REP Aug19 Post Acute

vol.27 no.6 • August 2019

repertoiremag.com

Incontinence care under a new payment system Don’t expect major shifts in customers’ incontinencerelated purchases.

Even so, PDPM may bring about some subtle changes in care management.

ease of choice for you, ease of use for your customer (this is what we call a win-win proposition)

IMMUNOASSAY SYSTEM

MOLECULAR POINT-OF-CARE

Lateral Flow Immunoassay Molecular

BV Trichomonas hCG Strep A Flu Mono RSV iFOB H. pylori Vitamin D PSA Testosterone TSH FreeT4

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

AUGUST 2019 • VOLUME 27 • ISSUE 8

PUBLISHER’S NOTE Gear Up for Selling season.......................... 4

PHYSICIAN OFFICE LAB Renew Your Customer View Every Year...................................................................6

PWH® LEADERSHIP SUMMIT

Growth by Inclusion

Spirit of Service

18

Successful sales reps consider their job to be one of service. Successful companies share the sentiment.

POST-ACUTE CARE

Professional Women in Healthcare® holds Second Annual Leadership Summit....... 10

IDN OPPORTUNITIES

Incontinence care under a new payment system Don’t expect major shifts in customers’ incontinence-related purchases.

Even so, PDPM may bring about some subtle changes in care management.

40

Contracting Executive Profile Christopher Johnson, Senior Vice President of Supply Chain, Wellforce Burlington, Massachusetts........................................ 14

repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2019 by Share Moving Media. All rights reserved.

Subscriptions: $49.00 per year for individuals; issues are sent free of charge to dealer representatives. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address.

POSTMASTER: Send address changes to Repertoire, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors. Periodicals Postage Paid at Lawrenceville, GA and at additional mailing offices.

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AUGUST 2019 • VOLUME 27 • ISSUE 8

SERVICE

TRENDS Interoperability: Are we there yet?

What reps should say when the subject comes up with customers...................................... 30

HEALTHCARE INNOVATION NIH testing universal flu vaccine ....... 45

HIDA INSIGHTS

Wounded soldiers aren’t forgotten After 25 years serving medical customers and sales teammates, Gary Corless continues his service … to wounded soldiers

24

HIDA Members Head to the Hill Where Tariffs and Preparedness Led the Agenda........................................ 50

WINDSHIELD TIME

HEALTHY REPS

Automotive-related news................ 52

QUICK BYTES

Health news and notes

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Technology news.................................... 54

INDUSTRY NEWS News/Classifieds.............................................. 56

We go together like…

You play a vital role in B. Braun Medical’s success. And our success depends on each other. Thank you for supplying the products healthcare professionals critically need and making B. Braun a leading healthcare provider.

B. BRAUN AND YOU

Sales representatives in your area are ready to discuss how to further improve your customer experience.

B. Braun Medical | Bethlehem PA | 1-800-227-2862 | BBraunUSA.com ©2019 B. Braun Medical Inc., Bethlehem PA. All rights reserved.

PUBLISHER’S NOTE

Gear Up for Selling Season It’s that time of year again! With college football right around the corner, kids going

back to school, and shorter days all mean it’s selling season. Hopefully you have enjoyed a nice summer break and are ready to finish the back half of the year strong.

As we move in to the next few months, we’ll be covering seasonal topics, as well as topics that tie into selling season – hopefully helping you hit plan for the year.

Given that we’re all in sales, we can all agree that having the right tools to help simplify our lives is important. So, in conjunction with this issue’s content, I wanted to remind you of a few Repertoire tools that are available through RepConnect to help you in the field.

Scott Adams

RepConnect is our app designed 100% for you. It can be found in the app store for free. Here are some of the features: • Manufacturer Listings • Website and contact info • Product literature that can be easily sent via email right from the app • Manufacturer rep rosters so you can find your rep for each company • BlackBook • CPT codes and Physician Office Setup Guides • Podcasts from Repertoire •P AMA, Molecular, Flu, Road Warriors and Their Untold Stories series

• 2-Minute Drills • Short videos designed as education modules to give you conversation starters in your territory • Here is a short list of our most recent 2-Minute Drills: • Sekisui Diagnostics – Silaris™ Influenza A&B Test • Quidel – QuickVue Adenoviral Conjunctivitis Test • Quidel – Solana • Midmark – Workstations

Our goal at Repertoire is to help you sell more through timely content that makes you knowledgeable, and to create tools to make your life easier. We are constantly working with the manufacturers to improve RepConnect, and over the next few months you will see some major upgrades from their listings.

As always, thank you for your support.

Dedicated to the industry, R. Scott Adams repertoire is published monthly by Share Moving Media 1735 N. Brown Rd., Suite 140, Lawrenceville, GA 30043 Phone: (800) 536-5312, FAX: (770) 709-5432; e-mail: info@sharemovingmedia; www.sharemovingmedia.com

editorial staff editor

Mark Thill

vice president of sales

Katie Educate

keducate@sharemovingmedia.com (800) 536.5312 x5271

lthill@sharemovingmedia.com managing editor

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

Alan Cherry acherry@sharemovingmedia.com

Lizette Anthonijs

Lizette@sharemovingmedia.com (800) 536.5312 x5266

sadams@ sharemovingmedia.com (800) 536.5312 x5256 founder

Brian Taylor

Subscriptions

www.repertoiremag.com/ subscribe.asp or (800) 536-5312 x5259

2019 editorial board Richard Bigham: IMCO Eddie Dienes: McKesson Medical-Surgical

btaylor@ sharemovingmedia.com

Joan Eliasek: McKesson Medical-Surgical

circulation

Doug Harper: NDC Homecare

Ty Ford: Henry Schein

art director

Laura Gantert

Mark Kline: NDC

Brent Cashman

lgantert@ sharemovingmedia.com

Bob Ortiz: Medline

bcashman@sharemovingmedia.com

4

sales executive - East

publisher

Scott Adams

August 2019

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Keith Boivin: IMCO Home Care

PHYSICIAN OFFICE LAB

Renew Your Customer View Every Year

By Jim Poggi

This month, I will pass along a bit of wisdom I learned

from an exceptionally skilled and successful general manager of health systems. His advice was simple but remarkably effective if used consistently. It applies to selling lab or any other product in our bag: “Treat every customer as if they were ‘new’ every year”.

Think about how you felt (and acted) the last time someone actively used their knowledge and expertise to help you solve a problem or help you to improve your skills or performance in a specific area. Did you feel supported, special and in good hands? Most folks do, and we all need to remember that more buying decisions are made to solve a problem than to take advantage of a unique or limited time opportunity. Hence, we know we need to position ourselves as consultants to our customers and prospects.

How does this relate to viewing our customers as “new” once a year? Using this approach provides a chance to change your mindset and that of your customer during a specific “new customer” visit. Doing so gives them and us the opportunity to see their situation and our mutual relationship with new eyes and openly critique our objectives, progress and needs for adjustment and refinement.

Hopefully it gets us away from gradually becoming accustomed to mediocre results and accepting the status quo.

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Taking the time and having the objectivity to critically examine progress against objectives keeps us sharp and more in charge of our destiny and results. It also helps us step away from solving immediate problems and responding to “fire drills” and gives us a chance to review the big picture. Whether you are selling lab or any other patient care solutions, this approach works wonders if you commit to it and ask your customers to as well.

Tips for getting the most out of this situation Inform your customers of your intent and outline the process before you meet. Gain agreement to take this approach and set guiding principles such as: • This meeting is a high-level review of our mutual business and will focus on examining our objectives and objectively challenging to what extent we are meeting them.

• Commit to focus on market and technology changes since the last “new customer” meeting. What has changed? What is the best way to respond to the changing environment?

• Questioning progress and process is not criticism.

• Assumptions are subject to review and change.

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PHYSICIAN OFFICE LAB • Opinions may differ, but facts should be universal and not vary.

• Focus on a limited number of items/issues to review and agree on them before you meet.

How to prepare Have your facts and data at hand before the meeting. Seek to understand and examine several factors that separate best-in-class customer performance from run-of-themill performance.

Run spend reports, gap reports and grade your service level to the client. Think about inventory, ordering and consulting services your company and best suppliers offer ahead of the meeting and bring up the pertinent ones during the meeting. If in doubt, ask your manager or other experienced rep how to best prepare for a comprehensive customer business review. Then, use their ideas to create an exceptional meeting for you and your customer.

Issues to explore Overall • W hat are their key clinical, economic and practice objectives?

• How are they preforming against them?

• What do their patient visit trends look like?

•H ow do their objectives and performance match up against current market conditions and your best customers’ performance?

Services/product/technology portfolio • What key services do they offer their patients?

• Which products do they order and in what volume?

•A re they taking proper advantage of private label opportunities?

• What special offers did they miss last year?

• Which applicable ones are coming up?

• What are their testing patterns?

• Do they match the customer’s objectives and patient needs?

• Are their testing systems up to date or subject to upgrade?

• Does their EMR and LIS system meet their needs?

Operations • Are their ordering patterns and frequency efficient?

• Have they experienced avoidable back orders?

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• How often have they had “fire drills” due to operational inefficiency or lack of planning?

Supplier support • Is their training up to date?

• Are there webinars or supplier visits that could help them with MACRA or other market conditions?

• Are there new products or technologies that could help them meet their objectives?

Questions to keep in mind and discuss with your customer to stimulate new thinking • What are the top 3 items that keep them up at night?

• What are the top 3 areas of improvement for the practice?

• What new regulatory and market issues are they experiencing?

• Are there things on the practice “wish list” they just can’t seem to make the time to get to?

• How would they rate their patient service level overall? By department? Lab, billing, nursing, reception, other • Do they feel the need to get objective input from a patient survey?

• Are they reporting under MACRA? How prepared do they feel? What gaps do they perceive?

Follow-up assures success The power of this meeting comes from objectively understanding strengths of the practice that they can leverage for better patient services and satisfaction, as well as issues to work on to become even better. So, follow-up is critical to assure the findings from this meeting translate into meaningful actions and improvements.

The three keys to success and improvement following the meeting • Agree on plans you can help with and prepare to implement with a schedule and specific deliverables • Engage your key suppliers based on customer needs and feedback • Track results quarterly If you implement these thoughts with your key customers, they will always feel “new” and special to you. This puts you in a strategic customer relationship and helps with both customer retention and customer penetration.

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PWH® LEADERSHIP SUMMIT

PWH® Board Members helped make this year’s event another inspiring and educational success.

Growth by Inclusion Professional Women in Healthcare® holds Second Annual Leadership Summit

By Rachel Bailey

“Growth” characterized the second annual PWH®

Leadership Summit, held June 5-7 in Minneapolis, Minnesota. The industry’s only conference dedicated to diverse and inclusive leadership development drew 200 attendees, 23 sponsors and more diversity.

PWH® (http://www.mypwh.org) is a member organization built upon a strong history of women leaders in the healthcare supply chain who continue to create a platform for progressive leadership.

The event kicked off with its signature variety of PWH® Leadership Insights. Respected influencers from within and beyond the healthcare industry shared their vision on topics from cultivating positive and socially responsible corporate cultures to planning for

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PWH® Chair Rachelle Ferrara (Senior Director, Global Enterprise and International Sales, Brassler USA Surgical Instrumentation Inc.) welcomes and thanks 200 attendees and 23 sponsors of the second annual PWH® Leadership Summit.

a “future state” of individual membership on corporate boards. Learning sessions included the following: •D avid and Jonah Stillman, first father-son Gen X/ Gen Z speaking team, enlightened attendees on how to make way for the newest generation to hit the workforce – Gen Z. •A panel of industry leaders moderated by Repertoire Publisher Scott Adams discussed the challenges of leading through emerging technologies and disruptive innovation.

•D uring a featured conversation between Cardinal Health CEO Mike Kauffman and Founder of the Institute for Gender Partnership™ Rayona Sharpnack, Kauffman challenged every attendee to invite at least one man to next year’s event.

•F inally, former Enron executive Cindy Kay Olson shared lessons learned (i.e. what to avoid) from the quick demise of one of the most complex and successful businesses in recent history.

“What I’ve gotten out of this conference has been very, very beneficial for me personally and in my professional career,” said Reggie Newhouse, director of national accounts for PDI Healthcare. “The Gen Z [session] was very interesting, but just the thoughts around diversity and what that means. Being an African American male in this industry, I’ve dealt with that my whole career. So, to look at it from a different perspective is going to be really impactful.”

Don Lovre, director of distribution for B. Braun Medical, Inc., explained that he initially signed up to attend to

Cris Pellegrino, Director of Distributor Relations, Metrex Research LLC received this year’s Jana Quin Inspirational Award. He is also one of the first male PWH® Associate members.

Leadership panelists seemed to agree that engaged communication with employees and customers helps organizations discover and implement innovative solutions.

support women from his organization and to network with customers.

“What I’ve gotten out of this conference has far exceeded my expectations.

I would highly recommend this to other men in my organization, and I’ll Lisa Hohman, CEO of Concordance take it back to my boss and Healthcare Solutions received the second annual Anne Eiting Klamar discuss it, and have a conLeadership Award of Distinction. versation about me possibly becoming an associate member of PWH®.”

Vice President, Premier Pam Daigle attended the PWH® Leadership Summit and also found that it surpassed her expectations. “The PHW® Summit exceeded my expectations in every way. What a tremendous opportunity to network with and learn from industry leaders. So happy to be a part of this group and very much looking forward to next year!”

PWH® Chair Rachelle Ferrara thanked PWH® Summit sponsors and PWH® Corporate Partners. “We wouldn’t be here without you.”

To all current and future PWH ® members she said, “We want you to know that you are not alone.

You have a network like PWH ® to align with you and to mentor you. We hope that PWH ® can be your compass as you grow and navigate through your career.

We look forward to seeing you next year, right back here in Minneapolis, June 3-5, 2020.”

Rachel Bailey is PWH® Connect editor

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Sofia 2 Lyme FIA: CLIA-waived Results in minutes, not days.

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IDN OPPORTUNITIES

Contracting Executive Profile Christopher Johnson, Senior Vice President of Supply Chain, Wellforce Burlington, Massachusetts contracting, analytics, streamlining dock to point-of-use for supplies, evaluating impact of add-on and cancelled cases to the supply chain, and implementing cost reduction programs focused around utilization review studies. He is currently the president of the New England Society for Healthcare Materials Management (NESHMM), a chapter of the Association for Healthcare Resource & Materials Management (AHRMM). He and his wife, Julie, live in Upton, Massachusetts, with their two children.

Wellforce is a health system in eastern Massachusetts comprised of Tufts Medical Center, Circle Health, and MelroseWakefield Healthcare, as well as physician organizations. Wellforce, with four community hospital campuses, an academic medical center, a children’s hospital and nearly 3,000 physicians, brings together the strengths of academic medicine and community care. The Wellforce system reaches from Cape Cod to the New Hampshire border.

Chris Johnson

Christopher Johnson has 20-plus years of healthcare supply chain experi-

ence working for the United States Army, Children’s Hospital Boston, Yankee Alliance, Owens & Minor, Tufts Medical Center, and now Wellforce. Born and raised in Maine, he joined the United States Army in 1996, and served as medical supply and logistics specialist. Over the course of his career, he has worked with more than 60 hospitals in various roles – value analysis, strategic

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Repertoire: Can you describe the most challenging and/or rewarding supply-chain-related project in which you have been involved in the past 12-18 months?

Christopher Johnson: Building out the Future State Supply Chain Organization Structure for Wellforce is the most rewarding and challenging project to date in my supply chain career. It’s exciting to

Some things go better together MedPro: We know distribution sales (+)

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IDN OPPORTUNITIES take what I have learned over the past 23 years, pick the brains of my seasoned and knowledgeable supply chain leaders, and collaborate with Wellforce senior leaders on this future state. We have an opportunity to implement best practices, address needed changes, factor in the changing healthcare landscape (not only acquisitions and mergers, but natural disasters, such as the Puerto Rico situation), and build out a world-class supply chain team and structure.

Developing and defining the IT security risk a vendor poses through scorecards and dashboards is well underway, and will continue to evolve and drive us to change our value analysis approach.

Repertoire: Please describe a project you look forward to working on in the next year.

Johnson: Developing and finalizing our Wellforce contracting philosophy. Where applicable, our goal is to have service-level agreements in place that are governed by metrics and share the risks with our manufacturing partners. We are taking a methodical approach on what our future state looks like and how supply chain will be able to support these contracts through analytics and business intelligence. This is certainly not new to the industry, and we’ve been working with several of our major business partners over the past year to develop contracts that are in the best interest of both the vendor and Wellforce.

Repertoire: How have you improved the way you approach your profession in the last five to 10 years?

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Did you have any help doing so, or was there any particular incident that was particularly significant?

Johnson: Adapt or die! It’s harsh, but it’s the reality of being a supply chain leader in healthcare. I’ve worked in the Boston healthcare market for most of my career, and throughout the last 11 years, I have taken advantage of networking opportunities. You quickly learn that the challenges you are facing are the same ones your peers are facing, so you don’t have to re-invent the wheel. I’ve also learned that projects can’t be done in a vacuum. If you lean on subject matter experts, find out what is working and what’s not working, and level set on goals and expected outcomes, you’ll be amazed what the end result looks like. I’ve had a great deal of help along the way and have been fortunate to work with some incredible leaders. Co-workers, peers and friends have pushed me along the way. My parents have always been wonderful role models, and my wife, Julie, has been a rock throughout the past 20 years. She is the glue that keeps everything together at home and has supported my long hours and travel to allow me to pursue my career.

Repertoire: In your opinion, what will be some of the challenges or opportunities facing the next generation of supply chain professionals? What should they be doing now to prepare to successfully meet those challenges and opportunities?

Johnson: Supply chain leaders will need to work more closely with IT to tighten up practices and processes associated with the evaluation of new products, technology and equipment. Developing and defining the IT security risk a vendor poses through scorecards and dashboards is well underway, and will continue to evolve and drive us to change our value analysis approach.

In addition, tomorrow’s professionals will need to understand supply chain outside of the hospital. The constant pressure to reduce length of stay and the technology that is ready to support homecare will force us to think and act differently. Educate yourself on how supply chain works for a surgery center, skilled nursing facility, home health, hospice and the doctor’s office. Supplies and equipment will always be needed, but our traditional approach of stocking, managing and accounting for supplies in clinical areas will shift to delivering and managing those supplies across the continuum of care and into patients’ homes.

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Spirit of Service Successful sales reps consider their job to be one of service. Successful companies share the sentiment.

S

ome healthcare distributors and manufacturers believe in extending their mission of service even beyond their own reps and customers. By championing a charity, foundation or a community non-profit, they try to imbue the spirit of service among the entire company as well as those who come into contact with its people. For example: • Henry Schein Medical and Henry Schein Cares Foundation partner with Children’s Health Fund as part of the company’s ongoing commitment to “helping health happen” and enhancing access to care for those most in need, according to Jennifer Kim Field, vice president, global social responsibility, Henry Schein Cares; and Cathy Gray, market development manager, Henry Schein Medical.

• Manufacturers and distributors in the industry can partner together to support charitable organizations that focus on shared interests, says Natalie Martin, director of creative services. “For NDC, the impact has been realized both by bettering local communities, as well as strengthening relationships with business partners beyond the office.”

• “As children move through the foster system, they’re usually given trash bags to carry what few belongings they have,” says Caitlin Jasper Jelks, manager, creative services, Concordance Health Solutions, about that company’s involvement with Together We Rise. “Concordance wanted to try to make a difference.”

• “Hunger and poverty are everywhere,” says Ashleigh McLaughlin, CFO, IMCO Inc. “It’s surreal to think that even in our local middle-class communities, the child sitting next to my daughter in class might be going to bed hungry.” IMCO is a supporter of the Provision Pack Program.

Surgical care globally The Lancet Commission on Global Surgery estimates that 5 billion people lack access to safe, affordable and timely surgical care, says Francesca Olivier, senior director of innovation and social responsibility, Medline Industries. “Medline helps remove barriers that prevent patients from receiving the care that every human being deserves by partnering with clinicians to deliver care, delivering education and training, and helping health facilities run more efficiently.”

Medline is a supporter of One World Surgery (www. oneworldsurgery.org), whose mission is to ignite the spirit of service and transform lives by providing access to high-quality surgical care globally.

“Through our work with One World Surgery, we bring the best of Medline’s resources and expertise in the areas of supply chain optimization and OR efficiency,” says Olivier. “This collaboration has already been able to reduce room turnover time, increase space utilization and create efficiencies in forecasting and inventory management. Ultimately, this leads to more patients served.”

Others in the industry can promote global surgical care, she adds, by: • Donating medical supplies to organizations that support healthcare facilities overseas.

• Formalizing support for medical service trips to low-income countries.

• Supporting physicians and surgical teams in One World Surgery.

• Working with Medline to elevate the capacity of health systems in low resource countries.

Food insecurity in Florida IMCO is a supporter of Provision Packs (www.provisionpacks.org), an organization that provides nutritional assistance to

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Spirit of Service low-income families, some of whom live in poverty, others who are homeless, says McLaughlin. The organization provides well-balanced, nutritional food for children on the weekend and on extended breaks during the school year.

“Provision Packs was founded five years ago by my dear friend, Carrie Torres,” explains McLaughlin.

“She was volunteering in her daughter’s class one Friday morning at the elementary school that our children attend. On this particular morning, they were making pancakes. The teacher pointed out several kids, and said that if they ask for seconds, we should give them as many as they want. [My friend asked] ‘Why?’ and she was told “Because it might be their last meal until Monday.’ She was stunned. We were all stunned.

Two years ago, IMCO stopped giving welcome gifts to attendees at its annual convention, directing that money instead to charity. In 2018 this morphed into the IMCO Pentathlon, where teams of members and vendors competed in minute-to-win-it-type games, with IMCO contributing $100 per point earned to Provision Packs. Attendees also had an opportunity to participate in a 50/50 raffle to raise additional funds. “We have raised over $9,000 so far this year for Provision Packs, including proceeds from our second annual Pentathlon,” says McLaughlin.

“The industry can help support the fight to end childhood hunger through donations,” she says. “Every dollar helps. Even more important, I challenge everyone to look within your own communities and make sure your local school system has a similar advocate in place protecting the needs of children.

“Donate your time and money and help spread awareness. If this is happening in our community, it’s happening in yours too.”

Supporting foster children

Source: Concordance

Source: Henry Schein

“Hunger and poverty are everywhere. It’s surreal to think that even in our local middle class communities, the child sitting next to my daughter in class might be going to bed hungry.” More than 26 percent of children in Florida face food insecurity, she adds.

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Together We Rise (www.togetherwerise.org) is a nonprofit organization dedicated to transforming the way youth navigate through the foster care system in America. Concordance Healthcare Solutions chose to support the organization for its “Contribute 2019” event in April.

An estimated 250,000 children enter the foster care system each year, says Jelks. “Many enter foster care with little to no personal belongings and are sometimes victims of abuse, poverty or neglect. As children move through the foster system, they’re usually given trash bags to carry what few belongings they have.”

At the event, teams of 10 were created, intermixing over 200 Concordance employees so that they were able to work with people from different states, different roles, different backgrounds, and get to know each other. Each team was tasked with completing five Sweet Cases and five Birthday Boxes.

“We were able to positively impact the lives of over 200 area foster children and, through the sale of special T-shirts, we also donated over $700 in cash to help with the day-to-day needs of the center,” she says. “Visit togetherwerise.org, where you can learn how to donate your birthday, host a fundraiser or even your next team-building event.”

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HEINE is the first company to replicate the halogen CRI (color-rendering index) properties with the lifelong capabilities of LED. And with LEDHQ technology, you may never have to change an otoscope or ophthalmoscope bulb again. With a 100,000-hour LED bulb lifespan, a facility with 25 units can see a return on their investment in a little over a year.* Compare costs using our interactive calculator. midmark.com/sibREPaug *1.57 years based on average instrument usage (8 physicians, 20 patients a day, 5 days a week.)

4.3 otoscope and 13 ophthalmoscope replacements per unit annually.

Š 2019 Midmark Corporation, Miamisburg, Ohio USA HEINE is a registered trademark of HEINE Optotechnik GmbH + Co. KG.

Spirit of Service A ‘charity of their choosing’ NDC supports many charities, including: •S econd Harvest Food Bank (feeds hungry people and addresses hunger issues in Middle and West Tennessee).

•F olds of Honor (provides educational scholarships to spouses and children of America’s fallen and disabled service members).

•Q uantum Leap Farm (strives to improve the quality of life and cultivate human potential through equine-assisted therapies).

In addition, NDC partners with ZOLL Medical Corporation to donate an automated external defibrillator every year to a charitable organization selected by one of NDC’s distributor members. Most recently, NDC member D & H Wholesale Medical, Inc. chose Quantum Leap Farm as the recipient of a ZOLL AED.

Source: IMCO

NDC offers employees two days a year of paid time to volunteer at any charity of their choosing. Additionally, NDC offers a “Dollars for Doers” program: When an employee volunteers at an eligible non-profit, the company donates to that organization. NDC also partners with its distribution partners to collectively support charitable initiatives.

NDC employees volunteer regularly at Second Harvest Food Bank because “giving back to local communities is an important part of independent distribution,” says Martin. At a recent volunteer event, NDC employees processed just over 8,000 pounds of food, ensuring meals for approximately 7,000 individuals throughout Middle Tennessee.

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In the case of Folds of Honor, NDC partnered with GOJO Healthcare for Military Appreciation Night during the annual NDC Exhibition. Industry leaders came together to celebrate active and retired military members, donating the proceeds from the evening to support scholarships for spouses and children of fallen soldiers.

Children’s health Children’s Health Fund (www.childrenshealthfund.org) envisions a future where all children in the United States get the care and support they need to thrive. Because healthcare is a critical component of that vision and inequities in access exist, CHF’s mission is to ensure access to high-quality healthcare for America’s most disadvantaged children. CHF also works to reduce health barriers to learning, brings the voice of children to local and national policy debates, and in times of disaster, activates care for those in need.

“Our relationship with CHF reflects the important role public-private partnerships can play to help strengthen the healthcare infrastructure, and demonstrates how we as a company leverage our relationships with customers and supplier partners to drive corporate social responsibility activity that ultimately impacts the communities we serve,” according to Jennifer Kim Field and Cathy Gray at Henry Schein.

Henry Schein Medical and Henry Schein Cares Foundation (a 501(c)(3) organization that works to foster, support, and promote medical and dental health by helping to increase access to care in communities around the world) will provide a combination of cash and inkind product donations valued at nearly $525,000 over four years. This donation will include a wide range of medical and dental products to support CHF’s mobile medical clinics and pediatric programs at 12 locations throughout the United States.

As part of the agreement, each site had an opportunity to request a custom product mix to meet their unique needs.

“We as distributors of healthcare products have a responsibility to impact change and expand access to care for those in need, and we can accomplish that through donations, showing support at Children’s Health Fund fundraiser events, and driving awareness by tapping into our various communications channels and networks of key industry leaders,” say Field and Gray.

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SERVICE Carry Forward is a 5K event that asks participants to show their support for warriors by carrying a flag, a weight or another person.

Wounded soldiers aren’t forgotten After 25 years serving medical customers and sales teammates, Gary Corless continues his service … to wounded soldiers After serving customers, teammates and vendors for 25 years in med/surg distribution – including serving as CEO of PSS (now McKesson Medical-Surgical) and COO of McKesson Medical-Surgical – Gary Corless decided to step up and put his beliefs into action. In April 2015, he became chief development officer of Wounded Warrior Project.® “Passive gratitude helps no one,” he says.

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“Everything that we build professionally and personally, we build on a foundation of safety and security that we largely take for granted. That foundation doesn’t just exist. It must be fought for … and lives are lost for it and forever changed for it.

“I had been grateful to those who served and sacrificed, but I had been mostly passively grateful. I needed to step up and put my beliefs into action.”

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SERVICE Founded in 2003, Wounded Warrior Project helps serve the physical, emotional and financial needs of post9/11 warriors and their families, so they can achieve their highest ambitions. It does so through a variety of programs, and also by supporting programs of other organizations with demonstrated abilities to fill gaps and augment its existing programs and services.

WWP programs support mental and emotional wellness, familiarization with VA benefits, education, financial planning, life skills, physical health and wellness, and career assistance.

“It is rare that a day goes by when we don’t hear from a warrior or family member,” he says. “I can’t tell you how many times we hear, ‘It saved my marriage,’ or ‘It saved my life.’

“Sometimes the wins are clearly visible,” he continues. “They may come in the form of someone being able to stand up long enough to cook dinner or even speak after years of silence.” Or it could be a warrior landing a job, getting a degree or moving into new housing.

Post-9/11 Each generation of warriors faces similar readjustment challenges in key areas, like finding civilian employment, healing the physical wounds, and dealing with the invisible wounds of war, such as traumatic brain injury and posttraumatic stress, says Corless. They may also struggle to establish a support system back home in their communities.

“ The nature of these wounds is humbling, and it motivates us on a day-to-day basis.”

Last year, 33,067 warriors participated in the program. They join hundreds of thousands of retired and active-duty soldiers who have done so since 2003. More than 50 warriors and family members sign up every day.

Corless’ team – Warrior Support – consists of development, public awareness and marketing. This includes fueling the mission as well as promoting and protecting the organization’s mission, vision, and purpose.

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But those who fought and became wounded since September 11, 2001, face some unique challenges.

Advances in medicine are saving more lives on the battlefield, which in turn means more veterans are living with severe injuries for decades, he says. And some of those injuries – such as brain injuries – may not fully exhibit themselves for years. “As a nation, we’re just learning about the impact of this type of warfare. The nature of these wounds is humbling, and it motivates us on a day-to-day basis.”

What’s more, battlefield injuries often present new challenges for the veteran as he or she ages. For example, the physical and social needs of someone who has been amputated and fitted with a prosthesis often change over time. Wounded warriors may need different medical equipment, different support systems, and even different housing as they age.

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A look at the post-9/11 warrior For the past 10 years, Wounded Warrior Project has conducted the largest, most statistically significant survey of this generation of wounded service members, says Gary Corless, chief development officer. “Over 30,000 warriors share their greatest challenges. Their needs guide our program investments and expectations.”

The 2018 Wounded Warrior Project Annual Warrior Survey was the ninth annual administration of the survey.

The web survey was fielded to 98,054 eligible WWP warriors from March 20 to May 14, 2018, and over 33,000 warriors completed the survey. Almost half of warriors (45.3%) deployed three or more times during their military career. Almost all warriors who deployed since 2001 did so at least once to a combat area (93.4%).

Key findings • The four most common selfreported injuries and health problems among warriors include:

• Post-traumatic stress disorder (PTSD) – 78.2%

• Sleep problems – 75.4%

• Back, neck, or shoulder problems – 73.7%

• Depression – 70.3% • More than 60% of warriors are employed, and most (47.6%) are working fulltime. The primary reasons warriors are not in the labor force include mental health injury (37.4%), physical injury (24.3%), retirement (15.6%), or current enrollment in school or in a training program (13.8%).

• Almost one quarter of warriors (22.6%) currently work for the federal government.

Slightly fewer warriors (15.6%) work in the military, including those on active duty and those working in other military jobs.

• Home ownership continues to increase. Among warriors, 59.6% of warriors own homes, with or without a mortgage balance.

• About three in 10 warriors (32.4% in 2018) need the aid and attendance of another person because of their injuries and health problems.

Among warriors needing

assistance, approximately one-fourth (23.2%) need more than 40 hours of aid every week.

• More than eight in 10 warriors (85.8%) said maintaining their health is either very important or moderately important, and 42.1 percent of warriors do moderate-intensity physical activity or exercise three or more days a week.

• Similar to 2017, about half of warriors (49.1%) assessed their health as excellent, very good, or good, but half (50.9%) reported their health as fair or poor.

• O ver 80% of warriors report that they were less productive than they would have liked because of their physical health or emotional problems. More than eight in 10 warriors (83.9%) indicated that they were less productive than they would have liked because of emotional problems.

• Female warriors are more likely than male warriors to say that their financial status is worse than a year ago (29.7% of female vs. 25.6% of male warriors). This financial trend, along with the higher homelessness rate among female warriors, is a growing area of concern to many.

• On a 10-item Social Provisions Scale, between 51.5%

and 81.9% answered positively in 2018 to each statement about their current relationships with friends, family members, co-workers, community members, and others. (Example: “There are people I can depend on to help me if I really need it.”)

• Past military experiences still adversely affect many warriors.

More than three-quarters of warriors (77.2%) had an experience that was so frightening, horrible, or upsetting that they were constantly on guard, watchful, or easily startled.

• Warriors understand that education is vital to improving their future opportunities.

About one in four (23.2%) are now enrolled in school.

•M aintaining a healthy weight continues to be a challenge for a large majority of warriors. The average body mass index (BMI) score for warriors is 30.8, slightly above the cutoff for obesity, which is 30.0.

About half (51.7%) of warriors have BMI exceeding the obesity cut-off; 6.2 percent are morbidly obese.

•A mong warriors, 50.9 percent had visited a professional to get help with issues such as stress, emotional, alcohol, drug, or family problems in the prior three months, but access to care remains an issue.

Source: 2018 Wounded Warrior Project® Survey

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Another issue unique to today’s soldiers is the fact that they come home to a country where relatively few others share their battlefield experience, says Corless.

Ninety-nine percent of the population today did not serve in today’s all-volunteer force. Active duty personnel number 1.3 million, or less than 1% of all U.S. adults.

Med/surg training ground Twenty-five years in med/surg distribution served as a good training ground for Corless’ current work at WWP, because it helped him gain three skills:

• How to lead by serving, that is, how to help others get what they need.

• How to keep and share perspective, that is, how to stop running from task to task...deadline to deadline. Instead, taking time to see where and how we fit into the bigger picture.

• How to get over oneself, that is, how to be a grateful, hard worker.

“I cherish the 25 years I had with my team,” he says. “For us it was always about each other. We wanted more for each other than we needed from each other. I woke up every day knowing I had thousands of bosses. I still do … and I love it.” Those “bosses” are: • Warriors. “Making sure we truly understand the changing needs of the 160,000-plus injured veterans and family members we serve directly through our programs as well as the millions of post-9/11 veterans we represent through our advocacy.”

• Team. “Making sure we have the best people, the right resources and a powerful culture.”

•S upporters. “Reaching the right person with the right message at the right time, so that each American knows how he or she can make a very real and positive difference in the life of a wounded veteran.”

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TRENDS

Interoperability: Are we there yet?

What reps should say when the subject comes up with customers

Medical device interoperability – that is, the ability of

equipment and devices to interface with the electronic medical record and other devices – remains a tough nut to crack. But that hasn’t stopped the feds, EMR developers, equipment and device manufacturers, and healthcare providers from continuing to work toward that goal.

“We are involved in discussions” about interoperability with others across the continuum of care, says Ken Harris, executive vice president, sales and marketing, Health o meter.

“To the extent manufacturers can be involved, our role is to ensure our messaging is clear and that caregivers can easily record accurate information for safe and consistent care.”

Distributor reps have a role to play as well.

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“As EMR connectivity projects go, it’s critical that distributor reps have a relationship with a manufacturer that stands behind their equipment, has local resources and the technical staff available for help,” says Harris.

Why it’s important In February 2019, the National Science Foundation issued a Request for Information asking stakeholders to help determine “whether a vision of sustained interoperability in the hospital and into the community is feasible, and if so, what it will take to realize it.”

“While healthcare systems are rife with medical devices and the data they produce, to date, these devices

“Transcribing these values from glucometers into a paper log and the electronic medical record is very common yet error-prone in intensive care units, given the lack of connectivity between glucometers and the electronic medical record in many U.S. hospitals,” they wrote in the March 2019 issue of “JMIR Medical Informatics.”

A total of 5,049 blood glucose tests (pertinent to 234 patients) were studied. Transcription errors in the paper log, the flow sheet, and in both resulted in eight, 24, and two insulin errors, respectively, the researchers found. As a consequence, patients were given a lower or higher insulin dose than the dose they should have received had there been no errors. Overall, 30 unique insulin errors affected 25 of 234 patients (10.7%).

“Reps should watch out for overly simplified claims of integration and hidden costs.”

– Ken Harris

Obstacles

are not interoperable and cannot effectively interact with each other and the broader healthcare ecosystem,” wrote the agency. Interoperability, on the other hand, “will provide greater support for patient safety, decrease medical errors, reduce provider burden, reduce practice variability across healthcare facilities/geographic areas and, ultimately, enhance medical care quality and outcomes.”

The absence of interoperability comes with a human cost.

Researchers from the University of Texas Health at San Antonio studied the accuracy – or lack of accuracy – of insulin-related decisions made on the basis of pointof-care blood glucose testing among critically ill patients.

If achieving total interoperability were easy, it would already be here. But it’s not that simple.

“The primary obstacles are the customer’s priority and access to technical and EMR resources,” says Harris. “All EMR integrations require resources, whether the scale is being connected directly or through a monitor, and customers don’t always have the time or resources for integration projects. For scales in particular, every interface, regardless of brand, requires project management and project resources for a single vital sign.”

“Ease of use and ease of deployment are two primary obstacles for interoperability of medical devices,” says Chad Darling, senior product manager, EMR Business Development, Midmark Corp. “First, if a system is difficult to set up, requires each device to be preconfigured or is not stable, you will most likely not see that device connected to the EMR. “Once the hurdle of connecting the device has been overcome, daily adherence becomes the next hurdle,”

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TRENDS he continues. “If it is easier to manually key in values or if the interoperability fails when the device is being used, staff will scan or key in the information instead of using the connected device as it was intended.

Oftentimes the end-user experience is overlooked for better interoperability.”

Garrison Gomez, executive director, marketing, patient monitoring and diagnostic cardiology, Hillrom, points out that the primary barrier to interoperability doesn’t always lie with medical devices or systems. “It is getting the right balance with the customer of its security

versus clinical workflows,” he says. “We have dedicated teams that work with the customer to apply best practices that we have obtained through our experience with both large and small systems.”

Interoperability as a selling point What should the distributor rep say in answer to this question from the customer: “Will this device interface with our EMR?” “Yes” is a good start. But the rep has to be upfront about potential complexity.

“For the majority of our devices the simple answer is ‘Yes it will,’’” says Gomez. The rep should continue, “How would you like to do it, as we have multiple options that allow for maximized workflow efficiencies while provide secure access to the data?”

Says Darling, “The typical answer – Chad Darling is ‘yes’. But we always double check if the EMR is uncommon or unique to a niche. We try to be very clear about the user workflow very early in the customer conversation. This is a major advantage, as it saves everyone time and ensures the dealer and the end user are very satisfied with their buying experience.”

“Reps should say ‘yes,’” says Harris. “However, based on the customer’s EMR system parameters and standards, every system is unique in some way. It’s important that the rep and the customer talk to the manufacturer so everyone understands what the installation looks like for their particular setup.

“Each customer organization decides which patient information can be entered, how it is entered and by whom,” he says. “So while our equipment is compatible with EMR systems, having the discussion of how each system is set up is critical to understanding how an implementation will take place.

“Health o meter® Professional Scales has a variety of connectivity

“ Once the hurdle of connecting the device has been overcome, daily adherence becomes the next hurdle.”

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TRENDS options for users to choose from, including data transmission through vital signs monitors or direct interface with EMR systems. We offer both wired and wireless options, built-in at the time of purchase as well as ‘backwards compatible,’ that is, connectivity options that can be added to scales already in use in the field.

“We also recommend that sales reps be careful when looking at EMR-capable products and fully understand all the aspects of what’s being communicated about a piece of equipment. Reps should watch out for overly simplified claims of integration and hidden costs, to make sure all aspects of an integration are fully understood before acquiring equipment or starting a project.”

Problems or issues?

And if the customer complains that the newly installed device or system is falling short of expectations, at least insofar as interoperability is concerned?

“First and foremost, the rep is a customer advocate,” says Harris. “And it’s almost impossible for a rep to understand all of the technical issues between the EMR system and the myriad of EMR-compatible equipment. It’s important that the rep coordinate discussions between the user and the manufacturer if an issue occurs … so that the manufacturer can take care of it.”

“Hopefully that doesn’t happen with Welch Allyn products as we provide on-site installation and configurations of our products with the customer,” says Gomez. “That

The paths to interoperability Repertoire asked several manufacturers of medical devices and equipment to talk about their path toward interoperability, and to share their thoughts on how distributor sales reps can fit in.

“Health o meter® Professional scales were the first in the market to be able to connect to an EMR system, and we have been the leader in connected scales for over a decade,” says Ken Harris, executive vice president, sales and marketing. “Our scales can be connected directly into an EMR system or connected via multiple vital signs monitors.

“In order to increase their workflow and simplify the transmission of data into a patient record, most customers choose to connect through a vital signs monitor that can transfer weight, height, BMI, blood pressure, blood oxygen saturation and temperature all with a single EMR interaction.”

“Midmark has been integrating medical devices for over 15 years, and has partnered with leading EMRs to solve interoperability issues and provide an integrated workflow that makes device interoperability easy to adopt,” says Chad Darling, senior product manager, EMR Business Development, Midmark Corp.

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“We sometimes see this type of transcription errors [i.e., the errors described by the researchers at University of Texas Health at San Antonio in the accompanying article] with vital signs devices. The Midmark Vital Signs device is fully integrated into leading EMRs, eliminating transcription errors and fitting seamlessly into the user’s workflow, promoting interoperability.”

“Hillrom is a market leader when it comes to proven, secure, safe, and simple connected solutions inside and outside the hospital,” says Garrison Gomez, executive director, marketing, patient monitoring and diagnostic cardiology.

“Through over a decade of innovation and collaboration on the development and deployment of our Welch Allyn Vital Signs Monitors, we have EMR partnerships with over 150 EMRs. “We have also recently received our authority to operate with the risk management frame (RMF), the Department of Defense latest security standards that we have also applied to our commercial customers. In addition, the two largest health systems in the U.S., along with over a hundred other IDNs, have standardized on our solution for patient monitoring, which has enabled them to diagnose and treat patients earlier.

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TRENDS said, if the rep was to get that call, they could quickly get Welch Allyn tech support on the phone with the customer.

We have a host of tools that [allow us to] quickly diagnose the situation remotely. In the event we can’t resolve the issue, we also have a direct support model with the majority of the top EMR companies, where we can quickly get their team on the phone with the customer to resolve the issue.”

Says Darling, “If a Midmark device is not working with a compatible EMR, Midmark technical support can work with our EMR partner to help resolve the issue affecting connectivity. Our national technical support network has partnered with leading EMR systems to ensure that if there are issues, we can get them resolved as quickly and as painlessly as possible.”

What a wonderful world this would be In issuing a “Request for Information” on interoperability of medical devices, data and platforms to enhance patient care earlier this year, the National Science Foundation shared its “Future Vision” of a healthcare system with interoperability. (Boldface added by Repertoire.)

• When people with serious injuries or illness are hospitalized, medical device additions and changes are automatically recorded with no deficit in patient safety, loss in data fidelity, or data security as the patient transitions across the continuum of care.

• Additional medical devices can be added or removed as the patient’s status changes, and details of these changes, calibration of the instruments, and each equipment’s unique device identifier [UDI] and configuration settings are recorded and synchronized.

• I f a piece of equipment breaks, it can be switched seamlessly with a device from another vendor.

• Data and settings from patient medical devices, such as insulin pumps, are identified, integrated, and time synchronized, and select data are included in the electronic health record.

• As autonomous capabilities are added, realtime care is logged, and supervisory control established to ensure the provision of realtime patient monitoring and support.

• Data flows through changes in equipment that occur in moves from the emergency room, to the operating room, to the intensive

care unit, to a rehabilitation facility, and finally to the home.

• E ach change in equipment configuration is noted in the supervisory system/medical record and in the metadata (e.g., the UDI) generated by the device. The resulting patient record from these systems will include device data, metadata, and care documentation.

•P atient records are stored and analyzed using medical black box recorder-equivalents to assess adverse events or examine unexpected positive outcomes. This helps create a learning health system.

Seamlessly flowing, interoperable data from medical devices and systems, when used effectively, could enhance patient outcomes, identify and reduce errors, enhance the efficiency of care delivery, reduce development times and costs, improve standardization/consistency of care delivery, and decrease healthcare provider burnout, according to NIH. Other industries (e.g., automotive, aviation and energy) have achieved high levels of interoperability, notes the agency. It’s time for healthcare to join them.

Source: Federal Register, https://www.govinfo.gov/content/pkg/FR-2019-02-15/pdf/2019-02519.pdf

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NEW PAMA CPT codes now available in the app

Pama updated CPT codes 2018 Infectious Disease Tests Test - Panels Basic Metabolic Panel (9 tests) Comprehensive Metabolic Panel (17 tests) Electrolyte Panel (4 tests) Hepatic Function Panel (10 tests) Lipid Panel (6 tests) Renal Function Panel (12)

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2017 Fee $11.60 $14.49 $9.62 $11.21 $18.37 $11.91

2018 Fee $10.44 $13.04 $8.66 $10.09 $16.53 $10.72

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Cardiac/Liver/Other Tests Albumin (Serum) Albumin (Urine) ALP ALT Aspirin Therapy AST Bilirubin, direct Bilirubin, total BNP CK,MB CK/CPK GGT LD Microalbumin (Quantitative) Microalbumin (Semi-quantitative) Total Protein Troponin I

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$6.79 $7.10 $7.10 $7.27 $29.47 $7.10 $6.88 $6.88 $46.56 $15.84 $8.93 $9.88 $8.28 $7.93 $6.28 $5.03 $13.50

$6.11 $7.78 $6.39 $6.54 $26.52 $6.39 $6.19 $6.19 $41.90 $14.26 $8.04 $8.89 $7.45 $7.14 $6.23 $4.53 $12.47

-10% 10% -10% -10% -10% -10% -10% -10% -10% -10% -10% -10% -10% -10% -1% -10% -8%

Lipid Tests HDL LDL Lp(a) Apolipoprotein Total Cholesterol Triglycerides

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Diabetes Tests Fructosamine Glucose on home use meter-type device Glucose Tolerance Test, each additional specimen > 3 Glucose Tolerance Test, initial 3 specimens Glucose, quantitative blood type Hemoglobin A1c

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$20.68 $3.21 $5.38 $17.66 $5.39 $13.32

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Renal Function Tests BUN Creatinine Creatinine (Urine)

84520/QW 82565/QW 82570/QW

$5.42 $7.03 $7.10

$4.88 $6.33 $6.39

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Individual Tests Amylase Calcium Ferritin Iron

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$8.89 $7.08 $18.70 $8.88

$8.00 $6.37 $16.83 $7.99

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Other tools available for distributors are: vol.26 no.1 • January 2018

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January 2018

2 Minute Drill Videos

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SPONSORED: HEALTH O METER® PROFESSIONAL SCALES

The Kilogram Revolution Why medical facilities are standardizing to metric measurements, and how KG-only scales can aid in the transition.

For many years, U.S. medical facilities have used the

imperial system (pounds) to measure patients’ weight. It’s not uncommon for hospitals to use the imperial system when weighing patients, but then switch to the metric system for medication dosing. Dosing is based on the patient’s weight in kilograms, so if the weight is recorded in pounds, it will need to be converted.

This often causes confusion and can lead to potentially fatal dosing errors. For example, an article published in the Pennsylvania Patient Safety Advisory found that in more than 25% of 479 reports submitted to the Pennsylvania Patient Safety Authority, errors occurred when the patient’s weight, measured in pounds or kilograms, was incorrectly recorded as the patient’s weight in kilograms or pounds, respectively.1 Utilizing an EHR system also increases the possibility of a mistake, as the system may have default values not standardized to one unit of measure.

Due to the risks associated with using both the imperial and metric system, medical facilities are choosing to

Sources:

standardize to the metric system. Organizations such as the Centers for Disease Control and the American Academy of Pediatrics recommended hospitals and healthcare facilities to only use the metric system to avoid confusion over patient weights and medication dosages.2 As part of metric standardization efforts, facilities are evaluating their current scales and their weight unit functionality. Though most scales offer a unit lock function, Drug-related it can be inadvertently unlocked morbidity and by staff. For optimum safety and security, many providers are mortality in now requesting kilogram-only the United scales, with no pounds (LB) States have been estimated option. Utilizing a scale that only offers weight measureto cost the ments in the standardized unit American health can help eliminate confusion care system or mistakes. $76.6– $136 Always striving to meet the billion annually.3 needs of healthcare providers and make their workflow weigh easier, Health o meter® Professional Scales offers kilogram-only scales for the entire continuum of care including, physician stand-on, large platform, wheelchair, and pediatric scales. For organizations that are unsure of future standardization requirements, select Health o meter® Professional scales offer Everlock®, an exclusive patent-pending feature that allows a scale to be permanently locked in KG or LB units, with no risk of accidental unlock. Everlock® can be activated at the time of first use or when the need arises.

To view Health o meter® Professional’s comprehensive line of KG only scales, visit www.homscales.com/ kgonlyscales.

ommonwealth of Pennsylvania Patient Safety Authority. (2009). Medication errors: Significance of accurate patient weights. Pennsylvania Patient Safety C Advisory, 6(1), 10–15. Retrieved from http://www.patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2009/mar6(1)/Pages/10.aspx 2 https://www.modernhealthcare.com/article/20150501/NEWS/150509993/a-gram-of-prevention-providers-urged-to-go-metric-to-avoid-medication-errors 3 Johnson JA, Bootman LJ. Drug-related morbidity and mortality: a cost-of-illness model. Arch Intern Med. 1995; 155:1949- 56.

1

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POST ACUTE

Incontinence care under a new payment system Don’t expect major shifts in customers’ incontinence-related purchases.

Even so, PDPM may bring about some subtle changes in care management.

Medicare’s new payment system for post-acute-care

facilities – the Patient Driven Payment Model, or PDPM – will bring changes to SNFs’ accounting and coding departments. It will also encourage SNFs to take a more individualized approach to the care of each resident, and it will reward them for doing so.

But Repertoire readers shouldn’t expect a huge change in the type or amount of med/surg products SNFs buy through distribution, at least not for incontinence management. That’s because providers who have been doing right by their patients will keep doing so, regardless of reimbursement.

“PDPM is a reimbursement change, not a clinical change, for our facilities,” says Nate Ovenden, RACCT, senior Medicare & managed care consultant, Good Samaritan Society, Sioux Falls, South Dakota. “I don’t

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see it directly impacting any incontinence issues we see in our buildings. What is medically necessary in RUGS IV is still medically necessary under PDPM. That is something CMS has been very clear about, and they will monitor drastic changes in behavior from RUGSIV to PDPM. “Our facilities have been trained to do the right thing at the right time for the right person,” he continues. “The only difference is that PDPM will help offset the costs of doing so a little more than RUGS-IV. So there is a bit of light at the end of the tunnel for facilities that have been doing the right thing.”

Winners and losers Effective Oct. 1, PDPM is designed to be budget-neutral.

But there will be winners and losers.

The winners? Skilled nursing facilities that accurately assess the needs of the resident upon admission, and provide care accordingly.

The losers? Facilities that cling to the old reimbursement method, which rewards SNFs that maximize the number of hours they spend providing physical therapy, occupational therapy or speech/language pathology therapy. Under PDPM, more therapy hours won’t add up to more reimbursement dollars. (That said, the level of therapy anticipated for each resident will continue to be one factor in the new reimbursement scheme.)

Under PDPM, residents will be classified into one group for each of five case-mix-adjusted components: • Physical therapy (PT).

• Occupational therapy (OT).

• Speech/language pathology (SLP).

• Nontherapy ancillary services (NTA).

• Nursing.

For each of the components, there are a number of groups to which a resident may be assigned, based on the relevant MDS 3.0 (assessment) data.

There are 16 PT groups, 16 OT groups, 12 SLP (speech/language pathology) groups, six NTA groups, and 25 nursing groups. PDPM classifies residents into a separate group for each of the components, which have their own associated case-mix indexes and per diem rates. Additionally, PDPM applies per diem payment adjustments to three components, – PT, OT, and NTA – to account for changes in resource use over a stay. The adjusted are then added together (with the unadjusted SLP and nursing component rates and the non-case-mix component) to determine the full per diem rate for a given resident.

For example, the non-therapy ancillary (NTA) component assigns points to specific services and conditions associated with higher NTA costs, Ciolek explains. Three incontinence-related MDS items (H0100C – Appliances: Ostomy; H0100D – Appliances: Intermittent Catherization; and I1300 Ulcerative Colitis, Crohn’s Disease, or Inflammatory Bowel Disease) are each assigned one NTA component point.

“Depending on how many of these are present and other conditions and treatments identified on the MDS, these incontinence-related MDS items may impact PDPM rates from roughly $20 to $50 per day,” he says.

In the nursing component, MDS items H0200C and H0500 – denoting urinary and bowel toileting training programs, respectively – are used as case-mix rate adjustors for eight of the 25 PDPM nursing component groups. They may impact PDPM rates from roughly $5 to $25 per day if associated restorative nursing services are also furnished, says Ciolek.

Incontinence issues often are directly associated with infections, skin conditions (including decubitus ulcers), functional impairment, falls, and cognitive

The old incontinence brief may be OK for more dependent people, but there are many products designed for younger and more independent residents in the future.

Dollar impact PDPM’s impact on incontinence care will depend not only on the component case-mix payment rates, including Minimum Data Set (MDS) resident assessment items that are clearly incontinence-related, says Dan Ciolek, associate vice president, therapy advocacy, American Health Care Association. “It also depends on other MDS items that can be influenced by or are side effects of incontinence issues.”

impairment associated with disturbed sleep patterns, he continues. These factors can significantly impact the PDPM case-mix groups for the NTA and nursing components, as well as impact the physical therapy, occupational therapy, and speech-language pathology PDPM components.

(Repertoire readers should note that for the first three days of the stay, providers will receive 300 percent of the calculated NTA payment component, to account for the typically heavy investment in med/surg supplies, drugs. etc., at the beginning of a resident’s stay. Starting on Day 4, this will drop to 100 percent.)

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POST ACUTE Customers’ purchasing habits Even if Repertoire readers shouldn’t expect a major shift in their customers’ incontinence-related purchasing, PDPM may bring about some subtle changes.

“Because PDPM is meant to be more patient-centered, nursing must ensure that caregivers accurately and fully describe the impact of the patient’s continence status, as that will be associated with the cost of pull-ons, incontinence pads or adult briefs,” says Dea J. Kent DNP, RN, NP-C, CWOCN, president-elect, Wound, Ostomy and Continence Nurses Society™ (WOCN®).

“Incontinence, whether bowel or urinary, is a valid diagnosis that requires a medical supply,” she continues. “Currently, incontinence supplies in some facilities may be accounted for, or may be billed, to the patient. It will be interesting to see how this model operates upon implementation. Some components of incontinence care

go unaccounted for, such as preventative creams, which ensure that skin health is maintained in areas that incontinence may affect. No single category in the current or future payment model accounts for those costs.”

Instead of the traditional “one-size-fits-most-everyone” approach, long-term-care providers will have to be thoughtful about what stock they carry, versus what individualized items they carry, she says.

“I hope that gone will be the days that because there is only one size of adult brief available, everyone who is incontinent will have that size placed on,” she says. “That is not the most dignified approach, it is not evidencebased, and it certainly does not support the Triple Aim,” that is, improving the patient experience of care, improving the health of populations, and reducing the per capita cost of healthcare. “In fact these practices actually lead to more urinary dependency,” she says.

Incontinence: Not necessarily a forever thing Incontinence impacts many short- and long-stay residents in a nursing facility, says Dan Ciolek, associate vice president, therapy advocacy, at the American Health Care Association.

“Not only are there numerous physical-health-related consequences, but residents can also be psychologically impacted by a loss of dignity and could become susceptible to social isolation and depression.”

PDPM’s emphasis on individualized care, along with new quality standards, may help.

Many forms of incontinence are preventable, and some can be reversed with focused interdisciplinary approaches, says Ciolek. The implementation of PDPM will align payments with the SNF Requirements of Participation

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(RoP) and Quality Reporting Program (QRP), he points out.

“This creates opportunities for providers to explore and develop innovative solutions to reduce the costs of care while maintaining or improving quality. I believe that over the next few years, providers will be exploring ways to prevent and treat incontinence using evidence and best practices.

“I have seen examples where SNFs have developed incontinence risk assessments, monitored the prevalence of incontinence, monitored call light patterns, conducted staff time studies, evaluated falls with and without injuries, noted prevalence of urinary tract infections and hospitalizations, identified associated skin disorders, tracked functional

independence, and evaluated resident, family and staff satisfaction and laundry and supply costs associated with residents at-risk for or who are currently incontinent,” he continues.

“From these analyses, they changed practices and interventions to be more evidence-based and residentcentered. For example, in states whose laws permit it, SNFs are identifying residents that are clinically appropriate for the delivery of Percutaneous Tibial Neuromodulation (PTNM) within the scope of practice of physical therapist services for certain types of urinary incontinence. They are experiencing notable improvements in the quality of care and resident and employee satisfaction, while reducing overall costs.”

“I also hope that it becomes standard practice to thoughtfully promote continence behaviors, even in the memory-impaired patient. Toileting is cheaper than placing a brief, and is less cumbersome on the staff. A focus on prevention of moisture-associated skin damage may also mean less pressure injury/ulcer development, since the skin health in those moist areas may have a hyperfocus instead of being an afterthought.

“Lastly, more continence awareness may lead to better assessment, and better and more appropriate intervention, which ultimately will make less work for caregivers, allowing them to spend more quality time with their patients.”

The need for facilities to help residents with bladder or bowel issues for quality and to maintain dignity will affect the products they select, says Susan LaGrange, RN, BSN, NHA, CDONA, FACDONA, CIMT, IP-BC, director of education for Pathway Health in Lake Elmo, Minnesota.

For example, the old incontinence brief may be OK for more dependent people, but there are many products designed for younger and more independent residents in the future, she says. It is essential to assess residents for the type of incontinence and to plan an appropriate program.

Because restorative nursing calls for providers to help residents achieve their highest level of functioning, it’s no surprise that things that aid mobility – e.g., canes and walkers – will be on their shopping list as well, just as adaptive equipment for eating has proven effective for some patients who were unable to feed themselves, she adds.

For suppliers, “the theme of the day is ‘value,’” says Ciolek. “Providers are going to become more sensitive to the balance between the overall costs of the incontinence-related products/devices/equipment, and their effectiveness. Once a person becomes incontinent, the costs of care and risks for additional negative health consequences increase markedly, so savvy providers will most likely be seeking solutions that would be effective at helping prevent or reverse incontinence.

“For residents whose incontinence is unlikely to be reversible, knowledgeable providers will be seeking solutions to reduce the risk for secondary health and psychological complications as well as avoid or minimize increases in direct staff care time needed to use the incontinence-related products/devices/equipment.”

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POST ACUTE The ‘highest level of functioning’ Restorative nursing for incontinent residents The concept of “restorative nursing” will play a strong role in incontinence care at post-acutecare facilities under PDPM, as it has under RUGS-IV, says Susan LaGrange, RN, BSN, NHA, CDONA, FACDONA, CIMT, IP-BC, director of education for Pathway Health in Lake Elmo, Minnesota.

The concept has existed for years, says LaGrange, who teaches restorative nursing around the country. It’s a formal program based on resident assessment that works on specific restorative programs, for example, passive range of motion, active range, splint or brace, bed mobility, walking, transfer, dressing, grooming, eating and swallowing, amputation or prostheses care, communication and toileting, she says.

“The whole idea is to keep residents at their highest level of functioning,” she says. What’s more, particularly for toileting, it’s a matter of maintaining residents’ dignity.

Evaluating a resident’s need for incontinence care calls for an interdisciplinary team approach.

Not only does the facility have to consider the resident’s toileting patterns, but other components that might be relevant, such as the person’s cognitive abilities, diagnosis, medications, and ability to get up and go to the toilet. The team also must identify the type of incontinence they’re dealing with. Someone with stress incontinence – that is, a resident who experiences small to moderate leakage when

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laughing or coughing – will have different needs than someone who is incontinent because they can’t get out of their chair or bed in time to get to the toilet.

When attempting to determine the type of incontinence, bladder scanners are a much less invasive way than catheters to identify how much urine the resident is retaining post void, she says.

“Depending on all these different types – the care plan will be different,” says LaGrange, In the past several years, facilities have begun to focus on fecal incontinence as well as urinary, she adds.

Begin at the beginning Traditionally, restorative nursing has often commenced only after formal therapy was completed in the long-term-care setting, points out Dea J. Kent DNP, RN, NP-C, CWOCN, president-elect, Wound, Ostomy and Continence Nurses Society™ (WOCN®). But under PDPM, facilities would be well-advised to evaluate residents and coordinate restorative nursing with therapy at the beginning of the stay. If they fail to indentify the need for restorative therapy upon admission, they won’t be able to capture reimbursement for it unless they undergo an interim payment assessment, or IPA. “In order to achieve the most success with patient care and the changing payment model, I believe the savvy director of nursing will partner with both the

staff educator and a continence expert, such as a Certified Wound Ostomy Continence Nurse from the community at large, to provide education, empowerment and validation for licensed and non-licensed nursing staff alike regarding incontinence etiology, treatment, containment, recognition and prevention.

“It will be important to recognize not just the type of incontinence from a medical pathology standpoint, but to also recognize the level of incontinence. The level of incontinence and type, in combination with mobility status, can be utilized to implement evidence-based best practice for appropriate product utilization as well as sound skin breakdown prevention strategies.

“This up-front education and validation will definitely allow the staff to provide timely, accurate and effective management of incontinence, which should not only contain and streamline costs, but likely promote an increase of quality of care, while maintaining and even boosting the self-image of the patients who are living with incontinence of all types.

“Additionally, bowel and bladder programs have been mandated for years, and at this point, the importance of restorative nursing care will exponentially increase.,” she says. “The demand for restorative nurse aides to assist with bowel and bladder programs to promote continence must have a serious renaissance.”

HEALTHCARE INNOVATION

NIH working to develop universal flu vaccine Researchers using cutting-edge technology could be close to developing a universal flu vaccine, according to PBS News Hour. Researchers at the Vaccine Research Center, part of the National Institutes of Health (NIH) (Bethesda, MD), have used virtual reality to magnify influenza to over 200 million times its actual size, with the goal of targeting the part of the virus that stays the same from strain to strain. The potential universal vaccine could protect against all known and unknown strains. The NIH began testing its most recent universal flu vaccine on humans in May 2019.

Researchers are waiting to see whether patients’ immune systems will respond with a strong defense.

Poll: Americans support potential of gene therapies A new poll from think tank the Pacific Research Institute (PRI), shows that Americans overwhelmingly support innovative gene therapies, which change the focus of medicine from treating illnesses to curing illnesses.

“Gene therapies have the potential to cure a wide array of difficult-to-treat diseases, including Alzheimer’s Disease, autism, cystic fibrosis, HIV, and cancer, among others” said Dr. Wayne Winegarden, director of PRI’s Center for Medical Economics and Innovation. “Our new poll shows that Americans see the potential for the innovation from gene therapies to find cures for often-deadly diseases that cut short people’s lives, and illnesses that strike newborns, infants, and toddlers.”

Gene therapies differ from many traditional medicines in that they aim to address the underlying cause of the disease with a one-time treatment, rather than treating its symptoms over a patient’s lifetime, according to a release. According to the poll, 80% of respondents agree that focusing on curing diseases is a greater priority than chronically treating them.

PRI’s new survey comes on the heels of the Food and Drug Administration’s approval of a new gene therapy designed to treat spinal muscular atrophy, which the media dubbed “the most expensive drug in the world.”

“Despite higher costs, our new poll shows that Americans are excited about the potential of gene therapies to save people’s lives – and are willing to pay for them, too,” said Winegarden. “Not only do gene therapies provide significant value, but they also have the potential for future health care savings on drugs and doctor visits.

Ensuring patients have access to these new cures that can improve their overall quality of life – and in many cases save their lives – is imperative.”

Tellingly, 78% of respondents agreed that developing cures for diseases should be pursued, despite high upfront costs. The poll also shows broad support for both private and public insurers covering these cures. Nearly seven in ten respondents (69%) think that insurance companies, Medicare, and Medicaid should pay for these treatments, and 67% would support an additional cost to their insurance payment to cover these treatments for all patients.

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SPONSORED: SYMMETRY SURGICAL®

Revenue Generators The right electrosurgical generator can mean improved clinical outcomes for a customer, and a disposable accessory revenue stream for distributor reps

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Physicians, clinicians, and surgery center administra-

Family Practice

tors have a host of choices when it comes to selecting a generator for their practice, and a knowledgeable distributor and/or sales representative can help them make the right one.

Generators are known as electrosurgical units (ESU), radio frequency (RF) electrosurgical generators, ‘Bovies,’ and high-frequency (HF) desiccators. These devices are used to cut, coagulate, fulgurate, and desiccate tissue, and there are numerous options available on the market today.

The most active practices using electrosurgery in the nonacute space today are dermatology, plastic surgery, OB/ GYN, and surgery centers.

Family practice doctors also use the Bovie® DERM 942 but, unlike dermatologists, they are more likely to purchase a single unit due to the cost. For this reason, Bovie® has created high-frequency desiccators that are more economical – the Bovie® DERM 101 and Bovie® DERM 102.

These devices are limited to 10 watts of output but provide wattage in accurate, 1/10th watt increments. While the 101 provides monopolar power, the 102 combines monopolar with bipolar power.

OB/GYN OB/GYNs who cut tissue are most likely performing a LEEP/LLETZ procedure (Loop Electrosurgical Excision Procedure or Large Loop Excision of the Transformation Zone). The electrosurgical generator OB/GYNs use must be able to cut and coagulate tissue and maintain enough power to complete the task. The classic device for this procedure is the Bovie® Specialist PRO A1250S-G – a scaleddown version of an operating room level electrosurgical generator. This system includes the electrosurgical generator and the Smoke Shark® II smoke evacuator on a mobile stand. As mentioned earlier, these types of devices also create quite a revenue stream of disposables, typically including an electrosurgical pencil, a grounding pad – with or without cord, and electrodes with loop and ball tips for each case.

Dermatology

Plastic Surgery

Dermatologists typically have one high-frequency desiccator in each of their examination rooms. The Bovie® DERM 942 is often their generator of choice for a highfrequency desiccator. These are small, relatively inexpensive units used for desiccating, fulgurating, and coagulating tissue (Note: These devices cannot cut), and they result in a revenue stream based on the required number of disposables they consume. These disposables include both sharp and blunt dermal tips, packaged sterile and non-sterile, along with sterile and non-sterile drapes to cover the handpieces.

Plastic surgeons need a powerful and versatile electrosurgical generator for the host of procedures they perform.

Many select the Bovie® Specialist PRO A1250S, which provides up to 120 watts of power. However, if their surgical techniques require both monopolar and bipolar energy during the same procedure, they must physically switch between monopolar and bipolar energy (either by breaking the sterile field themselves, or by having an assistant make the switch) as the monopolar coagulation energy and the bipolar energy displays are shared when using this device.

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In these procedures, a better solution is a unit with a dedicated output for bipolar energy to allow the surgeon to easily switch back and forth between energy modalities without delaying the procedure. Bovie® offers the perfect solution – the Bovie® Surgi-Center PRO A2350. While your customer may be tempted to acquire a cheaper, used OR 300watt generator with a 90-day warranty, the 200-watt Bovie® Surgi-Center PRO A2350, like all Symmetry Surgical ESUs, comes with the only four-year warranty in the industry.

Surgery Centers In the surgery center, the most common electrosurgical generator used is a 300-watt model, like the Bovie® OR PRO A3350, based solely on the surgeon’s familiarity with the same version they use in a hospital OR. However, as many surgical suites could accomplish all their procedures using a 200-watt system, the Bovie® Surgi-Center PRO A2350 (mentioned above) could save a facility a lot of money.

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In physician office and surgery center accounts, perhaps the main task to address is cutting. If the customer intends to cut tissue (as opposed to simply fulgurating and desiccating), they’ll need to ensure that this feature is available on the device, which can range between the 50-watt Bovie® Bantam PRO 952 and the 300-watt Bovie® OR PRO A3350. Devices in this class are frequently referred to simply as ‘Bovies’ – even though they may be manufactured by several other companies. However, Bovie® is the trusted brand name of the original electrosurgical generator and is a registered trademark of Symmetry Surgical.

Specialist PRO

Surgi-Center PRO

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Accessories With the exception of the monopolar and bipolar footswitches and the reusable DERM handpieces, which are all manufacturer-specific, most of the accessories in electrosurgical procedures are interchangeable. Electrodes, pencils, grounding pads, and a host of additional accessories work with virtually every manufacturer’s electrosurgical generator.

Each facility that performs electrosurgery is an opportunity for a sales rep to capture their disposable accessory revenue stream – and this should be the target of focus.

While these facilities are not always in the market for an electrosurgical unit, they are constantly purchasing disposables. Those reps who have invested in the relationship to earn their disposable business will likely be the first ones the facility calls when they are looking for a new ESU.

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HEALTHY REPS

Health news and notes Important tip for patients Patients whose surgeons had higher numbers of coworker reports about unprofessional behavior in the 36 months before the patient’s operation appeared to be at increased risk of surgical and medical complications, according to a study in JAMA Network. The researchers concluded that surgeons who model unprofessional behaviors may help to undermine a culture of safety, threaten teamwork, and thereby increase risk for medical errors and surgical complications. The findings suggest that organizations interested in ensuring optimal patient outcomes should focus on addressing surgeons whose behavior toward other medical professionals may increase patients’ risk for adverse outcomes.

From gloom to gratitude A positive outlook can lead to less anxiety and stress, according to a new study of caregivers, as reported by NPR. Here are eight skills to help cope with stress: 1) identify one positive event each day; 2) tell someone about that positive event; 3) start a daily gratitude journal, identifying even the little things for which you’re grateful; 4) identify a

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personal strength and note how you’ve exercised it recently; 5) set a daily goal and track your progress; 6) practice “positive reappraisal,” which means reframing unpleasant events in a more positive light (e.g., turn stop-and-go traffic into a moment to savor the stillness); 7) do something nice for someone every day; 8) pay attention to the present moment (try a 10-minute breathing exercise).

Risks associated with vinpocetine The dietary supplement vinpocetine may cause a miscarriage or harm fetal development, warns the U.S. Food and Drug Administration. These findings are particularly concerning, since products containing vinpocetine are widely available for use by women of childbearing age. Vinpocetine is a synthetically produced compound that is used in some products marketed as dietary supplements, either by itself or combined with other ingredients. Vinpocetine may be referred to on product labels as Vinca minor extract, lesser periwinkle extract, or common periwinkle extract. Dietary supplements containing vinpocetine are often marketed for uses that include enhanced memory, focus, or mental acuity; increased energy; and weight loss.

Sleep regularly Failure to stick to a regular bedtime and wakeup schedule – and getting different amounts of sleep each night – can put a person at higher risk for obesity, high cholesterol, hypertension, high blood sugar and other metabolic disorders, according to a study funded by the National Institutes of Health and published in Diabetes Care. In fact, for every hour of variability in time to bed and time asleep, a person may have up to a 27% greater chance of experiencing a metabolic abnormality. “Many previous studies have shown the link between insufficient sleep and higher risk of obesity, diabetes, and other metabolic disorders,” said study author Tianyi Huang, Sc.D., epidemiologist of the Channing Division of Network Medicine at Brigham and Women’s Hospital, Boston. “But we didn’t know much about the impact of irregular sleep, high day-today variability in sleep duration and timing. Our research shows that, even after considering the amount of sleep a person gets and other lifestyle factors, every onehour night-to-night difference in the time to bed or the duration of a night’s sleep multiplies the adverse metabolic effect.”

Vitamin D supplement won’t prevent type 2 diabetes Taking a daily vitamin D supplement does not prevent type 2 diabetes in adults at high risk, according to results of a study funded by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. “Observational studies have reported an association between low levels of vitamin D and increased risk for type 2 diabetes,” said Myrlene Staten, M.D., D2d project scientist at NIDDK. “Additionally, smaller studies found that vitamin D could improve the function of beta cells, which produce insulin. However, whether vitamin D supplementation may help prevent or delay type 2 diabetes was not known.”

The study enrolled 2,423 adults at 22 sites across the United States, and results were published in the New England Journal of Medicine and presented at the 79th Scientific Sessions of the American Diabetes Association in San Francisco.

Eat your broccoli Your mother was right; broccoli is good for you. Long associated with decreased risk of cancer, broccoli and other cruciferous vegetables – the family of plants that

also includes cauliflower, cabbage, collard greens, Brussels sprouts and kale – contain a molecule that inactivates a gene known to play a role in a variety of common human cancers. In a paper published in Science, researchers, led by Pier Paolo Pandolfi, M.D., PhD, director of the Cancer Center and Cancer Research Institute at Beth Israel Deaconess Medical Center, demonstrated that targeting the gene, known as WWP1, with the ingredient found in broccoli suppressed tumor growth in cancerprone lab animals.

Antibiotic shot may prevent childbirth-related infections A single injection of antibiotics significantly reduces the risk of infections when women who are giving birth

Failure to stick to a regular bedtime and wakeup schedule – and getting different amounts of sleep each night – can put a person at higher risk for obesity, high cholesterol, hypertension, high blood sugar and other metabolic disorders, according to a study funded by the National Institutes of Health and published in Diabetes Care. require the aid of forceps or vacuum extraction, a study published in Lancet concludes. The routine use of the prophylactic shot actually reduces antibiotic use in the long run, the study found. British researchers randomly assigned 3,420 women who had operative vaginal births to one of two groups: The first received a single shot of Augmentin (amoxicillin and clavulanic acid) within six hours of giving birth, and the second a placebo saline shot. Then they tracked infections over the next six weeks.

Compared with the placebo group, women who got the antibiotic had a 42 percent reduced risk for any infection, and a 56 percent lower risk of a bodywide infection. Antibiotic users had about half the risk of perineal wound infection compared with the placebo group, and they used less pain medication.

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HIDA GOVERNMENT AFFAIRS UPDATE

HIDA Members Head to the Hill Where Tariffs and Preparedness Led the Agenda Over 60 HIDA members convened in Washington, D.C. in early June to educate law-

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

makers and their staff about key issues affecting the healthcare supply chain. Attendees at the annual Washington Summit conducted 120 Capitol Hill meetings.

Distributors attending the event reported productive discussions with lawmakers and congressional staff who sit on key committees influencing healthcare and distribution.

These include the Senate Finance, Armed Services, and HELP (Health, Education, Labor, and Pensions) committees, as well as the House Ways and Means, Energy and Commerce, and Armed Services committees.

While trade policy and pandemic preparedness were top-of-mind, conversations also included the medical device tax, government purchasing reform language in the National Defense Authorization Act, and other issues.

From left to right: Chris Kerski, Cardinal Health; Jerrica Mathis, Crowell & Moring; Chris Fagnani, Lynn Medical; Steven Sepulveda, Mesa Biotech.

Here is a look at some of the topics HIDA members discussed with elected representatives:

Trade Policy and Tariffs Summit participants explained how tariffs on healthcare products create risk to the nation’s public health preparedness capabilities. Exam gloves and isolation gowns protect healthcare workers, first responders and patients

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from the spread of infectious diseases. Ebola is once again an epidemic on the African continent and a single case in the U.S. would drive a substantial increase in demand for this protective equipment and supplies overnight. Placing a tariff on these products will further stress supplies at a critical time.

In addition to raising the cost of care, summit participants explained that placing tariffs on healthcare goods could create risks for clinicians, first responders, and patients.

It is important for policymakers to understand the complexities of the U.S. healthcare supply chain, so tariffs and trade policies do not unintentionally constrain preparedness capabilities, they added.

Emergency Preparedness HIDA members thanked lawmakers for passing the Pandemic and All-Hazards and Advancing Innovation Act of 2018 (PAHPAI). This bill was a huge win for the industry as for the first time supply chain and commercial partnerships are included in legislation.

Specifically, the bill requires the communication of

Government Purchasing Reform Distributors cautioned lawmakers that the General Services Administration’s efforts to reform the federal procurement system leaves open the door for future inclusion of healthcare-related products on the Commercial Ecommerce Portals program. HIDA members asked that Congress either exempt healthcare products from purchase through this portal or greatly alter the process for their future procurement.

Many healthcare products are not well-suited for procurement through the ecommerce portals. MisSummit participants hear political insights and a forecast for the current Congress. taken delivery of the wrong surgical supplies or antibiotics, for example, could place patients’ lives at risk.

Additionally, many medical goods require specialized regional health systems to the supply chain. It also handling and storage. Exposing these to the wrong enrequires the federal government to assess ancillary vironment or comingling them with non-medical freight product availability, commercial market capacity and could render them useless or even harmful, summit identify substitutions in its annual process. Lastly, it attendees said. requires coordination with commercial market on reHIDA regularly advocates for distributors through meetsponse and re-entry. ings with lawmakers and partnerships with federal agencies HIDA members also shared their experience from year round. If you would like to get involved, or would like recent pandemics and natural disasters, emphasizing the more information about the HIDA Washington Summit, need for improved coordination and greater elasticity in please contact us at HIDAGovAffairs@HIDA.org. the supply chain. Summit attendees were grateful for the passage of PAHPAI, as it underscores the value of public and private sector coordination during an emergency.

Medical Device Tax Distributors thanked members of Congress for the two-year moratorium on the Affordable Care Act’s medical device tax. HIDA members explained to lawmakers the deleterious effect it had on medical device companies’ research and development efforts, and asked that the tax be repealed. Without congressional action to extend or eliminate the tax, it will take effect again at the end of this year.

Left to Right: HIDA President and CEO Matt Rowan, HIDA Chairman Mark Hineser, Louisiana Sen. Bill Cassidy, MD, and Chris Kerski, Cardinal Health.

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WINDSHIELD TIME Chances are you spend a lot of time in your car. Here’s something that might help you appreciate your home-away-from-home a little more.

Automotive-related news Going in the right direction A statistical projection of traffic fatalities for 2018 shows that an estimated 36,750 people died in motor vehicle traffic crashes, reports the National Highway Traffic Safety Administration. It is a lot, but it represents a slight decrease of about 1% as compared to the 37,133 fatalities that were reported to have occurred in 2017. Preliminary data reported by the Federal Highway Administration shows that vehicle miles traveled in 2018 increased by about 12.2 billion miles, or about a 0.4% increase.

Lunch on the go If you own a 2017 or newer GM vehicle, you can order Domino’s Pizza – if you want to – in your OnStarequipped vehicles via the Marketplace app, reports Car and Driver. Part of a larger food initiative that also encompasses McDonald’s and Starbucks, the app allows consumers to order a pizza for pickup or delivery to their home via the app, which works independently from their mobile device. Placing an order requires a user to have a Pizza Profile registered with Domino’s. New users can set one up either

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online or via the Domino’s mobile app. Including their preferred delivery address, preferred stores, and payment method information, it also permits the user to store their favorite orders for fast and easy reorders. Once established, users link their Pizza Profile to their vehicle, which permits users to order Domino’s from their vehicle’s touchscreen.

Charge it at Walmart Volkswagen AG unit Electrify America will significantly expand its U.S. network of electric vehicle charging stations at Walmart Inc. store locations, with an emphasis on America’s heartland states, the two companies announced in June, reports Reuters. Electrify America already has more than 120 operational charging stations installed at Walmart stores in 34 U.S. states. The companies did not disclose the number of new charging stations they plan to build. But according to sources familiar with Electrify America’s plans, the company will build 180 more charging stations at Walmart locations by the end of 2019.

Major automakers including General Motors Co. have announced plans to invest tens of billions of dollars on

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families of electric vehicles over the next few years, in a direct challenge to Tesla Inc., reports Reuters. But a lack of infrastructure for U.S. drivers to recharge vehicles is seen as a major barrier to mass adoption of electric vehicles, as consumers remain concerned over limited range.

Google Assistant and Waze Drivers can now get information about traffic conditions and more from the Google Assistant in Waze on Android phones in English. “Thanks to its community of millions of drivers contributing real-time data every second, Waze helps you beat traffic, while the Assistant lets you play music and podcasts, message your friends and call your family hands-free – without ever leaving the navigation screen,” reports Google in a June 10 blog. “Many of your favorite Waze features, like reporting traffic, pinpointing a pothole or checking for alternate routes, can also be accessed simply by using your voice. Just say ‘Hey Google, report traffic’ or ‘Hey Google, avoid tolls’ when navigating with Waze and your Google Assistant will help keep you connected, informed and minimize distractions while you’re on the go, so you can keep your hands on the wheel and your eyes on the road.”

Driving is not a permanent right “Because driving is essential for most Americans, we conceptualize driving as a permanent right, instead of a temporary privilege,” writes a Boston area primary care doctor in Health Affairs. “Our aging population demands a conscious and deliberate revision of this misimpression, so that it becomes normal for people to outlive their driver’s license. In the same way that we have processes in place for people to initiate driving – learner’s permits, driver’s education classes in high schools, driving tests – we need a concrete process for relinquishing a driver’s license. This parallel process should be managed by state driver’s licensing agencies, not by doctors.” The number of fatal crashes for each mile driven increases noticeably starting at ages 70-74 and is highest for drivers ages 85 and older. The elevated fatal crash risk among older drivers is largely due to their increased susceptibility to injury, particularly chest injuries, and medical complications, rather than an increased tendency to get into crashes. Yet there is wide latitude in the ways in which different states address the challenge of the aging driver.

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QUICK BYTES Editor’s note: Technology is playing an increasing role in the day-to-day business of sales reps. In this department, Repertoire will profile the latest developments in software and gadgets that reps can use for work and play.

Technology news Where have all the tablets gone?

Google’s reported decision to abandon tablets came as no surprise to those in the industry, reports Venture Beat. “Tablets are dying a slow death anyway,” they write. Tablets did not end up delivering as promised. The form factor never took off like smartphones, and it never replaced computers. In fact, the tablet market peaked at the end of 2014 and has been shrinking ever since. And yes, the PC market has also been declining, but it’s much, much larger. The tablet as we know it is going to disappear. The market won’t keep shrinking into oblivion, but the slate form factor will get squeezed out. It’s already happening. Smartphone screens

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have grown to make 7-inch tablets obsolete while laptops have gained touchscreens and removable screens. [Note: Google’s decision does not affect its Pixel phones or Pixel computers, such as the Pixelbook.]

PowerPoint critiques your PowerPoint Microsoft has launched a number of updates and new features to help you improve your PowerPoint presentations, reports TechCrunch. In fact, PowerPoint will even critique your presentation. Presenter Coach for PowerPoint is a new AI tool that offers feedback while you’re practicing your presentation in front of your computer.

It’ll tell you about your pacing, whether you are using inclusive language, and how many filler words you use. It also makes sure you’re not just reading your slides. After your rehearsal session, PowerPoint will show you a dashboard with a summary of your performance and what to focus on to improve your skills. This feature will first come to PowerPoint on the web and then later to the Office 365 desktop version. As for the visual design, Microsoft has added new features like Designer theme ideas, which automatically recommends photos, styles and colors as you write your presentation.

iPhone repairs at Best Buy Apple Inc. and Best Buy Co. announced this summer that they have extended a partnership that will allow the Minneapolis-based retailer’s technicians to fix iPhones at any Best Buy store in the United States, reports Reuters. The deal will cover all 992 U.S. Best Buy stores, up from about 225 stores previously. In addition, 7,600 of Best Buy’s socalled Geek Squad technicians are now certified to carry out the repairs using parts directly from Apple. Apple says that it now has 1,800 third-party repair providers in its U.S. network – three times as many as three years ago and enough to put eight out of 10 of its customers in the United States within a 20-minute drive of an authorized repair center.

Are you ready for some Folding?

At press time, Samsung Electronics was rumored to be ready to launch the Galaxy Fold, its foldable smartphone whose introduction was delayed earlier in the year, reports The Investor. Reviewers had complained about flickering screens and creases in the middle of the screen after repeated folds. “Most of the display problems have been ironed out, and the Galaxy Fold is ready to hit the market,” Samsung Display Vice President Kim Seong-cheol was quoted as saying this summer. Made from bonded layers of polymer material, the 7.3-inch Infinity Flex Display is engineered to be 50% thinner than other Galaxy displays, according to Samsung.

Navigate your way out of danger Google is adding tools to Google Maps and search to help you survive natural disasters, which we seem to be experiencing more frequently these days, reports USA Today. After all, when a hurricane, flood or earthquake affects your area, you may want to get of town quick. Google is launching a new navigation warning system as part of Google Maps to keep you informed and safe during such a crisis.

Google is not in the weather business, so it is tapping into such sources as the National Oceanic and Atmospheric Administration and Japan Meteorological Agency (for hurricanes) and the U.S. Geological Survey (for earthquakes).

Hurricane forecast cones and earthquake shake maps will begin rolling out on iOS. Flood forecast visualizations are reportedly coming soon.

Smartphone updates Updates in iOS 13 and Android Q will change your smartphone, reports Brian X. Chen in The New York Times. Some changes to look for: 1) Many of Apple’s iPhones will become faster with iOS 13, and apps will open up to two times faster; 2) Apple phones and Android devices will both get dark modes, to make screen-gazing a little Presenter Coach for easier on the eyes; 3) both PowerPoint is a new offer privacy enhancements, such as Apple’s new “Sign AI tool that offers In With Apple,” a button for feedback while using an Apple ID to sign in you’re practicing to iOS apps and websites.

your presentation in front of your computer. It’ll tell you about your pacing, whether you are using inclusive language, and how many filler words you use.

Alexa’s in the home phone

The Alexa-enabled, Motorola-branded home phone is now available, reports Dealerscope. The idea behind the Motorola AX Series is to merge two revolutionary technologies –albeit from different eras – into one singular product: the home telephone and voice control. The phone itself has a dedicated Alexa button that the user can press to access all kinds of phone-related features, including asking Alexa to call certain contacts, to call connected Echo devices, and more. Users can control all of their connected home devices through the service, just like they would with any Echo or Alexa-enabled device. “The idea of bringing Alexa to the home phone seems almost logical at this point, but at the same time it’s also a unique move,” according to the publication. “A consumer may not want to place an Echo speaker in every room in their home because, if anything else, they may just not want to own that many speakers. By putting Alexa in a home phone, they’re able to extend their access to the service through a product that does typically reside in multiple rooms.”

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INDUSTRY NEWS Henry Schein Medical expands its SolutionsHub portfolio Henry Schein Medical (Melville, NY) announced the expansion of its web-based SolutionsHub. This resource features a full suite of solutions to help customers improve patient outcomes, increase profitability, and run a more efficient business. The Henry Schein SolutionsHub has expanded to include providers of revenue cycle management, online scheduling, medical waste disposal, practice marketing, medication adherence, and hiring and recruitment solutions. A complete list of solutions and solutions providers can be found on the SolutionsHub’s newly launched website.

Share Moving Media announces new VP of Sales, West Account Executive Share Moving Media (SMM) (Lawrenceville, GA) announced that two new members have joined the SMM team.

Katie Educate has joined the company vice president of sales. In this role, Katie will oversee the sales teams for both the Medical and Dental divisions. Katie

INTEGRITY. CUSTOMER FOCUSED. ENTREPRENEUR. SUCCESS DRIVEN. If these words describe you, you may be a good fit for a sales role at US Medsource.

US Medsource is a full-line, regional medical distribution company based in Sarasota, FL. Our culture of integrity, customer service, hard work, and community is an important part of what makes us unique. We are currently looking for candidates that share these same values to come onboard as part of our sales team.

We offer one of the most aggressive commission plans in the industry with uncapped earning potential, full health benefits, and upward mobility in the company as we continue to grow.

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most recently was director of sales for Health Connect Partners, and is returning to SMM following a threeyear hiatus.

Scott Adams, managing partner for SMM, said, “Katie was an amazing Katie Educate salesperson and very successful in her previous roles with us, selling everything from the MAX to our magazines. We are thrilled she will be returning to lead our sales team and help achieve SMM’s vision and mission.”

Julie Seidel joined the company as West Account Executive. Prior to joining SMM, Julie was an administrator for K-12 students, where she worked to increase student engagement and completion rates for education management organization.

Julie Seidel “Julie joins us with an outstanding background in education, sales, and marketing. She is an experienced market and business development executive with proven success in effectively driving market share growth and sales for a specialized medical practice. We are excited that she has joined the team!” Adams said.

Hill-Rom unveils new corporate logo, global brand identity Hill-Rom Holdings Inc (Chicago, IL) announced a global rebrand as Hillrom with an updated brand promise of “Advancing Connected Care.” “With our rapid advancements in digital health and connected care, we are extending our physical healthcare environment solutions to the digital space,” said President and CEO John Groetelaars. “We are excited to launch our new brand, which reaffirms our identity and underscores our commitment to the continued transformation of our business.” The company said that the brand transition “propels Hillrom forward from its history in hospital beds and medical device development to one that advances connected care across the healthcare continuum.”

Beyond the company’s visual brand update, Hillrom is uniting its acquired company brands. The Welch Allyn brand will continue as a flagship product family for the company’s patient monitoring and diagnostic solutions. The Voalte brand, which Hillrom acquired in April, will continue as a cornerstone of the company’s expanded Care Communications product line. All other brands will be transitioning over time to the Hillrom brand, the company said.

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*IEC 60601-1-12:2014 (EMS), IEC 60601-1-11:2015 (homecare), and IEC 60601-1-2:2014 (EMC compliant).

Air worthiness: meets DO-160G for fixed- and rotary-winged vehicles; meets DO-160G for EMC radiated emissions. ©2017 Medtronic. All rights reserved. Medtronic. Medtronic logo and Further, Together are trademarks of Medtronic.

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