REP - Dec.23 - 30th Anniversay by BOC design Inc

C E L E B R AT I N G 3 0 YE A R S • 2 0 2 3

vol.31 no.12 • December 2023

A Year of Progress and Disruption A look at what made news in healthcare in 2023.

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CONTENTS DECEMBER 2023 • VOLUME 31 • ISSUE 12

A Year of Progress and Disruption A look at what made news in healthcare in 2023.  p. 10 PUBLISHER’S LETTER 30 Years of Repertoire .....................................................2 INFECTION PREVENTION Ready for Takeoff

Build your infection prevention checklist and watch your sales take flight................................................4

COMMERCIAL HEALTHCARE PROVIDERS Walmart Health’s Big Push

The retail giant is quickly expanding its health centers and offering virtual care to its employees...............................6

HIDA DSCSA Compliance

What distributors need to know............................................24

MARKETING MINUTE Determining Your Brand’s Marketing Audience.........................................................26 SALES Applied Impov

How the principles of improvisation can be used in a sales setting..................................................28

TRENDS Personalized Virtual Care

Leading health systems partner with consumer-focused platform for self-insured employers to expand access to patients................................20

Subscribe/renew @ www.repertoiremag.com : click subscribe Repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 350 Town Center Ave, Ste 201, Suwanee, GA 30024-6914. Copyright 2023 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, 350 Town Center Ave, Ste 201, Suwanee, GA 30024-6914. 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 • Repertoire | Celebrating 30 Years • December 2023

PUBLISHER’S LETTER

30 Years of Repertoire I’ve been thinking all year about what to write in

the Publisher’s Letter for this special issue. I kept landing on “culture.” For 30 years, Repertoire has been hitting mailboxes every month to bring a culture of excellence in healthcare sales. This is issue 362, and I could not be prouder of the content our team has created for this special issue. When I think about culture in business, so many great companies and people come to mind. Like Pat Kelly in his book “Faster Company”, the first chapter is titled “A Cross Between the U.S. Marines and Animal House”. Now there’s a culture! It reminds me of my start-up days with Billy Harris at Sempermed. Billy would tell everyone: “If you work here, you better wake up with two scoops of fun, or don’t show up at all.” And then there are the legends, the two characters who take the cake for culture, Scott Fanning and Jim Niekamp. The stunts they pulled off at Midmark are legendary. So much so they were able to start an entire business teaching others how to build a culture which would generate customers for a lifetime. Everyone knows the stories – dressing up as brides and grooms for HIDA, renting out Wriggley Field for a dealer vs. manufacturer baseball game, training a monkey to sell a power table, going undefeated in ping pong for 25 plus years, the mongoose stories – and my favorite, buying the first two ads ever in Repertoire Magazine, yet not submitting an ad until the second issue. When asked why, Scott replied, “Because if it sucks, I don’t want Midmark in it.” Some of Scott’s pearls of wisdom for creating a culture which generates customers for a lifetime include: 1. Non-card-carrying calls, in other words make it memorable. 2. Do favors for them. Find ways to say yes to your team and clients. 3. Remember them by making them look good in front of those they care about the most. 4. Care more about their success than your own. 5. Show them don’t tell them, creatively show them the problem you solve. 6. The best story always wins, know your company’s best story and perfect it. “Remember them, recognize them, and do favors for them.” – Scott Fanning, the legend Well Scott, here we are 30 years later, and hopefully we didn’t suck! I’d like to thank Brian Taylor, Chris Kelly, and Mark Thill for the legend of Repertoire magazine. I would also like to thank the industry, our advertisers, and finally our readers – you are the glue that holds us all together. Here’s to 30 more years! R. Scott Adams Publisher

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editorial staff editor

Mark Thill mthill@sharemovingmedia.com managing editor

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

Jenna Hughes jhughes@sharemovingmedia.com art director

Brent Cashman bcashman@sharemovingmedia.com circulation

Laura Gantert lgantert@sharemovingmedia.com

senior sales executive

Amy Cochran (West Coast) acochran@sharemovingmedia.com (800) 536.5312 x5279 sales executive

Aili Casey (East Coast) acasey@sharemovingmedia.com (404) 625-9156 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 350 Town Center Ave, Ste 201 Suwanee, GA 30024-6914 Phone: (800) 536-5312, FAX: (770) 709-5432; e-mail: info@sharemovingmedia.com; www.sharemovingmedia.com

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INFECTION PREVENTION

Ready for Takeoff Build your infection prevention checklist and watch your sales take flight. By Paul Girouard

I come from a family of pilots. My parents and brother were pilots. My Dad lived on an air ranch in Florida where

he would spoil his grandkids with airplane rides around Central Florida. You would think that my overprotective wife would be worried to see her children take off in exotic aircraft for parts unknown, but she wasn’t. She knew that pilots are all trained to use checklists before, during, and after their flights. The checklists helped to develop safe and consistent habits when flying. I pulled the following from the Aircraft Owners and Pilots Association (AOPA) website as an example of one of their many lists for pilots. If you are a pilot, you need to remember these (most importantly, the landing checklist); they’ll be on the exam!

Before-Takeoff Checklist: ` Auxiliary fuel pump––––––––––––––Off ` Flight controls––––––––––––––––––Free and correct ` Instruments and radios–––––––––––Checked and set ` Landing gear position lights–––––––Checked ` Altimeter––––––––––––––––––––––Set ` Directional gyro–––––––––––––––––Set ` Fuel gauges––––––––––––––––––––Checked 4

` Trim––––––––––––––––––––––––––Set ` Propeller––––––––––––––––––––––Exercise ` Magnetos––––––––––––––––––––––Checked ` Engine idle–––––––––––––––––––––Checked ` Flaps––––––––––––––––––––––––––As required ` Seat belts/shoulder harnesses––––––Fastened ` Parking brake–––––––––––––––––––Off

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Infection prevention checklist We should all use the discipline that pilots must have to build our infection prevention business. What kind of checklists could we develop? I’d start with collecting the following: ` Recommended product formulary that follows regulatory guidelines. Include product assortment from major sub-categories, hand hygiene, gloves, PPE, surface, sterilization. ` Cross reference information on the major brands in the category. ` A good list of go-to supplier representatives. You never know when you will need to call in a favor. ` Regulatory guidance documents. This may sound intimidating; however, the CDC and FDA have developed user-friendly guidance over the years. Having these on-hand provides you with the opportunity to be a trusted resource to your customer base. ` Become a member or tap into the appropriate associations. You will accelerate your learning and value as you become embedded into APIC, AORN, AHRMM,

and HIDA. These are good places to start, but you might want to check into the state chapters as well. ` Work with your go-to suppliers on providing samples where possible. Literature is good, but providing samples to show and tell really helps. Your manufacturers will start to see you as the go-to resource they want to prioritize and support. ` Develop reports on which customers are using or not using key products in the category. All these ideas are examples of saturation strategies that will help you sell more to existing customers. ` What metrics can you keep track of to make sure you are on course? It gets exciting to watch trends that provide confirmation on your planning. It is hard to believe that we are at the end of 2023. As the year slows down and things get quiet, work on your checklist. Build the framework of a checklist that keeps you on track and that you can come back to for on-going support for a successful 2024. Wash your hands.

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COMMERCIAL HEALTHCARE PROVIDERS

Walmart Health’s Big Push The retail giant is quickly expanding its health centers and offering virtual care to its employees. By Daniel Beaird

With its stated goal of becoming America’s neighborhood health destination, Walmart Health opened its first

center, a 10,000-square-foot facility in Dallas, Ga., in 2019. The large retailer acquired a telehealth provider in 2021 called MeMD and inked a 10-year deal with UnitedHealth Group in 2022 that aims to drive value-based care adoption for Walmart’s clinicians and launch a new Medicare Advantage plan. By the end of 2022, it had 32 Walmart Health locations. 6

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COMMERCIAL HEALTHCARE PROVIDERS As competitors Amazon, CVS Health and Walgreens began to acquire physician offices, Walmart Health announced a deepening presence in Florida and Texas, and expansion into new states Missouri and Arizona. By the end of 2024, it will have almost 80 Walmart Health centers in seven states. Additionally, Bloomberg reported in September that Walmart is in preliminary talks to acquire ChenMed, a primary care provider for seniors. The deal would be worth billions of dollars.

ChenMed is a prized asset ChenMed operates over 100 centers across 15 states primarily in the Southeast and in regions where Walmart already operates health facilities. It recently tapped UnitedHealthcare veteran and former CEO Steve Nelson as its president to lead its day-to-day management and operations. According to Rebecca Springer, lead healthcare analyst for PitchBook, ChenMed is the last scaled, multistate Medicare Advantage provider group that has not sold to a major retailer other than Cano Health, which has fallen into financial trouble. A steadfast culture is considered to be one of ChenMed’s biggest strengths. It’s a privately owned medical and technology company delivering high-touch and personalized primary care for Medicareeligible seniors. It’s been named a Fortune “Change the World” company and twice named a “Most Loved Workplace” by Newsweek. Its concierge-style medicine aims to bring better health outcomes to the neediest populations. ChenMed recently implemented a program to provide each of its patients with access to the services of a coordinated team. This 8

coincides with the federal government’s unwinding of the Public Health Emergency it established during the COVID-19 pandemic. ChenMed’s patients are generally 65 and older and many live in underserved areas. Its care teams will ensure those who are eligible for Medicaid successfully re-enroll within their particular state’s deadline and retain a variety of vital resources to support their health and wellness needs.

As Walmart’s customers began to adapt to a new normal during the COVID-19 pandemic, so did its employees. Walmart partnered with Included Health for virtual care collaboration that has produced good results for employees with diabetes, for example, who saw a 24% reduction on average in HbA1c levels. Included Health CEO Owen Tripp told the HLTH23 conference

Walmart has announced virtual primary care options for its employees nationwide after a successful rollout in select states, including a $0 copayment for virtual care visits.

A deal for ChenMed would be Walmart’s biggest move yet in healthcare. But ChenMed is a prized asset and other potential bidders could emerge, according to Springer, including Optum or a private equity consortium.

Virtual care expands to Walmart’s employees Walmart has announced virtual primary care options for its employees nationwide after a successful rollout in select states, including a $0 copayment for virtual care visits.

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in October that the pilot’s results, which included people with hypertension seeing blood pressure reduced by 14% and total cost of care decreased by 11%, dispel the myths about virtual care that make employers hesitant. He said they found that 33% of those who used the services were over the age of 45. They also saw success in connecting to patients with chronic needs as about 30% of people were seen for either chronic condition management or preventive care.

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11.75 in

A Year of Progress and Disruption A look at what made news in healthcare in 2023. By Pete Mercer

Last year was sort of a banner year for the 2020s – after all the challenges and obstacles we faced in 2020 and

2021, it felt like things were starting to turn around in 2022. Travel picked back up as COVID slowed down. Networking events came back in full force, allowing businesses to reconnect with their customers in a real and tangible way. 2022 also saw the combination of vaccinations and natural immunity begin to fight against the onslaught of COVID, giving humanity the edge that we desperately needed. 10

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TRENDS What about 2023? This year, we have continued to progress past the pandemic days and into periods of growth and disruption in the healthcare industry. To fully understand the scope of the challenges and successes of 2023, let’s take a look at some of the biggest events Repertoire covered throughout the year.

The end of the public health emergency Without a doubt, the biggest moment of the year was the end of the public health emergency order. In January, the Biden administration informed Congress that the COVID-19 national and public health emergencies would end on May 11. At the time, the Office of Management and Budget said that the “administration’s plan is to extend the emergency declarations to May 11, and then end both emergencies on that date. This wind-down would align with the administration’s previous commitments to give at least 60 days’ notice prior to termination of the PHE.” In February, the Department of Health and Human services said, “We are in a better place in our response than we were three years ago, and we can transition away from the emergency phase.” Repertoire Magazine covered the end of the public health emergency in a two-part series for the May and June issues, where we dove into the details of what it would look like for your provider customers and their patients. Many providers were concerned about how ending the public health emergency would affect Medicare coverage for millions of people. During the public health emergency, the federal government required state Medicaid agencies to provide coverage for people, even if their 12

CVS Health made some major moves this year, starting with the acquisition of Signify Health, a tech and services company that works to close gaps in care and address social determinants of health. eligibility changed. The expiration of that “continuous enrollment provision” meant that 17.4% of Medicaid and Children’s Health Insurance Program (CHIP) enrollees would likely lose Medicaid coverage. Some states were expected to be hit harder than others. Kaiser Health News found that enrollment in Medicaid and CHIP for the state of Nevada rose by 47% during the pandemic. Additionally, 25% of Illinois citizens were enrolled under the state’s rules. Rodney S. Alford, M.D.,

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president-elect of the Illinois State Medical Society said, “The continuous coverage provision has provided much-needed stability to patients who rely on the program to get healthcare services and has helped ensure that physicians who accept Medicaid patients can trust that their enrollment status is current.” One of the other significant ways that the end of the public health emergency affected the general public is through the COVID-19 vaccine. During the height of the

pandemic, these were available to the general public free of charge through the federal government. As the public health emergency came to an end, the vaccine would be available through the traditional healthcare marketplace. Tochi Iroku-Malize, M.D., the president of AAFP, said, “Transitioning COVID-19 vaccines to the commercial market may create financial and operational challenges for physician practices and could negatively impact access to and utilization of COVID vaccines for patients.”

Commercial healthcare providers emerge Another interesting development from 2023 is seeing a new form of healthcare provider emerge: the commercial

healthcare provider (CHPs). The CHP is a customer-facing primary care provider formed by major players like Optum, VillageMD, CVS Health, Amazon and Walmart that are meeting patients where they are with in-home, in-store and virtual care services as well as in primary care offices. Each organization has its own strategy for moving into the CHP space – some are acquiring physician practices and employing physicians to treat patients, others are looking to work on a contract basis to provide independent practices with support for IT, marketing and administration. No matter which category they fall into, the emergence of the commercial healthcare provider is going to have a significant impact

on medical care and medical sales. Bruce Penning, executive director, medical field sales for Henry Schein, told Repertoire back in May, “Sales representatives can no longer rely on one or two individuals in a practice to make buying decisions. They need to understand the alignment further ‘upstream.’ For example, is there a single person making decisions at the corporate level for all the satellite locations?” Walgreens’ VillageMD acquired Summit Health-CityMD at the end of 2022, which was a significant step into creating one of the largest independent provider groups in the country. Walgreens has continued to make moves in this space as recently as August 2023, when Walgreens and VillageMD

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TRENDS

expanded their full-service primary care model to Chicago. In January, Amazon Pharmacy introduced a prescription service for a flat, low monthly fee of $5. RxPass is designed to offer consumers the convenience of choice for all of their prescription needs, with medications that treat more than 80 common health conditions. Walmart Health announced in March that it planned to add 28 new clinics by Q1 of 2024. These clinics will provide primary care, dental care, behavioral health care, labs and x-ray, audiology and telehealth services. In a press release, Dr. David Carmouche, SVP, Omnichannel Care Offerings at Walmart said, “We know the cost and convenience of healthcare remains a barrier for many Americans, which is why we decided to bring our onestop model of healthcare to these communities. With 90% of the U.S. 14

This year, many organizations have tried to mitigate the nursing shortage through various programs and changes to the industry. An MGMA report went into great detail about the efforts of medical groups to overcome labor shortages and staffing hurdles. population located within 10 miles of a Walmart, Walmart Health is in a unique position to provide quality, affordable health and wellness services where our neighbors already live and shop.” CVS Health made some major moves this year, starting with the acquisition of Signify Health, a tech and services company that works to close gaps in care and address social determinants of health. In April, CVS Health and

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Catholic Health worked together to expand value-based care and health care access for Medicare beneficiaries across the Catholic Health Physician Network in the New York area. Optum introduced an interesting solution for healthcare in January with the Optum Mobile Clinic. These 45-foot-long, state-of-the-art RVs offer a wide range of health screenings and other services to augment the primary care experience.

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TRENDS Nursing shortage Even with the end of the public health emergency and the worst days of COVID-19 (hopefully) behind us, we are still wrestling with some of the challenges that were exacerbated by the pandemic. The U.S. Department of Labor predicts that more than 275,000 nurses are needed from 2020 to 2030, with opportunities for employment expected to grow at 9%.

Early in 2023, Mark Keroack, M.D., president and CEO of Baystate Health wrote an op-ed for Mass Live where he discussed the staffing shortages that hospitals are dealing with. He predicts that staff shortages could cause the next public health crisis, saying, “The driving forces for this shortage existed before the onset of the COVID-19 pandemic, which has only accelerated those

“ Providers and other industry stakeholders publicly reacted to these changes, saying that the proposed inpatient hospital payment update of 2.8% was “woefully inadequate.”

conditions. Baystate Health identified concerns with shortages in key staff categories as early as 2016 and forecasted a worsening as a larger portion of its workforce aged into retirement and patient demand increased due to an aging population in Western Massachusetts.” This year, many organizations have tried to mitigate the nursing shortage through various programs and changes to the industry. An MGMA report went into great detail about the efforts of medical groups to overcome labor shortages and staffing hurdles. Dignity Health Global Education and CommonSpirit Health launched a program in April to retain nurses in 21 states throughout the country. Idaho State University and Kootenai Health partnered in July to address the critical nursing shortage in North Idaho. In August, Optum and Capella University announced a new nurse practitioner program designed to address the nursing shortage in the United States.

Push back against IPPS Proposed Rule The Centers for Medicare and Medicaid Services issued the fiscal year 2024 Medicare hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) proposed rule. The proposed rule would update Medicare fee-for-service payment rates and policies for inpatient hospitals and LTCHs. The proposed increase in operating payment rates is projected to be 2.8%. This would be for general acute care hospitals paid under the IPPS, that successfully participate in the Hospital Inpatient Quality Reporting (IQR) program and are meaningful electronic health record (EHR) users. 16

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TRENDS This reflects a projected FY 2024 hospital market basket percentage increase of 3.0%, according to CMS, reduced by a 0.2 percentage point productivity adjustment. Providers and other industry stakeholders publicly reacted to these changes, saying that the proposed inpatient hospital payment update of 2.8% was “woefully inadequate.” The American Hospital Association said, “The AHA is deeply concerned with CMS’ woefully inadequate proposed inpatient hospital payment update of 2.8% given the near decades-high inflation and increased costs for labor, equipment, drugs and supplies. Moreover, long-term care hospitals would see a staggering negative 2.5% payment update under this proposal. These insufficient adjustments are simply unsustainable. 2022 was the most financially challenging year for hospitals during the pandemic, with half of hospitals finishing the year with a negative operating margin. So far, this worrying trend has continued in 2023, most recently with reports of record high hospital defaults. The AHA has repeatedly requested that CMS and the Administration remedy shortcomings in its previous market basket forecasts for all hospitals.” Premier said, “The Centers for Medicare & Medicaid Services (CMS) continues to use data sources for calculating labor costs that fail to capture the stratospheric rise in the cost of labor that have plagued hospitals since the pandemic started. This chasm between the 2.8 percent payment update and reality, coupled with uncomfortably high inflation, delivers a one-two punch to hospitals that must be addressed. Premier will continue to press CMS to adopt new or supplemental data sources to 18

calculate labor costs in the final rule that more accurately reflect the cost of labor, such as more real-time data directly from hospitals, inclusive of contract labor.” After many organizations weighed in over several months, CMS released the final rule in August, finalizing the payment rate increase of 3.1% for items and services paid under the IPPS.

burden of RSV in higher-risk populations, which includes older adults. ABRYSVO will address a need to help protect older adults against the potentially serious consequences of RSV disease. We are extremely grateful to the clinical trial participants, study investigator teams and our dedicated Pfizer colleagues for their roles in making this vaccine available.”

“ 2022 was the most financially challenging year for hospitals during the pandemic, with half of hospitals finishing the year with a negative operating margin. So far, this worrying trend has continued in 2023, most recently with reports of record high hospital defaults.” The first RSV vaccine is created, COVID numbers still low In yet another landmark event for vaccines, Pfizer introduced a preventative vaccine for RSV in infants and the elderly. This is the first vaccine that is designed to address RSV, a highly infectious respiratory disease that can be dangerous for young children and older adults. ABYSVO was initially only approved for individuals 60 years of age and older, but in August the FDA approved it for preventing RSV in infants as well. In June, Annaliesa Anderson, Ph.D., SVP and SSO, Vaccine Research and Development at Pfizer said in a media release, “A vaccine to help prevent RSV had been an elusive public health goal for more than half a century. Today’s approval is a monumental step forward in delivering on Pfizer’s commitment to help alleviate the significant

December 2023 • Repertoire | Celebrating 30 Years • www.repertoiremag.com

As for COVID, the WHO announced in May that it was no longer a global health emergency. WHO Director-General Tedros Adhanom said at the time, “For more than a year, the pandemic has been on a downward trend, with population immunity increasing from vaccination and infection, mortality decreasing and the pressure on health systems easing. This trend has allowed most countries to return to life as we knew it before COVID-19.” Numbers are still low today, but many are grappling with the effects of long COVID. The American Heart Association found in August that COVID may trigger new-onset high blood pressure. Additionally, the Mayo Clinic found that getting a COVID vaccine may reduce the severity of long COVID symptoms.

TRENDS

Personalized Virtual Care Leading health systems partner with consumer-focused platform for self-insured employers to expand access to patients.

The healthcare industry continues

to develop and innovate to meet consumer preferences and needs. The pandemic led to wider access to virtual care services, and technology has enabled new entrants into the healthcare industry to profit. One of those companies, Transcarent, has partnered with 10 health systems across the nation to form a virtual provider ecosystem. Transcarent 20

is a consumer-directed healthcare platform for self-insured employers. With an ecosystem of virtual point solutions, care professionals, and local healthcare facilities, Transcarent aims to make it easier for patients to have access to healthcare right from their phone or laptop. Employers using Transcarent as their companies’ healthcare provider receive competitive pricing previously

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only reserved for narrow networks. For the first time, members can access virtual care that works together with complex care services delivered locally at hospitals, according to Transcarent. The brand connects consumers with healthcare information, allowing them to get care on demand, find innetwork providers, locate prescription savings, explore care benefits, view lab

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TRENDS results, and access educational content. Transcarent offers resources that support patients with everyday care, surgery, at-home physical therapy, comprehensive case reviews, support for oncology care, behavioral healthcare, pharmacy, and more. Transcarent announced the National Independent Provider Ecosystem that includes health systems such as: ` Advocate Health ` Atrium Health ` Baylor Scott & White Health ` Corewell Health ` Hackensack Meridian Health ` Intermountain Healthcare ` Mass General Brigham ` Memorial Hermann Health System ` Mount Sianai Health System ` Virginia Mason Franciscan Health “We are proud to be collaborating with Transcarent as we accelerate the innovation of care delivery models that are transforming health care,” says Ketul J. Patel, CEO of Virginia Mason Franciscan Health and president of the Pacific Northwest division of CommonSpirit Health. “This alignment expands our commitment to serving our communities by further integrating care across our continuum, in part, by pioneering a range of digital experiences that will make health care easier to navigate, more affordable and more easily accessible for patients across our region.” Transcarent’s comprehensive care model will offer employers and their employees a personalized care experience in the virtual platform in collaboration with each health system. Consumers will also have access to expert clinical opinions, virtual physical therapy, orthopedic consultations, a pharmacy marketplace, access to immediate care quickly 22

Transcarent’s comprehensive care model will offer employers and their employees a personalized care experience in the virtual platform in collaboration with each health system. (or at home); and a cost effective same-day payment feature unique to Transcarent. Payment works through a direct-to-employer system that pays providers on the same day care is delivered. Value-based incentives allow employers receive competitive pricing previously reserved only for narrow networks, while maintaining access for members. Employees benefit from waived co-pays and coinsurance for making better decisions about care.

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“We are excited to partner with with Transcarent to provide employers across our region with better, more convenient access to highquality, value-based care options for their employees,” said David L. Callender, MD, President & CEO for Memorial Hermann Health System. “We know that business leaders are a catalyst for improved outcomes in health care, and by collaborating to enhance their employees’ wellness, we can work to improve the health of our communities together.”

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877.441.7440 1. Abbott Press Release: Abbott Introduces the Next Generation of Influenza A & B and Strep A Assays with Fastest-Ever Time to Molecular Results. 2. Abbott. ID NOW™ COVID-19 2.0 Product Insert. © 2023. All rights reserved. All trademarks referenced are trademarks of their respective owners. Any photos displayed are for illustrative purposes only. COL-19407-03 09/23

HIDA

DSCSA Compliance What distributors need to know. If your company, like most medical products

distributors, sells some pharmaceutical products (such as lidocaine or vaccines), you’re required to comply with the new Drug Supply Chain Security Act (DSCSA). The FDA recently gave healthcare suppliers a 12-month grace period in which to complete implementation of DSCSA requirements. It is important for all stakeholders in the medical supply chain to use this time to make final preparations for adoption of this new regulation. Congress passed the Drug Supply Chain Security Act (DSCSA) in 2013 as part of the Drug Quality and Security Act. The DSCSA outlined steps to identify and trace certain prescription drugs as they are distributed in the United States. Its intended purpose was to help protect consumers from exposure to drugs that may be counterfeit, stolen, contaminated, or otherwise harmful. Over the past decade, all stakeholders in the medical supply chain have been making steady progress on adoption of this track and trace system. However, any break in compliance could threaten the entire supply chain and prevent patients from accessing muchneeded medicines. Therefore, HIDA and other industry leaders have urged the Food and Drug Administration (FDA) to provide sufficient time to come into compliance and avoid sharp disruptions to drug distribution. In an August 2023 regulatory announcement, FDA declared that there would be a 12-month enforcement discretion and system stabilization period for the final phase of the DSCSA, but the law will still take effect on November 27, 2023. DSCSA is a federal law, and the FDA does not have the authority to change statutory deadlines – that requires an act of Congress. FDA created this stabilization period in response to concerns raised by HIDA and others in the medical supply chain. The 24

agency determined the entire industry would not be ready to meet all requirements by November 27, 2023. As a result, those trading partners would not have been able to legally ship or receive pharmaceuticals beginning on November 27. The FDA announced the stabilization period so that the pharmaceutical industry could avoid supply chain disruptions, drug shortages, and negative impacts on patients.

By Christina Lavoie, Director of Policy, Health Industry Distributors Association

‘ In an August 2023 regulatory announcement, FDA declared that there would be a 12-month enforcement discretion and system stabilization period for the final phase of the DSCSA.’ FDA stressed the following takeaways as part of the 12-month stabilization period: ` The FDA urges trading partners to view the extra 12 months as a stabilization period to finish implementation, troubleshoot problems, and otherwise prepare their systems for accurate, secure, electronic data exchange. ` The FDA reiterates that this guidance should not be used as a justification for trading partners to postpone implementation efforts. ` The FDA can still penalize companies for noncompliance. ` The 12-month stabilization period applies to pharmaceutical manufacturers, wholesale distributors, and dispensers. ` The FDA released additional guidance regarding wholesale distributor verification of returned saleable product, waiver and exemption process, and package level tracking requirements. HIDA continues to be a voice for the healthcare distribution industry, bringing together stakeholders and federal partners to ensure that our medical supply chain functions properly. We will work with our members during this 12-month stabilization period to educate them on best-practices to ensure full compliance.

December 2023 • Repertoire | Celebrating 30 Years • www.repertoiremag.com

MARKETING MINUTE

Determining Your Brand’s Marketing Audience When determining how to make a brand’s marketing tactics more successful, businesses are often told to create

campaigns that will appeal specifically to their “target audience.” What exactly is a target audience, and how does a brand determine who they are selling to, and what consumers they could potentially be selling to? Read on to learn about how businesses can determine their consumer audience, improve marketing tactics, and appeal to specific consumers.

A brand’s target audience includes all of the consumers they are trying to reach and engage with their marketing campaigns. Consumers that businesses should target may include a wide range of demographics, ages, genders, socioeconomic status, etc. A company should market toward consumers that have goals, interests, and purchasing capabilities that align with the company’s product or service offerings. Unique, tailored content created specifically to appeal to the audience’s goals and interests has the potential to boost a brand’s success and sales. To learn about your business’ audience: No. 1: Gather information on the existing audience

When determining your brand’s target market, start by tracking sales data related to individual customers. Gathering this information can include tactics such as talking to a business’ salespeople about trends they have observed in customers, or implementing a data-based survey after sales calls that gives a business an understanding of their current customer base. No. 2: Identify new targets Once a company establishes who their target audience consists of, they can move on to attracting new 26

customers. Customer groups that may be interested in a business can be determined based on their demographics, interests, needs, wants, and budgets that align with your company’s product or service. By directing company marketing efforts toward people that need, want, or can afford a product, it is more likely a customer will view content and make a purchasing decision. No. 3: Follow trends and distinguish brand from competition

Brands that stand out from their competition appeal to their consumer base with marketing tactics that differ from the industry competition. Keep in mind that trends, such as social media and technology, can impact marketing tactics. Leveraging current

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trends can help your business determine how to market to its target audience successfully. If your company in the medical distribution and sales industry could benefit from implementing marketing tactics that are specifically designed to capture the attention of your brand’s target audience, Share Moving Media can assist you. With over 30 years of experience in the medical supply chain industry, our team can help your company create content for marketing campaigns that capture your audience’s attention and boosts sales. For more information or to set up a brief session to discuss the needs of your business, please contact Scott Adams at sadams@sharemovingmedia.com.

C E L E B R AT I N G 3 0 Y E A R S

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C E L E B R AT I N G 3 0 Y E A R S

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Anne Eiting Klamar

Janis Dezso

C E L E B R AT I N G 3 0 Y E A R S

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Mike Malec CME Corp.

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Mixed Reviews for 2024 Physician Fee Schedule Many primary care doctors applaud it. Specialty physicians? Not so much.

vol.31 no.11 • November 2023

The Best of Equipment Sales — The tips, tricks, and insights into a pivotal product category for distributor reps.

Mixed Reviews for 2024 Physician Fee Schedule — Many primary care doctors applaud it. Specialty physicians? Not so much.

Respiratory Season

Home Blood Pressure Monitoring

C E L E B R AT I N G 3 0 Y E A R S

repertoiremag.com

vol.31 no.10 • October 2023

Respiratory Season

John Ballarin Abbott

November 2023

Octoberr 2023

vol.31 no.9 • September 2023

New entrants are reshaping the physician market.

Excellence in Sales C E L E B R AT I N G 3 0 Y E A R S

repertoiremag.com

September 2023

Midmark’s Experience Center brings together vendor, distributor and end user to map out physician office design and function

vol.31 no.8 • August 2023

Home Blood Pressure Monitoring — How blood pressure readings taken at home can reduce a patient’s anxiety and lead to better health outcomes.

A Hub for Collaboration — Midmark’s Experience Center brings together vendor, distributor and end user to map out physician office design and function

A Hub for Collaboration

C E L E B R AT I N G 3 0 Y E A R S

repertoiremag.com

August 2023

July 2023

vol.31 no.7 • July 2023

Meet the Disrupters

Awareness of the benefits of oral and medical care integration is growing. But implementing it will present some challenges, not only among providers, but patients too.

Excellence in Sales

Medical Distribution Hall of Fame

‘Revolutionizing Healthcare is not Easy.’

vol.31 no.6 • June 2023

Meet the Disrupters — New entrants are reshaping the physician market.

Joan Eliasek Medical Distribution Hall of Fame

A Spirit that Lives On Henry Schein celebrates 90 years of serving healthcare providers across the continuum of care.

‘Advanced Practice’ or ‘Scope Creep?’ — Disagreement about the role of nurse practitioners and physician assistants.

A Spirit that Lives On — Henry Schein celebrates 90 years of serving healthcare providers across the continuum of care.

Esther and Henry Schein

vol.31 no.5 • May 2023

vol.31 no.4 • April 2023

repertoiremag.com

June 2023

‘Advanced Practice’ or ‘Scope Creep?’ Disagreement about the role of nurse practitioners and physician assistants.

C E L E B R AT I N G 3 0 Y E A R S

repertoiremag.com

May 2023

‘Revolutionizing Healthcare is not Easy.’ — Awareness of the benefits of oral and medical care integration is growing. But implementing it will present some challenges, not only among providers, but patients too.

vol.31 no.3 • March 2023

C E L E B R AT I N G 3 0 Y E A R S

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April 2023

vol.31 no.2 • February 2023

C E L E B R AT I N G 3 0 Y E A R S

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March 2023

February 2023

January 2023

vol.31 no.1 • January 2023

The Best of Equipment Sales The tips, tricks, and insights into a pivotal product category for distributor reps.

How blood pressure readings taken at home can reduce a patient’s anxiety and lead to better health outcomes.

As our Share Moving Media family celebrates our 30th anniversary, we would like to take a moment to express our sincere thanks for your loyalty and support over the years. We are truly thankful for the wonderful industry we have the privilege to serve.

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SALES

Applied Impov How the principles of improvisation can be used in a sales setting. By Pete Mercer

Improvisational theatre is an art form that has been around for centuries, entertaining and regaling the masses

through the feat of thinking on your toes. This ability to be flexible and nimble in a high-pressure situation is crucial to the art and spirit of improvisation – without that ability, you’re not really doing improv.

While the art of improv is usually seen through the lens of performance and entertainment – live theater, comedy shows, and television programs like Whose Line Is It Anyway? – it’s also a skill that can be used just about anywhere, but especially in a sales environment. Most good sales reps are likely familiar with the idea of going with the flow of a sales meeting. Anything can happen, so it’s important to be open to the possibilities and opportunities in any sales conversation. This is why familiarity with improv is so important for sales reps! Repertoire Magazine recently spoke to Izzy Gesell about the power of improvisation and how it can be used in a sales setting. Gesell describes himself as an organizational alchemist, saying, “The big picture is it’s a process that turns something ordinary into something special. That’s what my approach offers sales reps. How do you set yourself apart? How do you become the person that your clients are looking forward to seeing? It’s about how you show up.”

Introducing the idea of “yes, and...” The most widely known principle of improvisation is “yes, and...” Essentially, there is no room for a no in 28

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CONTRACT ADMINISTRATION CONFERENCE

February 5–7, 2024 | The Westin, Cape Coral, FL

The Only Conference Focused On Improving Pricing Accuracy In The Healthcare Supply Chain Leverage an ideal venue for addressing contract administration challenges and finding solutions through case studies, roundtables, and working discussions. Build relationships with your counterparts from other links of the healthcare supply chain – providers, distributors, GPOs, and manufacturers – to improve contract management. Join Key Partners From Across The Healthcare Supply Chain: Healthcare Distributors • Healthcare Manufacturers • GPOs Healthcare Providers • Technology & Solutions Providers

SALES improv, putting the performers in the position of saying a hearty “yes” to each new situation. While the literal phrase “yes, and...” is certainly applicable for most improvisational situations, it doesn’t always have to be said outright. More often than not, the performer is just moving with the flow of the action to create the best scene possible. This is a simplified version of the idea of “yes, and...” Gesell says that there is a fundamental misunderstanding of what “yes, and...” really means. “A lot of folks think that ‘yes, and...’ focuses on the ‘yes’ and

that you have to agree with whatever you get. The ‘yes’ is an acknowledgment. ‘Yes, I hear you. And here’s my response.’ The power for the sales rep is that when you say, ‘I hear you,’ people feel acknowledged.” For Gesell, this idea opens the door for a partnership between the sales rep and the customer. “The benefit for the sales rep is that you learn to deal with reality by always acknowledging what the person said. We are all in charge of listening to the people around us.” Listening is a critical piece of the puzzle to creating this partnership.

Izzy Gesell

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Picture this: you are in a sales meeting with a big prospect, and it’s not going well. Why is that? It’s very possible that you are not really listening to the challenges and obstacles that the customer is faced with, which means that you aren’t meeting their needs. When you introduce something like “yes, and...” into these meetings, it shows that you are making efforts to listen and communicate a potential solution for them.

Dealing with hecklers In addition to his time spent coaching and training sales reps to introduce some flexibility into their toolbelt, Gesell also spent time onstage as a stand-up comedian. When he left standup, he transitioned into his role as a keynote speaker – a move that allowed him to transfer his skills to a different sort of stage. Mostly, it comes down to energy management. Gesell said, “Storytelling is a very important skill. If you think about hecklers in comedy, you have to learn how not to slam them because they are a part of the audience. How do you manage that negative energy? Do you deflect it? Do you absorb it? Do you belittle that person? Do you ask someone else for help?” He argues that a sales rep is an energy manager too. There’s an energy in the connection between the sales rep and the customer. Is there a positive energy? Is he focused? Is this person upset? How are they responding to your suggestions? More than anything, Gesell learned how to leverage his own vulnerabilities. There are plenty of popular comedians working right now that are using their own vulnerabilities to build a connection with their audience. That’s where the real connection happens – it’s easier to build a connection with people when

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SALES

you are vulnerable about what you are struggling with.

Opportunities and challenges for today’s sales reps According to Gesell, one of the biggest opportunities for sales reps is changing the way they deal with the world around them. Finding balance in an unbalanced world, learning to embrace spontaneity, dealing with unexpected reactions, and letting go of things you can’t control. Collaboration is key because the playing field, as well as the game itself, is constantly changing. But with improv, it’s easier to stay nimble in a changing dynamic. He said, “Every time you play the game, it’s different. You can play the same every day, and it’s different every time. With that, you learn to be creative 32

Collaboration is key because the playing field, as well as the game itself, is constantly changing. But with improv, it’s easier to stay nimble in a changing dynamic. in a way that deals with the situation, rather than what you expect.” On the other side of the coin, there are plenty of challenges facing sales reps right now. With Gesell’s experience conducting workshops and training on how to improve tactics of sales reps, he has found that the companies are perpetuating these challenges by not understanding what the sales reps are up against. The training provided by organizations isn’t as comprehensive as it should be, which can leave sales reps

December 2023 • Repertoire | Celebrating 30 Years • www.repertoiremag.com

unprepared to successfully navigate these challenges. “In order to grow, you need to be uncomfortable,” he said. “The companies that are not doing the best that they can are not investing in their people to help them become more confident, present, dealing with reality, and spontaneous than they can. I think that’s a shortcoming, because budgeting comes in and [companies] say, ‘We can’t spend that kind of money.’ There’s not a lot of long-range thinking.”

C E L E B R AT I N G 3 0 YE A R S • 2 0 2 3

vol.31 no.12 • December 2023

From Our Family to Yours Thank you for 30 years of awesome partnership

CONTENTS DECEMBER 2023 • VOLUME 31 • ISSUE 12

Join us as we look at some of the highlights of a 30-year learning journey.  p. 24

30 Years of Lab Examining the major trends and stories in the physician office lab market over the last 30 years.

10 Words of Wisdom Industry leaders reflect on lessons learned over the last three decades. ` SALES

18 Selling with Heart The timeless tenets of medical sales success.

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Celebrating 30 Years

Repertoire

December 2023

30 Years of Repertoire

` 30 YEARS OF REPERTOIRE

30 Years of Repertoire

30 Years of Lab

Â If you need any proof that the lab business is robust, clinically relevant and a powerful element of

December 2023

the value proposition of manufacturers and distributors alike, look no further than its technical and clinical performance over the past 30 years. Despite recessions, increasing levels of government regulation, reductions in reimbursement and the COVID pandemic, lab remains a cornerstone of healthcare in the United States. Its resilience is testament to how intertwined lab data is to diagnosis, treatment and monitoring for patients with both acute and chronic conditions.

Over the past 30 years, lab data has helped improve outcomes from virtually all of the leading causes of death, with the promise of further reductions based upon new diagnostic and metabolic markers, technology, and the application of large-scale data analysis. Join me to review some of the highlights of the past 30 years, and how the lab has played into this amazing history.

Repertoire Celebrating 30 Years www.repertoiremag.com

By Jim Poggi

The 1990s Presidents: George H.W. Bush and Bill Clinton. Top rock bands included Nirvana, Red Hot Chili Peppers and Pearl Jam. Top hip hop artists included Tupac Shakur, Dr. Dre and Snoop Dogg. Hit movies included the Lion King and the Big Lebowski. A new home averaged under $150,000. The average new car cost $15,000 in 1990 and $17,300 in 1999. Inflation ranged from 1.6% to 3.4%.

In the news The Hubble telescope was launched in 1990. The Gulf War ended in 1991. The Soviet Union ended in 1991. In 1991, the world wide web entered the commercial market. In 1992, the European Union was formed. In 1994, Nelson Mandela was elected the first black president of South Africa. The first hints of the coming opioid crisis emerged in 1995 as new, more potent opioid pain medication entered the market. Google was founded in 1998.

Lab news Prequel. In 1983, the first widely

accepted laboratory molecular tests were introduced by Gen-Probe. They included chlamydia and gonorrhea and presaged a massive flood of exciting and innovative molecular tests to come in later years.

Labs by the numbers. In 1993,

there were 154,000 U.S. labs. By 1999, the number was 169,000. Despite its dreaded advanced billing, CLIA ’88 did not dramatically damage the lab business.

CLIA ’88 was first officially implemented in 1992. Written into law in 1988, a variety of challenges by the lab industry and lab professional organizations resulted in multiple delays as well as changes to the original law. The big news on CLIA ’88 was two-fold. First and foremost, EVERY lab performing tests for human diagnostic purposes was to be held to the same personnel and performance standards. Secondly, lab tests were grouped into three cohorts: waived, moderate and high complexity, with personnel and testing standards escalating based on the level of complexity. Previously available tests for pregnancy, urinalysis, group A strep and home glucose monitoring were the first waived tests and represented the vanguard of the flood of waived tests to come.

Changing face of lab companies

due to consolidation: Bayer bought the lab business of Ames and Technicon in 1990. Beckman bought Coulter in 1998. Both Quest and LabCorp acquired smaller lab companies as consolidation also was embraced by the reference laboratory business. Going against the grain. PSS World

Medical (PSS) celebrated 10 years of operations in 1993. Under the direction of John Sasen, PSS built a strong physician lab business as others withdrew or reduced focus in this area. The strategy included not only focus on the physician office space abandoned by its competitors, but also successfully courting “direct sale” lab companies,

CLIA waiver and clinician demand for easyto-use lab diagnostic tests in point-of-care settings fueled the development of lateral flow tests, with readers to improve performance on the horizon for later years. Lateral flow takes hold. A large number of lateral flow test companies emerged and sold an increasingly broad range of fast, easy to use lateral flow diagnostic products. Beginning with pregnancy and strep, H. pylori antigen, influenza, RSV and other assays for pathogens emerged. Drug abuse tests also emerged. CLIA waiver and clinician demand for easyto-use lab diagnostic tests in point-ofcare settings fueled the development of lateral flow tests, with readers

including Abbott Diagnostics, to partner exclusively with PSS outside the hospital laboratory market. Ending the ’90s with a bang.

In November 1999, the FDA issued a consent decree against Abbott Diagnostics for quality system issues dating back to 1993. Only medically necessary products for HIV and blood supply testing were permitted to be sold. Abbott pulled more than 175 products off the market.

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December 2023

The back story

to improve performance on the horizon for later years. The intellectual property landscape for lateral flow had issues which will become a matter of importance a decade later.

30 Years of Repertoire

The 2000s The back story Presidents: George W. Bush and Barack Obama, the first African American U.S. president. Top rock bands included Linkin Park and The White Stripes. Top hip hop artists included Nelly, 50 Cent and Jay-Z. Hit movies included Gladiator and The Dark Knight. A new home averaged $221,000 after the housing bubble burst in 2008, halting a rapid rise in home prices over the decade. The average new car cost $21,000 in 2000 and $25,300 in 2010. Inflation ranged from 3.4% in 2000 to under 2% in 2010.

In the news The Sept. 11, 2001, attack on the World Trade Center brought

terrorism home to Americans for the first time. The war on terrorism began shortly thereafter and the hunt for Al-Qaeda principals began in earnest. The EU adopted the Euro in 2002. Twenty-five percent of the world’s population had access to the internet. Ronald Reagan passed away in 2004. A global financial crisis hit between 2007 and 2008, bringing a recession to the U.S. and halting the booming U.S. housing market as home prices retreated in most markets. Concerns about climate change captured worldwide attention. Concerns about obesity, especially among the younger population in the U.S., raised interest in healthy living trends and early diagnosis of type 2 diabetes.

Lab news Labs by the numbers. The

number of labs continued to increase from 169,000 in 2000 to 221,000 in 2010.

A little scandal anyone? Theranos

was founded in 2003 with the promise of cheaper, more widely available lab tests for a wide range of assays in virtually any location using its “proprietary” technology. In 2015 the technology and business model of Theranos were debunked and company principals brought under indictment. The Theranos value proposition seesawed between portable testing systems widely available at the point of care and low-cost reference lab testing using Theranos’ technology. It was learned that its technology was unreliable, not groundbreaking and many of the patient results Theranos reported from their reference lab were performed on lab instruments made by established lab companies using their technology.

Tox screening grew. As the

December 2023

opioid crisis took further hold, the clinical and laboratory community embraced lateral flow drug screening assays, with confirmation by more sensitive and specific means. A good news/bad news scenario unfolded. Screening for abused drugs took hold in the general workplace and transportation industry. But the opioid crisis continued to grow and some labs tested from a financial viewpoint and dodged medical necessity requirements. Ultimately new regulations regarding how often screening can be performed, which technologies can be used for confirmation and stricter guidelines for reimbursement were enacted.

Repertoire Celebrating 30 Years www.repertoiremag.com

10 years of experience with CLIA during the decade, manufacturers and distributors became more comfortable with investing time and resources in the physician office laboratory market. All major distributors sought out quality manufacturing partners to re-enter or grow their presence in this market. McKesson MedicalSurgical deployed a modest new lab program in 2005 to test the waters with five specialists, one category manager and a parttime vice president of sales. Microbiology began to undergo change. Antibiotic stewardship

initiatives coupled with new technologies began to reshape traditional microbiology and led to advances in identification of organisms, as well as identification of appropriate antibiotics. On the tertiary care/hospital side of the business, increased automation, especially in microbiology where automated instrument-based methods made inroads against culture plate methods improved time to result and decreased expertise level in result interpretation. PCR, time of flight assays (MALDI/TOF MS), and others created a revolution of sorts that ultimately trickled down to the point of care market.

CLIA-waived assays on the move.

Waived hemoglobin A1c assays were initially launched a decade earlier but took firm hold in the point-of-care market as greater emphasis was placed on diagnosis and management of type 2 diabetes. Waived quantitative cardiac assays including D-dimer and BNP entered the primary care market. The range of respiratory assays

and their adoption grew rapidly as influenza, group A strep and RSV became commonly performed respiratory tests in both the hospital and point-of-care market. The first reader-based lateral flow testing systems from the major manufacturers improved variability by removing visual reading and also increased sensitivity.

the possibility of an avian influenza pandemic in the future. Buy the numbers. Inverness (later

known as Alere) acquired lateral flow intellectual property from multiple sources as well as a number of lateral flow companies and began actions to assess royalty payments against several lateral

The impact of sequencing human, bacterial and viral genomes has had widespread impacts on human health, including mRNA vaccines for COVID, cell free DNA assays and human tumor cell genotyping for cancer diagnosis and treatment. EMR and Meaningful Use. In

2009, The Health Information Technology For Economic And Clinical Health (HITECH) Act was passed. It provided financial incentives for the changeover from paper patient records to electronic records. An initially large number of EMR companies whittled down to a smaller number as the decade moved on. Connectivity between the patient record and lab results from laboratory information systems (LIS) became a reality.

New diseases, new concerns.

The SARS outbreak (SARS is also a coronavirus, similar to COVID) in 2003 was largely confined to Asia, never reaching feared pandemic status, but foreshadowed COVID a decade later. The big questions were: which pathogen would break out next? How deadly would it be? How would it be diagnosed and treated? These questions persist as some experts point to

flow companies. Abbott, Quidel, OraSure, BD and others stayed independent through royalty settlements. In 2006, Inverness acquired Acon, a major producer of lateral flow assays. Acon was divested later on. In 2006, Siemens bought the lab diagnostic business of Bayer, except its home glucose testing business. Mapping the human genome was declared complete in April 2003. This seminal work was completed under the Human Genome Project funded by the National Institutes of Health and involved scientists from the U.S., United Kingdom, Japan, France, Germany, and China. The impact of sequencing human, bacterial and viral genomes has had widespread impacts on human health, including mRNA vaccines for COVID, cell free DNA assays and human tumor cell genotyping for cancer diagnosis and treatment. Disease states benefiting from gene sequencing technologies include cancer, heart disease, diabetes, and others.

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December 2023

We’re back… with more than

30 Years of Repertoire

The 2010s The back story The world gradually recovered from the recession begun in 2008. Baraka Obama was president followed by Donald Trump in 2016. Top rock bands included Queens of the Stone Age, Arctic Monkeys and Foo Fighters. Top hip hop artists included Drake, Future and Kendrick Lamar. Hit movies of the 2020s included Avengers: Endgame, Mad Max: Fury Road and Black Panther. The average cost of a new home was $292,700. A new car cost $24,300 in 2010, and $29,700 in 2019. Inflation averaged 1.4% during this decade.

Lab news Labs by the numbers. In 2011 there were 225,700 labs in the U.S. In 2019, there were 265,700. While the number of labs continued to grow, the Protecting Access to Medicare Act (PAMA), passed in 2014 and implemented in 2018 threatened to disrupt this trend by reducing reimbursement for lab tests. Readers changed rapid diagnostics tests/molecular became waived.

In 2014, Quidel launched Sofia and BD launched Veritor readers, improving sensitivity and creating more objective test results for common respiratory infections. Alere I became the first CLIAwaived molecular respiratory testing system. System connectivity to EMR was a noted feature of these systems. Multiple molecular platforms followed, some CLIA waived, broadening the range of respiratory and infectious disease tests available.

December 2023

In the news

of the world’s population and over 77% of the U.S. population.

Overall, this decade was marked by turbulence and economic and political divisiveness. Occupy Wall Street took place in 2011 protesting economic inequality. Black Lives Matter protests began in 2015 protesting police brutality and the death of Freddie Gray. Donald Trump became president in 2016. Great Britian made plans to exit the European Union in 2016. Osama Bin Laden was killed in 2011. Mass shootings in the U.S., including a school shooting in Sandy Hook, Connecticut and concert shooting in Las Vegas, increased in frequency. In 2011, New York state became the first state to recognize same sex marriage. Xi Jinping took power in China in 2013. NASA captured the first black hole images in 2019. Donald Trump was the first U.S. president to be impeached twice. The COVID pandemic appeared in late 2019, affecting over 44%

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PAMA squeezed the wrong end of the balloon. Despite lab being

only 3% of Medicare spending, Congress passed legislation requiring reductions in lab payments under the Clinical Lab Fee Schedule to align Medicare lab costs with the lower fees paid by private insurance. Fee reductions were capped at 10% in years 1 through 3, and 15% in years 4 through 6. Fees were cut in the first two years, but the CARES Act followed by the Protecting Medicare and Ameri-

can Farmers from Sequester Cuts Act halted further cuts. COVID beats PAMA. According to

the Office of the Inspector General, Medicare Part B spending on laboratory tests increased by $1.3 billion in 2021, from $8.0 billion in 2020 to $9.3 billion in 2021. The 17% increase was the biggest change in spending since OIG began monitoring payments in 2014. Emergency Use Authorization of COVID antigen, antibody and viral RNA detection tests created over 300 new tests from a variety of manufacturers. In addition to COVID, the growth of new non-COVID genomic tests also fueled this growth in lab spending under the CLFS.

What’s in a name? Inverness changed its name to Alere, capping a decade of organic growth and growth by acquisition. Key Alere brands included Cholestech, Biosite, Binax, Wampole and HemoSense. First CLIA waived hematology system. A waived hema-

tology system was launched by Sysmex in 2017.

Consolidation continues in distribution. McKesson Cor-

poration acquired PSS in 2013, creating the largest primary care distributor in the U.S. Cardinal Health sold its physician office lab business to Henry Schein in 2014.

Manufacturers make consolidation moves. Abbott buys Alere

in 2016, and sells off the Triage business to Quidel and the Epoc business to Siemens in 2017 due to antitrust concerns. Abbott continues to be the largest lab manufacturer in the U.S.

30 Years of Repertoire

The 2020s The back story Joe Biden was elected president in 2020 as the country found itself polarized regarding election integrity and focus on politics over legislative progress in Congress. Rock bands are surpassed in popularity by pop artists including Taylor Swift, Justin Bieber and Harry Styles. Nonetheless, the Rolling Stones launch their “60” tour in 2022 beginning in Madrid, Spain and concluding in Berlin, Germany. Top hip hop artists included Drake, Lil Baby and Future. Movies of the 2020s included The Creator, Saw X and Reptile. The average cost of a new home was $430,000. A new car cost $48,000. Inflation began the decade at 1.4%, hit 6.5% in 2022 and currently stands at 3.7%.

police brutality. The first ever mRNA vaccines were developed at unprecedented speed and deployed against COVID in 2021. Russia invaded Ukraine in 2022. The James Webb telescope was launched into space with the objective of seeking out the first stars and galaxies formed following the big bang. The U.S. Capitol was attacked by rioters protesting the election of Joe Biden on Jan. 6, 2021. Political polarization impacted legislation, local and national elections and contributed to focus on social and political issues that divide the nation. Elon Musk bought Twitter for $44 billion in 2022. Hamas attacked Israel killing more than 1,000 civilians in 2023. Inflation, especially in food and housing, rose to levels not seen in the U.S. for 30 years.

In the news

Lab news

The COVID pandemic resulted in widespread infection, severe disruption of the supply chain, social isolation intended to reduce the spread of infection and a rapid increase in inflation. Mental and emotional health issues rose in part due to social isolation. George Floyd was killed in 2020, leading to protests against

Labs by the numbers. There

December 2023

Diabetes and cancer will continue to see major advances in both diagnosis and treatment. A clearer understanding of the relationship between inflammation and disease will emerge.

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are 323,000 U.S. labs in 2021. While concerns continued about access to lab services in rural areas, the number of U.S. labs hit a record high.

Expanding its testing footprint dramatically. Quidel bought

Ortho Clinical Diagnostics

in 2022. Quidel expanded its offerings into high volume chemistry and immunoassay to complement its molecular and rapid test kit offerings. More name games. AACC

announced that it is changing its name to the Association for Diagnostics & Laboratory Medicine (ADLM) aligning its name with the expanded variety of test methodologies it supports. AI matey. Artificial intelligence interprets linkages in complex data sets, especially in the rapidly expanding portfolio of cancer tests. Tumor genotyping predicts cancer outcomes based on large scale data sets. Go home and test. Respiratory, pregnancy, glucose, fertility and abused drug test home testing surges following the COVID pandemic. Remote office visits increase in popularity during this same time frame. What’s next? A few predictions emerge. Point-of-care and home testing will continue to grow. Their value will be determined by availability of test results to the patient and healthcare provider, increasing the importance of EMR and large data solutions. Population data will be mined to understand large scale health trends. Diabetes and cancer will continue to see major advances in both diagnosis and treatment. A clearer understanding of the relationship between inflammation and disease will emerge. The biggest prediction: changes will come that we cannot imagine or foresee!

30 Years of Repertoire

Words of Wisdom

Passion. Presence. Empathy. Relationships. These are a few of the words that several leaders in the med/surg community gave when Repertoire reached out asking them to impart what they have learned over the course of their careers. We would like the thank the following individuals for sharing their insights: ` Rob Saron, former President and Director/SVP Global Distribution, Bovie Medical

` Brad Connett, President, U.S. Medical Group, Henry Schein

` Brad Hilton, Senior Vice President of Primary Care Sales, McKesson Medical-Surgical

` Cindy Juhas, Chief Strategy Officer, CME Corp.

` Bill McLaughlin Jr., President and CEO, IMCO ` Mark Seitz, Chairman, NDC, Inc. ` Bill Sparks, Founder and CEO, MedPro Associates ` Brian Taylor, Co-Founder and former Publisher of Repertoire Magazine

` Jon Wells, President and CEO, Midmark

Truth By Rob Saron, former President and Director/SVP Global Distribution, Bovie Medical

December 2023

My father always said, “tell the truth and you never need to remember what you said.”

story of very early in his career when there was an order he knew he wasn’t going to be able to deliver on time, so he made up something about a warehouse fire. But he quickly realized that unless he told the truth, he was never going to keep his stories straight. He said that was the one and only time he ever lied to a customer. That was really one of the great things about Richard. You knew immediately what he thought. Candy coating a response was not how Richard explained his position. “That’s not going to fly” is an example of a typical response to a proposal.

I tried to follow that mantra in business and in life. I still do. Truth isn’t always the easy way out, but your customers need to know what the real story is. I once discussed this with Richard Riley, our main contact at PSS. Richard was something like the 20th employee at PSS, and he worked there essentially his entire career. He told me a

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He was also the first distributor to argue with me over who was going to pay for lunch. If your customers know they can depend on you to always tell them the truth, then they will know they can always rely on you. During the pandemic, it was very easy to blame issues on the container mess and shipping woes. That was true and worked for a couple of years, but when I hear it now, I roll my eyes. So, understand the factors involved and don’t rely on a story – tell the TRUTH! It will simplify your life and your customers will appreciate you for it.

Presence By Brad Connett, President, U.S. Medical Group, Henry Schein

are two parts of presence: our ability to be present and our presence as leaders when we show up for others. Leaders need to be present, and this involves proximity. We need to be in front of our teams, actively listening. One philosophy I believe wholeheartedly in is the most important person at any given time is the individual in front of you. This means attending to our teams and silencing our phones. Again, this means actively listening to what our teams are saying and paying attention to their non-verbal cues. As a leader, being present is a way to differentiate yourself and most importantly, a way to create meaningful connections with your team members.

The second part is having a presence. Having a presence requires a combination of attributes: ` Poise. A strong leader can handle stress without letting it affect others. ` Effectiveness. Successful leaders don’t stray from their objectives – they accomplish what they have set out to do. ` Stability. Leaders who are balanced and steady amid challenges will encourage others to act the same. ` Calmness. Great leaders keep a level head and have high emotional intelligence.

` Confidence. Leaders with confidence exude a belief in themselves and their team. ` Resilience. Effective leaders don’t shrink in the tough moments and can pivot when the need occurs. Leaders with presence anchor around mutuality, respecting a common basis with teams, and demonstrate consistency. Consistency is the attribute that holds it all together.

That’s why Repertoire has had 30 years of success. Repertoire stayed true to what they were focused on: distribution and the art of selling. It is an honorable profession that has changed and morphed. It’ll keep changing, but it’s not going away. We serve the oldest profession in the world. Lastly, for those of us who’ve been in the industry for a while, we’ve been blessed and fortunate with our roles and careers. But it’s important not to take ourselves too seriously. Yes, we need to take our responsibility seriously, but in the scheme of things, if we left tomorrow, the business would be fine, and the industry would be fine. To that end, I believe passing along generational leadership is important. And Repertoire has done that through

It is an honorable profession that has changed and morphed. It’ll keep changing, but it’s not going away. We serve the oldest profession in the world. Repertoire has been consistently present for 30 years in the industry. It was founded by Brian Taylor and Chris Kelly, who understood the importance and value of distribution. Subsequently, the next generation of leadership with Scott Adams and John Pritchard remained focused on that.

its coverage of the industry and at its events like the Medical Distribution Hall of Fame. Repertoire has done an incredible job of honoring the industry and being present through the small and transformational changes it has undergone over the last 30 years.

December 2023

Presence is vital from a leadership standpoint. There

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Repertoire

30 Years of Repertoire

Excellence By Brad Hilton, Senior Vice President of Primary Care Sales at McKesson Medical-Surgical Growing up, my dad would always say “a job worth doing is a job worth doing well.” He

demanded Excellence, and talked about it regularly. Sometimes, I would give him a list of excuses on why things were hard or why they weren’t right, and he would simply say “our customers deserve better.” That was very a powerful message, and something that I’ve taken with me throughout my career.

Demanding Excellence is a good thing. It fosters an “iron sharpens iron” mindset, as well as teamwork. It’s important to note that Excellence is not the same as Perfection. No one is perfect, but we should aspire and drive towards Excellence in our pursuits. It feels like we are less inclined these days to push for Excellence, to have courageous conversations, to disagree without being disagreeable or to accept responsibility for

our individual actions when we fall short. Perhaps a rededication to the ideal of Excellence would get us back on track. Thank you, Repertoire Magazine, for promoting Excellence in healthcare sales for the past 30 years, and for keeping our industry and its sales professionals connected.

Relationships Bill Sparks, Founder and CEO of MedPro Associates

December 2023

The consolidation that went on with healthcare distribution in the ’80s and ’90s changed our world. When I was in southern

used to be. I don’t necessarily mean that in a negative way. The relationships we have now are a little bit deeper and stronger. The job titles and businesses we work for may change, but relationships stick. They’re difficult to build, but long lasting. I know Scott Adams believes in relationships, and that’s a big reason why we do business together. There was a time when Brian Taylor, Chris Kelly and I talked about doing Repertoire together. After a couple months of discussions, I decided it wasn’t a fit, because I was too busy doing my own thing with MedTech and didn’t know the ins and outs of putting together a magazine. That being said, the

California, I probably had 20 distributors all doing physician sales. When consolidation happened, it created a different type of relationship with them. It shifted toward the relationships we have with individuals, but within a corporate structure. We didn’t have that before. I think that’s one of the big changes that happened. Relationships are still important, they’re just not like they

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relationship that Brian, Chris and I had continued to thrive over those years. Those were my days at MedTech. Brian and Chris helped us advertise and tell our story in Repertoire. We had our national meetings covered by Repertoire, as well as new hires and appointments highlighted. My relationship with Repertoire continues to this day with MedPro Associates. Looking back over the years, I think it takes a special relationship to stay connected in this industry when folks move to different companies and different positions. Repertoire has helped foster those relationships. There’s a personal piece of it that can follow you, and you shouldn’t take it for granted.

On behalf of MedPro, the manufacturers we represent, and our partners in medical distribution, we would like to congratulate Repertoire on an amazing 30 years supporting healthcare distribution and medical sales. The audience Repertoire has provided us and the connections we’ve made based on our relationship with this publication are beyond measure, and we are grateful for the last 15 years of opportunities to advertise and promote our company and partners. MedPro provides contract medical sales to all major healthcare markets, and Repertoire has been a key piece of the growth and success we’ve had as a company.

Wishing you many more years of success!

30 Years of Repertoire

Empathy By Jon Wells, President and CEO, Midmark When I think about the important role Midmark and our teammates play in medical, dental and animal health environments, the word I immediately think of is empathy. Midmark is more than

a company that sells products and services. We are a design company that provides new ideas to enhance the quality of care and healthcare experience for staff and patients. We do this by listening to our customers with an empathetic ear. The work we do at Midmark touches 10 million patient experiences every day, and this work is grounded by empathy. It is part of our culture. It is where design thinking begins – building

a deep understanding of our customers’ work to design meaningful solutions. One example of empathetic design is our mobile workstations. We recognize that healthcare providers experience challenges due to the differences in staff height. Bending or stretching to reach supplies and equipment or hunching over a computer dramatically impacts caregiver safety, hindering the ability to provide great care. To address these issues, we collaborated with health systems across various disciplines to design a unique, ergonomic workstation. Midmark workstations have the longest range in surface height,

allowing medical staff to easily adjust the height to adapt to their dynamic needs. Through empathy, a simple cart has become a breakthrough ergonomic solution. Empathy and design are not just engaging words. They represent how we carry out our mission of improving the experience between the patient and the caregiver. This is at the heart of everything we do and allows Midmark to make a meaningful difference in delivering healthcare.

Adaptable By Bill McLaughlin Jr., President & CEO, IMCO

December 2023

Adaptable is an essential concept within our business, holding significant importance for us in both our interactions with our distributor and vendor partners.

staying profitable. We champion the importance of collaboration and working with committed and trusted vendor partners to support our distributors on this journey. IMCO and our Members understand there is not a onesize-fits-all formula. We believe each customer deserves the time and engagement to ensure their business is understood to make the best recommendations and provide support for their business. To be that resource and expert for customers is important

Every one of our independent distributor members embodies this spirit, evident in their relentless efforts to establish and maintain a customer-focused business while

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to fostering long-term fruitful relationships. I believe even with technology, cost awareness, the time-sensitive nature of the healthcare landscape, personal interaction and trust is the key to continued success. IMCO and our Members are strong, collaborative, and act quickly to adapt to the needs of our customers and changing environment. Repertoire, too, has adapted to the changing marketplace, while focusing on the relationships that make this industry great.

Passion By Cindy Juhas, Chief Strategy Officer, CME Corp.

If you’re going to be successful as a rep or leader in this industry period, you’ve got to do something to push yourself along and not just let people manage your career for you.

You must manage your own career. And to manage your career, I believe you must have passion. One of the key moments of my career happened early on. I asked for a job that was not available at the time

and that I didn’t have the background for, but that I knew I could do. I got the job and it changed my career path. Even without the experience, I knew that I could do this job. I thought about how to do it, and I was passionate about it. People sometimes look at their career and say, “This is what I should do.” But rarely do people think about, “This is what I want to do,” or “This is what I know that I really feel strongly about and I can do it very well.” Anybody that has their own successful business or role

within their organization knows how important passion can be. If you really love what you do and you’re passionate about the work you put in each day, you will find success in your career and your organization because of that hard work. It makes you driven. It makes you work hard. It does all those things, and ultimately you’ll succeed. I know that in this industry, women can oftentimes be less selfconfident than men. Find what you’re passionate about and your selfconfidence and drive will blossom!

Specialize By Mark Seitz, Chairman, NDC, Inc.

Three companies come to mind when I think of independent distribution companies who have found success by pivoting away from being full-line independent distribution companies to something more focused: ` Milwaukee, Wisconsin-based Medico Mart, a second-generation independent distributor, seized upon an opportunity to be a vaccine distribution specialist. When they identified the unmet need, their business really took off.

` Nashville, Tennessee-based

Metro Medical had the courage to focus on pharmaceutical distribution and ended up having a successful liquidity event with one of the nationals. ` Wixom, Michigan-based Lynn Medical, another second-generation business, decided to focus on cardiology. They have done a great job creating a national footprint in that category. When I first arrived in the med/ surg business 18-plus years ago, there were lots of broadline, alternate site distributors, and hospital focused distributors. But we are seeing more of these independent distributors find success by taking hold of a specialty they can exploit.

By specializing, you do not dilute your efforts by trying to do too many things for too many people. Instead, you’re building a moat around your ability to compete. Yes, there is a risk involved. You hate to walk away from today’s revenue for tomorrow’s growth, but that is what it comes down to when you specialize. It is having the courage to change when you see the opportunity. I look forward to Repertoire Magazine being there to highlight the difference makers for the next 30 years.

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Celebrating 30 Years

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December 2023

Independent distributors that were historically broadline, but had the courage or the conviction to specialize, have done extremely well.

30 Years of Repertoire

Reflections on 30 Years By Brian Taylor, Co-Founder and former Publisher of Repertoire Magazine

Scott Adams asked if I would contribute some thoughts on the 30-year anniversary of Repertoire Magazine. He sug-

So, I share my friend’s words and hope they resonate with you like they did with me:

` Aspire to be more than you think you can be – you’ll be

gested that we share any words of wisdom with the distribution community. He gave us some direction by providing a list of words that describe successful people. We could focus on one of these attributes or come up with one of our own to paint a picture of success for the men and women in the industry:

` Inspired ` Reliable ` Challenged ` Consistent ` Engaged

` Have a plan and work hard

on it – but don’t forget to play

hard as well.

When I retired, someone said he never met anyone, looking back on their career, who ever said, “I only wish I had spent more time at the office.”

December 2023

` Brave ` Resilient ` Steady ` Curious ` Encouraging ` Determined

surprised how often you get there. ` Don’t procrastinate – what are you waiting for? ` Be carefully reckless – step out of your comfort zone.

You get the idea. All of the above are admirable and at a given point in time necessary for success in virtually any business endeavor. You all can recall being all those things at one time in the course of a month or week or even a day. I have been retired for nearly 10 years, and though I still follow the trends in the industry and the successes of friends and colleagues, I am so far removed from the rapid changes you all have experienced over those years, enduring the pandemic, shutdowns, consolidation of customers, supply chain issues, etc., that asking me for specific advice on how to do your job better, would (for those

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who know me) be like asking me how to make a 3-foot putt. I recently went to a memorial service where an old friend made a wonderful tribute to our mutual friend who had passed. He listed a number of life lessons he had learned from our friend’s life. I thought that I might share some of those words of wisdom, if you will, that might serve you well in your working life and hopefully beyond. When I retired, someone said he never met anyone, looking back on their career, who ever said, “I only wish I had spent more time at the office.”

` Treat people you meet as if they are your friend, and they

probably will be.

` You will be surprised how much YOU learn by being a mentor.

` You can’t tell the important people in your life that you love

them too many times.

` Create wonderful memories with friends and family and you will live in their hearts forever. ` Cherish every day – tomorrow is promised to no one. Thanks to all who have supported Repertoire for these 30 years and continued success for all of you in this wonderful industry.

Congratulations, Repertoire, on 30 YEARS of editorial excellence!

Midmark touches the lives of 10 million patients every day. Thank you for being a genuine partner and helping make a meaningful difference in the delivery of healthcare.

Sales

Selling with Heart The timeless tenets of medical sales success. By Brian Sullivan

Â It was 1990 and I was a young, naïve salesperson, working fresh out of college for Welch Allyn.

After spending several months working on the factory floor, stuffing boxes in shipping and taking orders in customer service, my marching orders came. “Sully, your sales territory is ready. You’re moving to Kansas.” Now, as a kid who grew up in Waterbury, Connecticut who had never been on an airplane, my first reaction was, “Let’s go!” My second reaction was, “Where exactly is Kansas?”

I am often asked by rookie salespeople who attend my sales seminars how have things changed in sales, specifically medical sales, over the last 30 years. While much has certainly changed, I prefer to talk about what has NOT changed – nor will ever change.

December 2023

No. 1: Hard work is rewarded

Truth is, I would rather hire a new salesperson who has demonstrated grit and hustle than the one with the fancy college resume. Give me the rep with the “doorto-door salesperson” mentality who understands that if you want to double a commission check, double the number of prospecting calls you make. Double the amount of people you know within a customer account. Double the number of presentations you deliver. Because there is no sales process, marketing plan, or CRM tool that is more effective than simply busting your hump to be amazing at selling/serving others. The hours and energy you invest come with an ROI. No. 2: Relationships still matter

Ask any successful sales leader who has been in this industry

for three decades and they will tell you the same thing. The friendships that have been and can be made (whether working on the distribution or manufacturing side) are priceless. They not only lead to a ton of laughter and bonding, they also lead to warm introductions to customers, potential business partners and tons more. Let’s not over complicate it, friends help friends. But these friendships/relationships don’t just happen. You need to work on them. Which means you can’t be

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that manufacturer rep who says, “There’s no use reaching out to that distribution rep. He never wants to ride with me or even meet for coffee.” Or don’t be that distribution rep who says, “I don’t need to return that manufacturer rep’s call. I’m too busy.” Treat everybody great, whether you see a short-term benefit or not. Be likeable. Ask for help. Do people a favor. Send them a lead. Make them an introduction. Buy them a beer. GIVE first and receive second. WORK for the friendship.

30 YEARS

CONGRATULATIONS ON

Thank you, Repertoire, for your dedication and excellence in serving the healthcare distribution channel. To learn more about B. Braun Medical, visit bbraunusa.com ©2023 B. Braun Medical Inc. Bethlehem, PA. All rights reserved. 23-0522_110123

Sales

Two of the greatest mentors of mine (and so many others) were Welch Allyn legends John Moran and Tony Melaro (both in the Medical Distribution Hall of Fame.) While there are a ton of qualities that made them sales pros, the quality that glued them to their distribution (and end-user) customers was just how genuine they were with others. I have often said in my seminars that the byproduct of being a selfless, loving, and genuine person is you sell a lot of stuff. And if you are like Moran and Melaro, combine that with a little bit of humor, energy, and fun, and you become unstoppable.

test/exam coming up and you felt like you didn’t study enough. Except for sales champions, that feeling never goes away. And that’s OK. Because it’s that urgency that forces you to make the extra 10 sales calls, follow up with that client more quickly, and study that new product your company just started selling. No. 4: Knowledge and skill separate champions from the average

In healthcare sales, you need to have a thorough understanding (knowledge) of the product, industry, and competition. Skill, on the other hand, equips you

If you want to be a top performer, you need to carve out 30-60 minutes each week to do nothing but study. Your brain is a stock price, and its value is either going up or down. But you control that stock price.

No. 5: Create amazing experiences for others

Industry legends Scott Fanning (Midmark), Rob Saron (Bovie/ Symmetry), Cindy Juhas (CME), Bill Sparks (MedPro Associates) and some elite others will tell you that to be successful, you can’t look, act and sound like every other salesperson or company. They understood/understand that the market is competitive, and often the only thing separating one solution from the next is the interaction and trust built with the salesperson. So, look at every interaction as “showtime.” Which means if you are putting on a sales meeting or training session, doing a live product demo, or delivering a virtual presentation for a potential customer, it needs to include passion, pride, and enthusiasm. And when appropriate, humor and creativity are icing on the cake. Do this better than your competition.

Conclusion No. 3: Healthy sense of urgency is good

Remember, we are blessed to be salespeople in this industry. Each day we have an opportunity to present and sell products/services that create healthy businesses and more importantly, healthy, and happy patients. Call it cheesy but the world needs us. Keep that in mind, and if you are lucky enough to be in this industry for 30-plus years, you will be able to look back on your career feeling a sense of pride and appreciation that you not only were able to call yourself a medical salesperson, but a damn good one.

December 2023

Industry legend Pat Kelly (PSS) used to say, “When you’re ripe, you’re rotten.’ Whenever he reached a goal, there was always a bigger one ahead. That’s urgency. Whether you have been in sales for three decades or three weeks, you know that nagging feeling that you have at the end of the day that you didn’t get everything done. It’s a bit like that feeling you had back in school when you had a big

with the techniques and strategies required to navigate sales interactions, handle objections, and ultimately close deals. In essence, knowledge provides the foundation for successful sales interactions, while skill allows salespeople to execute and capitalize on that knowledge. If you want to be a top performer, you need to carve out 30-60 minutes each week to do nothing but study. Your brain is a stock price, and its value is either going up or down. But you control that stock price.

As Founder of PRECISE Selling, Brian Sullivan, CSP creates top performers in sales, customer service, negotiations, leadership,

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and presentation skills through seminars and Internet training programs. He is also the author of the book, “20 Days to the Top How the PRECISE Selling Formula Will Make You Your Company’s Top Sales Performer in 20 Days or Less”. To learn more, go to www.preciseselling.com.

Congratulations on 30 years of serving our industry and building a lasting legacy. Thank you for your ongoing support of PWH® as a Corporate Patron. We are proud to partner with Share Moving Media to support the distribution industry with leadership development that promotes excellence in sales!

Join leaders in Louisville, KY April 29 – May 1, 2024 to celebrate the PWH® Legacy and 20th Anniversary! LEADERS DON’T WAIT! Early Bird registration ends 1/31/24 mypwh.org//leadership-summit-2024

Congratulations on

YEARS

REPERTOIRE You’ve given our incredible sales team so much valuable information and industry insights over the last three decades. What a moment to look back over years of great memories. From McKesson Medical-Surgical.

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30 Years of Repertoire

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Celebrating 30 Years

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December 2023

or 30 years, the medical community, payers, the government, and the American public have worked to understand what “high-value care” really is. And for 30 years, Repertoire has been watching. We have reported as medical care expanded to include behavioral health, oral health, even socioeconomic wellbeing. We have watched retail clinics, urgent care centers, IDNs, digital health and even private equity firms transform medical delivery. We have reported how medical technology has affected healthcare providers and their patients. And we have watched med/surg distributors and manufacturers work tirelessly to address all these changes. Join us as we look at some of the highlights of that 30-year learning journey.

30 30 Years of Repertoire

Sun Setting on Solo Practices

December 2023

Once rugged individualists, doctors were joining groups when Repertoire started publishing 30 years ago. Some contracted with physician prac-

tice management companies (remember PhyCor?) to take care of the business side of medicine, while others sold their practices to hospitals and hospital systems ... only to back out of those agreements and go back on their own ... only to sell their practices once again to hospitals and health systems, insurance companies and even private equity firms. By the end of 1999, physician practices around the country were calling it quits with physician practice management companies (PPMs). The year before, an estimated 5% of the 70,000 physicians who were affiliated with PPMs “unwound” those agreements and became independent again. Three factors were at work: First, the plunging value of PPMs’ stock prices, particularly worrisome for doctors whose deals were heavily weighted on the stock side. Second, some doctors found that the value proposition just wasn’t there. PPMs had promised to reduce administrative burdens and enhance revenues in return for 15% to 20% management fees. But it didn’t happen. And third: Maybe physicians just weren’t ready to share their practices with a business partner. But unwinding from PPMs was no panacea for the challenges facing physicians in the 21st century. In 2003, Goldman Sachs Vice President Chris McFadden asked THE question: “How do you take undercapitalized and undermanaged practices, which are confronted by outside challenges, such as HIPAA, and allow the physicians to focus on providing better care, while someone else handles all these other issues? ... [T]he cauldron is boiling over with many of the same issues that were emerging in 1989 and 1990.” Nine years later, in 2010, it was clear that physicians had turned 180 degrees since the late 1990s and embraced ownership by hospital-based integrated delivery systems. “There is rarely a hospital we talk to that doesn’t already have or is in the process of acquiring a physician practice,” Deborah Holzmark, RN, senior manager, Dixon Hughes, a CPA and consulting firm in North Carolina, told Repertoire.

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Two years after that, a new entrant joined the physician practice market: Insurers. With years of experience monitoring and paying claims, insurers claimed they possessed the management expertise and databases to affect how – and what – care is delivered, to whom, and with what results. In June 2011, Highmark Inc., an independent licensee of the Blue Cross and Blue Shield Association, announced its intention to pursue an affiliation agreement with West Penn Allegheny Health System in Pittsburgh.

‘ How do you take undercapitalized and undermanaged practices, which are confronted by outside challenges, such as HIPAA, and allow the physicians to focus on providing better care, while someone else handles all these other issues?’ By April 2017, fewer than half (47.1%) of physicians owned their medical practice. The American Medical Association estimated that in 2018 about 200,000 physicians worked for a medical practice that was owned or partially owned by a hospital or health system. But even ownership by a large healthcare organization couldn’t guarantee security for doctors – or health systems, for that matter. Increasingly, health systems found themselves competing for the physician market not only with insurers, but with drugstore chains and other retailers, such as Amazon Care, Best Buy, CVS, Dollar General, Walgreens and Walmart. None were new to the game, but they were persistent. By May 2023, Repertoire reported on other “disrupters,” each with its own strategy. Some were acquiring physician practices and employing physicians, others worked on a contract basis to provide independent practices with support for IT, marketing and administration. (A spin on the old physician practice management concept.) Either way, it became clear that all roads in primary care medicine were leading toward consolidation.

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Digital Medicine Thirty years ago, “going digital” meant digitizing medical devices like thermometers and scales. Soon the term

referred to transitioning from hard-copy patient records to EMRs, and then connecting those EMRs to diagnostic instruments in the physician’s office. Most recently, digitalization has come to mean connecting the medical team to patients in their homes or at work via continuous glucose monitors, apps and wearables. Virtual medicine has shaken longstanding traditions in healthcare delivery and will probably keep doing so for some time to come.

December 2023

FDA grapples with apps In the summer of 2011, the FDA issued draft guidelines for apps, which the agency defined as software programs that run on mobile communication devices and perform the same functions as traditional medical devices. In its formal guidance issued two years later, the agency wrote that mobile apps had the

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potential to transform healthcare by allowing doctors to diagnose patients outside of traditional healthcare settings and helping consumers manage their own health and wellness. The FDA said it would focus its attention not so much on wellness apps (e.g., those that measure steps) but on apps that presented a risk to patients if they failed to work as intended.

giving rise to companies such as AliveCor, Empatica, EnLiSense, Nemaura and VivaQuant. But with wearables came questions. “It is yet to be determined whether the growth of wearables will improve the diagnosis of pathology and improve outcomes or not,” Dr. Tom Schwieterman, vice president of clinical affairs and chief medical officer for Midmark, told Repertoire. “Whether the constant monitoring will improve cost of care is, in my mind, an even larger question.” Karl Poterack, M.D., medical director of applied clinical information for Mayo Clinic, raised another question. “A device can accurately measure steps – but is that a modality worth measuring?” What’s more, very few practices had the infrastructure to import and sift through the massive amounts of data these devices could generate, he said. Physicians were also concerned about assuming liability and responsibility for reviewing that data – something that had not been clearly defined.

‘ It is yet to be determined whether the growth of wearables will improve the diagnosis of pathology and improve outcomes or not.’ A new challenge: Hackers

By 2018, continuous glucose monitoring (CGM) was transforming the way blood glucose levels were monitored and managed by people with type 1 diabetes. (CGM for people with type 2 would follow.) In that year alone, the FDA cleared three systems for marketing in the United States, by Dexcom, Medtronic and Senseonics Holdings. (The Abbott device had been approved for marketing in 2017.) CGM had been shown in clinical studies to reduce the risk of hypoglycemia and diabetic emergencies.

Wearables: What are they good for? By 2019, the term “wearables” was ubiquitous in discussions about health. An estimated 14 million U.S. adults subscribed to a digital health/wellness service, and some studies showed that 40% of U.S. adults wore some kind of digital health technology. The industry flourished,

Who gets left behind? Digital technologies were widely accepted as effective medical tools, but by 2023, some people questioned how equitable they were. Questions were raised about the accuracy of data gathered by wearables among people of color. And in a study of patients with diabetes, researchers noted that rewards by payers or employers based on healthier eating habits and lifestyles (aided by digital technologies) could end up rewarding the rich and penalizing the poor. www.repertoiremag.com

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Continuous glucose monitoring

As remote monitoring grew, concerns persisted about patient privacy, system interoperability and patient data overload. By October 2021, the healthcare community was considering how to cope with ransomware. It was becoming clear that medical devices would have to be scrutinized not only for the possibility of hackers interfering with them to hurt or even kill people, but also to prevent hackers gaining access to electronic medical records, personal patient information and even providers’ financial systems.

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Disintermediated? Not Even Close Distributors’ fears of being “disintermediated” by Internet-based medical markets ran rife in the 1990s.

But by the end of 2000, following the collapse of such e-markets as Cimetek Commerce and Promedix, those fears were quelled. Yet a lot of work remained to be completed in order to integrate e-commerce into the med/surg supply chain.

The decision by Ventro in December 2000 to shutter Promedix – its specialty medical products e-procurement site – wasn’t an indictment of business-to-business electronic marketplaces so much as an indictment of B2B marketplaces that weren’t based in existing businesses, Repertoire noted the following month. By becoming leaders in e-commerce, med/surg distributors could strengthen their place in the supply chain. That’s exactly what they did, though it wasn’t a totally smooth journey. By 2004, any web surfer could find bargains on medical scales, blood pressure equipment, even ultrasound equipment. But to call it ‘disintermediation’ would have been way off base. The dot-coms’ niche in medical commerce was pretty narrow, according to manufacturers, distributors and Internet exchange executives who spoke with Repertoire. “The bigger picture, perhaps, is that finally, the Internet is starting to deliver on its promise of improving the information flow among trading partners,” Repertoire wrote. “And that far outweighs any potential threats posed by disintermediation.”

learning more about the account,” Jack Moran, managing partner, MedTech/MedCare, told Repertoire in 2018. “Today, before such meetings, our reps have already invested time in the office to learn about the customer. They’re saying, ‘If I’m going to that meeting, I need to make sure I know more than I have to know.’ That’s very much a new skill, versus just being really good at talking about products and forming relationships. Yes, we need to do all that today. But doing our homework is critical.”

‘ The bigger picture, perhaps, is that finally, the Internet is starting to deliver on its promise of improving the information flow among trading partners. And that far outweighs any potential threats posed by disintermediation.’

December 2023

E-commerce and the sales rep Smart reps took advantage of that improved flow of information. In 2011 Repertoire noted that for the sales rep, four things were most important: relationships, communication, time and information. “Without relationships, there’s no sale. But without communication, time and information, even the strongest relationships suffer. Starting with the personal computer a couple of decades ago, and extending through to smartphones and iPads, sales reps – like society at large – have been the beneficiaries of technology.” “In the past, we would show up at an account with the distributor rep, then spend a lot of time

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Richard Bigham, vice president, primary care market, IMCO, added, “Traditional sales presentations and product demonstrations are being utilized less frequently due to the proliferation of product information available to today’s buyer. These buyers utilize multiple platforms and networks to research potential products and suppliers, resulting in a highly informed consumer and nontraditional sales cycle. Adoption and utilization of social media for communication with their customer base and to provide visibility to potential customers will be a necessary skill set and behavior for these tenured reps.”

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High-Value Care: Moving Target

December 2023

High-value care: It’s what physicians, payers and patients want. But it’s difficult to define and difficult to incentivize, particularly in a healthcare system built on fee-for-service. The healthcare community has been trying to nail this moving target for 30 years.

In September 2004, James Martin, M.D., board chair of the American Academy of Family Practitioners, stated what many others were thinking: Current reimbursement methods were at odds with high-value care. “Payers reimburse only for face-to-face encounters, thus forcing patients to visit their doctor when a phone

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conversation or e-mail might address their problem,” he said. “The front office staff is overworked dealing with insurance issues, government regulations and the like. And by being slow to implement automated systems in their offices, physicians and their staffs are missing opportunities to deliver more efficient, better care.”

intended to tie 85% of all traditional Medicare payments to quality or value by 2016 and 90% by 2018. The feds took a step in that direction by passing the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, in April 2015. MACRA might have been a step in the right direction, but observers said it fell short of its goal. “The main takeaway is that MGMA members view MIPS [Merit-based Incentive Payment System] as a reporting program without a clear link to actual quality improvement,” said Mollie Gelburd, associate director of government affairs, Medical Group Management Association, in 2019.

‘ The readmissions policy is reminding us that no matter what kind of doctor you are, you’re responsible for seeing the big picture.’ Like Medicare, private payers were convinced of the wisdom of ditching fee-for-service reimbursement. In August 2020, UnitedHealth Group released a report showing that primary care physicians who were paid under global capitation – which pays a set amount per month per patient – achieved key quality metrics at higher rates than physicians paid under fee-for-service. Findings include higher screening rates for breast cancer, higher levels of controlled blood sugar levels and higher rates of functional status assessment and medication review. Even so, progress toward value-based care was uneven, with the American Medical Association reporting that 87% percent of physicians said their practice still received payment through fee-for-service. Writing in a December 2021 JAMA Internal Medicine editorial, Niloofar Latifi, M.D., of John Hopkins School of Medicine, pointed out that fee-for-service leads to more care, and that more care often means poorer care and outcomes. “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.” www.repertoiremag.com

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Five years later, in 2009, the American College of Physicians wrote, “Fee-for-service reimbursement has decimated primary care by rewarding doctors who perform procedures, while financially penalizing those who provide more consultations, counseling and long-term health management.” Soon after, nine physician specialty societies published a list of 45 common low-value tests and procedures, that is, tests and procedures that were often unnecessary. The list – part of the “Choosing Wisely” initiative of the American Board of Internal Medicine – offered evidence-based recommendations that physicians and their patients should discuss to help make decisions about the most appropriate care based on the individual situation. (In August 2022, 10 years after it was started, the Choosing Wisely campaign announced it had grown to include lists of low-value services from more than 80 professional societies, citing a total of more than 600 procedures.) “The trend is clearly moving toward outcomes and performance-based care,” said Tom Schwieterman, M.D., director of research and development for Midmark, in February 2010. “Doctors will be increasingly incentivized and paid based on how well they manage their disease management programs.” By February 2012, governmental and private payers were beginning to demand that providers address the total cost of care rather than care delivered just in the acute-care facility, the doctor’s office, the long-term-care facility or the home. In that same year, Medicare pointed to excess readmissions of previously hospitalized patients as a sign of low-value care and announced it would penalize hospitals for readmissions after 30 days of discharge of Medicare patients with pneumonia, heart attack and heart failure. Two years later the agency added elective hip/knee replacement and chronic obstructive pulmonary disease to the list. “The readmissions policy is reminding us that no matter what kind of doctor you are, you’re responsible for seeing the big picture,” that is, the patient’s overall health, not just the condition that caused him or her to be admitted to the hospital, said Tina Shah, MD, MPH, pulmonary and critical care fellow, University of Chicago, and a health policy researcher. In 2015, Health & Human Services Secretary Sylvia Mathews Burwell announced that the agency

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Medical Care ‘On Location’ In the movie industry, to shoot scenes on location means to film away from the studio. If the “studio” in

medicine is the traditional physician’s office, “on location” today might refer to a drugstore, a grocery store, a workplace clinic, even a home. To what extent must medical professionals practice on location to accommodate patients’ calls for convenience and to stay competitive? ... To be continued.

In 2006 and 2007, pundits were predicting that as many as 5,000 retail clinics would dot the country in just a couple of years. That didn’t happen. In 2010, there were only about 1,200 clinics in 38 states. That said, in 2010, such clinics accounted for 12 to 13 million patient visits. And operators of retail clinics looked ahead toward a bright future, one that would find them expanding into chronic disease management and closer partnerships with hospitals and hospital systems.

December 2023

‘ At the very least, [physician practices] must be able to handle appointments in a timely manner. They must understand what they can do to provide a competitive advantage.’ Sure enough, by 2013, there were more than 1,400 MinuteClinics, Take Care clinics, Little Clinics, Clinics at Walmart, and other retail clinics in the United States. Were doctors worried? “I would say they ought to be more aware than concerned,” said Ken Hertz, principal, Medical Group Management Association Health Care Consulting Group. The retail clinic did indeed present competition to the classical practice model, he said. And they addressed walk-ins far more efficiently than the traditional physician office. “At the very least, [physician practices] must be able to handle appointments in a timely manner. They must understand what they can do to provide a competitive advantage.” Steady growth of retail clinics was far from assured, however, as some operators scaled back on their commitment to in-store clinics. In October 2019, for example, Walgreens announced it would

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close all (157) of its company-managed Walgreens Healthcare Clinics but continue to work with its network of local health system operators who owned and operated approximately 220 clinic locations inside Walgreens. (History repeated itself in October 2023, when Walgreens announced it would close 60 underperforming VillageMD clinics.) Retail clinics weren’t the only non-hospital sites encroaching on the traditional healthcare establishment at the turn of the 20th century. By 2014, urgent care centers had grown in numbers, and hospital systems, private equity firms, insurers, doctors and private companies took note. Nearly 10 years later, in August 2023, the Urgent Care Association reported there were over 14,000 urgent care centers in the U.S., with a 7% growth rate for new ones. More than 78% of the U.S. population lived within a 10-minute drive of an urgent care center. And through consolidation, those centers were getting bigger. The 2020s also brought about a new concept in healthcare – home-based primary care. Not to be confused with traditional Visiting-Nurses-style home care, this type of care allows the primary care team to monitor patients in their homes and manage chronic conditions, such as heart and lung disease. Here’s the rationale: Clinics had been built to optimize the productivity of clinicians in a feefor-service healthcare world, wrote one healthcare executive in 2023. But that model was fading, and it didn’t work well for people who were unable to go to a doctor’s office due to age or disability. According to the American Academy of Home Care Medicine, an estimated 2 million frail, seriously ill and vulnerable adults – many with two or more chronic conditions – were unable to visit physicians’ offices. The question was, and remains: Is homebased primary care sustainable in a fee-for-service world, given its demanding systems and logistics requirements? ... Another developing story.

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Stretch Time for Primary Care Advances in diagnostics and medical/surgical therapies have expanded the capabilities of primary care physicians. But so too has a growing awareness of the impact on human health of factors that tra-

ditionally were never considered medical/surgical, such as oral health, mental/behavioral health, public health and even health in extreme temperatures. Med/surg may remain bedrock for Repertoire readers, but physicians might welcome a dialogue with their reps about some of these other factors affecting their patients and their practices.

‘What is the likelihood that that specific cancer will spread or cause significant disease?’ That’s where cancer diagnostics is going today and in the future.”

Opioid use disorder Opioids – once used primarily to relieve pain following surgery or cancer, or at the end of life – were being used widely by 2010 to relieve severe pain caused by chronic low-back injury, accident trauma, arthritis, sickle cell, fibromyalgia and other conditions. With the increase in opioid usage, however, concerns grew about abuse, addiction and diversion. Opioid use disorder continued to grow throughout the decade, putting an enormous burden on primary care, where the majority of opioid prescriptions were written.

Systemic and oral health converge

December 2023

Cancer: A chronic illness By 2010, improvements in diagnostics and treatment had transformed some cancers from death sentences to chronic illnesses, presenting new challenges to primary care doctors as well as specialists. Thanks to molecular diagnostics, clinicians had come to realize that cancer was a heterogeneous disease. “Not all cancers are the same,” said John Blackwood, vice president and general manager of Beckman Coulter’s immunoassay business center. “So the question goes from, ‘Does the patient have cancer?’ to,

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In January 2017, Oakland, California-based Kaiser Permanente opened a pilot integrated medical-dental clinic in Beaverton, Oregon. The clinic, Cedar Hills Dental and Medical Office, made Kaiser Permanente’s Northwest division the first commercial health care organization to integrate medical and dental health records as well as offer coordinated services. In 2018 researchers continued to connect the dots between oral health (particularly periodontal disease) and chronic medical conditions. In October 2018, Dominion National, a dental insurer and administrator of dental and vision benefits, released a study indicating people with chronic health conditions such as asthma, diabetes and heart disease who received preventive dental care covered by insurance had fewer emergency room visits and hospital stays.

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Chronic diseases common and costly Repertoire reported that in 2018, chronic diseases and conditions – such as heart disease, stroke, cancer, type 2 diabetes, chronic obstructive pulmonary disease, obesity and arthritis – were among the most common, costly, and preventable of all health problems. As of 2012, about half of all adults – 117 million people – had one or more chronic health conditions. One in four adults had two or more. Caring for people with diseases that used to be fatal called for physicians to expand their knowledge about treating chronic illness.

and public health professionals started to pay more attention to inequities in medicine. In 2021, the Blue Cross and Blue Shield Association – the national federation of 35 independent and locally operated Blue Cross and Blue Shield companies – launched its National Health Equity Strategy, a multiyear program to focus on four conditions that disproportionately affect communities of color: maternal health, behavioral health, diabetes, and cardiovascular conditions. In its announcement, BCBSA noted the Black men were 70% more likely to die from a stroke as compared to non-Hispanic

The question goes from, ‘Does the patient have cancer?’ to, ‘What is the likelihood that that specific cancer will spread or cause significant disease?’ Behavioral health and the primary care practice In April 2021, as many as 40% of patients seen in primary care settings were reported to have a mental illness, and as many as 70% of primary care visits stemmed from psychosocial issues. At the time, integrating behavioral and physical health was still uncommon among U.S. physician practices. But a year and a half later, 70% of all primary care visits included a behavioral health component, and 118,500 primary care physicians had co-located with nearly 140,000 behavioral health clinicians in 23,000 primary care practices.

December 2023

Public health and primary care: Worlds apart

The COVID pandemic drew attention to the gap between public health and medicine. From the start of the 20th century, medical and public health practitioners had been educated in separate schools and upon graduation, went their separate ways. But by January 2022, almost two years after COVID struck, the two professions came to realize that collaboration was essential, given escalating healthcare costs, ever-widening health disparities, increasing emphasis on preventive health and, of course, outbreaks of infectious disease.

Inequities in health care Propelled by COVID and other societal factors (e.g., Black Lives Matter), researchers, clinicians Repertoire Celebrating 30 Years www.repertoiremag.com

White men; millennials from majority Black and Hispanic communities had lower diagnosis rates of major depression compared to White communities; and African American adults were 60% more likely than non-Hispanic White adults to be diagnosed with diabetes by a physician; and Black mothers had three times higher maternal mortality and two times higher morbidity than White mothers.

Climate: Its impact on emergency and chronic illness Socioeconomic issues aside, the medical community by 2023 was coming to realize another public health threat – climate change. In April 2023, the World Health Organization stated what most people suspected: Global temperatures and the frequency and intensity of heatwaves were only going to rise in the 21st century. Heatwaves could acutely affect large populations for short periods of time, often triggering public health emergencies, excess mortality and cascading socioeconomic impacts. But researchers came to realize that extreme heat has a long-term impact on health as well, causing cumulative physiological stress on the human body and exacerbating respiratory and cardiovascular disease, diabetes and renal disease. Addressing the health implications of extreme temperatures would continue to fall onto hospital emergency departments, public health authorities, community health centers and primary care physicians.

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Medicine Over the Wire

In 2010, telemedicine was no sure thing. “We’re not there today because of the complexities involved,” Jim Woodburn, M.D., vice president and medical director for clinical initiatives at OptumHealth, a UnitedHealth Group company, told Repertoire. But Dr. Woodburn and others would probably agree we are there today.

According to a 2016 annual survey by the National Business Group on Health, nine in 10 large employers said they would make telehealth services available to their employees. By 2018, the American Hospital Association and the National Association of ACOs (Accountable Care Organizations) were among organizations voicing their support for a proposed $100 million program to promote telehealth among low-income families and veterans, with a focus on services and applications delivered directly to patients outside healthcare facilities.

‘ Telemedicine means providing patients with accessible and available technology that complements the important patient-provider relationship.’

Telemedicine advocates caught a break with the 2024 Physician Fee Schedule from Medicare, as several telehealth-related provisions instituted during the COVID Public Health Emergency were extended until Dec. 31, 2024. They included: ` Temporary expansion of the scope of originating sites for services furnished via telehealth to include any site in the United States where the beneficiary is located at the time of the telehealth service, including an individual’s home. ` Expansion of the definition of telehealth practitioners to include qualified occupational therapists, qualified physical therapists, qualified speech-language pathologists and qualified audiologists. ` Continued payment for telehealth services furnished by rural health clinics and Federally Qualified Health Centers. ` A delay in the requirement for an in-person visit with the physician or practitioner within six months prior to initiating mental health telehealth services.

December 2023 40

Telemedicine soared in 2020 due to the pandemic, but usage plateaued afterward. Still, it was clear the technology wasn’t going away. The medical community pondered the details: What role would telemedicine play in urgent care and chronic care management? Would it lead to fewer in-person visits? Would it change the type – and number – of services offered in the clinic? “We don’t pretend to read all the tea leaves, but we believe the right ecosystem is a hybrid model,” that is, a combination of face-to-face and virtual visits, said David Houghton, M.D., MPH, the head of Ochsner Health’s telemedicine and digital health initiatives in New Orleans. “That means providing the level of care that is appropriate every time and providing patients with accessible and available technology that complements the important patient-provider relationship.”

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