

The gap was less pronounced in

ʯ Accelerate pending payments to healthcare providers

ʯ Clarify quality mitigation approaches and expand these to other models

ʯ Allow all ACOs 90 days to determine

mid-size facilities (101 to 250 beds) and not evident in small facilities (100 beds or fewer).

ʯ March was the month when

ʯ Removing spending associated with COVID-19 patients from ACO performance calculations

ʯ Allowing ACOs with agreements that expire Dec. 31, 2020, to extend their agreement period by one year

ʯ Giving ACOs in the MSSP’s BASIC

COVID-19 had its greatest impact in

track the option to maintain their

if they want to drop out of the

the first quarter of 2020. Nationally,

current level of participation for 2021

program without penalty

in that month, in mid-size facilities,

Coronavirus diagnoses dropped by half for Boston Hospital staff after mask requirement

ʯ Adjusting program calculations to

the decrease in average per-facility

mitigate the impact of COVID-19

revenues based on estimates in-

on ACOs

network amounts in 2020 from 2019 was 4%; in large facilities, 5%.

ʯ Facilities in the Northeast

ʯ Expanding the definition of primary care services – used to determine beneficiary assignment – to include

After Brigham and Women’s Hospital

experienced a greater impact from

(Boston, MA) began requiring that nearly

COVID-19 than those in the nation

everyone in the hospital wear masks, new

as a whole. For example, in the

An April survey by the National Associa-

coronavirus infections diagnosed in its

Northeast, the decline in average per-

tion of ACOs (NAACOS) found 56%

staffers dropped by half or more. The

facility revenues based on estimated

were at least somewhat likely to leave the

hospital mandated masks for all health-

in-network amounts in March 2020

program if CMS did not take additional

care staffers on March 25 and extended

from March 2019 was 5% for mid-

steps to insulate them from the adverse

the requirement to patients on April 6.

size facilities, 9% for large ones.

financial effects of the pandemic.

The Journal of Healthcare Contracting | June 2020

telehealth codes

47

EDITOR’S NOTE

Graham Garrison

No time to delay In a spring press briefing for local and national media, Warner Thomas, president and CEO of Ochsner Health echoed a concern that many hospital and health system leaders no doubt shared. It wasn’t about COVID-19. It was the residual effect of what COVID-19 has done to public health in the United States – namely, the delay of medical care.

Many people with medical issues were fearful to leave their house. “That has significant implications,” said Thomas. “We’ve heard of people who have had strokes who delayed care out of fear. Minor heart attacks as delayed care.

People with broken hips that have delayed care for multiple days. That is not a good situation.”

At Piedmont Hospital’s ER in Atlanta, Georgia, on some days Allocation from there were more physicians than traditional suppliers patients, according to the Atlanta and sourcing from Journal-Constitution. Patients needing medical care for things unrenew ones are part lated to COVID-19 were afraid of the new normal. to go to the hospital or physiThere is no way cian’s office for treatment.

“You’re thinking, where are around the current challenges, according all of the patients?” Dr. Sean told the AJC. “Where are to supply chain Sue the patients having heart attacks, leaders JHC spoke to strokes, diabetic ketoacidosis?” amid the pandemic.

Indeed, the coming weeks and months will resemble a balancing act of preparedness and vigilance for COVID-19 cases, with an urgency in ramping back up normal care and elective surgeries that had been put off due to the pandemic.

Testing for COVID-19 will be key. Hospitals and health systems are making testing a routine part of the screening process for patients and employees, not just for the ER, but nearly every place where care is delivered.

“If you come into one of our facilities you are going to be tested, whether you come in to be

48

admitted, or have a procedure,” said Dr. Robert Hart, chief medical officer, Ochsner Health.

To ensure patients can have elective surgeries as soon as safely possible, a roadmap to guide readiness, prioritization and scheduling was developed by the American College of Surgeons (ACS), American Society of Anesthesiologists (ASA), Association of periOperative Registered Nurses (AORN) and American Hospital Association (AHA). The groups joined the Centers for Medicare and Medicaid Services (CMS) and praised their thoughtful tiered approach to postponing elective procedures, ranging from cancer biopsies to joint replacements that could wait without putting patients at risk. Readiness for resuming these procedures will vary by geographic location depending on local COVID-19 activity and response resources. A joint statement, developed

by ACS, ASA, AORN and AHA, provided key principles and considerations to guide health care professionals and organizations regarding when and how to do so safely.

Meanwhile, supply chain leaders will have to continue to navigate possible product disruptions. Allocation from traditional suppliers and sourcing from new ones are part of the new normal. There is no way around the current challenges, according to supply chain leaders JHC spoke to amid the pandemic.

Only through. “You’re going to have to really sort through it,” said Ed Hardin, vice president, supply chain, Froedtert Health. “Roll up your sleeves and vet these guys.”

June 2020 | The Journal of Healthcare Contracting

Patient positioning can make all the difference for consistent BP measurements.

We know you realize the importance of blood pressure capture, the effects it can have on diagnosis and the impact to patients. However, following AHA/AMA recommendations for patient positioning during BP capture will help ensure more consistent, accurate and repeatable BP measurements. Something as simple as the patient’s feet not resting flat on the floor can increase the measurement by 5 to 15 points.1

See what else can effect BP capture and download the Better BP Checklist at: midmark.com/BPpositioning

1

https://www.ncbi.nlm.nih.gov/pubmed/10450120

Š 2020 Midmark Corporation, Miamisburg, Ohio USA

Thank You. To the devoted caregivers on the front lines, and all those who sustain them, we send our heartfelt gratitude.

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