REP August 22

vol.30 no.8 • August 2022

repertoiremag.com

Respiratory Season: A Surprise Package COVID’s impact lingers.

We make diagnostics that matter

We know it’s been a challenging year, and it matters that we made it through together. That’s what trusted partnerships are all about. Our experienced sales and service teams are always here to help ensure your success, providing diagnostic products that deliver the highest quality results.

Because for you, for us, and for your customers, every result matters.

POINT-OF-CARE READER

RAPID DIAGNOSTICS

800.332.1042/sekisuidiagnostics.com © 2022 SEKISUI Diagnostics, LLC. All rights reserved. Acucy and OSOM are registered trademarks of SEKISUI Diagnostics, LLC. Because every result matters is a trademark of SEKISUI Diagnostics, LLC.

CONTENTS AUGUST 2022 • VOLUME 30 • ISSUE 8

Respiratory Season: A Surprise Package COVID’s impact lingers.  p. 36

A Team Effort

PUBLISHER’S LETTER Take a Deep Breath.............................. 2

PHYSICIAN OFFICE LAB

Mary Ann Tindall never loses sight of the patients and customers she and her team serve........................................ 16

MARKETING MINUTE

How Many Players on the Field?

What was once a product category managed by an account manager, sales manager and lab suppliers now has an increasing number of specialists...................................... 4

Why Medical Suppliers Need More Consistency in Content Marketing How often do medical suppliers need content? It’s more than you think.............. 20

IDN OPPORTUNITIES

DISTRIBUTION

Battling Cancer Amid COVID

Excellence Through Partnership IMCO 2022 Annual Conference and Trade Show................................................ 8

How MD Anderson’s supply chain mobilized to protect employees and one of the largest and densest concentrations of cancer patients in the world during the pandemic.............. 24

IDN NEWS IDNs in the News................................... 30

TRENDS What the Future Holds Making sense of the latest economic trends and what it means for healthcare..... 32

HIDA HIDA brings preparedness, shipping issues to Capitol Hill..... 35

TRENDS Is Less More?

Fewer procedures, more conversations, may lead to less ‘low-value’ care................. 46

Completing the Picture If interoperable user-friendly EHRs are the key to value-based care and population health, why don’t we have them?................ 52

QUICK BYTES Technology news................................... 58

TRENDS Breaking the Rules of Healthcare: The Doctor-Patient Power Dynamic Closing the knowledge gap while improving the doctor-patient relationship will require better communication and greater trust.... 60

NEWS Primary Care and Industry News........................................... 63

Subscribe/renew @ www.repertoiremag.com : click subscribe repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2022 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.

www.repertoiremag.com

•

August 2022

1

PUBLISHER’S LETTER

Take a Deep Breath

editorial staff editor

Mark Thill mthill@sharemovingmedia.com managing editor

Graham Garrison

2017 was the last time we had an off-the-charts flu season. Think about all

that has taken place since then, not only a global pandemic, but in many cases our way of life. We are all more conscious when in public with social distancing, washing our hands, and in some cases still wearing masks.

Yet even with all the extra precautions, it appears we may be in store for a respiratory season that will no doubt be one for the record books.

The southern hemisphere has recorded an incredibly high flu season, which historically predicts what’s to come for us. To help you and your caregivers prepare for the season, we’ve moved our respiratory content up to August versus the traditional September issue. From the cover story to the supplement, we hope this content gives you the tools you need to have a successful next few months while helping your providers deliver state-of-the-art care through proper diagnoses.

As you can see on the cover, we have multiple sponsors this year. Each of these manufacturers deliver quality products that you will find in the respiratory supplement. Many of them also have 2-minute drills found in RepConnect to help you start the conversation with your clients. As the famous saying goes, “put your money where your mouth is.” These manufacturers have done just that by sponsoring this issue to help you. Please show them your gratitude of their support by selling their products this respiratory season. Each of them supports distribution, and their teams are ready to help you wherever they can.

One final note, the No. 1 comment we hear from each of the diagnostic companies is, “It’s never too early to get the providers prepared.” So, start selling the test kits today and keep your clients in front of what appears to be a roller coaster ride this season.

Dedicated to the industry, R. Scott Adams

2

August 2022

•

www.repertoiremag.com

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

Pete Mercer pmercer@sharemovingmedia.com art director

Brent Cashman bcashman@sharemovingmedia.com circulation

Laura Gantert lgantert@sharemovingmedia.com

sales executive

Amy Cochran acochran@sharemovingmedia.com (800) 536.5312 x5279

publisher

Scott Adams sadams@sharemovingmedia.com (800) 536.5312 x5256

founder

Brian Taylor btaylor@sharemovingmedia.com

Subscriptions

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

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.com; www.sharemovingmedia.com

Quidel has developed an innovative line of respiratory products for decades.

So whatever respiratory season may bring, we’re ready.

1979

2015

Quidel founded

1999

Receives FDA clearance for world’s first rapid diagnostic flu test QuickVue Influenza Test (A/B)

2011 1996

Influenza A+B, RSV, SARS* Antigen Assays

2020

Receives FDA EUA for Sofia 2 SARS Antigen FIA, Sofia 2 Flu+ SARS FIA (ABC), QuickVue SARS Antigen Test, and Solana SARS-CoV-2

Quidel launches Sofia automated analyzer FIA

First company to receive CLIA waiver for Strep A with QuickVue In-Line Strep A Test

QuickVue®

Introduction of Solana assays

2018

Solana®

Receives FDA clearance for QuickVue Influenza A+B which meets FDA’s Class II RIDT requirements

Influenza A+B, RSV + hMPV, SARS-CoV-2*, Bordetella Complete Assays

Sofia®/Sofia 2

Influenza A+B, RSV, SARS* Antigen, Flu + SARS* Antigen Assays

To get the right RIDT for your customers, contact a Quidel Account Manager at 800.874.1517 or visit quidel.com *THESE TESTS ARE AVAILABLE FOR SALE IN THE USA UNDER EMERGENCY USE AUTHORIZATION. These SARS tests have not been FDA cleared or approved, but have been authorized by the FDA under an Emergency Use Authorization (EUA) for use by authorized laboratories for the detection of proteins (QuickVue and Sofia) or nucleic acids (Solana) from SARS-CoV-2, not for any other viruses or pathogens. These tests are only authorized for the duration that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection and/or diagnosis of COVID-19 under Section 564(b)(1) of the Federal Food, Drug and Cosmetic Act, 21 U.S.C. § 360bbb-3(b)(1), unless terminated or revoked sooner.

AD10183500EN00 (06/22)

PHYSICIAN OFFICE LAB

How Many Players on the Field?

What was once a product category managed by an account manager, sales manager and lab suppliers now has an increasing number of specialists.

Have you ever wondered why the number of players on sports teams varies so much? Basket-

ball has five, hockey six, baseball nine and soccer and football teams each have 11. My personal conclusion is that the reasons involve the size of the playing field, the way a point is scored and the type of equipment used. There may be more to it, but those factors seem to be the fundamentals.

So how does this relate to the business of selling lab products?

What was once a product category managed by the account manager and their sales manager along with their trusted lab suppliers has now become a business with an increasing number of laboratory specialists employed by major distribution companies.

Specialists are not truly a new type of sales team resource. Well before there were lab specialists, there have

been sales representatives devoted to specific markets and customer types, including corporate accounts, government customers, group purchasing organizations and others. In the early going in the development of lab specialists’ roles, they were dedicated to general lab sales rather than for specific technologies or products.

But recent trends in the distribution business of selling lab products include a proliferation of lab special-

By Jim Poggi

ist roles, including those of specialists dedicated to specific lab products and technology. The growth in specialists devoted to molecular products is a good example. It seems that more complex technologies and those trickling down from the tertiary care hospital market are believed to lend themselves well to hiring specialists and deploying them as a consultative resource. In this article I plan to examine the increase in specialist roles and how lab specialists impact the distributor account manager’s role and responsibility as the person most responsible for customer satisfaction and management.

The role of lab specialist First, why have lab specialists at all?

In the world of distribution, it’s been widely believed that to effectively sell lab products, specialized knowledge of the products, how and why clinicians use them and factors such as reimbursement and management of the patient and quality control data was needed. For a long time, distributors relied on their trusted key manufacturing partners to develop and deliver this information. But the 4

August 2022

•

www.repertoiremag.com

CLINICAL LABORATORY SOLUTIONS FOR PHYSICAN OFFICES AND TOXICOLOGY LABORATORIES

Urine drug screening test methods using Abbott’s Technical Consulting Services

TECHNICAL CONSULTING SERVICES INCLUDE:

Laboratory licensure process • CLIA 1 application and submission • COLA2 accreditation enrollment • Applicable state licensing • Proficiency testing enrollment Lab Staffing and Personnel • Evaluation of personnel requirements and qualifications • Verification of Lab Director and staffing credentials

Implementation of written lab compliance manuals per regulatory guidelines • Laboratory administrative policies and procedures • Pre-analytical processes and protocol • Quality Control protocol, acceptability limits and documentation • Quality Assurance implementation • Written job descriptions and competency assessment forms • Proficiency testing and split sample protocol

• Assistance with staffing technical lab positions

• Maintenance and daily monitors

Site preparation and workflow design • Instrument and equipment site preparation

Education and laboratory compliance training during initial set up • Training on laboratory standard operating procedures

• Evaluation of pre-analytical, analytical and post-analytical lab testing phases Validation protocol and summary • Instrument installation and assay set up • 3 days on-site training and validation guidance • Moderate or high complexity testing validation review

• Training on CLIA/COLA compliance standards Ongoing technical consulting support • Inspection preparation and support • Periodic compliance audits • Technical consulting resource via phone and email

(855) 425-9428 | CLS_SALES@ABBOTT.COM 1. Clinical Laboratory Improvement Amendments (CLIA) 2. Commission on Office Laboratory Accreditation (COLA) *Licensure, COLA and PT fees must be paid directly to applicable agency. Client is responsible for employing qualified personnel. © 2022 Abbott. All rights reserved. All trademarks referenced are trademarks of either the Abbott group of companies or their respective owners. COL-11506 v1 06/22

PHYSICIAN OFFICE LAB availability of increasingly sophisticated products and technology marketed to the physician office has given rise to an increasing number of specialist roles. Whether we needed these roles in the earlier days of selling lab or not, I do believe this trend has significant advantages for distribution companies. They enhance the distributor’s reputation as a knowledgeable consulting resource, provide more control over product preference and allow distributors to consider offering products from early stage companies that may lack field sales resources. Specialists also deepen relationships between the distributor and the end user customer.

Specialists can be particularly useful in business reviews with large IDNs, retail convenience clinics and urgent care chains who have their own specialist roles. I believe specialists also foster adoption of newer technologies in the physician office market.

These advantages do come with a cost since they complicate role definition and communication within the growing team and may create concern and anxiety on the part of lab suppliers. This team dynamic creates additional responsibilities for the successful distributor account manager and as a result provides opportunities for personal and professional growth as you take on a more challenging role in directing the larger team and the sales process in front of your customers. You are still the quarterback in the sales process and most intimately responsible for knowing every element of your customers’ needs, preferences, personnel capabilities and purchasing requirements. This is a significant responsibility all by itself. Added to it is the need to understand the basics of the newer technology to understand how it fits into the customer’s 6

August 2022

•

www.repertoiremag.com

needs and whether it is a solution appropriate for them.

Discussions among you, your lab specialist and your key lab supplier need to be effectively managed to make sure all parties are on the same page and providing a consistent customer value proposition. More players on the field means more time coaching the team and more detailed team interaction. The roles of each team member need to be established, respected and consistently followed to avoid team conflict or confusion by the customer. This is a more sophisticated sales process that requires more intense management.

While this was perhaps not a longterm trend, molecular and immunoassay tests in particular are growing in acceptance and are commanding a far larger audience than ever before due to increased clinical utility and better management of the patient treatment program. The savvy account manager keeps an eye on these trends and asks how they can impact their business.

The account manager needs to be a better coach than ever before and needs to know which resource, supplier or specialist to deploy, when and why. For simpler waived tests, there is likely to be little change. But for more complex technologies with

The account manager needs to be a better coach than ever before and needs to know which resource, supplier or specialist, to deploy, when and why. For simpler waived tests, there is likely to be little change.

Keys to success What are the keys to success for the account manager as lab specialist roles become more common and more specific to individual products and technologies? My recommended first step is to pay attention and stay informed regarding emerging technologies and products. You need to understand their overall customer fit and how they could be integrated into the clinical practices of your current customers and prospects. Do they open doors to customers you have not been able to successfully sell to before? Do they expand testing opportunities for your current customers?

A few years ago, technology for confirmation of toxicology screening results was popular and led to a new class of laboratories emerging.

a more sophisticated customer value proposition the sales process will more likely include a broader range of sales personnel.

As you work in this more complex environment with a broader range of specialists and product offerings, the successful account manager can grow in coaching, communication and project management skills improving their territory management and even future professional growth prospects. The future is bright for the distributor account manager who takes the time and effort to learn how to thrive in this more complex selling environment not just for increasing sales but also for personal and professional growth. Learn to effectively work in this new environment and reap the benefits.

SPONSORED

QUIDEL

Quidel provides easier, faster test results with new molecular platform

By Pete Mercer

Finding the right testing option is always a challenge for physician offices. It’s important to find a platform

that provides timely test results without sacrificing accuracy, while also being user-friendly for anyone that might need to access the platform.

In a recent podcast, Tammi Ranalli, the senior vice president of molecular diagnostics for Quidel Corporation, sat down with Repertoire Magazine publisher Scott Adams to discuss the new molecular diagnostic innovations at Quidel.

A new sample-to-result molecular platform Quidel is introducing a new molecular platform, something that Ranalli calls a “10-year labor of love” to get off the ground. The Savanna sample-to-result molecular platform is a

cartridge-based system that is easy to use and provides incredibly fast results.

Ranalli explained, “We all know that a hospital lab or emergency department is seeing a totally different patient profile than your typical physician's office. Even within physician offices, pediatricians are going to have very different needs

than a regular internal medicine specialist. We sought to provide the most flexible testing solution for different needs, without developing separate products.”

Savanna has two main features that makes it a powerful tool for practices. First, Savanna provides a fast turnaround time for test results – about 20 to 30 minutes – which can greatly streamline patient care efforts for physicians and improve the impactful decision-making process. The other is a feature called Test Select, a variety of customizable panel sizes that allow the end-user to either select or deselect any of the analytes on the panel. With this feature, physicians can run a wider range of tests with ease and accuracy.

“The ‘one size fits all’ approach is not really a great option when you’re trying to address the dynamic needs of different types of providers,” Ranalli said. “These panels allow for testing of multiple respiratory viruses, including RSV, influenza A and B, and COVID-19, as well as GI panels, STI panels, and a broader pharyngitis panel. This feature puts the testing power back in the hands of the clinician, all within the same platform.”

“Our goal at Quidel is to democratize the benefits that our diagnostic tests can provide,” Ranalli said.

“Working together, we strive to enable access, regardless of where you live, to the kinds of fast, accurate, and cost-effective testing that will allow your doctors to chart their courses of treatment with confidence.” www.repertoiremag.com

•

August 2022

7

DISTRIBUTION

President and CEO Bill McLaughlin.

Excellence Through Partnership IMCO 2022 Annual Conference and Trade Show Courtesy of IMCO IMCO recently hosted it 2022 Annual Conference and Trade Show in Orlando, Florida. “Excellence Through

Partnership” was the show theme, which demonstrates the culture and beliefs we all have about how we work together.

Our members and vendors achieve excellence in the level of service they provide their customers each and every day.

Our 2022 Conference was filled with numerous opportunities for members and vendors to connect to achieve success and strengthen their partnerships. Bill McLaughlin, IMCO president and CEO, explained what the theme meant to him: “Partnering with someone is a beginning, striving for excellence with those partners comes with effort and collaboration not everyone is willing to achieve.”

Vendor participation for our trade show was filled to capacity. IMCO had an increase of over 30% of members 8

August 2022

•

www.repertoiremag.com

in attendance from last year’s conference. We partnered with 7 new members and 9 new vendors in 2022, and almost all were in attendance at this year’s conference.

Highlights On Sunday, we offered “ The Sales Playbook” featuring our Sales Emphasis Line (SEL) Vendors, the first of its kind. This session allowed attendees to learn how to successfully create a road map for selling more products and understanding the value proposition each Vendor partner

brings from a clinical efficacy and profitability standpoint.

IMCO has worked hard to enhance the value of the SEL Program, and this session demonstrated our commitment to the program and vendors. The Sales Playbook program will definitely be a part of the meeting going forward!

IMCO has continued to enhance its E-Commerce Data offering and it now contains products from 130 manufacturers, 75,000+ products, 65,000+ with one or more images, and 60,000+ hand cleaned with improved descriptions and descriptors.

With the addition of Vendor Vaults on our new and always-improving AccessIMCO, IMCO is seeing an astounding increase in site hits for both members and vendors. Through a Vendor’s Vault, a member can quickly search for products and pricing, and access product information, promotions, literature, and training videos. They can also view contract terms and connect directly with field sales representatives. Vendors have full access to their vault analytics and the ability to modify and add collateral to support and promote their product line.

We currently have 45 key vendors participating in our Member Incentive Program (MIP). Roughly 90% of

Andrea Root accepting GOJO Industries Vendor of the Year with Angie Euston and Steve Dennison.

members earned dollars on this program last year. We are excited to see future growth with member participation and sales in 2022.

IMCO is expanding its support for distributors with their digital marketing. We understand our industry and a distributor’s vital role within it. With an effective digital marketing strategy, they will get noticed, stay top-ofmind with current and future customers, grow sales, and stay competitive.

Sunday evening, we had a great welcome reception to kick off our 2022 Conference where Members and Vendors were able to reconnect with old friends and make new ones.

Monday evening, we enjoyed each other’s company out on the hotel’s lawn with great food, drinks, and games.

CEO Bill McLaughlin and our new Director of Primary Care Adam Deets took on challengers for cornhole after dinner at our “Wine Down with IMCO” event.

Tuesday evening, we celebrated the end of our 2022 Conference with Casino Royale where we encouraged everyone to dress in their favorite past or present dynamic duo or stellar squad from pop culture, movies, sports,

GOJO Industries Vendor of the Year.

Clarity Diagnostics Vendor of the Year.

www.repertoiremag.com

•

August 2022

9

DISTRIBUTION business, politics, music or television. While we always see a good amount of participation from attendees, this year, people went all out with their group and duo costumes.

The Powerpuff girls, Bob Ross and his painting, Wayne and Garth of Wayne’s World, Thing 1 and Thing 2, the Talladega Nights crew, and more celebrated another noteworthy convention with us.

Speakers and sessions Keynote speaker Connie Podesta educated our IMCO audience with how to “Stand Out from the Crowd.” Her session was equally as entertaining as it was informative and gave members and vendors new insights in which to lead and grow their brand in the coming year.

After Bill’s opening address, we had our highly acclaimed TED-styled presentation Industry Insights, including: ʯ Dirk Beveridge, Founder of UnleashWD – A Time to Lead with Purpose and Humanity ʯ IMCO’s Jay Butler – Optimize your IMCO Partnership,

Sempermed Booth of the Year.

10

August 2022

•

www.repertoiremag.com

ʯ ʯ

Scott Stiver, Carew International – Perception as It Relates to Leadership and Selling, Scott Adams, Share Moving Media – Social Marketing: Content Delivered Through Omni Channel Market.

Other sessions included: ʯ Defining Your Business Ambition | Owner/ Manager Roundtable – Facilitated by Dirk Beveridge, Founder of UnleashWD ʯ Dirk Beveridge’s “Innovate! How to Create Relevancy in the Age of Disruption” ʯ A “Social Marketing Strategies – A Member’s Perspective” Panel facilitated by Scott Adams, Share Moving Media with Carla Rodych – Canada Medical, Chris Walsh - Zoetek Medical Sales and Services, Colton Mason – Supreme Medical Fulfillment Systems, and Sanjay Shah – AMSCO Medical. ʯ “The Lowdown on GPOs” with IMCO’s Bob McCart and Kimberly Shamblin followed by

Microdissection Needles Microdissection Needles Microdissection Microdissection Needles Needles Microdissection Needles Delivers precision and accuracy inNeedles electrosurgical procedures Delivers precision and accuracy in electrosurgical procedures Microdissection Microdissection Needles Delivers precision andand accuracy in in electrosurgical procedures Delivers precision accuracy electrosurgical procedures Microdissection Needles Microdissection Needles Delivers precision and accuracy in electrosurgical procedures Delivers precision and accuracy in electrosurgical procedures

Delivers Deliversprecision precisionand andaccuracy accuracyininelectrosurgical electrosurgicalprocedures procedures

Delivers precision and accuracy in electrosurgical procedures

Optimal Control |Better Better Precision Optimal Control | Better Precision Optimal Control | Better Precision Optimal Control | Better Precision Optimal Optimal Control Control | | Better Precision Precision Optimal Control | Better Precision Optimal Control | Better Precision Optimal Control | Better Precision Tungsten tip Tungsten tip

Fully insulated Fully insulated High-grade tungsten maintains High-grade tungsten maintains Fully Fully insulated sharpness throughout procedure Fullyinsulated insulated Fully Fully insulated insulated sharpness throughout procedure High-grade tungsten maintains High-grade tungsten maintains Fully insulated High-grade High-grade tungsten maintains High-grade tungsten tungsten maintains maintains High-grade tungstenthroughout maintains sharpness throughout procedure sharpness throughout procedure sharpness procedure Fully insulated sharpness sharpness throughout throughout procedure procedure sharpness throughout procedure High-grade tungsten maintains Compatible with any standard Compatible any standard sharpness throughout procedure cauterywith hand-pencil cautery hand-pencil Compatible with any standard Compatible with any standard Compatible with anyany standard Compatible Compatible with with any standard standard Compatible with any standard Concentrates delivery of cautery hand-pencil cautery hand-pencil cautery hand-pencil Concentrates delivery of cautery hand-pencil cautery cautery hand-pencil hand-pencil Compatible with any standard energy to a ~5 micron tip, energy to a ~5 micron tip,spread minimalizing thermal Concentrates delivery ofof cautery hand-pencil Concentrates Concentrates delivery delivery minimalizing Concentrates delivery of Concentrates Concentrates delivery delivery ofof of spread energy tothermal a ~5 ~5 micron tip, energy to a micron energy to a ~5 micron tip, energy to a ~5 micron tip, Concentrates delivery oftip, energy energy to ato ~5 a ~5 micron micron tip, tip, spread minimalizing thermal minimalizing thermal spread minimalizing thermal spread minimalizing thermal spread energy to aspread ~5spread micron tip, minimalizing minimalizing thermal thermal minimalizing thermal spread

allows for lowertip Tungsten Tungsten tiplower allows for power settings Tungsten Tungsten tip tip Tungsten tip for lower power allows allows forsettings lower Tungsten tip allows for lower allows allows for for lower lower power power settings allows forTungsten lower tip settings power settings power power settings settings power settings allows for lower power settings

Ultra-Sharp Ultra-Sharp needle tip needle tip Ultra-Sharp Ultra-Sharp ® Ultra-Sharp Ultra-Sharp Ultra-Sharp Ultra-Sharp needle tip needle tip® needle tip needle tipUltra-Sharp needle needle tip tip ® needle tip ® ® ®® ®

® Olsen and andBovie Bovie Microdissection ® Olsen Microdissection ® ®come ® Olsen and Bovie ®® a Microdissection ® in needles wide array ofof ®Bovie Olsen and Microdissection Olsen and Bovie Microdissection Olsen and Bovie needles come inMicrodissection a®Microdissection wide array Olsen Olsen and and Bovie Bovie Microdissection Olsen and Bovie Microdissection needles come in avariety wide array of configurations for surgical needles come infor array of array needles come aofof wide of needles come aain wide array of configurations a awide surgical needles needles come come inain in avariety wide wide array array of needles come in a wide array ofof configurations for a variety of surgical procedures.

The ultra sharp design configurations forThe afor variety of surgical procedures. ultra design configurations for asharp variety of surgical configurations aavariety variety of surgical configurations configurations for for variety ofof ofsurgical configurations fora a variety surgical procedures.

The ultra sharp design coupled with the finest tungsten wire procedures.

The The ultrafinest sharp design coupled with the tungsten wire design procedures.

The ultra sharp procedures. ultra sharp design procedures. procedures.

The The ultra ultra sharp sharp design procedures.

The ultra sharp design coupled with the finest tungsten wire allows for optimal control and better coupled with the finest tungsten allows for optimal control andwire better coupled with the finest tungsten coupled with the finest tungsten wire wire coupled coupled with with the the finest finest tungsten tungsten wire coupled with the finest tungsten wire allows for for optimal control better outcomes any procedure requiring allows for optimal control and and better outcomes for any procedure requiring allows for optimal control and better allows for optimal control and better allows allows for for optimal optimal control control and and better allows for optimal control and better outcomes for any procedure requiring precise tissue dissection. outcomes any procedure requiring precise for tissue dissection. outcomes forprocedure any procedure requiring outcomes forany any procedure requiring outcomes for any procedure requiring outcomes outcomes for for any procedure requiring requiring precise dissection. precise tissuetissue dissection. precise tissue dissection. tissue dissection. precise tissue dissection. precise precise tissue tissue dissection. dissection.

Theprecise fine needle tip concentrates the The fine needle tip concentrates the The fine needle tip concentrates the electrosurgical energy, allowingthe for lowTheelectrosurgical fine needle tip concentrates energy, allowing for lowThe fine needle tipless concentrates the electrosurgical energy, allowing for lowpower settings and risk of thermal The fine needle tip concentrates The fine needle concentrates the the The The fine fine needle needle tiptip tip concentrates concentrates the electrosurgical energy, allowing for lowpower settings and less risk of thermal electrosurgical energy, allowing for lowpower settings and less risk of thermal spread. electrosurgical allowing for lowelectrosurgical energy, allowing forlowlowelectrosurgical electrosurgical energy, energy, allowing allowing for power settings and less energy, risk of thermal spread. power settings and less risk of thermal spread. spread. power settings andrisk less risk of thermal power power settings settings and andless less risk ofof of thermal power settings and less risk thermal spread.

See our Q3 promos at symmetrysurgical.com. spread. spread. spread. spread.

See our Q3 promos at symmetrysurgical.com.

Scan Here for Q3 Promos

Ask your sales representative forsymmetrysurgical.com. a demonstration today.

See our Q3 promos at Seesales our Q3 promos at symmetrysurgical.com.

Ask your representative for a demonstration today.

Asksales your representative sales representative for a demonstration See our Q3 promos at symmetrysurgical.com.

Ask your for a demonstration today. today.

See See our our Q3 Q3 promos promos at symmetrysurgical.com. symmetrysurgical.com.

See our Q3 at promos at symmetrysurgical.com.

See our Q3 promos at symmetrysurgical.com.

Ask your sales representative for a demonstration today.

Ask Ask your your sales sales representative representative forfor for a ademonstration a demonstration demonstration today. today. today.

Ask your sales representative for a demonstration Ask your sales representative

customerservice@symmetrysurgical.com • 800.251.3000 • www.symmetrysurgical.com customerservice@symmetrysurgical.com • 800.251.3000 • www.symmetrysurgical.com customerservice@symmetrysurgical.com • 800.251.3000 • www.symmetrysurgical.com 07.05.2022 v1 customerservice@symmetrysurgical.com • 800.251.3000 • www.symmetrysurgical.com 07.05.2022 v1 customerservice@symmetrysurgical.com • 800.251.3000 • www.symmetrysurgical.com 07.05.2022 v1 07.05.2022 v1 07.05.2022 v1 customerservice@symmetrysurgical.com customerservice@symmetrysurgical.com • 800.251.3000 • 800.251.3000 • www.symmetrysurgical.com • www.symmetrysurgical.com customerservice@symmetrysurgical.com • 800.251.3000 • www.symmetrysurgical.com customerservice@symmetrysurgical.com • 800.251.3000 • www.symmetrysurgical.com

07.05.2022 07.05.2022 v1v1 v1 07.05.2022 v1 07.05.2022

DISTRIBUTION

IMCO Team in costume at Tuesday night’s casino royale.

Cash Cow Adam Deets with winner Robert Sampson Jr. of D&&H Medical Supply.

ʯ ʯ ʯ

Bobby Noon of APN Healthcare and Bob Miller of Gericare Medical Supply at Sunday night’s Welcome Reception.

“Advancing Distribution with Healthcare and Government Leaders: Highlights From HIDA” with Elizabeth Hilla of HIDA. Scott Stiver’s “Master the Art of Listening – Maximizing your Distribution Opportunities” Scott Stiver’s “Invest in the Relationship” The Collaboration Connection | Member Roundtable Discussions with discussions such as Supply Chain Disruption, Team Building: HR in a Post-Pandemic World, Equipment Sales, Handling Extended Care Challenges, Connecting with Customers through Marketing and E-Commerce, and the popular IDEA Workshop.

Award winners IMCO had its first tie for Vendor of the Year in 2021.

Recipients were Clarity Diagnostics and GOJO Industries.

The 2022 Scholarship Winners were Bert Pineres of American Medical Supplies & Equipment, Gerald Martin of Grove Medical, and Jeff Rainforth of JML Medical.

IMCO’s Equipment Performance Incentive Contest (EPIC) is a year-long equipment contest in which Members sales reps sell 10 key Vendor lines of products and earn points based on sales orders and Vendor 12

August 2022

•

www.repertoiremag.com

Bill and Ashleigh McLaughlin

interactions throughout the year. We handed out over $20,000 in prizes to all our ‘21 winners.

2021 EPIC Winners ʯ 10th Bert Pineres – American Medical Supplies & Equipment ʯ 9th Kristina Pacheco – Canada Medical Ltd. ʯ 8th Gerry Volponi – Canada Medical Ltd. ʯ 7th Christopher Tuzzeo – Bell Medical Services, Inc. ʯ 6th Gerald Martin – Grove Medical Inc. ʯ 5th Tyler Reichenbach – Medical Resources ʯ 4th Brian Hodgson – Omni Medical Supply ʯ 3rd David Ellis – Atlantic Medical Solutions ʯ 2nd Victor Amat – American Medical Supplies & Equipment ʯ 1st Angi Muse – Booth Medical For the second year in a row, the Best Booth Award at the trade show went to Sempermed, as they created an engaging Gilligan’s Island themed booth coined “Glove-igan’s Island” with the entire cast in attendance.

We can’t wait to see what our Vendors come up with next year. Save the date, May 7-10, 2023 at the Hilton Orlando.

Meeting Your

Evolving Needs with Unmatched Quality Dynarex Resp-O2™—our innovative line of outstanding respiratory solutions—is bounding ahead with an even wider variety of premium products. Now with an extensive selection of SUCTION SOLUTIONS, TRACHEOSTOMY CARE supplies, OXYGEN THERAPY products, BRONCHIAL/ASTHMA MANAGEMENT supplies, and so much more—Dynarex Resp-O2™ is your go-to for all of your respiratory needs!

PRODUCTS INCLUDE: • Peak Flow Meters • Volumetric Spirometers • Tracheostomy Kits • Suction Catheters & Kits • Suction Connecting Tubing

Learn More: dynarex.com/resp or call (888) 396-2739

SHORTEN OR TIME1*

REDUCE READMISSIONS2†

ADDRESS SSI RISK3-5‡

*STRATAFIX™ Knotless Tissue Control Device shortened OR time compared to traditional sutures in total hip arthroplasty, based on retrospective analysis of 5958 cases from the Premier Perspective® Hospital Database. † Patients with DERMABOND PRINEO System had lower readmissions than patients with skin staples in a retrospective, observational study using the Premier Healthcare Database in total knee arthroplasty (N=1942), 2012-2015; LOS 2.8 days vs 3.2, P=0.002; discharge to SNF 26% vs 39%, P=0.011; 30-day readmissions 1.8 vs 4.4%, P=0.006. ‡ Plus Sutures were proven in vivo to kill bacteria on the suture known to be associated with SSIs (Staphylococcus aureus, Staphylococcus epidermidis, methicillin-resistant S aureus [MRSA], methicillin-resistant S epidermidis [MRSE], Escherichia coli, Klebsiella pneumoniae) in an animal model. § Compared to traditional sutures based on a retrospective analysis of 7,410 spinal fusion and laminectomy procedures from the Premier Perspective® Hospital Database, using STRATAFIX barbed sutures was associated with lower OR time (P=0.015) and costs (P=0.02) than traditional sutures. || In a meta-analysis of 21 RCTs, 6462 patients, 95% CI: (14, 40%), P<0.001. ¶ Ethicon Plus Antibacterial Sutures (MONOCRYL® Plus Antibacterial [poliglecaprone 25] Suture, Coated VICRYL® Plus Antibacterial [polyglactin 910] Suture, and PDS® Plus Antibacterial [polydioxanone] Suture).

ACS/SIS=American College of Surgeons/Surgical Infection Society; CDC=Centers for Disease Control and Prevention; LOS=length of stay; NICE=National Institute for Health and Care Excellence; RCT=randomized clinical trial; RKI=Robert Koch Institute; SNF=skilled nursing facility; SSI=surgical site infection; WHO=World Health Organization.

In today’s changing surgical environment, your customers need Ethicon Advanced Wound Closure products In addition to Ethicon’s renowned sutures and topical skin adhesive products, 3 advanced technologies can help your surgical customers successfully meet today’s challenges in their procedures.

STRATAFIX® Knotless Tissue Control Devices • Shorter OR times1* • Lower OR costs6§ • Antibacterial (sutures with Plus technology only)

DERMABOND® PRINEO® Skin Closure System • Shorter length of stay2† • Reduced readmissions2† • Simplified at-home wound care for patients7

Plus Antibacterial Sutures • Only triclosan-coated sutures available worldwide • 28% reduction in SSI risk with triclosan-coated sutures shown in meta-analysis8||¶ • Triclosan-coated sutures recommended by 6 health authorities including WHO and CDC9-13# #CDC, WHO, ACS/SIS, NICE, and RKI guidelines on reducing the risk of surgical site infections are general to triclosan-coated sutures and are not speciic to any one brand.

For complete indications, contraindications, warnings, precautions, and adverse events, please reference full package insert.

References: 1. Sutton N, Schmitz ND, Johnston SS. Comparing outcomes between barbed and conventional sutures in patients undergoing knee or hip arthroplasty. J Comp Eff Res. 2018;7(10):975-987. doi:10.2217/cer-2018-0047. 2. Sutton N, Schmitz ND, Johnston SS. Economic and clinical comparison of 2-octyl cyanoacrylate/polymer mesh tape with skin staples in total knee replacement. J Wound Care. 2018;27(Sup4):S12-S22. 3. Ming X, Rothenburger S, Nichols MM. In vivo and in vitro antibacterial efficacy of PDS Plus (Polidioxanone with Triclosan) suture. Surg Infect (Larchmt). 2008;9(4):451-457. 4. Storch ML, Rothenburger S, Jacinto G. Experimental Efficacy Study of Coated VICRYL Plus Antibacterial Suture in Guinea Pigs Challenged with Staphylococcus aureus. Surg Infect (Larchmt). 2004;5(3):281-288. 5. Ming X, Rothenburger S, Nichols MM, Rothenburger S. In vivo antibacterial efficacy of MONOCRYL Plus Antibacterial (Poliglecaprone 25 with Triclosan) suture. Surg Infect (Larchmt). 2007;8(2):1-5. 6. Johnston S, Chen B, Tommaselli G, Jain S, Pracyk J. Barbed and conventional sutures in spinal surgery patients: an economic and clinical outcomes comparison. J Wound Care. 2020;29(5):S9-S20. 7. De Cock E, van Nooten F, Mueller K, et al.

Changing the surgical wound closure management pathway: time and supplies with PRINEO* vs. standard of care for abdominoplasty surgery in Germany. Poster presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 11th Annual European Congress, November 8-11, 2008; Athens, Greece. 8. Ahmed I, Boulton AJ, Rizvi S, et al.

The use of triclosan-coated sutures to prevent surgical site infections: a systematic review and meta-analysis of the literature. BMJ Open. 2019;9:e029727. doi:10.1136/bmjopen-2019-029727.

9. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017;152(8):784-791.

10. WHO Global Guidelines for the Prevention of Surgical Site Infection. Geneva: World Health Organization; 2016. https://www.who.int/gpsc/ssi-guidelines/en. Accessed October 6, 2020.

11. Ban KA, Minei JP, Laronga C, et al. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg. 2016;224(1):59-74.

12. NICE Guideline Updates Team (UK). Surgical site infection: prevention and treatment. NICE website. https://www.nice.org.uk/guidance/ng125/chapter/Recommendations#closuremethods.

Accessed April 3, 2020. 13. Prevention of postoperative wound infections. Recommendation of the Committee for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute. Bundesgesundheitsbl. 2018;61(4):448-473.

©2020 Ethicon US, LLC. All rights reserved. 155365-201009

DISTRIBUTION

A Team Effort Mary Ann Tindall never loses sight of the patients and customers she and her team serve.

In Mary Ann Tindall’s 30+ years in supply chain management, purchasing, distribution operations and project

management – including successfully navigating her fully-staffed Detroit, Michigan, Cardinal Health distribution center through the COVID pandemic – she has learned that employee engagement is always invaluable. “Getting to know employees and their families is key to sustaining a culture built on caring for others,” she says. “The result of our work is what can help and inspire others to want to grow and learn.”

Tindall joined Cardinal Health’s Detroit center when it opened in 2017. Today, the 275,000-squarefoot facility employs 140 employees and stays open year-round. It is home to 166,087 square feet of bulk and travel aisles and 36,740 square feet of dedicated Special/Low Unit of Measure space. In addition, it contains over 60 pieces of power equipment with onboard computers and 11,432 square feet of batterypowered industrial truck (PIT) parking and maintenance areas.

“We track over 54,000 product locations via our AIMS Warehouse Management System and process over 27,000 customer orders per month, with an average nightly pick volume of 11,000 pieces,” Tindall explains. “The facility has 22 dock doors and utilizes Penske Transportation to manage our dedicated private fleet, with 23 drivers serving both acute and ambulatory customers throughout all of Michigan, northern Indiana and northern Ohio. We process one ton of cardboard daily and deliver product via 330 delivery carts to our customers nightly. We also support Baxter Renal and are equipped with a frozen drug freezer and refrigerator (total 3,357 square feet combined) and a 4,755 sq. ft chemical vault. Our LUM (low 16

August 2022

•

www.repertoiremag.com

The voice of the customer

Mary Ann Tindall

unit of measure) operation “ValueLink” operates six days a week.”

Effectively managing such an extensive operation depends on growing employee engagement to drive process improvements, she continues.

“We focus on Lean Hoshin Planning and employee engagement to drive process improvements down to the floor level, where we receive ideas and suggestions for how to improve efficiencies, safety, ergonomics, quality and bottom-line costs. Over the past three years, we have implemented 75% of our employees’ ideas and the number of employee suggestions has tripled. Our documented history (by employee and category) helps enable direct recognition for each employee!”

First and foremost, Cardinal considers the Voice of the Customer, she says. Indeed, Tindall is astutely aware of the quality of her team’s work and its impact on patients. That said, without its employees, the distribution center cannot fulfill its commitment to customers and patients – hence the second voice, Voice of the Employee. “Together, we work to get the right product in pristine quality to the hospitals we service each night,” she says.

Next, Cardinal listens to the Voice of the Process to determine ways to make its employees’ jobs easier and more efficient. “We ran Kaizen events and Gemba observations to improve processes,” she says.

“Finally, Cardinal looks at the Voice of the Business,” she notes. “Collaboration and communication with our customers are key so that we can align our strategy and set stretch goals to serve the hospitals and their patients. We’ve made changes to our inventory forecasting, analytics, segmentation and transportation strategies to become more agile, maximize customer fill rates, reduce storage and handling costs, and utilize our warehouse space more effectively.

“By focusing on the customer, employees and processes, we can

drive improvements to our Voice of the Business, she continues. “For staffing strategy, we stay ahead of turnover and find creative ways to keep a pipeline of candidates. In our facility we have run several stay-toplay raffles and contests to have fun and keep productivity levels up. We measure productivity and share performance with our employees as we set ourselves up to succeed in a competitive environment.”

2020: A new world In March 2020, the pandemic hit and the world went silent – or so it seemed. Food, medical supplies and more were in high demand and short supply. As much as Tindall and her team wanted to support their customers and patients, it wasn’t easy.

“We felt the direct shortage of PPE supply to our customers and saw volumes drop as elective surgeries were cancelled,” she recalls. “We then had to manage through a period of lower volume and reduced hours until hospital departments opened again. Like everyone, we wore masks all day, every day. In fact, we continue to wear masks due to heavy COVID transmissions rates in Southeast Michigan.

It was an adjustment on everyone’s part to work in masks, along with the fact that we are essential to care and consistently worked the front lines throughout the pandemic.

“The freeways were empty early on in the pandemic and it was an unusual and uncertain time, as we did not know how many employees might contract COVID,” she continues. “We spent a lot of time modifying the facility to be compliant with social distancing rules (adding lunch breaks, installing touchless faucets, adding cleaners, reducing in-person meetings, removing conference room chairs, putting up plexiglass cube barriers and asking

questions at our gate for entrance).

We had several employees directly impacted by COVID-19. Employees dealt with loss of family members and many were sick themselves.”

It seemed there were more shared stories than not of friends and family who contracted the disease. And yet, Tindall’s team remained committed to serving those in need – their customers and their patients. “In spite of their fears of the unknown, the team knew there were customers and patients who depended on us to be professional and remain present to get our supplies to those in need,” she recalls. “Our employees would come to work and talk about seeing our Cardinal Health supplies being used at the hospitals and how this impacted them. We all shared a common experience of truly being essential to care and this made us stronger and more resilient. From a leadership perspective, we remained calm, consistent, proud, appreciative and grateful for our environment and our meaningful work.

“Once hospital and surgery centers reopened, we experienced surges in product ordering, fluctuating inbound volumes and employee/ customer concerns. We immediately

shifted our focus and utilized our strategies to assist customers in obtaining PPE, and then managing their customer-owned inventory of PPE. Our customers had been managing through high levels of donations, variations on products and spot buys whenever possible to ensure their employees had the critical PPE they needed. There were challenges in handling mass amounts of materials, and we were called upon to assist and relieve them of regulatory pressures, health and safety requirements, inventory handling and transportation requirements by merging this inventory into our own facility.”

For the most part, the Detroit team addressed supply and demand issues, such as helping customers keep product on hand for areas that were closed or addressing shortfalls of key items that weren’t being produced fast enough and/or were running behind in the supply chain.

Safety was paramount, making it essential to add cleaners and retrofitting to touchless systems. And, as it became harder and harder to find essential workers who were available to work, she increased wages. “Thankfully, our staffing remained consistent and resilient to handle volumes during

www.repertoiremag.com

•

August 2022

17

DISTRIBUTION times when employees were out ill with COVID,” she notes.

“Our team is like a family, and we care about one another,” she continues. “We recently had an associate pass away and our team rallied to help with a GoFundMe page and to support the family in any way we could.

We have held numerous fundraisers to support charities that are meaningful to our team members. When our employees experience family loss and financial difficulties, Cardinal Health supports them through our Employee Assistance Programs. And the company’s diversity celebrations and cookouts offer a positive boost as well.”

Flexibility and innovation As was true for many, the Detroit team gradually transitioned into a post-pandemic era, one that is reminiscent of life as it looked 2 ½ years ago while still keeping an eye on the future. “During the pandemic, we focused a lot on building bench strength to ensure we had the necessary knowledge and talent to run the facility,” she says. “In the postpandemic era this bench strength has now been accelerated and employees have been promoted into key positions. The speed of promotions and development is unprecedented. Collaboration with our inventory and transportation teams also continues to work well to not only speed up supply chain but also reduce endto-end supply chain costs. We look forward to our opportunities with automation and the new environment this will bring to us in Detroit.”

Indeed, from robots to visual indicators, Tindall has stood by innovative technology that allows her distribution center to address changes in the healthcare industry, while ensuring her team can safely take advantage of new and efficient tools to 18

August 2022

•

www.repertoiremag.com

increase productivity. The impending introduction of robots to the facility will help improve productivity, reduce employee ergonomic concerns and improve quality through visual indicators, she explains. “We also have added days of inventory on hand (DIOH) and modified forecasting techniques to deal with surges in PPE and other items. We store customer-owned inventory and assist our customers in managing the flow and product expirations. And we have developed programs and initiatives to help our customers manage their inventory par levels in their hospitals.

Systems such as WaveMark™ Supply Management, Workflow Solutions, which provides a scalable platform that integrates with medical providers’ clinical and financial systems, and 2 bin Kan Ban, which uses two physical bins to manage inventory, usually of small but critical parts, have helped streamline ordering and utility room optimization.

“We continue to recruit and develop associates for future leadership positions,” Tindall continues. “Given the ongoing workforce shortages in the healthcare industry, we are cross training our associates to work in both hospitals, as well as at our distribution center.” And, by incorporating smaller delivery vans to transport inventory, the facility will improve its turnaround time and fill critical delivery requests.

“We must always look out for our employees to ensure we can bring our best self to work, each and every day. The most effective way to rally our teams is by involving them in developing new processes and programs where they can demonstrate and apply their ideas. We remained steadfast throughout the pandemic in articulating and living our values of integrity, inclusion, innovation, mission driven and being accountable.” And they intend to continue doing so moving forward.

We Ensure Healthcare Providers Have What They Need, When They Need It Through innovative supply chain management programs, Dukal ensures our extensive line of medical products are available for distribution, ready to meet the everyday demands of healthcare professionals. > Contact sales@dukal.com to learn more • Skin and wound care • Diagnostic equipment • Personal care and admissions • Disposable apparel • Exam room equipment and supplies • Patient care • Personal protection • Surgical solutions

MARKETING MINUTE

Why Medical Suppliers Need More Consistency in Content Marketing How often do medical suppliers need content? It’s more than you think.

Over 97% of marketers agree that content marketing is essential to their marketing strategy in 2022. However,

not everyone creates content equally. What you post, where you publish it, and how often you make content varies considerably between industries. Despite the differences, consistency in content marketing is crucial to every strategy.

Healthcare content marketing is a broad category of strategies that involve creating digital content to build awareness, educate your audience, and convert leads into customers. For the best results, consider using several channels in your content marketing.

Here is a general overview of how often successful businesses post content on each of their marketing channels: ʯ Blogs: Two to four times a week ʯ Social Media: One to two times a day ʯ Email Marketing: Once a day to once a week (depending on your audience and message) 20

August 2022

•

www.repertoiremag.com

Since these are average statistics, your actual numbers will vary. The best way to decide how often you should post content is to perform A/B testing. Change how often you post content on each channel during your tests and see what number of fresh posts gets the best response.

Benefits of Consistency in Content Marketing If you stick to the above schedule for sharing consistent content, you will create hundreds of new pieces each year.

That can quickly feel overwhelming without the proper healthcare content marketing strategy. However, adjusting

your processes to handle that number is worth the effort, as these three benefits show.

Encourage Customer Loyalty About 65% of your revenue comes from loyal customers.

Your content isn’t just for bringing in new customers but also for keeping existing customers loyal to your brand.

These loyal customers already follow you on social media or subscribe to your blog.

Consistent quality content ensures they continue to get value from your content channels so they can purchase more from your company.

Broader Brand Exposure Search engine optimization is a strategy to rank your content in consumer searches. For example, when a hospital decision-maker searches for products for their facilities, your content can appear at the top of their search results, pointing to what products you offer.

The more content you have online, the more searches you can appear, which increases your online visibility. Over half of your website’s traffic comes from online searches.

Greater Authority in Your Industry Brand authority comes from other people’s opinions of your company. If consumers in the healthcare industry consider you an expert and trustworthy source of information, you are considered a healthcare authority.

You must publish consistent, quality content to encourage positive opinions of your business. Each piece is another chance to establish yourself as an authority in healthcare, leading to more conversions.

How to Create Consistent Content for Your Marketing Campaigns Use these five tips to be consistent in content marketing across all your marketing channels.

1. Brainstorm Topics in Advance An expert content creator can write a 1,500-blog post in two to three hours. However, most people take significantly longer to research, create, and publish online content. Brainstorming for topics is one of the forgotten steps of content creation that many people don’t calculate into their schedule.

If you resort to coming up with topics as you create content, you risk settling on mediocre content themes to meet your deadlines. Instead, plan content ideas weeks or even months before you create and publish the content.

You can hold brainstorming sessions where you and your marketing team research common search phrases, questions your customers are asking, and the types of content your competitors post. Then, use that list to narrow done the best topics.

2. Create a Content Calendar Content calendars keep you organized. For example, you will be working on dozens of content projects simultaneously if you run several campaigns, including a blog, various social media platforms, and email. A content calendar keeps all the projects and their due dates in one convenient location, so you never miss a deadline and create consistent content.

3. Plan Content Series Some marketers use content series to help fill their calendars with predictable and regular content. A content series is a group of posts all on the same topic.

For example, as a healthcare supplier, you might create a blog post series on nursing homes where you cover their pain points, needs, and products that could ease the flow of nursing home activities. The next series could follow the same format but focus on a different healthcare facility.

4. Streamline the Content Creation Process The amount of content you can create is limited by the people and time you have available. While you can’t add more hours to the day, you can reduce the time it takes to create content.

Investing in scheduling tools, content management systems, and content creation tools will streamline the process and help you create the amount of content you need with the available time and personnel.

5. Outsource Your Content Marketing Content and marketing agencies will help you meet your content marketing goals. They can create content consistently through scalable marketing strategies that grow as you grow.

Because of the training and experience of content agencies, you are guaranteed quality content.

When you outsource your content creation, you free up your own time so that you can focus on other parts of your marketing strategy.

To learn more about Share Moving Media’s healthcare marketing products and solutions, visit sharemovingmedia.com. www.repertoiremag.com

•

August 2022

21

SPONSORED

GOJO

GOJO’s Supply Resiliency Keeps up with Healthcare Demands As a category leader in hand hygiene, sustainability, and manufacturing, GOJO is committed to being a resilient, trusted supplier. The family enterprise has recently activated a new manufacturing and supply chain strategy that will meet

customers’ needs even during periods of high demand. By adding more than 3 million square feet of supply chain capacity, GOJO is ready to deliver trusted hand hygiene and surface disinfecting solutions to end-users and distributors.

Increased Capacity During the pandemic, GOJO invested millions of dollars in increasing manufacturing abilities. Now, with significant increases to production and warehousing, the family enterprise is more robust and capable in all areas of the supply chain.

“We believe the world will forever be changed by the COVID-19 pandemic and we see this translating to a sustained increase in awareness of the importance of safe and effective hygiene practices,” said GOJO President and CEO, Carey Jaros. “This will result in ongoing, heightened demand for our essential PURELL® skincare and surface solutions. Our responsibility to keep the world healthy and well has never been greater. Expanding our manufacturing infrastructure is one of the many ways we are responding as the market leader in these challenging times.”

GOJO accomplished this by increasing access to raw materials and component supplies through established suppliers. Additionally, new creative partnerships ensured GOJO would maintain a steady supply of essential raw materials, including domestically made bottles. As a result of these enhancements, bottle capacity has doubled compared to 2019.

Better Flexibility To prepare for future surges, GOJO has ensured that product delivery 22

August 2022

•

www.repertoiremag.com

and manufacturing operations can be scaled to full output without costly and reactive one-off solutions.

A partnership with Three Rivers Energy allowed GOJO to expand its Coshocton, Ohio, facility to produce ethanol the meets USP requirements from Ohio corn onsite. Locally sourced, high-grade ethanol will be used to make PURELL® Hand Sanitizer, Surface Spray, and Wipes products. This partnership increases the processing capability up to four times the 2019 capacity.

Having a dedicated source of ethanol will not only enable GOJO to meet current demand but will allow it to rapidly scale up production of PURELL® products whenever they are needed.

Improved Control GOJO has also reduced dependencies to eliminate most typical supply risks and enable them to improve decision-making abilities in times of high demand.

By vertically integrating numerous facets of the supply chain within the U.S., GOJO is empowered to be more flexible and quickly adapt processes to meet changing customer needs. They now have control of critical components for the entire portfolio. Plus, new partnerships for component sourcing allow redundant supply capabilities for most raw materials, including ethanol, bottles, pumps, corrugate, and labels.

Additionally, investments in advanced logistics have expanded the integration of automation, digital processes, and production technology to drive increased efficiencies and reduce manufacturing lead times at plants.

Heightened Response GOJO has developed and introduced strategies that provide transparent communication of order acknowledgments, tracking, return to stock status, and other critical product information.

This development started during the early stages of the pandemic when GOJO optimized its process for prioritizing orders and shipments.

As demand reached record levels, the team focused on delivering critical supplies to frontline healthcare workers and first responders.

It was apparent that SKU consolidation would be necessary to maximize the ability to supply the market, which meant increased internal and external communication and collaboration. This early decision to focus on a “go-to” portfolio represented insights from GOJO’s pandemic preparedness plan, which was developed after the H1N1 outbreak. The insights learned from the supply challenges of the COVID-19 pandemic have positioned GOJO to serve its enduser and distribution partners in substantive ways.

IDN OPPORTUNITIES

Battling Cancer Amid COVID How MD Anderson’s supply chain mobilized to protect employees and one of the largest and densest concentrations of cancer patients in the world during the pandemic.

By Graham Garrison

MD Anderson Cancer Center Campus

Editor’s note: This article originally ran in The Journal of Healthcare Contracting, a sister publication of Repertoire Magazine.

The University of Texas MD Anderson Cancer Center (MD Anderson) is one of the world’s most respected centers

devoted exclusively to cancer patient care, research, education and prevention. MD Anderson’s mission is to eliminate cancer in Texas, the nation and the world. The organization does this through outstanding programs that integrate patient care, research and prevention.

With one of the largest and densest concentrations of cancer patients in the world, MD Anderson’s job of providing an adequate and consistent supply of quality personal protective equipment (PPE) took on an even greater significance.

“The effect on the supply chain 24

August 2022

•

www.repertoiremag.com

was a hyperfocus on all products needed to ensure the safety of our patients resulting in sourcing from non-traditional sources, increased inventory and the expanded distribution of various products,” said MD Anderson Chief Procurement Officer Calvin Wright.

While hospitals across the globe had issues with PPE, MD Anderson had to be extra cautious due to its patient population. Many of its patients are immunocompromised, even if they’re in the hospital for a non-cancer related issue like a spinal fusion or a cardiac

event. This required MD Anderson to be overly conservative to protect the safety of its patients. For example, restricting visitors and utilizing N95 masks and Power Air-Purifying Respirators (PAPRs).

Working with MD Anderson’s IT leadership, disparate data systems were synchronized to provide a daily institutional dashboard on PPE inventory levels, days on hand and utilization rates. Another supply chain team member, Value Analysis Program Director Renato Maclan, facilitated a daily supply chain briefing for more than 100 weeks in which any safety concerns related to supplies (stockouts, substitutions, backorders, recalls, etc.) were addressed immediately to prevent impact to patients and clinicians. “We like to say Renato was the ‘glue’ that kept our supply chain responsiveness focused and together,” Wright said.

“He is just one of the individual heroes from the supply chain organization that worked endless hours and absolutely refused to relent to protect patients and staff.”

for any local, regional, national or global challenge that can touch our ability to deliver the best cancer care in the world.”

Per Matt Berkheiser, Associate Vice President of Environmental Health & Safety at MD Anderson, “These exercises are important to test our plans and the supply chain team is always included in the

Incident Command structure. These scenarios take time to plan and being creative is essential to test our thought processes. The drills are valuable, but we must be prepared for the unexpected. One thing I have learned is not to let our imagination fail us.”

“Our staff has been resilient, and both supply chain team members and

Lessons learned Several things have come out of the pandemic that have actually strengthened the supply chain. In December 2019, prior to the pandemic, MD Anderson’s Incident Command Structure participated in a tabletop exercise centered on a global pandemic that initiated out of Europe and was spreading globally. “How prophetic,” Wright said. “Although we had foresight that this could happen, the actual COVID-19 pandemic far exceeded most expectations we had in terms of readiness. We need more of these exercises, and they should also include our distributors and critical suppliers. We must really think outside the box going forward

Lauri and inventory planners

MMS management

www.repertoiremag.com

•

August 2022

25

IDN OPPORTUNITIES clinicians have proven this repeatedly amid major supply disruptions. MD Anderson clinicians have adapted to the new environment with a strong willingness to assist their supply chain teammates,” Wright said. “Clinicians have familiarized themselves with supply chain terminology, like supply backorders, allocation, functional equivalents, and third-party logistics (3PL). The collaboration between the supply chain and clinical operations teams during the pandemic has been great and continues to improve.”

At the initial stage of the pandemic, well before the first reported case in the U.S., MD Anderson’s sourcing and contracting, and materials management teams, foresaw how a global pandemic could impact its patients and employees.

“As such, we initiated large bulk orders for medical grade N95 and Level 3 isolation masks. This was accomplished through utilization of a Texas based historically underutilized business (HUB) that was also the second largest domestic manufacturer of N95 at the time. This contractual arrangement ensured us stable supply of the ‘highest quality’ N95 and Level 3 isolation masks throughout the pandemic,” Wright stated, adding that “MD Anderson’s support of local and Texas-based diversity and small business suppliers is critically important and an essential part to the organizations’ diversity, equity and inclusion initiatives.”

MD Anderson also found value in local community collaboration. For instance, the organization partnered with a local community college and MD Anderson’s innovation team to print 3-D face shields.

“Additionally, we worked with a local company to manufacture, test and 26

August 2022

•

www.repertoiremag.com

SCM finance team

MMS offsite receiving team members

One Device, Two Exams The Welch Allyn Diagnostic Cardiology Suite has both ECG and spirometry capabilities, helping you shorten the path to diagnosis with results you can trust. Reduce manual data entry with a single connection to leading EMR manufacturers.

Take advantage of a secure, connected workflow.

Clinician launches the Diagnostic Cardiology Suite from the EMR.

An ECG is captured and saved for physician review, edit and signature.

The final report with discrete data is uploaded to your EMR.

Learn more at hillrom.com/cardiodcs-primarycare Baxter, Hillrom, Welch Allyn and Diagnostic Cardiology Suite are trademarks of Baxter International Inc. or its subsidiaries.

Hillrom is a part of Baxter

APR38390 Rev 1 08-JUL-2022 ENG – US

IDN OPPORTUNITIES

alter isolation gowns,” Wright said.

“These were wonderful collaborations.”

Nationally, MD Anderson was one of the first healthcare providers to join the Healthcare Industry Resiliency Collaborative (HIRC), which is a partnership of leading healthcare providers working with major manufacturers and distributors to increase transparency in the end-to-end supply chain.

Several other advances that were refined during the global pandemic include: ʯ A significantly better understanding of MD Anderson’s highest risk exposure ranked by priority and importance conducted through several comprehensive risk management exercises and modeling, led by 28

August 2022

•

www.repertoiremag.com

the organization’s Enterprise Risk Management team.

ʯ

Establishment of a 3PL program to help manage critical PPE and supply inventory that exceeded local capacity and capability of traditional distribution channels.

ʯ

Creation of real-time inventory dashboards around critical supply inventory designed to let the supply chain team know emergent areas of need or concern.

ʯ

Permanent implementation of a daily supply chain briefing (with representatives from materials management, sourcing and contracting, finance,

system and support, value analysis, pharmacy, operating room, environmental health and safety, clinical administration and our group purchasing organization) to review backorders, supply shortages and emerging threats to the healthcare supply chain.

Looking ahead, Wright said the supply chain team will be focused on several initiatives, including improving the organization’s 3PL program, inventory management capabilities and quality of information about the products used across the enterprise, as well as enhancing supply chain resiliency in terms of demand forecasting, improved supplier and manufacturer partnerships, redundancy in critical supply availability, and overall business intelligence.

SPONSORED

SRI TRANG

PPE in a Time of Uncertainty: A Logistical Nightmare

By Pete Mercer The supply chain for any industry can be a fickle beast, especially in the light of the obstructions of the last few years. In a matter of weeks, a

domino effect created by the coronavirus pandemic crippled the supply chain of just about every major market in the world, not least of all the healthcare industry. Shortages of PPE and other medical supplies are still being felt by health systems across the country.

While we are seeing some improvements since the onset of the pandemic, we’re a long way from being back to where we were before. In a recent episode of the Repertoire Podcast, Repertoire Magazine publisher Scott Adams sat down with Billy Harris, former CEO of Sri Trang USA, to discuss the current state of the PPE logistics market.

The current state of logistics According to Harris, the containers play a significant role in how we got to this point. He said, “The big issue is, as we see it, China really got ahead of the rest of the world and pulled in a tremendous amount of containers that left the globe very short in other parts of the market. It’s taken us about two years to get containers repositioned so that we could then stuff them with produced products.”

The availability of containers is just one component of the bigger picture – the containers need to ship on an ocean vessel and be unloaded once they arrive in the port. Without the personnel and equipment to get containers unloaded and moved across the shipping yard, we begin to see blockages that trickle from the

cargo ships waiting in harbors to the lack of containers at the source of the shipping channel. This is just one aspect of that domino effect we saw in early 2020.

While we are certainly still feeling some of the pressure points in the PPE supply chain, it looks like the situation is starting to stabilize and improve. Harris said, “Container movements are getting a little bit of relief. During the height of the pandemic, ocean freight rates peaked at just above $30,000 to move a container from South Asia to the east coast of the United States.

Containers are now starting to get positioned and becoming available, and we’ve seen those rates come down a little bit.”

How to move forward In order to move forward, Harris says we need to think about PPE logistics with a short-term framework – planning for the rest of 2022 and rolling into 2023. Right now, we are facing a “whipsaw effect” where there is more capacity for PPE than there is current demand. Even so, “the issue that we still deal with is getting those to move in a flawless fashion, whether it be through ports or on the ground,” Harris says.

With inventories stocked domestically, how can we avoid future pitfalls in shipping PPE in the United States? Harris says, “It’s all about getting those goods to move. This means that you may have to work with and contract with multiple carriers, vendors, and suppliers to move your goods instead of a shortlist of your primaries. We have been forced to look outside of our normal everyday relationships that we worked with during the pandemic, so it’s just an expansion of your supply relationships.”

Additionally, you can position your company outside of certain markets. With regards to Sri Trang, Harris said, “We’ve avoided using the West Coast as much because of all the congestion, the labor shortages, and the potential for worker’s strikes at the ports. We have looked at secondary and tertiary types of markets to move our goods in and out of, and it has served us well to be able to make sure that we’ve been able to keep our customers with the flow of products.” www.repertoiremag.com

•

August 2022

29

IDN NEWS

IDNs in the News Midwest: Henry Ford Health wins 2022 Premier Alliance Excellence Award Premier has named Henry Ford Health, an integrated nonprofit health system providing a full continuum of services throughout southeast Michigan, the winner of the 2022 Premier Alliance Excellence Award.

The Alliance Excellence Award recognizes innovative healthcare providers that demonstrate an unparalleled commitment to healthcare transformation, using Premier as a key partner. Henry Ford Health – which includes five acute care hospitals, two destination facilities for complex cancer and orthopedics and sports medicine care, three behavioral health facilities, primary care and urgent care centers – supports Premier’s strategy and vision through its participation in more than half a dozen committees, including Premier’s Board of Directors Advisory Committee and Strategic Advisory Committee, as well as SURPASS®, Premier’s highly committed purchasing program.

Henry Ford Health

30

August 2022

•

www.repertoiremag.com

In addition, Henry Ford Health leverages Premier’s strategic supply chain services, Remitra™ procure-to-pay technology, and the full range of PINC AI™ data and technology tools – including INsights clinical intelligence, advisory services and collaboratives – in its delivery of exceptional, cost-effective care throughout the communities it serves. Through Henry Ford Innovations (HFI), the health system partners with PINC AI™ Applied Sciences to accelerate the research, testing and development of new products, services, interventions and other novel healthcare initiatives.

Henry Ford Health was selected from Premier’s nationwide alliance of more than 4,400 U.S. hospitals and 225,000 other provider organizations.

Midwest: UPMC breaks ground on new UPMC Presbyterian UPMC has broken ground on the largest hospital in Pittsburgh’s history and the largest health care construction project in Pennsylvania.

The new $1.5 billion, 17-story UPMC Presbyterian, to be completed in 2026, will be home to 636 private patient rooms and premier people-focused clinical facilities where UPMC clinical teams and physician-scientists will deliver nationally renowned specialty care that includes transplant, cardiology and cardiac surgery, and neurology and neurosurgery. The existing UPMC Presbyterian was built more than a century ago.

The spaces within the building are designed to embrace technological advances while supporting patients and staff in an attractive environment that matches the innovation and care provided

by UPMC. The new UPMC Presbyterian is the second major project to begin construction since UPMC first announced three new, large facilities several years ago. The UPMC Mercy Pavilion will treat its first patients in spring 2023.

Details about the new UPMC Presbyterian campus: ʯ The new UPMC Presbyterian is the most transformative construction project in the history of UPMC and the flagship hospital where patients with the most complex conditions will receive life-saving care. ʯ The hospital will house specialties that include transplant, cardiology and cardiac surgery, and neurology and neurological care from worldrenowned physicians and clinical teams.

ʯ ʯ

ʯ

ʯ

ʯ ʯ

ʯ

ʯ

The 17-story, $1.5 billion project will encompass 1.2 million square feet of space.

The project will create an estimated 3,400 construction jobs over four years and offer significant opportunities for Minority, Women and Disadvantaged Business Enterprise vendors.

The hospital will include 636 private patient rooms with innovative in-room digital capabilities, respite areas and a gym for use by staff and visitors.

Nearly one-fourth of patient rooms can be adapted to become intensive care rooms.

Acuity-adaptable rooms will allow patients to transition through their care in the same space – limiting patients transferring from one unit and care team to another as they recover.

The building will meet or exceed green building standards.

The tower’s design captures UPMC’s vision for linking patients, visitors and staff to nature and to Pittsburgh’s Oakland neighborhood.

The hospital façade will be made of energy-efficient, patterned glass, and will reflect and blend into the design of the existing campus and surrounding neighborhood.

A 450-space parking garage will reduce congestion at existing parking facilities.

Northeast: Mount Sinai researchers develop a rapid test to measure immunity to COVID-19 Mount Sinai researchers have developed a rapid blood assay that measures the magnitude and duration of someone’s immunity to SARS-

UPMC Presbyterian

CoV-2, the virus that causes COVID19. This test will allow large-scale monitoring of the population’s immunity and the effectiveness of current vaccines to help design revaccination strategies for vulnerable immunosuppressed individuals, according to a study published in Nature Biotechnology in June.

The test takes less than 24 hours to perform and is scalable to use broadly in the population. It measures the activation of T cells, which are part of our adaptive immune response to SARS-CoV-2 infection or vaccination and help protect against severe disease outcomes or death.

Long-term protection from viral infection is mediated by both antibodies and T cell response. Many recent studies point to the importance of determining T cell function in individuals who have recovered from or been vaccinated against COVID-19 to help design vaccination campaigns.

However, before this study, measurement of T cell responses has been rarely performed because of the associated technical challenges.

South: Federal government fines Northside Hospital over $1 million for not sharing medical prices According to a report from The Atlanta Journal-Constitution, the federal government has fined Northside Hospital for violating the rights of patients to transparent health care price information. Last year, CMS started to require hospitals across the country to post the price of certain services on their websites.

This measure is intended to help patients shop and plan for the cost of medical care, and the lists are required to be posted in specific formats that are accessible and consumer friendly. After the federal rule was implemented, CMS contacted hospitals across the country that didn’t comply and warned them of the violations before issuing fines.

The AJC examined hospital compliance in Georgia with the new federal rules, scoring each with a report card. Northside scored the lowest in the AJC ’s findings. www.repertoiremag.com

•

August 2022

31

TRENDS

What the Future Holds Making sense of the latest economic trends and what it means for healthcare.

You’ll have to forgive Economist

Alan Beaulieu for not being rattled over the latest breaking news and headlines related to the economy.

His company, ITR Economics, has provided business leaders with economic information, insight, analysis, and strategy since 1948. ITR Economics is the oldest privately held, continuously operating economic research and consulting firm in the United States.

“Right now, there is a lot of fear in the news and in people’s minds, mostly caused by inflation and high 32

August 2022

•

www.repertoiremag.com

Alan Beaulieu

prices that seem destined to go on and on and on,” Beaulieu said. “That is straight-line thinking that never leads to a proper view of the future.

There are way too many nuances for a straight line to be the correct view.”

ITR’s outlook is one of disinflation (easing inflation) beginning perhaps as early as next quarter, with the potential for some deflation in select areas (e.g., oil prices and a few other commodities may edge lower next year). “This is not a period of runaway inflation with interest rates that will rival the early 1980s,” he said.

Because the exam room should feel

SAFE, WELCOMING & COMFORTABLE We made it our mission to design exam tables that are visually appealing, inclusive & loaded with value.

Up to 700-pound weight capacities

Exclusive safety features come standard in base price

Industry leading warranties for peace of mind

Visit us at brewercompany.com or call 262-293-7121

Models with most storage space available in market

TRENDS Beaulieu offered the latest forecast for 2022 and 2023, insights into some key economic indicators, and thoughts on how these trends are affecting hospitals and health systems when it comes to their workforces and operations.

Forecasting 2022 and 2023 The ITR Economics forecast for 2022 and 2023 calls for slower economic growth from now through well into 2023, but no recession.

“The first-quarter decline in GDP was technical, with no troublesome drop in key GDP segments like consumer and business spending,” Beaulieu said. “We have been forecasting the U.S. and global economies since 1948. Our average forecast accuracy four quarters out is 94.7%. Our leading indicators give us an edge over other prognosticators and those that depend on headlines. Capital Goods New Orders (without aircraft) are also slowing in their rate of rise, but not to the point where we are getting a signal of a pending recession.”

Consumer demand Consumer demand is flattening on a deflated (inflation-adjusted) basis, “but not to the point where we believe it will tip the economy into recession,” Beaulieu said. “The overall slower growth is normal given the withdrawal of stimulus checks and that the rate of spending was at an incredibly high and unsustainable level. The surprise is that some people did not expect this slowdown. That is not to say there are not concerns, but income adjusted for inflation is above where we were before COVID, and the outlook is that consumers will keep spending at a sufficient level to keep the economy growing.”

“When it comes to the healthcare industry, the average weekly wage of healthcare workers in the U.S. over the last 12 months is a record-high $1,150.56 with an annual growth rate of 6.6%, which is a record-high year-over-year rate of rise,” Beaulieu said. “Expect the rate of rise to slow later this year or early 2023 as disinflation trends become more evident,” he said.

“The annual average amount of people working in healthcare as of May 2022 is 16.114 million, 231,975 below the March 2020 level. The number of workers continues to rise and can be expected to continue to move higher in the years to come.”

Workforce shortages

The cost of doing business

“Labor shortages are a reality that will be with us for years to come, and wages will keep moving higher, but not at the same pace as we have been experiencing,” Beaulieu said. “The decelerating rate of rise in wages is consistent with our outlook

“Operating margins are getting squeezed in many industries, which highlights the need for efficiency gains, automation wherever possible, and practical cost management.”

“ The annual average amount of people working in healthcare as of May 2022 is 16.114 million, 231,975 below the March 2020 level. The number of workers continues to rise and can be expected to continue to move higher in the years to come.”

Inflation Beaulieu said inflation for the Producer Price Index for pharmaceutical preparations in the U.S. through May 2022 is at 1.4%. It was 2.4% in February 2020 (pre-COVID). Inflation for this PPI had been easing from June 2015 through March 2021.

34

August 2022

•

www.repertoiremag.com

for disinflation in the coming year.

Employers will have to not only pay well, but they will have to actively work on culture to attract and retain talent. Naturally, efficiency gains and automation will be a top priority for every industry in the years to come.”

Yes, tracking economic trends has been an adventure “Tracking economic trends from March 2020 through to today has been a definite challenge to our resources given the essentially unprecedented nature of the pandemic on a modern global economy and the incredible levels of government spending associated with the pandemic,” Beaulieu said. “Fortunately, our theories and methodologies worked extremely well for our clients and subscribers, and our year-end 2020 and year-end 2021 forecast accuracy continued to exceed 94.7% (our average fourquarter accuracy since 1985).”

“It feels very rewarding to continue to accurately guide businesses and individuals through the most turbulent times in our lifetimes.”

HIDA GOVERNMENT AFFAIRS

HIDA brings preparedness, shipping issues to Capitol Hill In June, leaders from across the healthcare distribution industry convened in Washington,

D.C. for HIDA’s first in-person Washington Summit in three years. The Washington Summit is our opportunity to engage with Members of Congress and their staff.

At the opening breakfast of the Washington Summit, HIDA honored Senator Richard Burr (R-NC) as the recipient of the Preparedness Policy Excellence Award. Throughout his career, Senator Burr has been a leader in preparedness, including the 2006 passage of the Pandemic and All-Hazards Preparedness Act (PAHPA), which created the modern framework for responding to pandemics, biothreats, and natural disasters.

“I have spent my career writing preparedness legislation that we hope we never have to use,” Senator Burr said. “As we chart our way out of COVID, we need to update our preparedness plans for this decade and the decade to come.”

Following breakfast, healthcare distribution advocates fanned out across Capitol Hill for more than 115 meetings with Senators and Representatives – both Republicans and Democrats – from 40 states. In a series of meetings, we discussed a variety of legislative issues to boost preparedness and streamline the medical supply chain. ʯ PREVENT Pandemics Act: This bipartisan legislation strengthens the nation’s public health and medical preparedness and response systems in the wake of the COVID-19 pandemic.

The PREVENT Pandemics Act recognizes the vital role of public-private partnerships in managing medical supplies during a pandemic, by incorporating a vendor-managed inventory

component into the Strategic National Stockpile (SNS).

ʯ

Ocean Shipping Reform Act: HIDA applauded Congressional passage of the most comprehensive maritime legislation in 40 years. The new law empowers the Federal Maritime Commission to combat unfair trade practices in the shipping industry and addresses price gouging on container shipping fees by ocean carriers.

ʯ

Fast Pass: A Fast Pass Critical Cargo Pilot Program for Medical Supplies would authorize federal agencies to partner with ports and marine terminal operators to identify critical cargo and expedite its movement through the ports and across all modes of transportation.

ʯ

Strengthening America’s Strategic National Stockpile Act: A bill to boost domestic manufacturing to diversify sources of personal protective equipment (PPE). Provisions of this bill were incorporated into the bipartisan innovation package.

By Mary Beth Spencer, Director of Government Affairs

HIDA greatly appreciates the enthusiasm and dedication of our member advocates, who are crucial to making our industry heard on Capitol Hill. As we continue our efforts to educate Congress about the value of distribution, the contributions of the health distribution industry remain invaluable. www.repertoiremag.com

•

August 2022

35

36

August 2022

•

www.repertoiremag.com

Respiratory Season: A Surprise Package COVID’s impact lingers.

Respiratory season always comes with many questions

and a few surprises. The 2022-2023 season promises to be no exception.

For starters, the effects of COVID-19 will linger.

In May the Centers for Disease Control and Prevention reported that one in five COVID-19 survivors aged 18–64 years and one in four survivors aged 65 and older experienced at least one condition that might be attributable to previous COVID-19 four weeks or longer after experiencing acute symptoms. Among all ages, the highest risks in the study were for acute pulmonary embolism and respiratory symptoms.

The 2022-2023 season may deal some wild cards as well, like avian influenza (HPAI) Asian (H5N1). Sporadic human infections with HPAI Asian H5N1 virus resulting from direct or close contact with infected sick or dead poultry are expected to continue to occur, and some of those cases will likely be fatal, according to CDC. Personto-person transmission has been very rare, but should the virus recombine with human influenza A viruses, an influenza pandemic could result. www.repertoiremag.com

•

August 2022

37

Respiratory Season: A Surprise Package

“The biggest challenge reps will face is how to offer customers sound advice in an ever-changing market,” says Cisco Merrill, senior director of sales, alternate sites and channels, Cepheid. “They are often viewed as the product expert and trusted consultant to their customers, but with state-by-state regulations changing, Americans facing COVID fatigue and our country working through the dynamics of re-opening safely, managing a complex economy, high inflation, etc., it can be a burden to offer solutions that provide the best patient care but help them keep their practice doors open.

“The most successful reps tend to understand their customer’s needs the best, and then partner with the appropriate manufacturers and solutions that allow them to best meet those needs.”

Precarious position “While daily case rates have significantly declined since the Omicron surge, several COVID-19 mitigation measures (i.e. mask-wearing and social distancing) have been lifted and are no longer being enforced,” says Chris Girard, U.S. product manager, point of care, BD IDS. “These mitigation measures were critical in limiting viral transmission during last year’s respiratory season.

“During the hot summer months, people spend more time outdoors, which allows less opportunity for viral respiratory transmission. However, during the cooler winter months, people tend to congregate indoors, which allows respiratory viruses like COVID and the flu greater opportunity to spread from person to person. If we are not masking up and socially distancing like we were last respiratory season, the expectation is that we will be in a much more precarious position for viral transmission of COVID, flu, and other viruses that cause the common cold this respiratory season. For these reasons, having access to combined COVID and influenza in-office diagnostics will be important for medical providers to distinguish between the overlapping symptoms present in these conditions.”

Commenting in mid-June, Girard pointed out that several countries in the Southern Hemisphere such as Australia were reporting the worst flu season in years. The Department of Health showed Australia had recorded more than 38,000 flu cases. About 70% of those cases (more than 26,000) were reported in just a two-week period from May 9-22.

“This significant spike in influenza cases can likely be attributed to the global relaxation of mitigation measures for COVID-19,” he said. “Based on the current public health data being reported in the Southern Hemisphere, we can expect a significant increase in influenza prevalence and transmission in the United States during this upcoming respiratory season.”

More susceptibility than usual “Much will depend on whether COVID-19 surges again mid-fall or early winter,” says Mike Abney, senior vice president, North American sales and distribution, Quidel.

“If it does not surge, then we are poised for a more prominent, perhaps even moderate to severe influenza season.

Without the COVID-19 surge, people will be even less inclined to exercise [non-pharmaceutical intervention], mask-wearing, etc. than they are now – and they will be more likely to catch a respiratory disease.

“With the greatly reduced incidence of influenza in the last two ‘seasons,’ the population’s herd immunity is likely down, making our citizens even more susceptible than usual – and making the high-risk people even more at risk,” he says. “The presumed viral interference exerted

by SARS-CoV-2 could be absent, also opening the door for more rapidly spreading influenza.

38

August 2022

•

www.repertoiremag.com

GET RE ADY

CLIA

GET SET

WAIVED

Respiratory season is right around the corner and Abbott is here to support you and your customers. The ID NOW™ system is a leading molecular point-of-care (POC) platform in the US with specialized teams to assist with sales, implementation, clinical and technical support across all testing sites.

ID NOW™ COVID-19

5-13 minutes - EUA authorized for

near patient testing environments

1

ID NOW™ STREP A 2

2-6 minutes - Requires no culture confirmation for negative results3

ID NOW™ INFLUENZA A & B 2

ID NOW™ RSV

more true positives than RADTs

more true positive than RADTs4,5

5-13 minutes - Detects up to 20% 2

< 13 minutes - Detects up to 25%

WE ARE HERE TO SUPPORT YOU AND YOUR CUSTOMERS. REACH OUT TO YOUR ABBOTT REPRESENTATIVE TODAY.

877.441.7400 1. ID NOW™ COVID-19 Product Insert 2. Merckx J, et al. Diagnostic Accuracy of Novel and Traditional Rapid Tests for Influenza Infection Compared With Reverse Transcriptase Polymerase Chain Reaction: A Systematic Review and Meta-analysis. Ann Intern Med. 2017 Sep 19;167(6):394-409. Based on the reported Flu A sensitivities of readers and ID NOW 3. ID NOW™ Strep A 2 Product Insert 4. Chartrand, C. et al. Diagnostic Accuracy of Rapid Antigen Detection Tests for Respiratory Syncytial Virus Infection: Systematic Review and Meta-analysis. J Clin Microbiol. December 2015 vol. 53 no. 12 3738-3749 5. ID NOW RSV Product Insert RADTs, Rapid antigen detection tests (lateral flow) The ID NOW COVID-19 product has not been FDA cleared or approved. It has been authorized by the FDA under an Emergency Use Authorization (EUA) for use by authorized laboratories and patient care settings. The test has been authorized only for the detection of nucleic acid from SARS-CoV-2, not for any other viruses or pathogens, and is only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostic tests for detection and/or diagnosis of COVID-19 under Section 564(b)(1) of the Act, 21 U.S.C. § 360bbb-3(b)(1), unless the authorization is terminated or revoked sooner. © 2022. All rights reserved. All trademarks referenced are trademarks of their respective owners. Any photos displayed are for illustrative purposes only. Any person depicted in such photos is a model. COL-12805-01 06/22

Respiratory Season: A Surprise Package

“Interestingly, there has been influenza this winter and spring and it is almost purely influenza type A. The herd immunity versus type B, therefore, might decline even more than that vs. type A. We should expect, if COVID-19 declines, to see potentially a more prominent surge of influenza B than usual.”

A significant respiratory season Jonathan Overbey, head of corporate alliances and channel management, Sekisui Diagnostics, says that as more physicians test for COVID and get back negative results, they are once again testing for flu and other respiratory conditions, such as strep, mono and RSV. “As we know, these didn’t go away during the pandemic; they just didn’t get tested [as patients] avoided the doctor’s office,” he says. “We expect a strong flu season this year, but that could change if another variant impacts testing. It appears people are moving on and living with COVID-like endemic viruses, and we have suppressed our immune systems over the last two years.

“If there is not another super contagious variant breakout and possible shutdown of in-person school and in-person activities, it should be a significant respiratory season. Reps should discuss all these options now with their accounts to ensure they have ALL of the respiratory test kits on hand.”

Expect the unexpected Cisco Merrill of Cepheid suggests the country prepare for the unexpected. “Respiratory seasonality is no longer 40

August 2022

•

www.repertoiremag.com

a set time of the year. You used to be able to set a calendar as to when customers would start to pre-book flu. Cases would spike as children started back to school and would dip in late spring as the weather turned warm. That is no longer the case.

“Positive flu cases were still being reported in June, RSV cases spiked across the country in higher numbers than we have seen in years, COVID cases are again on the rise, and Omicron has mutated more and lasted longer than all its predecessors,” he says. “So as the summer months begin to wind down, kids head back to school and the weather turns cool, who knows what will be thrown our way? One constant is that if you put your customers’ and patients’ needs first, by providing the sound guidance and solutions that aid them in impacting better outcomes, you will always put them in a position to be successful as well as yourself.”

An element of unpredictability In response to Repertoire’s questions, an Abbott spokesperson says, “Our most recent respiratory seasons have shown an element of unpredictability that is historically uncommon for respiratory season. Customers must now consider potential COVID-19 variants, its impact to future waves, unknown levels of other respiratory viruses and labor shortages. “Preparedness has never been as important as it is today. Distributors will play a key role this upcoming respiratory season to help customers proactively plan their rapid testing needs to provide quick and accurate answers to their patients.”

MADE IN THE USA

Respiratory Season: A Surprise Package

Respiratory season Q&As Repertoire submitted questions to vendors about their respiratory-related diagnostics products. Here are their responses.

BD-Integrated Diagnostic Solutions Q: Have you made any changes to your line of respiratory diagnostic products that Repertoire readers should be aware of? If so, can you explain them?

A: We are continuing to strive to make testing easy, accessible, and affordable. Our combined COVID19 & Flu A+B test leads the way here with a simple, single-sample test with clear results in 15 minutes. The test is also able to detect a co-infection with COVID-19 and influenza. We are continuing to offer promotional bundles as well that cover the capital cost of the analyzer so that customers are only paying for the tests they use.

And we know that the pandemic continues to be unpredictable, so we are not requiring any contract commitments from customers to still receive great pricing and value from our systems.

Q: What sales challenges can Repertoire readers expect to face this respiratory season insofar as in-office diagnostics are

concerned? How will successful reps overcome those challenges?

A: During respiratory season, there is increased prevalence and cocirculation of several viruses and conditions that present with overlapping symptoms. These viruses and conditions include (but are not limited to): influenza, COVID-19, seasonal allergies, group A strep, RSV, and other viruses that cause the common cold (adenovirus, rhinoviruses, and other coronaviruses, etc.). All these conditions present with common upper respiratory symptoms such as cough, sneezing, sore throat, and runny nose, making it incredibly difficult for providers to accurately assess, diagnose and treat a patient’s symptoms off clinical presentation alone.

For these reasons, having access to combined COVID and influenza in-office diagnostics will be important for medical providers to distinguish between the overlapping symptoms present in these conditions. Furthermore, we now have FDA-authorized and

approved treatments for COVID and influenza, so having tests that can differentiate between each virus will be critical to successfully implement the Biden Administration’s “Test to Treat” initiative.

Q: Last fall Repertoire reported that BD received Emergency Use Authorization (EUA) in February and March 2021 for the BD® SARS-CoV-2/Flu assay, which is run on the BD MAX™ System; and the BD Veritor™ System for Rapid Detection of SARS Co-V-2 & Flu A+B test. Any updates?

A: BD has partnered with ImageMover MD, a result management and workflow services organization that helps customers intake patients, digitally store results, and automatically share results with the patient and state/federal health departments. This result management system is available at no-charge to BD Veritor™ customers and works with all BD Veritor™ assays. To learn more, email: BDVeritorOrder@imagemovermd.com

Quidel Q: Have you made any changes to your line of respiratory diagnostic products that Repertoire readers should be aware of?

A: Quidel offers a full suite of respiratory diagnostic testing from visual read to high throughput molecular.

All of our products are readily available, manufactured domestically, and are supported by a vast commercial organization including our territory account managers, strategic account managers, channel

42

August 2022

•

www.repertoiremag.com

sales directors and various product sales specialists.

Q: What sales challenges can Repertoire readers expect to face this respiratory season insofar as in-office diagnostics are concerned? How will successful reps overcome those challenges?

A: Challenges for distributors in the upcoming season could include the volatility of COVID surges as well as increases of flu, Strep A, and

RSV during what would typically be deemed as offseason. Given the uncertainty, clinicians must be ready to provide accurate and fast testing at a moment’s notice.

It is imperative for a distributor sales representative to stay closely connected with both end user customers as well as manufacturing partners to be able to recommend a tailored solution for each customer and to share which products are readily available. It is important to

Is it COVID-19 or the Flu? Quickly detect and differentiate between Influenza and COVID-19* with a single test this flu season, with clear, trusted, digital results in 15 minutes.

See what’s new at BDVeritor.com/COVID-Flu *Emergency Use Authorization Information for the SARS-CoV-2 and SARS-CoV-2 & Flu A+B assays: • These products have not been FDA cleared or approved; but have been authorized by FDA under EUA for use by authorized laboratories • The BD Veritor™ System for Rapid Detection of SARS-CoV-2 has been authorized only for the detection of proteins from SARS-CoV-2, not for any other viruses or pathogens; the BD Veritor™ System for Rapid Detection of SARS-CoV-2 & Flu A+B has been authorized only for the detection of proteins from SARS-CoV-2, influenza A and influenza B, not for any other viruses or pathogens; and, • These products are only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection and/or diagnosis of COVID-19 under Section 564(b)(1) of the Federal Food, Drug and Cosmetic Act, 21 U.S.C. § 360bbb-3(b)(1), unless the declaration is terminated or authorization is revoked sooner.

BD Life Sciences, 7 Loveton Circle, Sparks, MD 21152-0999 USA 800-638-8663 BD, the BD Logo and Veritor are trademarks of Becton, Dickinson and Company or its affiliates. © 2021 BD. All rights reserved.

Respiratory Season: A Surprise Package

follow real-time trends of various disease states in respective geographies including the CDC map and also Quidel’s virena mapping at: https//beinformed.quidel. com/, says Abney.

Q: Last fall Repertoire reported that in October 2020, Quidel received EUA to market the Sofia® 2 Flu + SARS Antigen

FIA, to be used with the Sofia® 2 Fluorescent Immunoassay Analyzer. Any update?

A: Yes. Three developments: ʯ In December 2020, Quidel received EUA to market the QuickVue SARS Antigen Test, to be used in traditional healthcare spaces. ʯ In March 2021, Quidel received EUA to market the

ʯ

QuickVue At-Home COVID-19 Test, a visually read diagnostic for COVID-19 to be used at home or in the workplace.

In May 2022, Quidel received EUA to market the Solana SARS-CoV-2 Assay, an updated and easier to use version of our HDA molecular assay.

Sekisui Diagnostics Q: Have you made any changes to your line of respiratory diagnostic products that Repertoire readers – i.e., distributor sales reps – should be aware of? If so, can you explain them?

A: Yes! We are hoping for FDA EUA authorization for three COVID tests soon. We will then launch through our distribution partners a COVID Antigen test on our Acucy reader as well as a lateral flow antigen test under our OSOM brand and a combo Flu and COVID test too.

Q: What sales challenges can Repertoire readers expect to face

this respiratory season insofar as in-office diagnostics are concerned? How will successful reps overcome those challenges?

A: The biggest challenges remain to some degree, with supply chain issues and rolling backorders for PPE and some other materials.

Reps continue to work hard and advocate for their customers.

With diagnostics, they need to manage their accounts that testing is needed for more than just COVID, and they need to bring in other respiratory kits despite any short-dated COVID tests they have on hand, etc. Testing is the best

way to control the spread of any respiratory issue and that includes testing for all things to “rule in” or “rule out” a diagnosis.

ties, is that we will be offering both of our respiratory offerings (Covid Plus & 4-Plex Plus), as we are at production levels that afford us the ability to offer our customers both products this respiratory season.

existing Xpert Xpress SARS-CoV-2/ Flu/RSV product. Key enhancements include the addition of a 3rd gene target for SARS-CoV-2 (RdRP now included in addition to E and N2), to be more robust against mutations, to include the addition of eNAT for anterior nasal and nasopharyngeal swabs, which mitigates the need to use a hood when transferring patient samples, as the eNAT solution neutralizes the active COVID sample. Additionally, the former test would provide a positive result within 46 minutes. The new COVID Plus assay, provides a positive result within 20 minutes.

Q: Last fall Repertoire reported that in March 2020, Mesa Biotech received an EUA for the AcculaTM SARS-Co-V-2 test, which is distributed by SEKISUI Diagnostics. Any update?

A: In February 2021, ThermoFisher acquired Mesa Biotech and has taken over all commercial sales and operations for all of Mesa Biotech product lines. Sekisui Diagnostics is no longer a distributor of Accula.

Cepheid Q: Have you made any changes to your line of respiratory diagnostic products that Repertoire readers should be aware of? If so, can you explain them?

A: From a preparations standpoint there is no difference in how we are treating 2021 versus 2022. We are going to produce and deliver as much respiratory product to the market as we can make. Our production levels have increased quarter over quarter since the start of the pandemic, and we intend to deliver our Xpert® Xpress CoV-2 plus and Xpert® Xpress CoV-2/Flu/RSV plus assays to our ever-expanding customer base. One change, due to our increasing production capabili-

44

August 2022

•

www.repertoiremag.com

Q: Last fall Repertoire reported that in September 2020, Cepheid received EUA for Xpert® Xpress SARS-CoV-2/Flu/RSV for qualitative detection of the viruses causing COVID-19, Flu A, Flu B, and RSV infections from a single patient sample. Any updates?

A: In September 2021, we received EUA Authorization for our Xpert Xpress CoV-2/Flu/RSV plus, improving on the already stellar

Standardizing PCR testing throughout your care continuum provides patients with the quality they deserve no matter where and when they seek care.

Meet the challenges of today’s world with a higher level of PCR excellence. Our scalable testing solutions deliver unmatched results.

Speed, plus Accuracy, plus Flexibility That’s the PCRplus advantage.

Scan here for more information US-IVD. In Vitro Diagnostic Medical Device.

TRENDS

Is Less More?

Fewer procedures, more conversations, may lead to less ‘low-value’ care.

Less is more: Is it true regarding healthcare services and

procedures? Many clinicians think so but have found that eliminating “low-value care” is more difficult than it sounds.

Research shows that fear of malpractice, patient demands and old med school habits continue to drive physicians to provide diagnostic, imaging and pharmacological services that do little good for their patients, and at worst, lead to poorer health outcomes. It’s called low-value care and has been defined as services that are of limited to no benefit to patients, may cause patients harm, and lead to waste of healthcare resources.

“The potential negative consequences of medical overuse include adverse effects of treatments and procedures, invasive and dangerous follow-up tests and treatments, overdiagnosis, psychological harm, treatment burden, social consequences, and dissatisfaction with health care,” concludes Niloofar Latifi, M.D., of John Hopkins School of Medicine, writing in a JAMA Internal Medicine editorial in December 2021. For example, routine preoperative electrocardiograms before cataract surgery have been associated with a cascade of testing, treatment, and specialist referral at an estimated annual cost for Medicare of $35 million, she says. Low-value testing in annual health examinations has been associated with more specialist visits and additional noninvasive and invasive testing.

46

August 2022

•

www.repertoiremag.com

www.repertoiremag.com

•

August 2022

47

TRENDS Choosing Wisely® Based on the principle of avoiding services with no or minimal benefit to patients, the American Board of Internal Medicine Foundation in 2012 helped launch the Choosing Wisely® campaign. The program calls for professional societies to create lists of low-value services that physicians should avoid and encourages physicians to engage in conversations about overuse.

The campaign started with lists from nine medical societies and has since grown to include lists from more than 80 societies, citing more than 600 procedures in total. In addition, the program has spread beyond U.S. borders to 25 other countries, including Canada, the United Kingdom, Germany, and Japan.

In a Perspective piece in the New England Journal of Medicine in

April, internist Elizabeth J. Rourke, M.D., of Brigham and Women’s Primary Care in Boston, raised questions about Choosing Wisely, calling it an “immediate public relations win for the medical profession in 2012, demonstrating that doctors were stepping up to address low value and high costs in medicine.”

But, she continues, “[t]en years later, it’s clear that making lists and publicizing them are not sufficient to reduce low-value care.” Medical services that do not improve patients’ health continue to account for an estimated 10% to 20% of health care provided in the United States, costing $75 billion to $101 billion per year, she says.

“In a capitalist economy oriented toward growth, more has always been more, and newer has always been better. In this context,

Spending on low-value care Despite the efforts of the medical societies participating in the American Board of Internal Medicine’s Choosing Wisely® initiative, success in reducing low-value care and spending has been modest at best, concluded researchers reporting in JAMA Internal Medicine in December. The reason could lie in the characteristics and expected impact of the services identified in Choosing Wisely recommendations. Some of their findings:

ʯ

ʯ

ʯ

48

Low-value services identified in the 626 Choosing Wisely recommendations largely cover imaging (26.8% and laboratory studies (24.9%).

Nearly half (45.4%) of recommendations identify services that are low cost (<$200), such as serum vitamin D tests or electrocardiograms.

Most recommendations (43.8%) identify low-value services that cover common clinical scenarios, such as low back pain, pregnancy, or acute respiratory tract infection, or uncommon clinical

August 2022

•

www.repertoiremag.com

ʯ

ʯ

scenarios, such as pediatric nephrolithiasis (38.5%).

Nearly half (44.8%) of identified low-value services have high potential for direct harm (e.g., central venous catheter placement), while 62% have high potential for cascades (e.g., opioid treatment, preoperative electrocardiogram, and prostate specific antigen test).

Most services with low direct harm nevertheless have high cascade potential and 19.2% of recommendations name services with high direct harm and high cascade potentials.

parsimony is a hard sell. In addition, cognitive biases such as the therapeutic illusion that leads us to overestimate benefits and underestimate harms are present in both doctors and patients.”

Physicians who want to reduce low-value care should begin by listening to their patients’ wishes, Rourke says. “My experience mirrors the findings of a 2015 study that used surveys, interviews, and focus groups to assess how patients understood low-value care. The study found ‘quite powerfully’ that patients favored ‘replacing excessive tests with time for clinicians to talk, listen and personalize’ and that ‘the vast majority of Americans who currently view reducing low-value care in a positive light do so because they see it as a means to improve communication with their clinicians.’ In short, these patients – and I – want more of the conversations that the [American Board of Internal Medicine] set out to promote in 2012.”

Time to talk Daniel B. Wolfson, executive vice president and COO of the ABIM Foundation told Repertoire, “After a decade of Choosing Wisely we know what helps in addressing low-value care and have worked with specialty societies to create many valid and meaningful recommendations. But we completely agree that now is the time for delivery systems and other entities to use multiple interventions to promote value-based care.

“Our role was in starting the movement, and we always knew it would take others joining us to create projects and interventions that would help ensure reductions of low-value care. Beginning with awareness, cultural changes, and prioritizing low-value care, the next

phase would be multiple efforts to de-implement care.”

Wolfson points out that this is already occurring in pockets of the healthcare system, including among 14 large healthcare systems whom the Foundation worked with under a grant from the Robert Wood Johnson Foundation. That effort led to a 20% to 30% reduction in the use of antibiotics, he says. In another example, Cedars-Sinai Health System used its decision support tool in Epic to alert physicians when their care instructions deviated from Choosing Wisely’s evidence-based guidelines during inpatient visits.

“An alert was triggered, for example, if a physician tried ordering a sedative for a sleepless older patient, as sedatives can put seniors at risk for falls and more,” he says. “Physicians

‘ In a capitalist economy oriented toward growth, more has always been more, and newer has always been better. In this context, parsimony is a hard sell.’ could choose to follow the suggestion or override it. The study found a significant difference in health outcomes and costs between those that followed the suggested alerts and those that didn’t.

“The conversations we ignited continue, with many physicians reporting that Choosing Wisely conversations occur daily in their hospitals and clinical practices,” says Wolfson. “Multiple journals, including the Journal of Hospital Medicine and JAMA Internal Medicine, feature regular sections on Choosing Wisely

and/or overuse. Specialty society meetings have tracks on overuse and their Choosing Wisely recommendations. And conversations also occur in medical education and training through the Costs of Care’s STARS program,” which provides training for medical students to lead value improvement initiatives at their own medical schools.

Value-based care Mary Campagnolo, MD, MBA, FAAFP, a board member of the American Academy of Family Physicians,

www.repertoiremag.com

•

August 2022

49

TRENDS

A ‘Choosing Wisely’ list Following are the American Academy of Family Physicians’ clinical recommendations for the American Board of Internal Medicine’s Choosing Wisely® initiative.

1. Don’t order annual electrocardiograms (EKGs) or any other cardiac screening for low-risk patients without symptoms.

2. Don’t routinely prescribe antibiotics for otitis media in children aged 2-12 years with non-severe symptoms where the observation option is reasonable.

9. Do not routinely screen for prostate cancer using a prostate-specific antigen (PSA) test or digital rectal exam.

10. D on’t transfuse more than the minimum of red blood cell (RBC) units necessary to relieve symptoms of anemia or to return a patient to a safe hemoglobin range (7 to 8 g/dL in stable patients).

3. Don’t routinely recommend daily home glucose monitoring for patients who have Type 2 diabetes mellitus and are not using insulin.

11. D on’t screen for carotid artery stenosis in asymptomatic adult patients.

4. Don’t use dual-energy X-ray absorptiometry (DEXA) screening for osteoporosis in women under age 65 or men under 70 with no risk factors.

12. Don’t screen women older than 65 years of age for cervical cancer who have had adequate prior screening and are not otherwise at high risk for cervical cancer.

5. D on’t schedule elective, non-medically indicated inductions of labor or Cesarean deliveries before 39 weeks.

13. Don’t screen for genital herpes simplex virus infection in asymptomatic adults, including pregnant women.

6. Don’t do imaging for low back pain within the first six weeks, unless red flags are present.

14. D on’t screen for testicular cancer in asymptomatic adolescent and adult males.

7. Don’t perform Pap smears on women under the age of 21 or women who have had a hysterectomy for non-cancer disease.

15. D on’t perform pelvic exams on asymptomatic nonpregnant women, unless necessary for guidelineappropriate screening for cervical cancer.

8. Do not require a pelvic exam or other physical exam to prescribe oral contraceptive medications.

16. D on’t perform voiding cystourethrogram (VCUG) routinely in first febrile urinary tract infection (UTI) in children aged 2-24 months.

Source: American Academy of Family Physicians, https://www.aafp.org/family-physician/patient-care/clinicalrecommendations/clinical-practice-guidelines/choosing-wisely.html

50

August 2022

•

www.repertoiremag.com

believes that “at its core, the [Choosing Wisely] campaign shares a major theme with family medicine – encouraging conversations and shared decision-making between physicians and patients regarding the risks, benefits and necessity of common tests and procedures.” But those types of conversations can be difficult in today’s fee-forservice system.

“Fee-for-service payment models incentivize ‘sick’ care by rewarding physicians for ‘doing things to people,’ i.e., tests and procedures,” she says. “In contrast, value-based payment models prioritize primary care and wellness.

‘ The vast majority of Americans who currently view reducing lowvalue care in a positive light do so because they see it as a means to improve communication with their clinicians.’

“Value-based payment rewards efficiency while maintaining sensitivity to patients’ physical, emotional and social needs. For example, value-based care incentivizes reduced emergency department visits or unnecessary hospitalizations by focusing on prevention for patients at high risk. Similarly, value-based care encourages practices to work with local social service agencies to address social or emotional needs that may be affecting the patient’s health.

“We firmly believe that value-based payment models, which base physician payment on outcomes as opposed to the number and type of services, enables physicians to provide person-centered, proactive care that better serves patients.”

Says Wolfson, “Change in health care is often slower than we’d like, especially in reducing low-value care, as we’re continually working against the perception that more is better. Choosing Wisely helped change that conversation, and we believe that the vast majority of the clinical recommendations from the campaign advanced our goals of promoting conversations between clinicians and patients about reducing overuse.

“We’re certainly not all the way there yet, but there is greater awareness of these issues amongst clinicians and patients than when we started.”

TRENDS

Completing the Picture If interoperable user-friendly EHRs are the key to value-based care and population health, why don’t we have them?

By Thomas Campanella

An Electronic Health Record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-

centered records that make information available instantly and securely to authorized users. While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care. EHRs are a vital part of health IT and can: ʯ Contain a patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results ʯ Allow access to evidence-based tools that providers can use to make decisions about a patient’s care ʯ Automate and streamline provider workflow

Interoperability in healthcare is the ability for devices, software, and information systems to connect within or outside the boundaries of physician practices and health systems to exchange and access patient data for the purposes of addressing health issues with individual patients and the general population.

EHRs can improve patient-centered care by sharing results among clinicians. Diagnostic decisions can be made more accurately and safely and be patient specific if EHRs show results among all the applicable clinicians that are seen by the patient.

The value of interoperability includes the following: Reduced Medical Errors: 1. Interoperability offers organizations ways of preventing medical error deaths by making it possible to share data across systems and applications. This allows care providers to have a better understanding of how and why these errors occur and empowers them to act.

52

August 2022

•

www.repertoiremag.com

2. Simply standardizing data within a single healthcare system is not enough. To fully enable physicians to reduce errors, interoperability must happen externally across healthcare organizations – not just within departments in a single organization.

Increased Efficiency: 1. Presenting data to care providers in real time and in a consistent manner can boost efficiency across an entire organization.

Real-time data and other healthcare analytics advancements would enable providers to quickly identify the root of a patient’s

problem and empower them to make more informed and faster decisions. For example, an emergency room patient might need blood tests performed, costing the healthcare system time and money. With interoperable data, a care provider might access the patient’s health record and find they already had blood tests conducted earlier in the week with some other healthcare provider.

2. Seamless exchange of health data will not only cut down on the repetitive tasks physicians often perform but also on the administrative ones, such as patient data entry, greatly impacting the quality of care being delivered and leading to more cost savings and efficient workflows.

Tools that are connected to the existing patient record and EHR will be essential in identifying patients most at risk and assure resources can be allocated rationally which will have a positive impact on patients’ health, health costs and overall population health.

If EHRs are not interoperable, primary care physicians, for example, would not have a complete picture of their patient’s health status which could result in adverse consequences.

Patients’ health suffers and healthcare costs and population health are negatively impacted if there is lack of interoperability of Electronic Health Records.

Empowering the primary care physician While it is important that EHRs are interoperable, it is also very important that the data provided to the busy clinician is both user-friendly and actionable, especially for the primary care physician.

Researchers in a VA-funded study stated the following: Electronic health records are overloading outpatient docs with info in “disparate files and folders rather than presenting comprehensive, actionable data in a context that gives meaning.”

The study, “Electronic Health Records’ Support for Primary Care Physicians’ Situation Awareness,” contends that EHRs “are not rising to the challenges faced by primary care physicians because EHRs have not been designed or tailored to their specific needs. As researchers see it, many EHRs as currently configured, make it too difficult for primary care docs to do their job in a streamlined and efficacious manner – requiring navigation through multiple screens and tabs to find basic information, increasing redundancy and decreasing efficiency.

Current EHRs are overloading primary care physicians with information in disparate files and folders rather than presenting comprehensive, actionable data in a context that gives meaning. EHRs should be redesigned to improve situational awareness for busy primary care physicians and support their tasks including reviewing patient information, care coordination, and shared decision-making.”

As noted above, EHRs should be redesigned to provide user-friendly actionable data for the primary care physician. As we find ways to provide primary care physicians with actionable data within the EHRs, the primary care physician will be required to take ownership of that data. As the role of the primary care physician expands as part of our risk/ value-based world, it now becomes important that they operate in a teamcentered approach to address their patients’ healthcare needs. www.repertoiremag.com

•

August 2022

53

TRENDS The primary care team may need to consist of nurse practitioners, physician assistants, social workers, disease specific educators (depending upon the risk factors of their patients), and staff that understand data analytics. Some or all of these positions could be employed, outsourced to third parties, or addressed through collaborated relationship within their community.

Because primary care physicians are the key to providing value-based care and population health, all of this will require changes as to how we pay the primary care physicians for the services they and their team provide.

Some form of capitation or global payment needs to be implemented by payers to reward primary care practices for the multifaceted work and value they provide their patients and our overall health system.

Finally, as we find ways to provide primary care physicians and their team with actionable data within the EHRs, primary care physicians will be required to act on this data as part of their overall patient care.

The role of EHRs in addressing public health A critical success factor in addressing a public health crisis is seamless communication and collaboration among all the key stakeholders. That communication and collaboration become even more challenging when multiple entities at the state, local and national level have different degrees of responsibility for public health as well as diverse regulations and policies. Compounding this challenge is inadequate funding for public health at all levels.

The only way such a multiple level and layered system can effectively operate would be to provide seamless linkages among all the key 54

August 2022

•

www.repertoiremag.com

stakeholders with a common agenda.

Information and surveillance systems and communication tools are necessary to bring together the critical data and related actions to adequately address our public health needs especially during times of crisis such as the COVID-19 pandemic.

Sadly, the lack of a seamless information and surveillance system and appropriate communication tools contributed to the breakdown of our public health system during the COVID-19 pandemic and contributed to the increased number of hospitalizations and deaths in our inner cities.

Specifically, the inability to adequately connect providers of care and non-profit and government social service and public health agencies as well as the lack of information relating to social determinants of health have a negative impact on the health status of our most vulnerable population.

Responsibility of disease surveillance is shared among federal, state, and local public health agencies, but to be effective those responsibilities require a seamless inter-connected information system.

Complete and interoperable EHRs allow access and data sharing across the public health system, facilitating better monitoring, and reporting of suspected and confirmed cases, treatment regimens and abnormal conditions.

As noted by an article in the National Library of Medicine: “In addition to research-related use of data, there is also a need for the collection and integration of data from EHR systems and its communication to public health information systems in order to inform critical policy making and intervention planning. Developing interconnected health data nodes

that include, but are not limited to, EHRs, public health surveillance and reporting systems, disease registries, and patient-reported data is critical to a COVID-19 response and multiple other health conditions. An IT infrastructure to support public health that leverages EHRs and associated health data is needed.”

The long journey As noted in a thoughtful article in JAMA in March of 2021, “The patchwork of the United States’ health care delivery is accentuated by fragmentation of information systems that silo populations and care settings and deepen disparities.

Interoperability – i.e., computer systems’ ability to exchange information and put it to use – has been on the minds of policy makers, technology leaders, electronic health record (EHR) vendors, and health systems for decades; however, significant challenges have hampered the nation’s progress toward true interoperability.

The following are some of the key moments in how we got to this point with EHRs: ʯ In 1996, the Health Insurance Portability and Accountability Act (HIPAA) elevated security and privacy of patient data, standardizing what patient information was to be protected and how this had to be achieved. ʯ It took until 2004 for coordinated efforts, such as the national health information technology (IT) network to be created by the Office of the National Coordinator for Health Information Technology (ONC). ʯ This was advanced in 2009 through the Health

ʯ

ʯ

ʯ

ʯ

Information Technology for Economic and Clinical Health (HITECH) Act which incentivized EHR adoption. The HITECH Act also created health IT policies and standards and promoted electronic exchange of useful health information between patients and clinicians via, what it termed, meaningful use.

The 21st Century Cures Act, passed in 2016, further encouraged collaboration across federal agencies and between public and private organizations to improve the quantity and quality of information exchange.

August 4, 2020 – ONC Cures Act that addresses interoperability and patient access to their EHRs was passed.

On September 15, 2021, CMS published three FAQs which explain that CMS will not take enforcement action against certain payers for the payer-to-payer data exchange provision of the May 2020 Interoperability and Patient Access final rule until future rulemaking is finalized. CMS’ decision to exercise enforcement discretion for the payerto-payer policy until future rulemaking occurs does not affect any other existing regulatory requirements and implementation timelines outlined in the final rule.

Please review the relevant FAQs for details.

On December 8, 2021, CMS announced the publication of a Federal Register Notice (FRN CMS-9115-N2) to

Real-time data and other healthcare analytics advancements would enable providers to quickly identify the root of a patient’s problem and empower them to make more informed and faster decisions.

ʯ

formalize its decision to exercise enforcement discretion not to take action against certain payer-to-payer data exchange provisions of the May 2020 Interoperability and Patient Access final rule (see FAQs associated with this decision). The Administrator also released a blog on this notice, which included additional information about the administration’s commitment to increasing health data exchange and investing in interoperability.

February 21, 2022, more promises that we are close to finish line, but still not there yet.

Barriers If we, as a society, recognize the value of interoperable EHRs that share data

across all relevant stakeholders, why has it taken over 20 years to implement?

A combination of technology challenges and incumbent self-interest from major EHR vendors and large health systems attempting to protect their market shares from disruptors are the key reasons why we still do not have true interoperability.

According to an article in the National Library of Medicine, hundreds of government-certified EHR products are in use across the country, each with different clinical terminologies, technical specifications, and functional capabilities. These differences make it difficult to create one standard interoperability format for sharing data.

In fact, not even those EHR systems built on the same platform are necessarily interoperable because they are often highly customized to an organization’s unique workflow and preferences. www.repertoiremag.com

•

August 2022

55

TRENDS Interoperability itself is complex. The term refers to more than just the ability to exchange information. For two EHR systems to be truly interoperable, they must be able to exchange and then use the data. For this to occur, the message transmitted must contain standardized coded data so that the receiving system can interpret it. However, lack of standardized data is an issue that has plagued the U.S. health care system for decades and now certainly limits the ability to share data electronically for patient care.

There has been plenty of fingerpointing over interoperability issues.

Both providers and vendors have been accused of “information blocking” or intentionally interfering with the flow of information between different EHR systems.

In a survey of HIE leaders, 25% of respondents said that health systems routinely coerce providers to adopt and use certain EHR technology rather than simply making it possible to collaborate across these technologies. In addition, they reported that hospitals and health

Lack of standardized data is an issue that has plagued the U.S. health care system for decades and now certainly limits the ability to share data electronically for patient care.

Perhaps the biggest obstacle facing EHR interoperability is not technological but cultural. As in other industries, interoperability in health care requires the close coordination and collaboration of various stakeholders, including patients, providers, software vendors, legislators, and health information technology (IT) professionals. Yet the U.S. health care delivery system continues to have a culture defined by silos, fragmented processes, and disparate stakeholders, and where data have become more of a commodity and competitive advantage than a basis for coordinated care.

systems selectively share patient health information or do not always share complete information. The perceived motivation was that by controlling patient referrals and having exclusive access to patient data, they could potentially improve their revenue and enhance their market dominance.

Also, as noted in an article in JAMA, “Challenges remain given that patient data have been treated as a commodity owned by EHR vendors, potentially leading to reluctance to share data due to a desire to maintain vendor market share as well as increasing barriers

for smaller companies to enter the interoperability space.”

The Humana President and CEO Bruce Broussard in a November 18, 2020 opinion article in Stat wrote: “Making interoperability a widespread reality requires contending with the fact that vendors profit from building closed systems that are only marginally interoperable.

To effectively drive change, American health care leaders will need to communicate the importance of interoperability by leveraging their purchasing power and strengthening the regulatory environment.”

No more excuses While I am not an expert in this field, I do know that after 20-plus years of promises, I am still skeptical and tired of the excuses as to why we do not have true interoperable EHRs. It is more than just interoperability that is needed; we also need to have userfriendly actionable data (including applicable social determinants) being provided in a timely manner to have a positive impact on patients’ health, as well as on our population health, especially during times of crisis such as COVID-19.

I believe that interoperable EHRs will spur innovation between vendors and entrepreneurs that will positively impact our society. I also believe that interoperability along with price and quality transparency requirements will also spur competition and innovation in the provider space that will benefit our communities and society overall.

Tom Campanella is the Healthcare Executive in Residence at Baldwin Wallace University. Backed by more than 35 years of experience in the industry — particularly the health insurance, physician and hospital sectors — he’s focused on strategic advising and community outreach. Follow Tom’s articles on LinkedIn for his latest weekly coverage of the healthcare industry and to read archived publications (www.linkedin.com/in/thomascampanella). If you want to receive his monthly recap, e-mail him at tcamp@bw.edu.

56

August 2022

•

www.repertoiremag.com

UNIVERSITY

When was the last time you invested time into your career?

Metrex CaviWipes™ 2.0

Brewer Access™ High-Low Exam Table

BD Port Access Kit & AllPoints™ Port Access Systems Kit

Bovie® Smoke Shark II

In the next 8 minutes you can be conversational on these 4 products!

Invest in “YOURSELF” by scanning these codes

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 The iPod’s swan song Don’t be sad over the end of an era. Instead, be thankful that it happened. At least, that was the vibe Apple wanted to give off in its late May announcement that after its introduction over 20 years ago, the iPod would no longer be produced.

“Music has always been part of our core at Apple, and bringing it to hundreds of millions of users in the way iPod did impacted more than just the music industry – it also redefined how music is discovered, listened to, and shared,” said Greg Joswiak, Apple’s senior vice president of Worldwide Marketing. “Today, the spirit of iPod lives on. We’ve integrated an incredible music experience across all of our products, from the iPhone to the Apple Watch to HomePod mini, and across Mac, iPad, and Apple TV. And Apple Music delivers industry-leading sound quality with support for spatial audio – there’s no better way to enjoy, discover, and experience music.”

The iPod helped transform Apple from a struggling computer manufacturer to the world’s biggest company, CNET reported. “After its release in 2001, the iPod, helped along by the iTunes music store, became one of the most iconic gadgets of all time, spawning a host of imitators and legitimizing the market of MP3 players that it dominated.”

The company did say that customers could still purchase iPod 58

August 2022

•

www.repertoiremag.com

touch through apple.com, Apple Store locations, and Apple Authorized Resellers while supplies last.

Facebook cracking down on fake feedback According to The Verge, Facebook is cracking down on user reviews to prevent people from leaving fake feedback on businesses’ pages. The company has updated its Community Feedback policy to address this widespread issue.

“As more people and businesses rely on valuable feedback from customers – such as ratings, reviews, recommendations and questions & answers – we’re dedicated to keeping that information relevant and authentic,” the company said in a release. The new policy was created to ensure that reviews are based on real purchasing experiences, and to keep irrelevant, fraudulent and offensive feedback off of our platforms. More than 200 million businesses connect with their customers through Facebook apps and technologies, according to the social media giant.

Facebook’s new guidelines “protect against people who leave fake bad reviews as a way to get refunds or other freebies out of a business that wants to please its customers, and they’re also supposed to tackle incentivized reviews,” The Verge reported.

“This addresses the overly positive (and usually very vague) reviews businesses pay random users to leave on their pages. I’m guessing that this applies to any (actually real) bad reviews businesses pay users to change as well.”

Standards for the Metaverse The metaverse is gaining momentum. And with that comes a need for

some sort of standards, according to leading tech organizations.

Announced in June, The Metaverse Standards Forum brings together leading standards organizations and companies for industrywide cooperation on interoperability standards needed to build the open metaverse. The Forum will explore where the lack of interoperability is holding back metaverse deployment and how the work of Standards Developing Organizations (SDOs) defining and evolving needed standards may be coordinated and accelerated.

gaming, and more – at new levels of scale and immersiveness.

Multiple industry leaders have stated that the potential of the metaverse will be best realized if it is built on a foundation of open standards.

Building an open and inclusive metaverse at pervasive scale will demand a constellation of open interoperability standards created by SDOs such as The Khronos Group, the World Wide Web Consortium, the Open Geospatial Consortium, the Open AR Cloud, the Spatial Web Foundation, and many others. The Metaverse Standards Forum aims to

Multiple industry leaders have stated that the potential of the metaverse will be best realized if it is built on a foundation of open standards.

Open to any organization at no cost, the Forum will focus on pragmatic, action-based projects such as implementation prototyping, hackathons, plugfests, and open-source tooling to accelerate the testing and adoption of metaverse standards, while also developing consistent terminology and deployment guidelines.

The metaverse is motivating the novel integration and deployment of diverse technologies for collaborative spatial computing, such as interactive 3D graphics, augmented and virtual reality, photorealistic content authoring, geospatial systems, enduser content tooling, digital twins, real-time collaboration, physical simulation, online economies, multi-user

foster consensus-based cooperation between diverse SDOs and companies to define and align requirements and priorities for metaverse standards – accelerating their availability and reducing duplication of effort across the industry.

“The metaverse will bring together diverse technologies, requiring a constellation of interoperability standards, created and maintained by many standards organizations,” said Neil Trevett, Khronos president.

“The Metaverse Standards Forum is a unique venue for coordination between standards organizations and industry, with a mission to foster the pragmatic and timely standardization that will be essential to an open and inclusive metaverse.” www.repertoiremag.com

•

August 2022

59

TRENDS

Breaking the Rules of Healthcare: The Doctor-Patient Power Dynamic Closing the knowledge gap while improving the doctor-patient relationship will require better communication and greater trust.

By Dr. Robert Pearl

The year is 578 A.D.

The place: Constantinople.

The patient: Justin II, emperor of the Eastern Roman Empire.

The great and feared ruler has a stone wedged in his urethra. Crying out in pain, Justin II begs the physicians of his court to do something, anything! The doctors gather around him, nervous and rightly so. Their ruler has a long history of murdering his enemies.

The physicians, worried they’ll lose their heads if something goes wrong, hatch an ingenious plan. They insist that the emperor, himself, hand over the scalpel, thus signifying his consent to go forth with the operation.

Medical historians point to this moment as the birth of “informed consent,” the process of acquiring a patient’s permission before starting treatment.

Informed consent today: Bad form One and a half millennia later, informed consent still plays a part in the doctor-patient relationship, but not a meaningful one.

60

August 2022

•

www.repertoiremag.com

Doctors today view informed consent as yet another administrative burden, heaped on a pile of other bureaucratic and regulatory tasks that serve only to slow them down. In the 21st century, informed consent is most often a boilerplate document, rife with legalese and a litany of potentially negative patient outcomes, up to and including death.

In reality, these consent forms aren’t used to educate patients about the real risks they face nor do they exist to make patients equal partners (or even participants) in the healing process. The form’s perceived lack of importance is exemplified in many academic medical centers by how often the task of acquiring the patient’s consent is relegated to the lowly intern.

Informed consent could be a powerfully effective document, used to help patients understand their disease and increase their commitment to healthy living. These measures could improve clinical outcomes and, in doing so, increase physician satisfaction and fulfillment, too.

But first, doctors must recognize what’s standing in the way of success. This article, the seventh in a series,

spotlights an outdated and unwritten rule of healthcare, one physicians have followed for decades.

The rule: Doctors tell patients what to do (and patients should comply) For most of the 20th century, the doctor-patient relationship constituted a series of simple and straightforward exchanges. When a patient broke a bone, the doctor reduced the fracture and cast it. When a patient came in with strep throat, the doctor prescribed penicillin. For more complicated medical matters, there was little a physician could do.

That changed in the 1970s, ‘80s and ‘90s, thanks to rapid advances in science and technology. As physicians accrued ever-greater medical expertise, the knowledge gap between doctors and patients widened. Before long, the balance of power tilted heavily in the physician’s favor.

Over these decades, the public grew increasingly reliant on (and deferential to) physicians. Patients looked to the doctor to decide what was best. And upon rendering a decision, physicians expected patients to comply, a viewpoint that persists today in the American Medical

Association’s Journal of Ethics: “In many fields (e.g., law, education, economics), it is generally accepted that decisions are best made by experts.” And so, for doctors, “Utilizing paternalism selectively in decision making is not only necessary but obligatory.”

Then along came the internet With the online information boom of the late-20th century, patients began using the internet to research their own medical problems, weigh their treatment options and – more than ever – question the authority of their doctors.

These days, patients hesitate to just comply with their doctor’s orders. They prefer, instead, to hear what the doctor thinks and then decide for themselves whether or not to adhere. Quite often, patients don’t. As much as half of the time, Americans don’t take their medications as prescribed. Likewise, up to 75% of physical therapy patients choose not to complete their treatment plans.

Among people with psychiatric illnesses, rates of adherence to medications and counseling have now fallen to dangerously low levels. www.repertoiremag.com

•

August 2022

61

TRENDS These gaps in care have serious consequences: Americans are among the sickest people in the developed world with the highest rates of chronic disease and the lowest life expectancies. Doctors, meanwhile, are frustrated, fatigued and dissatisfied (a phenomenon known as burnout).

Updating informed consent for the 21st century Patients may be more demanding and consumerdriven than ever, but that doesn’t mean they’re better informed at the point of care. In fact, 1 in 3 patients with a chronic disease don’t understand their own illness because they struggle to comprehend what their doctor tells them.

It’s not enough for doctors to inform. They also must listen, asking patients to explain what they’ve heard and what will happen next. This allows the physician to clarify any misunderstandings.

Closing the knowledge gap while improving the doctor-patient relationship will require better communication and greater trust. Neither will happen until there is a more equal balance of power in the exam room.

Though it won’t be easy to convince doctors to adopt such a power-sharing model (and no regulatory body can mandate it), physicians may be persuaded by the probability of better clinical outcomes. Here’s a means to that end.

Introducing the ‘informed commitment’ process Leaders at a World Health Organization symposium presented evidence that patients are more likely to adhere to a treatment plan when they are involved in its creation, fully informed about the details and part of the solution.

So, rather than approaching the informed consent process as a bureaucratic task, doctors and patients would benefit from a three-step process I’m calling informed commitment: 1. Inform then listen. Research demonstrates that patients often misunderstand their doctors. The medical profession has made strides this century toward better educating patients about their disease, the risks and benefits of treatment, and potential complications – all while striving to weed out medical jargon. But it’s not enough for doctors to inform. They also must listen, asking patients to explain what they’ve heard and what will happen next. This allows the physician to clarify any misunderstandings.

2. Get the patient to commit on paper. Research has shown that people are 42% more likely to achieve their goals when they put them on paper. Therefore, the second step involves the patient writing down (a) what treatment they’re consenting to and (b) what they, themselves, must do to maximize their health going forward.

3. Review the plan together. The final step would be for the physician to review the information the patient has provided, both verbally and on paper, and discuss any outstanding gaps in understanding.

Doctors follow the paternalistic approach, in part, because they believe it saves time. They assume that telling patients what to do is the fastest and easiest approach.

In reality, paternalism is a prescription for poor adherence that leads to preventable complications.

The “informed commitment” process will demand more of the doctor’s upfront time. But 20 minutes spent helping patients understand their illness, and their role in the healing process, will pay off significantly. That’s because doctors will save hours of time not having to address the consequences of medication nonadherence or their patients’ failure to follow treatment plans. And with better outcomes, physicians will regain the professional and personal satisfaction that comes with helping people live longer, healthier lives.

Dr. Robert Pearl is the former CEO of The Permanente Medical Group, the nation’s largest physician group. He’s a Forbes contributor, bestselling author, Stanford University professor, and host of two healthcare podcasts. Pearl’s newest book, “Uncaring: How the Culture of Medicine Kills Doctors & Patients,” is available now. All profits from the book go to Doctors Without Borders. For more information or to sign up for his newsletter, visit robertpearlmd.com.

62

August 2022

•

www.repertoiremag.com

NEWS Primary Care News Bank of America commits $40 million to expand access to primary health care

MGMA data shows that physician compensation increased in 2021

To increase access to health care services in medically underserved communities, Bank of America has committed $40 million in low-cost, long-term capital to finance the development and expansion of community health care centers and other primary care facilities across the United States. Bank of America will partner with non-profit community development financial institutions (CDFIs) to distribute the funding. In addition, Bank of America will provide $100,000 in philanthropic grants to help with CDFI operational costs and help spark the creation of new health centers.

Bank of America will provide low-cost capital to several CDFI partners, including Primary Care Development Corporation (PCDC). To date, PCDC has financed more than $1.34 billion in primary care projects through direct investment and leverage. Such investments support facility acquisition and renovation, program and practice transformation, operating support, service line growth, and technology acquisition. PCDC strengthens service delivery through training and technical assistance and advocates for meaningful policy change to improve primary care financing, reimbursement, service delivery, and workforce training and pipeline development. Over the last 30 years, through a combination of financing and technical assistance, the organization has created and preserved more than 18,000 jobs while impacting millions of people.

According to a new report from MGMA, data shows that despite the continued pandemic-related disruptions in 2021, medical practices managed to restore a sense of normalcy in productivity and compensation. The 2022 MGMA Provider Compensation and Production report, which reflects data from over 192,000 providers across 7,7000 organizations, found that compensation for most physician specialties reached or exceeded pre-pandemic levels in 2021. Here are some of the key takeaways: ʯ Physician compensation is on the rise ʯ Primary care, surgical specialist and nonsurgical specialist physician compensation as well as advanced practice provider compensation rose between 2% to nearly 4% over the last year. ʯ Additionally, providers coming out of residency and newly hired to a practice in 2021, report earning 7 – 10% more in guaranteed compensation than their counterparts in 2020. ʯ Productivity levels trend upwards ʯ Physician-owned practices report higher levels of productivity in collections and work RVUs, however, experiencing a fewer number of encounters compared to their hospital-owned counterparts. ʯ Positive signs for things to come The most recent MGMA Stat poll hints at a good sign for the rest of the year – currently reporting that a majority of practices are at or above 2021 visit volumes.

Industry News Midmark collaborates with state, STEMoriented groups to garner enthusiasm for local manufacturing in a tight labor market Midmark Corp., announced a joint effort with the West Central Ohio Manufacturing Partnership (WCOMP) and Ohio STEM to advance STEM and bolster interest in manufacturing. Recently, Midmark hosted 10 educators from seven school districts to learn about STEM careers, immersing K-12 teachers in STEM education to foster curiosity and build a solid STEM foundation among their students.

“It’s critical we proactively prepare our local youth to meet future talent needs,” said Dr. Tom Schwieterman, vice president of clinical affairs and chief medical officer at Midmark Corporation, as well as chairman of the Ohio Department of Education STEM Committee. “As Midmark continues to be on the forefront of creating the digital ecosystem in ambulatory care, our need for local STEM talent will only intensify.”

During the event, educators toured Midmark’s facilities, learned about the skills needed to pursue STEM careers, specifically engineering and manufacturing, and received www.repertoiremag.com

•

August 2022

63

NEWS resources to better expose students to math, science and technology throughout their education careers, inspiring youth to pursue STEM opportunities in their local communities. Areas of focus included digital design and 3-D computing/modeling as well as electrical and software.

Educators were also able to see a product in its early stages of fabrication to final assembly and understand the dayin-the-life of engineering and manufacturing teammates at Midmark. Today, most Midmark Teammates employ STEM within their daily jobs, no matter their role.

trials. SCRI, which is the research arm of Sarah Cannon, HCA Healthcare’s Cancer Institute, offers end-to-end clinical trial site support services with a deep expertise in early-phase oncology research and drug development as well as a specialized contract research organization (CRO).

Together, USOR and SCRI will create a fully integrated oncology research organization aimed at expanding clinical research, accelerating drug development and increasing availability and access to clinical trials for community oncology providers and patients, including those in underserved communities. The joint venture plans to offer an expanded clinical research network, a broader portfolio of clinical trials, and enhanced data and analytics capabilities to better match patients with clinical trials.

BD collaborates with Mayo Clinic Platform

In addition to this event, through Midmark’s workforce development program, the company partners with several local high schools in Darke County. Midmark also offers a four-year college scholarship for a local student pursuing a degree in a technical field, which includes co-op experience as well as a full-time job opportunity after graduation. The company hires several co-ops each term in electrical, computer, mechanical and biomedical disciplines.

Midmark, which manufactures most of its equipment in Ohio, has also just recently completed the building of a technology center at its Versailles campus. Midmark solutions employ many of the STEM technologies which include clinical standards, advanced engineering within its solutions, mathematical modeling for quality monitoring and science-based techniques for optimizing manufacturing.

McKesson, HCA Healthcare form oncology research joint venture McKesson and HCA Healthcare announced an agreement to form a joint venture combining McKesson’s US Oncology Research (USOR) and HCA Healthcare’s Sarah Cannon Research Institute (SCRI). USOR is the research arm of McKesson’s The US Oncology Network and draws from a network of experienced investigators and dedicated clinical staff who specialize in oncology clinical 64

August 2022

•

www.repertoiremag.com

BD announced a collaboration with Mayo Clinic Platform to access de-identified patient data from Mayo Clinic Platform_Discover to perform detailed post-market surveillance on its products to fuel innovation and unlock a faster, more efficient path to market, with the ultimate goal of improving patient care.

Mayo Clinic Platform_Discover, an enabling product of Mayo Clinic Platform, represents one of the most robust de-identified data sets available from 10 million patients, including both structured and unstructured data, images, 1.2 billion lab test results, 3 million echocardiograms and more than 640 million clinical notes.

Using data mining, next generation artificial intelligence (AI) and machine learning tools, BD will analyze the realworld data – which provides information outside what is typically gathered in a clinical trial – to generate deeper insight into the patient experience that will help the company accelerate and enhance innovation around both existing products and unmet needs.

“For years, randomized control trials have been considered the gold-standard in evaluating safety and efficacy for medical devices, but experts from industry and academia who are examining the tight parameters around clinical trials are seeing added value in leveraging insights from real-world data to truly understand whether we are meeting patients’ needs,” said Lisa Boyle, vice president of global clinical affairs and medical affairs strategy for BD. “We need to be leveraging real-world evidence, using datasets like those from Mayo Clinic Platform, to understand the many parameters that we wouldn’t normally capture in a clinical trial and understand patients’ care pathways and address the needs of diverse patients in order to establish better solutions for better outcomes and experiences.”

Better BP is Better Care ®

Set the stage for better care and set yourself apart with this Midmark approach.

We designed the only fully integrated point of care ecosystem to help promote a more consistently accurate blood pressure measurement by targeting 3 key areas using 3 unique products.

1. Proper Patient Positioning The Midmark® 626 with Patient Support Rails+ is designed to promote AMA-recommended patient positioning for blood pressure capture.1 The barrier-free low chair height allows most patients to place their feet flat on the floor while the rails support the arm at heart height.

2. Accurate, Consistent BP Capture IQvitals® Zone™ with the SPRINT BP Protocol introduces automation at the point of care that can help ensure a higher level of standardization, minimizing human variables while maximizing consistency and data accuracy.

3. EMR Connectivity Seamless connectivity from the IQvitals Zone device to the EMR saves time and reduces the likelihood of data transcription errors.

Midmark Zone technology imports data into the EMR using a secure Bluetooth® Low Energy connection at the point of care.

Midmark 626 Barrier-Free® Examination chair with Patient Support Rails+ and IQvitals Zone Vitals Signs Monitor shown.

1

Proper Patient Positioning

+

2

Accurate, Consistent BP Capture

+

= Better BP Contact your Midmark Representative to start the conversation. See all 3 at: midmark.com/3steps 1 https://www.ama-assn.org/system/files/2020-11/ in-office-bp-measurement-infographic.pdf Bluetooth is a registered trademark of Bluetooth SIG, Inc. © 2022 Midmark Corporation, Miamisburg, Ohio USA

3

EMR Connectivity

™

Tough on germs

At Sri Trang infection prevention is our calling.

Ventyv® is the premier brand of Sri Trang USA, Inc. Sri Trang is a proven glove producer protecting the world against infection since 1991. We look forward to protecting you and your patients.

Visit sritrangusa.com/rep or ventyv.com for more information Hello@ventyv.com • Sri Trang USA, Inc. • 5820 W. Cypress St., Ste H • Tampa, FL 33607 Call 1-844-784-5683 (844-STGLOVE)