REP DEC 19

vol.27 no.12 • December 2019

repertoiremag.com

Manufacturer Reps to Watch

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

IMMUNOASSAY SYSTEM

MOLECULAR POINT-OF-CARE

POINT-OF-CARE READER

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

DECEMBER 2019 • VOLUME 27 • ISSUE 12

Manufacturer Reps to Watch

16 Trends

Will Wearables Affect Sales of Diagnostic Equipment?

38

At the very least, sales reps should be prepared for changes in the way physicians use traditional diagnostics.

Dr. Tom Schwieterman

PUBLISHER’S LETTER Investing in You................................. 4

PHYSICIAN OFFICE LAB Trust Your Gut The future for non-invasive breath-based tests..................................... 6

Additional Safeguards Sell waived molecular tests?

Your customers face some changes in April......................................10

IDN OPPORTUNITIES Contracting Executive Profile Jocelyn Bradshaw, Senior Vice President, Strategic SourcingHealthTrust, Nashville, Tennessee...............................14

Post-Acute

Respiratory Care PDPM implications for post-acute providers

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

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

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

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DECEMBER 2019 • VOLUME 27 • ISSUE 12

TRENDS From ‘Kickback’ to ‘Value-based Arrangement?’

Proposed rules from HHS could change what’s accepted and what’s not in today’s expanding continuum of care......42

HIDA’s Streamlining Expo & Business Exchange: Where the Industry Meets

The Needlestick Safety Discussion

51

The truth about sharps injuries?

They still happen....................................52

QUICK BYTES Technology News...........................62

INDUSTRY NEWS Oral medication for type 2 diabetes approved .......................66 News ........................................................68

Healthy Reps

Health news and notes

58

Windshield Time

Automotiverelated News

64

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OUR $1 BILLION COMMITMENT TO HELPING END AMERICA’S IV FLUID SHORTAGES At B. Braun, we’re investing over $1 billion to help ensure the shortages of the past several years are really a thing of the past. Introducing Solutions for Life—our long-term commitment to help end America’s IV fluid shortages. With two modern IV fluid production facilities here in the U.S., and FDA-approved IV solutions manufactured in Europe, we’re creating sustainable IV solutions for the American healthcare system.

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See our story at BBraunUSA.com/SolutionsforLife ©2019 B. Braun Medical Inc. Bethlehem PA. All rights reserved.

PUBLISHER’S LETTER

Investing in You It’s hard to believe 2019 is in the books. For those of us here at Repertoire, it’s been a

great year for the magazine as well as for the launching of the Road Warriors podcast.

As I look back on the year we were blessed with tons of great content as well as the support of the manufacturing community continuing to invest in the magazine – and more importantly – investing in you. As you flip through this issue and read about the manufacturer reps to watch, take note of these companies, as well as each of the manufacturers that advertise in Repertoire. These are the manufacturers that support you and distribution.

It’s one thing to have manufacturers say they support distribution; it is a completely different thing when they invest dollars in you and your business by advertising and educating you on their products and services in Repertoire. This is truly them putting their money where their mouth is! As you start out 2020, please remember these manufacturers when you are in front of your clients.

A few things to look for next year: We will continue to have the lab column, and plan to add a sales column every other month. We’re also gearing up to do another series of Road Warriors podcasts and few other topical podcasts to help you bring valuable content to your customers.

The most exciting thing is that in early 2020, we’ll be launching a new website for physician office managers. The goal of PhysicianOfficeToday.com is to be a resource for you and your practices, with a med/surg content focus. The site will host manufacturer listings with literature and sales material, physician office set-up guides, CPT codes, and other tools to support running a practice. It will be filled with content to help your practices deliver excellent care to their patients and stay informed on things like MACRA, flu, PAMA, etc.

We hope you will support the site and let us know anything you think we need to add to it.

Scott Adams

Happy New Year, R. Scott Adams Publisher

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

editorial staff editor

Mark Thill

vice president of sales

Katie Educate

keducate@sharemovingmedia.com (800) 536.5312 x5271

mthill@sharemovingmedia.com managing editor

Graham Garrison ggarrison@sharemovingmedia.com

sales executive - East

Lizette Anthonijs

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editor-in-chief, Dail-eNews

Alan Cherry acherry@sharemovingmedia.com art director

Brent Cashman bcashman@sharemovingmedia.com

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sales executive - West

Amy Cochran

acochran@sharemovingmedia.com (800) 536.5312 x5279

publisher

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

Brian Taylor

Subscriptions

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

btaylor@ sharemovingmedia.com

Joan Eliasek: McKesson Medical-Surgical

circulation

Doug Harper: NDC Homecare

Ty Ford: Henry Schein

Laura Gantert

Mark Kline: NDC

lgantert@ sharemovingmedia.com

Bob Ortiz: Medline Keith Boivin: IMCO Home Care

Quality Products for your Outpatient Care Settings The Top Cardiology Health systems rely on GE Healthcare SHOULDN’T YOU? MedPro Associates and GE Healthcare bring you reputable products to your outpatient care settings, including: > Diagnostic Cardiology

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PHYSICIAN OFFICE LAB

Trust Your Gut

By Jim Poggi

The future for non-invasive breath-based tests

A decade ago, there was not much to talk about when

it came to breath tests. On the lab side, alcohol breath tests were by far the most widely known and used breath test. Recently, H. pylori breath tests for diagnosis of peptic ulcer joined the small list of lab breath tests. On the nonlab diagnostic front, spirometry was widely used. Both alcohol and spirometry tests found their way into our primary care, ER, urgent care and other markets. They are well understood and accepted by both the distribution community and the clinicians we serve, but hardly represent a large product portfolio or clinical or revenue opportunity with our customers.

However, due to a variety of factors, including new non-invasive measurement technology and a better

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understanding of gastrointestinal bacteria (GI microbiota), the list of new and soon-to-be launched noninvasive tests using the breath as a sample are coming to market. In this article I intend to share information on some of these new and emerging breath-based tests.

Will all be applicable to our primary care customers? No. At the same time, some of the tests are still somewhat controversial, and clinical opinion is divided upon just how useful they are. So, there is some uncertainty about where these developments will lead us.

One thing I am confident of: non-invasive breath testing is coming to our market. Each test will be judged on clinical utility, workflow efficiency and potential economic benefits.

There are three classes of new non-invasive breath based diagnostic methods entering the market: • Gastrointestinal health assessment • General health and cancer markers • Gas exchange/pulmonary function tests

Gastrointestinal health assessment H. pylori testing led the charge and has been well accepted as an alternative to stool tests to detect active H. pylori infection in the GI tract. It’s used to help diagnose peptic ulcer as well as to determine whether H. pylori has been effectively eliminated from the GI tract following antibiotic therapy. Other hydrogen breath tests measure lactose and fructose intolerance to help understand whether intolerance for either of these is the cause of diarrhea, nausea, vomiting or other relatively common chronic GI disturbances. Effective use of these tests can lead to dietary modifications to improve GI and overall health. While these tests are typically not done in primary care settings, they are well-established tests and improve patient care. They have potential to move into the primary care market since there is a substantial need for better diagnosis of general GI distress complaints, and public awareness is high with a range of prebiotic and probiotic nutritional supplements claiming relief of GI symptoms.

Another hydrogen breath test targeted to diagnose a cause of GI disease and discomfort is known as Small Intestinal Bacterial Overgrowth (SIBO). This test is also typically hospital based and intended to determine whether the relative amount of small intestine bacteria is normal or excessive. If determined to be excessive, the patient is put onto antibiotic therapy to remedy the bacterial overgrowth. The key consideration in this therapy is to avoid lowering the normal intestinal microbiota too much and create an invitation for C. difficile. For this reason, I don’t expect this technique to migrate out of the hospital and gastroenterology specialty market.

General health and cancer markers There is emerging evidence that certain cancers can be detected by measuring volatile organic compounds (VOC) in breath. The principle is that certain VOC expression patterns in breath are normal and others may indicate cancer or other diseases. Further, there is evidence that different cancers have different VOC expression patterns.

While research is early, it looks promising and I expect we will learn more in short order as clinical testing proceeds.

Ketone (acetone) measurements have been around in urine and serum for many years. They are used to help assess whether a person is in a state of ketosis, which is associated with the ability to selectively burn fat preferentially to carbohydrates. Ketosis is different from the dangerous condition of ketoacidosis, associated with excessive concentrations of glucose for long periods of time. Ketosis measurements are commonly used by bariatric physicians and even some home fitness users and others on diets to manage their diet to lose weight as part of an overall health program.

New breath-based products are coming to market to provide an accurate, easy-to-use system to assess nutritional status. I expect breath measurements of ketones to migrate into wellness centers and bariatric patient care practices. The test is fast, simple, accurate and helps the patient to understand their nutritional status to actively manage their weight loss program.

Gas exchange/pulmonary function tests Traditionally, acute respiratory conditions have been diagnosed in emergency rooms with arterial blood gas (ABG) and electrolyte measurements to understand the patient’s respiratory status. While effective and offering a wide range of testing parameters including O2, CO2, pH and others, ABG has its challenges. It is particularly invasive, requires high skill in acquiring a good arterial blood sample and can take at least 15-30 minutes for a result. In acute respiratory distress, time is the enemy. It also carries some risk of infection due to its invasive nature.

Recent advances in technology have resulted in new breath-based measurements of most of the same parameters offered by ABG, but non-invasively and in under two minutes. This technology can potentially expand the usefulness of respiratory testing beyond the ER into presurgical patient assessment, and other clinical areas. It is just entering the hospital market and offers an interesting option to respiratory assessment in the hospital. Future in primary care? Maybe for smoking cessation clinics and management of chronic respiratory conditions.

The future for non-invasive breath-based tests is just beginning to become clear. What’s it going to take for new tests to emerge? A few factors come to mind. A better understanding of the GI tract and role of microbiota in health and disease. A deeper understanding of which substances can be reliably assessed in breath samples and development of clinical proof for new technologies. Trust your gut; it knows more than it’s telling. But we are learning more each day.

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December 2019

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PHYSICIAN OFFICE LAB

Additional Safeguards Sell waived molecular tests? Your customers face some changes in April.

Editor’s note: Bobbi Pritt, MD, chair of the College of American Pathologists (CAP) microbiology committee, answered Repertoire’s questions about upcoming changes for CAP-accredited laboratories, coming up in April.

CAP-accredited medical laboratories that perform

waived molecular will be expected to conform to four additional safeguards effective April 2020: 1. Establish written procedures to monitor for the presence of false-positive results.

2. Establish written procedures to prevent specimen loss, alteration, or contamination during collection, transport, processing, and storage.

3. Establish written policies for safely handling and processing samples from patients with suspected infection due to avian influenza, SARS, Ebola, or similar emerging pathogens.

4. Lab report should include a summary of the test method and information regarding clinical interpretation, if appropriate Approximately 15,500 labs in the U.S. are accredited by a CMS-approved accreditation organization. Of those, CAP accredits about 6,300. (Statistics current as of April 2019.)

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Bobbi Pritt, M.D., MSc, DTM&H, chair of the CAP Microbiology Committee and professor, Mayo Clinic Alix School of Medicine, responded to questions from Repertoire about the changes and how physician offices can comply.

Repertoire: When are labs expected to comply with these new requirements?

Bobbi Pritt: Labs that are inspected around April 2020 will be the first to be inspected with the 2019 edition of the checklist. The CAP makes it checklists available electronically to CAP-accredited laboratories so that they can start working on coming into new compliance with new or revised requirements immediately after they are published. However, they will not be evaluated for compliance with the new requirements until their next onsite inspection with the new checklist edition. Laboratories have on-site inspections every two years, with an interim self-inspection every other year.

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PHYSICIAN OFFICE LAB Repertoire: How binding are the CAP checklists and the Laboratory Accreditation Program?

Dr. Pritt: The CAP’s Laboratory Accreditation Program has deeming authority with the Centers for Medicare and Medicaid Services (CMS) as an approved accrediting organization. So, if a laboratory is using the CAP as its accreditor for CLIA compliance, its CAP accreditation is very important.

Laboratories that are accredited by CAP are expected to comply with all the checklist requirements. They are not optional. Laboratories are required to demonstrate compliance with all phase I and phase II checklist requirements. If a laboratory is found to be out of compliance during an onsite Having a false inspection, it will be cited with positive result a deficiency and is required to could lead to submit documentation of corunnecessary rective action within 30 days treatment and after the inspection. A laboraa failure to test tory’s accreditation decision is for the true cause of the dependent on correction of all patient’s illness. deficiencies. This includes the four new requirements.

Repertoire: The first new checklist requirement – POC.08675 Quality Monitoring Statistics – calls for written procedures to monitor for the presence of false-positive results (owing to nucleic acid contamination, for example) for all molecular microbiology tests. Is this a departure from today’s standard practice? If so, how?

Dr. Pritt: Yes, this will be a new process for many labs performing only waived testing. However, it is important for all settings that are using new molecular amplification tests, even if they have a CLIA waived status, since DNA contamination is a real risk and can result in false positive patient results. Having a false positive result could lead to unnecessary treatment and a failure to test for the true cause of the patient’s illness. The benefit of monitoring for falsepositive results is that laboratories can have an additional layer of assurance that their test results are accurate and that they are providing the best results possible for their patient.

Repertoire: The second new checklist requirement – POC.08690 Specimen Handling Procedures – calls for written procedures to prevent specimen loss, alteration, or contamination during collection, transport, processing, and storage. Is this a departure

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from current practice? If so, how? And who would be responsible for this?

Dr. Pritt: This may be a new process for some settings where these types of procedures were not previously in place. However, having procedures for specimen handling is a widely acknowledged best practice and something that all settings that perform patient specimen testing should adhere to. The medical director of the testing facility would be responsible for ensuring that the components of this new checklist requirement are met.

Repertoire: The third new checklist requirement – POC.08715 Safe Specimen Handling/Processing – says there must be written policies for safe handling and processing samples from patients with suspected infection due to avian influenza, SARS, Ebola, or similar emerging pathogens. Is this a departure from current practice? If so, how?

Dr. Pritt: Yes, this is also a new practice that many laboratories may not have previously implemented. Many healthcare facilities that provide waived, point-of-care testing may not consider that they could be the first ones to encounter patients infected with high-consequence infectious diseases. Therefore, this new checklist requirement will help to raise awareness and ensure that these settings are prepared. Not all labs may currently follow this practice, but it is widely recognized as best practice.

Repertoire: The fourth new checklist requirement – POC.08730 Final Report – calls for the report to include a summary of the test method and information regarding clinical interpretation, if appropriate.

What is the rationale for this requirement?

Dr. Pritt: Now that we are starting to get into multiple testing options – antigen tests, PCR tests – it’s important to include the method in the name or description of the test on the report, so that clinicians reading the report can use this information to interpret the significance of the result.

For example, if a patient was tested by a less sensitive influenza antigen detection method, then it may not be safe to rule out influenza in that patient.

To learn more about the history and rationale for the new checklist requirements, read “New requirements for molecular micro testing,” September 2019 CAP Today, at www.captodayonline.com/new-requirements-for-molecular-micro-waived-testing/

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IDN OPPORTUNITIES

Contracting Executive Profile Jocelyn Bradshaw, Senior Vice President, Strategic SourcingHealthTrust, Nashville, Tennessee

Comments from nominator Michael Berryhill, COO of HealthTrust: Jocelyn Bradshaw leads the sourcing teams responsible for negotiating contracts across the entire care continuum, which includes nursing, surgery, lab, radiology, pharmacy and capital equipment, as well as the HealthTrust global sourcing team in Shanghai, China. She oversees the HealthTrust Supply Chain Board and clinical advisory boards, and directs the supplier diversity program and environmental sustainability efforts.

Jocelyn has held executive level roles in the GPO marketplace for 15 years. As a leader of negotiators, she is a great role model, demonstrating skills at setting strategic direction for the core GPO portfolio.

Her unflappable demeanor creates a steadfast presence that suppliers and providers have come to rely on through many challenging situations. She is a popular mentor in the HealthTrust Leadership Development Program, which is a critical component of the company’s talent management and succession planning strategy. Her work ethic, intelligence, professionalism and focus on the patient are key attributes to our success. We at HealthTrust could not be more pleased to have her as part of the Senior Leadership Team.

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Jocelyn Bradshaw

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HealthTrust at a glance: HealthTrust provides group purchasing, consulting and clinical integration assistance to more than 1,500 hospitals and 3,200 non-hospital sites.

Year joined HealthTrust: 2013 Born/raised: Born in Amarillo, Texas; raised in Fort Worth area.

Degree(s): Bachelors of Science in Information Systems, University of Texas, Arlington First “real job out of school: Started working for Johnson & Johnson in a vocational education program during my junior/senior years of high school. After graduating high school, I continued my employment at J&J, total of about 10 years.

Some prior work highlights: 1. My time at J&J was invaluable. Having the opportunity at a young age to work in a Fortune 100 company provided me many learning opportunities that I otherwise may not have experienced, or at least certainly not as quickly.

Being young, I really did not know what I truly wanted to do in my career. The team at J&J helped me explore various business roles (IT,

finance, marketing, sales administration, contracting). It was here that I developed a passion for working in healthcare.

2. The division of J&J I worked for ended up closing, and I took a position outside healthcare (LSG Sky Chefs/Lufthansa). I quickly realized I wanted to remain in healthcare and fortunately had the opportunity to take a position at Broadlane. I spent 8+ years at Broadlane. Again, a phenomenal team of people that allowed me a great opportunity to continue to grow/develop/learn.

A key mentor or event in your life: I have had the pleasure of working for/with some great bosses and leaders during my career. While I could certainly highlight a number of individuals who played a key role in my development, the individual who played the strongest role in setting my character and values is my father. My father did not have the opportunity for higher education and spent his working life trying very hard to take care of our family.

My father believed that every job mattered and was worth doing well – big or small. He had a strong work ethic, never gave up, and always tried to be honest and strive to do what is right. I have tried to emulate those attributes as much as possible throughout my life.

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Manufacturer Reps to Watch

Success in sales – theoretically – isn’t hard to figure out: Work. Work

hard. Do the right things.

But it’s in the “doing” that things get tough: Meeting aggressive sales goals. Dealing with competitors. Balancing work with the exigencies of your personal life.

Selling isn’t easy. But three things can help: Sharing with and learning from others in the field.

Humor. Getting over yourself.

You’ll find plenty of all three in this year’s “Manufacturer Reps to Watch” feature. Ride along with these reps and see if their thoughts and stories don’t sound a lot like yours.

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Manufacturer

Reps to Watch

Lisa Hoglund Territory Account Manager Quidel Riverview, Florida 30+ years in medical sales Primary call point: Hospital and physician office lab

Snapshot • Born/raised: Born in Lansing, Michigan (a Spartan baby – MSU), grew up in Portage, Michigan.

• Undergraduate degree: BS in business marketing from University of South Florida • First “real” job: Physician Sales & Service (now McKesson Medical-Surgical) • Complete this sentence: The one thing I did NOT expect

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when I got into medical sales was/is: To build so many lifetime relationships.

•F amily info: Married to an amazing husband for five years; three beautiful children, ages 20, 23 and 24.

Truly blessed. Although I am 39 and holding …

•H obbies/activities: Boating, traveling, spending time with family and friends.

Repertoire: When, how and why did you get into medical sales?

Lisa Hoglund: In my senior year at USF, I attended a job fair in which PSS had a booth to recruit new candidates.

Intrigued with the company, I circled back to the booth several times to learn more about the role, responsibilities and expectations. I was determined to get an interview and obtain an offer. My interest in medical sales stemmed from the years I worked for my father, a veterinarian, through high school and college. I had the opportunity to meet and speak with several sales consultants who shared their experience and knowledge of the business.

Repertoire: Mentor or role model?

Hoglund: This is a difficult question to answer, as I have had the good fortune to work with so many amazing people over the years who have impacted my life in a positive way.

However, I do want to acknowledge one particular individual, Ed Read (aka Mr. Ed), who early in my career taught me the importance of discipline, organization, the power of knowledge and follow-up. He provided me the foundation that I still to this day embrace and practice in my career and personal life.

Repertoire: What are the 2-3 most important things you can do for distributor reps to enhance their sales?

Hoglund: Be of value in educating on products and on how to best position to the end user, then strategize and prospect to earn new

business. Always be responsive in a timely manner, and provide support in any way I can to achieve the goals of the partnership.

Repertoire: How can distributor reps help in your sales efforts?

Hoglund: Embrace the opportunity to work together in targeting accounts to grow and win new business. Share in customer-facing to identify the

Hoglund: I absolutely love ridedays with reps. It’s the No. 1 reason why I do this job. Gives us both the chance to have real time in front of the customer, talk about products and sell! There is no opportunity too big or too small. It’s all relevant in growing business. The relationships and friendships that I have grown over the years with distributor reps are priceless.

“ Having FUN is the key in loving what you do.” gaps which we can fill with products and solutions to offer quality care for their patients.

Repertoire: What is the biggest change you anticipate in medical products sales in the next 5 years?

Hoglund: We will continue to see consolidation of both the end user customer and the medical companies who sell into this market segment. It will be more important than ever to have relationships with key decisionmakers and gain the knowledge of how best to partner in achieving the goals of both parties.

Repertoire: Care to share a memorable ride-day story?

Hoglund: I have had so many memorable ride-days over the years, it’s difficult to single out one particular day. Having a plan for the day is ideal.

Of course, closing new business on those days makes it all worthwhile, but having FUN in doing so is the key in loving what you do.

Repertoire: Ride-days with distributor reps: What’s to like? What’s not to like?

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Manufacturer

Reps to Watch

David Hughes Sales Executive MTMC Fishers, Indiana (Nominated by Nuance Medical) 14 years in medical sales Primary call point: Physician/clinic

Snapshot •B orn/raised: Lake Forest, California •U ndergraduate degree: Business administration, California State University, Chico •F irst “real” job: Bellman in Laguna Beach, California. “I got to meet new people, work in a beautiful place and make pretty good tips.”

• Family info: Married to Cristina (born and raised in Caracas, Venezuela). Three children: Robert, Elena and Henry.

•H obbies/activities: Hooked on golf, but enjoys most things outdoors, e.g. surfing, mountain biking, hiking, yard work. Likes the Indianapolis Colts, as well as exploring new places and spending time with family and friends.

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Repertoire: When, how and why did you get into medical sales?

Dave Hughes: I grew up with my dad [Tom Hughes] working from home. As I listened to him speak with his customers, I believed his sales career enhanced his enthusiasm for people and life in general. He and

Bill Sparks (founder of MedTech Associates, which later merged with MedCare to become MTMC) had become colleagues and friends during their Welch Allyn days in the 1970s.

When I graduated from college in 2005, two older brothers – Mark and Brian – were already MTMC

reps. Bill offered me the Indiana territory and the opportunity to follow in a Hughes family tradition of serving people and carving out my own career.

Repertoire: Mentor or role model?

Hughes: Chris Ashbaugh helped me launch a successful career from the start. We worked together every day for four months, strategizing about product benefits, our dealer network, end users, how to continually add value to customers. He is creative, professional, personable and hardworking – all with humor and fun.

Assuming responsibility for a strong territory representing companies like Welch Allyn, GE, ZOLL, etc., could easily have been intimidating for a naïve 23-year-old California transplant. Chris’s tutelage and confidence in me paved my path to success – plan my work, work hard, follow through, and enjoy life. I still operate today from Chris’s roadmap.

Repertoire: What are the 2-3 most important things you can do for distributor reps to enhance their sales?

Hughes: First, be responsive. Time is money! Communication is critical! I respect my distributor reps’ time; the quicker I am in helping them, the more efficient they can be. Fast follow-through builds trust with customers and keeps everyone in the loop.

Second, own the lead. When a lead comes in, see the deal all the way through from start to finish. That includes knowing the product’s features, advantages and benefits. Is it a good fit with the customer’s needs?

What other products might augment the sale? What other services might cement a long-term relationship?

Third, be a product expert and a consultant. When customers have one point of contact for many different products, they save time researching products and pricing.

When they know that you care about them, they’ll rely on YOU. Repertoire: How can distributor reps help in your sales efforts?

Hughes: Distributor reps are “feeton-the-street.” Invaluable! They know

nothing and no one for granted. Personalization and end-user relationships will be paramount.

Repertoire: Ride-days with distributor reps: What’s to like? What’s not to like?

Hughes: The best ride-days offer the opportunity for two people to get to know each other in a relaxed setting – time to build a friendship, establish trust and mutual goals. However, if the ride-day lacks thoughtful planning, it’s ineffective and wastes everyone’s valuable time and expertise.

“ Everyone bought something from us that day.” key players and decision-makers, pain points and needs – and the power of relationships. The more they share customer profiles, the more I can funnel product knowledge and services that will prove mutually beneficial.

Repertoire: What is the biggest change you anticipate in medical products sales in the next 5 years?

Hughes: Healthcare consolidation will continue. As customers become more efficient, product standardization will become the norm. Take

Repertoire: Care to share a memorable ride-day story?

Hughes: Probably the day I rode with Todd Van Duyn (Henry Schein rep at the time, now my MTMC counterpart). I’ve never had a rideday where a distributor rep had so many leads and opportunities lined up. We rode together in Richmond, Indiana. He knew his accounts, anticipated their needs, and his customers valued that he came prepared!

Every customer bought something from us that day.

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Reps to Watch expertise of the B. Braun portfolio to the end user specific to their individual facility needs, so they can reach whatever their goals might be. Things move fast in the outpatient market, so it is critical for me to respond and be available when distributors need answers or recommendations for our shared customers. The overall collaboration between manufacturer and distributor is key to providing a winwin-win scenario so we can get the end user to where they want.

Brantley Jordan Ambulatory Care Specialist B. Braun Medical Austin, Texas 10+ years in medical sales Primary call point: Surgery center, surgical hospital, oncology/hematology, pain management, stand-alone ER

“ Things move fast in the outpatient market, so it is critical for me to respond and be available when distributors need answers or recommendations for our shared customers.”

Snapshot •B orn/raised: Austin, Texas •U ndergraduate degree: BS from The University of Texas at Austin •F irst “real” job: Worked at a carwash the summer after I turned 16 •F amily info: My wife, Erin, and I live in Austin with our two boys – Landon and Gavin.

• Hobbies/activities: Spending time with family and all things outdoors/active and fun

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Repertoire: When, how and why did you get into medical sales?

Brantley Jordan: I started in medical sales in May 2009 with Walgreens Option Care. I sold DME, respiratory therapy and infusion therapy to hospitals, physician offices and post acute care.

Repertoire: What are the 2-3 most important things you can do for distributor reps to enhance their sales?

Jordan: Our distributor partners are responsible for many accounts across every product line within these facilities. My job is to provide the clinical

Repertoire: What is the biggest change you anticipate in medical products sales in the next 5 years?

Jordan: The biggest change I foresee is the shift of procedures from the hospital setting to the outpatient market space. With all of the changes in our healthcare systems, there is a large focus on decreasing financial costs and increasing patient outcomes/satisfaction. The goal is to keep patients out of the hospital if possible, and this is where all facets of the outpatient world come into play.

Repertoire: Ride-days with distributor reps: What’s to like?

What’s not to like?

Jordan: I really enjoy ride-days with my distributor reps. It is great to be able to spend time with each one of them on a personal level while also getting in front of strategic customers to uncover new opportunities. We are also able to get in front of key decision-makers at each account to share our individual expertise and provide an actionable value-add solution.

for distributor reps to enhance their sales?

Kost: 1) Be accessible via email or phone in order to answer any questions, and 2) make it as easy as possible for distributor sales reps to have the tools needed to detail our products.

Timothy Kost National Account Director – Healthcare, Non-Acute GOJO Industries Tampa, Florida 31 years in medical sales Primary call point: Post-acute

Snapshot • Born/raised: Middletown, Ohio • Undergraduate degree: Nursing degree from the University of South Carolina • First “real” job: Registered nurse (six years in shock trauma ICU at Medical College of Georgia) • Complete this sentence: The one thing I did NOT expect when I got into medical sales was/is: The number of conference calls that can be scheduled that are not relevant to actual sales!

• Family info: Married to my incredible wife, Michelle, for 14 years. We live in Tampa with our toy poodle Zoey. My mother, Bea, celebrated her 100th birthday in September and lives a few miles away in independent living with her dog, Annie.

• Hobbies/activities: Golf; the Gamecocks; and volunteering the past 23 years at the Masters as a gallery supervisor.

Repertoire: How can distributor reps help in your sales efforts?

Kost: They are calling on end users every day and create the demand locally. Allows me to work more effectively with the GPOs and long-termcare chains by having representation in the field.

Repertoire: When, how and why did you get into medical sales?

Tim Kost: I was on the product evaluation committee at Medical College of Georgia in Augusta, evaluating the latest products and technology.

I had sales reps who couldn’t relate product to patient care. I thought I could do a little bit better!

Repertoire: Mentor or role model?

Kost: Greg Conner, vice president of sales, healthcare, GOJO, has continually offered his assistance and insights into sales strategies, techniques and enhancing my market knowledge. Throughout my 12 years with GOJO, he has always been willing to roll up his sleeves and work in the trenches and collaborate to meet the needs of our customers and distributors. I consider Greg a mentor, role model and friend.

Repertoire: What are the 2-3 most important things you can do

Repertoire: What is the biggest change you anticipate in medical products sales in the next 5 years?

Kost: The ongoing changes in reimbursement and influence of the GPOs will impact how and what we sell.

Repertoire: Ride-days with distributor reps: What’s to like?

What’s not to like?

Kost: It’s good to get to know and meet the individual rather than all communication via email and phone.

You also see how they work and what you can do to make it easier for them.

Repertoire: Care to share a memorable ride-day story?

Kost: A customer 90 miles away needed emergency product. I fired up the company van and headed down I-75 S. Hit a bump and back end of van dropped. That’s when I noticed the back left tire and part of the axle rolling past me! That was the last time I drove a company delivery vehicle!

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Reps to Watch

Taylor Hughes Lusted Senior Account Manager Sekisui Diagnostics Atlanta, Georgia 8 years in medical sales Primary call point: Physician office

Snapshot •B orn/raised: Tampa, Florida/ Atlanta, Georgia •U ndergraduate degree: Degree in sports management and minor in marketing, University of West Georgia.

(Go Wolves!)

•F irst “real” job: There is nothing more “real” than waiting tables. I did so in high school and college, and it was one of the best preparations for a sales career. It teaches you to: • Build rapport with a variety of customer personalities.

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• Prioritize when multi-tasking.

• Pay attention to detail.

• Anticipate the needs of the customer and provide good customer service.

• Improve your problemsolving skills in highpressure situations.

•C omplete this sentence: The one thing I did NOT expect when I got into medical sales was/is: To love my career as much as I do.

• Family info: I have a wonderful husband – CJ – who

I married last March. He played baseball in college and is in real estate.

We have three dogs (Lola, Zeus and Ziggy Stardust), a cat (Puss N Boots) and two chickens (Sookie and Albert Einstein). As you can tell, I don’t like animals.

• Hobbies/activities: Spending quality time with my family and friends.

I am a huge movie buff, and I love kickboxing, the outdoors and kayaking.

Repertoire: When, how and why did you get into medical sales?

Taylor Hughes Lusted: Growing up, I was always told I should be in sales. Having both parents with sales backgrounds had an impact as well.

Repertoire: Mentor or role model?

Lusted: My role model is my dad, Mike Hughes. He has been in the industry and worked for Midmark Corporation for 32 years. Aside from the impact he has had in my personal life, he is a great inspiration. Growing up, dinner table conversations would sometimes be business situations and how to handle them. Ha! Repertoire: What are the 2-3 most important things you can do for distributor reps to enhance their sales?

Lusted: 1) Provide clear targets for products. (They only have thousands to sell.) 2) Always answer your phone, text, or email. Respond in a reasonable amount of time. Communication is key! 3) Be the expert on your product portfolio Repertoire: How can distributor reps help in your sales efforts?

Lusted: I started my medical sales career as a distributor rep, so I understand clearly what they go through on a day-to-day basis. This in turn helps me in my own sales efforts.

The most helpful thing is identifying a qualified target and helping me gain access to the decision-maker.

Repertoire: What is the biggest change you anticipate in medical

products sales in the next 5 years?

Lusted: There will be a continued emphasis on improving patient care and the patient experience. With patient outcomes on the front line, offices need to focus on utilizing EMR and technology to streamline and help with patient outcomes.

Health system consolidation has been prevalent for a while now and will continue to evolve.

Molecular flu is the way of the future; the test is more sensitive and specific, and reimbursements are

working with my colleagues. I love being in front of the end user and getting to know the reps on a more personal level. What is not to like?

Coffee breath.

Repertoire: Care to share a memorable ride-day story?

Lusted: When I have a day scheduled with a distributor rep, I really look forward to it. The most memorable experience for me has to be the ride-days in The Villages in Florida.

“I love being in front of the end user and getting to know the reps on a more personal level.” great. Hospital systems want to keep patients out of the ER and fatalities low with the flu epidemics we have been experiencing. As a society we are becoming more impatient, so point-of-care testing is imperative in a physician office setting.

Repertoire: Ride-days with distributor reps: What’s to like?

What’s not to like?

Lusted: I schedule 3-4 ride-days a week with my partners. You can gain access to the decision-maker easier this way, and I genuinely enjoy

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Reps to Watch

Rich Pilla Channel Sales Specialist Roche Diagnostics – Point of Care Long Island City, New York 4.5 years in medical sales Primary call point: Physician/clinic, post-acute

Snapshot • Born/raised: Worcester, Massachusetts/Milford, Massachusetts • Undergraduate degree: BS in business management, Bentley University • First “real” job: Beyond stocking shelves at the local market in my hometown as a 15-year-old kid and then tending bar to pay my way through college, my first “real 9-to-5 job” was for Olde Discount Stockbrokers, selling municipal bonds while studying for the Series 7 exam to sell stocks. I did not love the role, but it instilled in me a solid “hunter mentality” and strong work ethic. It taught me to be humble and put in extra time, and hammered home that the “numbers game” aspect of sales was not something to be taken lightly. Every “No” did indeed bring me closer to a “Yes,” while making our

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required 300+ cold-call dials a day before we could even think about leaving.

• Complete this sentence: The one thing I did not expect when I got into medical sales was/is: What seems to be a lot of turnover. I have come across many people in my short period of time in the industry who not only have had multiple roles, but who have gone to multiple companies – sometimes three or four – in what seems to be a short stretch.

• Family info: I just got married at the end of September and was blessed to get away to the Greek Islands with my wife for our honeymoon.

• Hobbies/activities: I love to spend time with family/ friends, am a big football fan, and absolutely love to golf.

Repertoire: When, how and why did you get into medical sales?

Rich Pilla: I’ve always wanted to help people, and working in this field is genuinely rewarding on so many levels, knowing you are trying every day to make a difference in a family’s life by providing top-quality diagnostic testing, which in turn can be a life-changer. I love being on the cutting edge of technology, as manufacturers like Roche are constantly investing in research and development.

Repertoire: Mentor or role model?

Pilla: Dean Greg Hall, the chair of the Social Sciences department at Bentley University, helped me understand to “inspect what you expect,” and also the importance of developing strong/lasting relationships in life. He also helped me become a more strategic thinker, i.e., playing “more chess and less checkers,” so to speak. I had a tendency to see a problem and want to solve it immediately in one step, when in fact there are often many smaller strategic steps that need to happen in order to properly (and safely) accomplish the goal/task at hand.

Repertoire: What are the 2-3 most important things you can do for distributor reps to enhance their sales?

Pilla: First, as simple as it sounds, earn their trust by working hard for them. My mentality is not to be constantly asking for favors, (e.g., “I need you to bring me into this or that account.”). I strive to constantly give them a reason to want to work with me, by pounding the pavement and getting to know the territory. Hopefully I’ve earned their trust trying to find mutually beneficial wins for us and their accounts, hence enhancing their sales along the way.

Second, get to know them, and not only in the sense of work. Take pride in the relationship. Treat them the way you want to be treated.

And third, be reliable and get back to them ASAP – all the time.

Their time is valuable, and they have a ton going on. My mentality is, if

they are taking the time to reach out to me, it must be important, so get them what they need fast.

Repertoire: How can distributor reps help in your sales efforts?

Pilla: A good relationship between distributor and manufacturer is a partnership built on earned trust.

Distributors help all my sales efforts – from introductions to key people in accounts, to working together on deal strategy.

more capable of getting real-time results at the point of care.

Repertoire: Ride-days with distributor reps: What’s to like?

What’s not to like?

Pilla: I’ve always enjoyed spending time with reps. It’s another chance to get to know them and learn from them. I am a glass-half-full person: More positives always come out of working together, as long as both parties are prepared, focused and are

“ Selling stock hammered home that the ‘numbers game’ aspect of sales was not something to be taken lightly.”

Repertoire: What is the biggest change you anticipate in medical products sales in the next 5 years?

Pilla: There is more and more focus on bringing better, faster, and cheaper testing closer to the patient.

I believe that IT/connected wearable technology has tremendous upside, as more and more testing is decentralized and patients are more and

genuinely bringing solid solutions to doctors and practices alike.

Repertoire: Care to share a memorable ride-day story?

Pilla: On the majority of ride-days, the day flies by because it didn’t feel like work at all. I believe that comes from solid pre-call planning and developing strong relationships along the way.

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Reps to Watch

Sam Sample Jr. Account Manager Medtronic Jackson, Mississippi 10 years in medical sales Primary call points: Physician office, urgent care clinics, ambulatory surgery centers

Snapshot • Born/raised: Ebenezer, Mississippi • Undergraduate degree: Public relations/communications, Mississippi State University • First “real” job: Selling multifunction copiers, printers and faxes for Lanier Worldwide • Complete this sentence: The one thing I did NOT expect when I got into medical sales was/is …” How hard the nursing staff works to take care of their patients, both before, during and after the case has finished.

• Family info: I have two amazing parents, and I am one of four boys, me being the oldest.

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I will be starting this new year off right, as I will marry my beautiful fiancée, Mary, in January 2020.

• Hobbies/activities: In 2014 I moved back to Mississippi, where I was born, to be closer to my parents, who live on our 365-acre farm. There are a lot of fun things to do on our farm. I enjoy getting outdoors hunting, hiking, fishing and spending quality time with my close friends and family.

Repertoire: When, how and why did you get into medical sales?

Sam Sample Jr: I started with Lanier Worldwide in Jackson, Mississippi, in 2002, as an entry level sales rep.

After a year of hard work I was promoted to a corporate regional trainer and moved to Atlanta. Later I was promoted to sales manager in Huntsville, Alabama, where I led a successful sales team in North Alabama and Birmingham selling multifunction copiers, printers and fax machines.

During my time as a sales manager, several great sales reps whom I had hired and trained moved into medical sales. I stayed in touch with many, and I saw how much they enjoyed their new careers and how they seemed so

fulfilled in their new roles, so I figured there must be something to this fascinating industry. After a few interviews I settled on what I would consider the company of my dreams to work for – Medtronic (formally Covidien).

I owe my Medtronic career, in part, to the late Mike Worley, who was the regional manager in North Alabama for Covidien. He took a chance on me and knew that with a little polish, I could shine! Thanks Mike!

Repertoire: Mentor or role model?

Sample: I come from a long line of Sam Samples. I am actually the sixth Sam Sample in a row. (The middle names have changed over the years, so I am a Jr., after my dad.) My father, Sam Sample Sr., is the best role model I can think of. He and my mother have been happily married for 42 years, and he has always had a strong work ethic and moral compass.

He started his career washing trucks for a local power company and then moved up to be a lineman working on power lines. Eventually he became the manager of the local office of the power company.

He and his crew would go out in the worst of the worst weather to restore power to local residents. No matter the circumstances, we never saw him complain once. Even after a hard day’s work, he made time for his family and more work to do on the farm. His hard work, and his dedication to God and his family are what inspire me today to be half the man that he is. We share the same name, and to me, that is the biggest honor I could have been given.

Repertoire: What are the 2-3 most important things you can do for distributor reps to enhance their sales?

Sample: The first and most important thing I can do is be responsive.

Distributor reps are my customers, just as physician offices, dermatology clinics and ASCs. If they reach out to me with a question, I try to get them an answer quickly. The second thing I can do is to be a great resource, from a clinical and procedural standpoint, for general questions and for meeting with their customers in person to discuss our products in depth. Last, I realize that I work for a big company at Medtronic, and they might need assistance with a product that is outside of my responsibility. I ask them to send me anything they might need when it comes to Medtronic, and I put them in touch with the correct person quickly.

Repertoire: How can distributor reps help in your sales efforts?

Sample: Our focus in my division of Medtronic is wound closure products, specifically Medtronic suture, V-Loc barbed suture and topical skin adhesive. These products are traditionally a little more difficult to convert, as suture is seen more as a preference item instead of performance. How distributor reps can assist us is by getting out of their comfort zone with their customers, talking about our clinical products and asking for a chance to show potential savings with a quality product.

We at Medtronic support them in having those conversations and are an expert resource.

Repertoire: What is the biggest change you anticipate in medical products sales in the next 5 years?

Sample: Every year we see payers drive revenue to ambulatory surgery centers. Also, each year we see the Centers for Medicare and Medicaid Services (CMS) remove inpatient-only procedures, which allows the alternate site community to expand while keeping costs down. In the next five years we will see these trends continue.

“ We share the same name, and to me, that is the biggest honor I could have been given.

Repertoire: Ride-days with distributor reps: What’s to like?

What’s not to like?

Sample: Distribution sales reps have some of the best relationships with their customers, and I appreciate when they trust me enough to bring me into their accounts. It’s great when we have a chance to pre-call plan before the ride day, talk about the upcoming appointments and execute the plan together. Some great camaraderie comes from spending the day together in the field.

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Reps to Watch

Peter Sanda Amplify Rep Group Plympton, Massachusetts 12 years in medical sales Primary call point: Hospitals, physician office/clinics, surgery centers

Snapshot •B orn/raised: Boston, Massachusetts/Pembroke, Massachusetts •U ndergraduate degree: BS in business administration, marketing concentration, Merrimack College, North Andover, Massachusetts •F irst “real” job: Restaurant manager for two years after college.

• Family info: Married to Heather for 10 years; three children (Norah, Lily and Myles).

• Hobbies/activities: Most of my time these days is dedicated to work or my family. Whenever possible I enjoy traveling, almost all sports (go Patriots!), and I like to consider myself an amateur chef.

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Repertoire: When, how and why did you get into medical sales?

Peter Sanda: I started in medical sales 12 years ago after selling copiers for a couple of years. Many other reps I was working with had transitioned into medical sales and it seemed like a natural progression.

There seemed to be many different avenues to go down and a lot of opportunity for success if you were willing to put in the work.

Repertoire: What are the 2-3 most important things you can do for distributor reps to enhance their sales?

Sanda: First: Respond. Quickly. It may not sound like much, but every question an end user has about your products is an opportunity to make an impression both for you and the distributor rep. Time is critical, and if you are not responding and moving a sale along, you are increasing

the chance of losing out on sales – and making a poor impression for your distributor rep.

Second, provide enough knowledge to the distributor rep that they can identify opportunities, but they are not inundated with unnecessary specs they won’t remember.

Third, foresee challenges/opportunities before they present themselves. If you act more as a consultant than simply a rep trying to push product, it greatly increases the end users’ comfort level and chances they will purchase from the distributor.

Repertoire: How can distributor reps help in your sales efforts?

Sanda: All I can ask from a distributor rep is to give me a chance to present the products I represent to their customers. Some distributor reps are simply order-takers, but the more successful reps present different options and let their customers make informed decisions. When a facility is looking to purchase dozens of exam tables or supply carts, it is a significant investment, and it makes sense for the customer to do their due diligence. The distributor rep can make that process easier for the customer and get me in front of them.

Repertoire: What is the biggest change you anticipate in medical products sales in the next 5 years?

Sanda: First, healthcare policies and reimbursement will always be a determining factor to changes in the industry. The importance of patient satisfaction scores affecting

reimbursement has a substantial effect on the equipment that I sell.

Second: Consolidation. The fact that hospitals/IDNs are merging, and the fact that manufacturers are merging or being sold, will continue to have ripple effects through the industry. I believe larger hospital groups will continue to explore selfdistribution, although I don’t think it will be successful on a large scale throughout the country.

build relationships with both customers and distributor reps.

Repertoire: Care to share a memorable ride-day story?

Sanda: A couple of years back I went on a ride-along out to Nantucket Hospital with a distributor rep. They were interested in seeing supply carts, so I brought two demo carts along with me. It was too expensive to bring my car on the ferry, so I ended up just

“ The importance of patient satisfaction scores affecting reimbursement has a substantial effect on the equipment that I sell.”

Repertoire: Ride-days with distributor reps: What’s to like?

What’s not to like?

Sanda: They absolutely can be valuable if the day is planned out and scheduled appropriately. Simply walking around knocking on doors is not something I find productive. However, if the calls are targeted and meetings are scheduled based upon opportunity, a ride-along can be a perfect way to

pushing them right onto the ferry with me. When we arrived on the island and started looking for a cab, I realized that I would need to push the carts over a couple hundred feet of cobblestone – not ideal for those casters. I needed to pay a cab a few extra bucks to try to meet me as I was carrying a cart. It was an interesting day, and we even missed our scheduled ferry back home. We did end up getting a nice sale, which is all that matters!

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Reps to Watch

Greg Stulic Territory Portfolio Manager Midmark Tampa, Florida 8 years in medical sales Primary call point: Physician/clinic

Snapshot • Born/raised: Long Island, New York/East Lake, Florida • Undergraduate degree: Criminology degree from the University of South Florida.

• First “real” job: My father’s printing company. I was 13 years old when I started working there. I handled project typesetting, shipping/receiving, printing press and check-encoding machines.

No doubt I was the only kid in my class talking about invoices, rush orders, project numbers and deadlines.

• Complete this sentence: The one thing I did NOT expect when I got into medical sales was/is: How rewarding it is.

There’s nothing like walking around a practice that you’ve been able to influence by improving their workflow, making them more efficient and improving the experience

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between patient and caregiver.

• Family info: My amazing wife, Melina, who’s always in my corner. We’re blessed to have three children – Lorenzo, Luca and Gia. Had two cats but down to one. Her name is Spaghetti. (RIP Meatball, still love you pal!)

• Hobbies/activities: Woodworking, exercising, golf, cooking, coffee mornings with my wife and wrestling with my boys. We’ve also recently moved, so I’m in a constant state of changing/rearranging things in the new house. I’m wired to continually look for ways to improve designs and processes from working at Midmark, and I can’t help but bring that home with me.

Repertoire: When, how and why did you get into medical sales?

Greg Stulic: I wanted to make a difference and have a positive impact on the lives of others.

Repertoire: Mentor or role model?

Stulic: First role model is my mom, Anita. Her work ethic is unparalleled, and even in retirement, she’s working harder than ever as a grandparent. Next would be Mike Hughes, who hired me at Midmark, showed me the ropes and went with me every step of the way through months of training around the country. More recently is my manager, Dave Cantwell.

I met him years ago, when he was my Midmark rep and I was a brand-new distributor. The knowledge that he shared with me regarding Midmark’s value proposition really opened my

eyes. Last is my colleague, Chris Huppert. Since I started at Midmark and even today, I consider Chris a wealth of knowledge and perspective.

Repertoire: What are the 2-3 most important things you can do for distributor reps to enhance their sales?

Stulic: After college, I worked as a food distributor for five years, selling to restaurants and hotels. Then I made the transition to medical sales, selling to physician offices. The experience of working with many different vendors as a distributor has given me a unique appreciation of how I can support the reps I work with now.

The best vendors treated me as their customer as well as end user. In addition, I should be the distributor’s subject matter expert, as well as being available and reliable. Lastly, flexible.

The reps I work with should think of me as an extension of themselves, which is why we always strategize before any call and decide together what will have the biggest impact during our time with the customer.

Repertoire: How can distributor reps help in your sales efforts?

Stulic: Never assume that a customer won’t invest in the full Midmark portfolio. You’d be surprised what can happen when we get in front of the right mobilizers. And that’s the biggest way to help. Search out and cultivate mobilizers. These people aren’t easy to find and can come from different backgrounds (purchasing, clinical, IT, planning and design), but you’ll know they are a mobilizer

because when they understand your value prop, they’re your biggest cheerleader in their organization.

Repertoire: What is the biggest change you anticipate in medical products sales in the next 5 years?

Stulic: Since Midmark has adopted the Challenger ideology, we recognize that customers are typically 57% of the way through the purchase process before ever contacting a rep. The challenge becomes getting further out in front of the decisionmaking process.

There’s been an evolution from feature-and-benefit selling to insightdriven marketing. Customer loyalty is driven now by the purchase experience. As sales professionals, we need to work harder to discover the problem that the customer is trying to solve. That includes delivering timely insights from like-minded individuals and groups. When a customer asks to meet with you, they aren’t looking for you to recite what’s in your literature. They are really asking you, “Tell me something I don’t know. I want to learn something. Your product may be great, but how does it fit into my world and solve my problem?”

Repertoire: Ride-days with distributor reps: What’s to like?

What’s not to like?

Stulic: Spending one-on-one time with reps gives me an opportunity to tap into their customer base, and better understand their challenges and how to support them. I’m seeing a much more targeted approach to ride-days by distributors than in the

past. We may have one opportunity in mind and a couple of secondary stops that are either early in their decision-making process or towards the end. We have a strategy and goal in mind for each of them. The rest of our time is spent enjoying the camaraderie, talking about future deals and past deals, or the last vendor fair where Midmark dressed up as a “gold digger” providing tools with the current promotion to strike gold.

“ No doubt I was the only kid in my class talking about invoices, rush orders, project numbers and deadlines.”

Repertoire: Care to share a memorable ride-day story?

Stulic: A rep and I had a meeting with a customer to discuss how our digital ECG connected to eClinicalWorks.

We came up with a plan to discuss the difference between our integration versus interfacing, with the intention of walking out with an order for an ECG. The conversation went better than expected, and a big reason for that was because we were dealing with a mobilizer, and we began to unravel a much larger problem for them. As many Midmark conversations do, it began around one product, then quickly transitioned to another, and soon enough the entire portfolio.

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Manufacturer

Reps to Watch

Nicole Gibson Territory Manager Primary Care Hillrom Marietta, Georgia 10 years in medical sales Primary call point: Physician/clinic, post-acute

Snapshot • Born/raised: Born in Long Island, New York; raised in Marietta, Georgia • Undergraduate degree: Marketing degree from Kennesaw State University • First “real” job: Business development for Chase Professionals, selling recruiting in 2008 after the recession when no one was hiring, Talk about challenging.

• Complete this sentence: The one thing I did not expect when I got into medical sales was/is: Looking back, initially medical sales was to have been a steppingstone into a marketing role.

However, my experience has taught me to appreciate the opportunity I have to improve patient care and

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help caregivers diagnose and improve outcomes.

• Family info: My husband, Justin, and I met in college in Atlanta and have been married for six years; we welcomed our beautiful daughter, Peyton, two years ago, and our first child, Tripp, the golden-mix mutt.

• Hobbies/activities: Traveling, reading, spending time with my family and doing anything outside and on the water!

Repertoire: When, how and why did you get into medical sales?

Nicole Gibson: I began my career in the orthopedic division at BSN medical in Charlotte, North Carolina. (Medical sales in this division was a way to feel connected to my previous years as a competitive swimmer.) I enjoyed learning about medical manufacturing from inside the corporate office and working my way up in various roles within the organization, until accepting an outside sales position, which allowed me to move back home to Atlanta.

Repertoire: Mentor or role model?

Gibson: Several mentors throughout

my career have helped me get to where I am today, and their impact will influence me in the future. One of them – Marc Jones – has been a colleague and is my current manager. He taught me the value of good teammates and helped increase my business acumen in planning. He is someone I can call to bounce ideas off of, and collaborate with to be more successful – similar to what I hope to provide to my distributor reps now and in the future.

Repertoire: What are the 2-3 most important things you can do for distributor reps to enhance their sales?

Gibson: I would say being responsive and valuable are the two most important attributes of being a manufacturer rep. Distributors are inundated with customer demands and corporate initiatives, and my goal is to be an asset to them and their customers for the benefit of the caregivers and their patients. Second, it is important to be at the forefront of the rapidly changing healthcare industry as it relates to their customers and patients. Third, it is important to be proactive regarding new opportunities and detailed post-sale service. My ultimate goal is to make their day go as smoothly as possible and be the go-to manufacturer in the primary care setting.

Repertoire: How can distributor reps help in your sales efforts?

Gibson: Relationships and strategic planning. My distributors’ relationships in our mutual accounts are invaluable. Covering a larger territory, I cannot be everywhere. My partners

do an excellent job identifying opportunities, determining the stakeholders within the accounts and bringing me in as the expert to answer more in-depth questions and discover additional needs and opportunities.

Repertoire: What is the biggest change you anticipate in medical products sales in the next 5 years?

Gibson: More consolidation within the IDNs, including their acquisition of outpatient practices, and the standardization of those practices to a

Repertoire: Ride-days with distributor reps: What’s to like?

What’s not to like?

Gibson: Considering most of my career has been spent in orthopedics, my tenured distributor reps are extremely valuable in helping me continue to learn about my new call points in primary care – cardiologists and pediatrics. Also, I enjoy the personal relationships built over time as we work together to reach our mutual goals. Ride-days are also extremely important times to deliver

“ Digital technology will continue to advance in regard to wearable technology and software-based plans, and the patient will become as much our customer as the physicians’ office, as patients continue to be more responsible for their care.” specific formulary of equipment and products. This trend will continue to consolidate services into one healthcare system. Digital technology will continue to advance in regard to wearable technology and software-based plans, and the patient will become as much our customer as the physicians’ office, as patients continue to be more responsible for their care.

information on new technology and workflow optimization.

Repertoire: Care to share a memorable ride-day story?

Gibson: I have had so many memorable ride-days, but my most rewarding are those that end in a sale that benefits the patient, the providers, and my distributor partner.

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TRENDS

Will Wearables Affect Sales of Diagnostic Equipment?

At the very least, sales reps should be prepared for changes in the way physicians use traditional diagnostics.

Editor’s note: In the fourth and final part in a series on wearables and mobile medical apps, Repertoire asks Midmark’s Dr. Tom Schwieterman how – or if – these technologies might affect the sale and usage of traditional physician office diagnostic equipment.

Dr. Tom Schwieterman

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Repertoire: Fitbit says that 14 million U.S. adults subscribe to a digital health/wellness service, and pay an average $174 annually for different apps. Other studies show close to 40% of U.S. adults use or wear some kind of digital health technology. With that in mind, do you think wearables and mobile medical apps will change how or how often physician practices use traditional in-office medical technologies, such as ECG/EKG machines, blood pressure monitors, ultrasound units, etc? If so, how?

Dr. Tom Schwieterman: I feel this will change how common point-ofcare tests are utilized. When people are monitored 24-7 for health issues with wearables, even when having no symptoms, it is common for the device to “pick up problems.” Often, these wearables findings – e.g., irregular beats, blood pressure spikes – have little clinical significance and would have gone unnoticed by the patient.

Providers have seen this occur with home blood pressure monitors, where patients present to the office with concerns about an overly high or low blood pressure at one point or another. Care teams must repeat the

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TRENDS I suspect the provider-based point-of-care devices will be more commonly used to confirm or rule out a wearable ‘diagnosis’ from a patient. testing at the point of care, but also must investigate the patient finding by asking questions about factors known to temporarily drive up blood pressure, such as: “Did you just finishing exercising?” “When was your last cup of coffee?”

Patient-driven testing comes with the added concern of how the test was done, when it was done, and with what device.

When diagnostic devices were only in the purview of the clinician, these issues were less common. Now that more sophisticated diagnostic devices – such as watch-based cardiac rhythm monitors – are in the hands of those with little or no clinical training, the actual findings are difficult to assess. Is there a problem or is there not a problem?

I suspect the provider-based point-of-care devices will be more commonly used to confirm or rule out a wearable “diagnosis” from a patient. It is yet to be determined whether the growth of wearables will improve the diagnosis of pathology and improve outcomes, or not.

The answer is not clear at this juncture. Whether the constant monitoring will improve cost of care is, in my mind, an even larger question.

Repertoire: How might the popularity of wearables affect distributor reps who sell diagnostic equipment? Should they modify their approach, or emphasize different points to their physician customers than those they have traditionally emphasized?

Schwieterman: The term “point of care” is increasingly becoming less meaningful. Why? Because the point of care is quickly becoming all-inclusive. Instead of just referring to traditional healthcare settings like a physician office or hospital, it is increasingly referring to the home, retail clinic, or even place of employment.

With the majority of healthcare decisions and factors that influence health outcomes occurring away from a traditional healthcare setting, clinical thought leaders are seeking additional ways to diagnose or influence patients in these non-traditional points of care. Thus, it is likely we will continue to see an increasing number of diagnostic protocols to include wearables or home-based tests. For instance, it is now considered best practice to check blood pressure in the home before officially diagnosing someone with hypertension.

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I would encourage diagnostic equipment distributor reps to understand the disease diagnostic protocols and understand whether wearables play a role in the conditions related to the diagnostic device. If they do, understand the role your device plays in that protocol. Is yours the official gold-standard test, such as an ECG or A1C test? Is yours a way to confirm a finding of an at-home test, or corroborate the finding, such as with a blood pressure or Holter monitor? Is yours a way to gauge the clinical severity of a situation, such as a spirometer for respiratory issues?

Know where your test fits and how it relates to the current protocol. It is quite possible that will change as the consumer technologies improve.

Repertoire: Anything to add about how the abundance of wearables and mobile medical apps might change the traditional office visit for patients and their physician?

Schwieterman: Wearables and mobile apps are arming patients with sophisticated information about their own bodies. This is a relatively new phenomenon for providers.

Increasingly, instead of patients coming in with symptoms, they are coming in with preliminary diagnoses. “Doc, my device says I have a heart rhythm problem…” “Ruling out” a problem can be more complicated than “ruling in” a problem. So, yes, I feel certain at-home data is and likely will continue to increasingly change the traditional office visit.

These diagnostic devices also add incredible new power to manage health issues by giving the patient more tools to employ in their care paradigm. In many cases, they can shed light on the black box of information that can occur between office visits. We can now monitor heart rhythms, blood pressure, temperature, blood glucose, and other measures relatively inexpensively and often continuously. This can be of great help in understanding exactly what is going on with the patient and how the patient is doing.

Someday, this may help eliminate unnecessary testing and allow for fewer visits. However, we are still early in this transformation. So, time will tell how much these consumer technologies will augment – or possibly replace – some or all of the provider care management process.

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TRENDS

From ‘Kickback’ to ‘Value-based Arrangement?’

Proposed rules from HHS could change what’s accepted and what’s not in today’s expanding continuum of care.

On Oct. 9, the U.S. Department of Health and Human

Services released proposed rules that would revamp parts of the Anti-Kickback Statute and Stark Law. The proposed rules are intended to protect against overutilization of medical services while giving physicians and other healthcare providers flexibility to coordinate care for patients. And they are intended to protect outcomes-based payment arrangements that reward improvements in patient health.

Much of the rules are directed at providers and what they can or cannot do to coordinate care. But medical products manufacturers, distributors and providers might be affected too, particularly as digital and connected technologies become a standard part of their repertoire.

HHS is seeking comments on what role – if any – suppliers should play in value-based arrangements.

Terry Chang M.D. The agency has reservations.

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“We are concerned…and solicit public comments about the risk that some companies that manufacture medical devices covered by Federal health care programs, particularly implantable devices used in a hospital or ambulatory surgical center setting, might misuse value-based arrangements to disguise improper payments for care coordination intended as kickbacks to purchase the medical devices they manufacture,” HHS writes.

But HHS raises questions about how the term “device manufacturer” should be defined. Does it include digital tech companies? How about companies that offer traditional devices as well as software? The answers they ultimately arrive at will affect the supply chain.

Share Moving Media – publisher of Repertoire and the Journal of Healthcare Contracting – asked AdvaMed, the Washington, D.C.-based association for medical manufacturers, to comment on the proposed rules and their

TRENDS that “traditional device manufacturers” would not have a role in care coordination and management.

However, today’s medtech companies don’t just produce devices and diagnostics that save and improve lives.

They provide solutions that comprise a range of products Share Moving Media: The proposed rules issued by and services to improve care coordination and managethe HHS Office of Inspector General (OIG) include ment, and patient outcomes. They are true partners worka discussion about how to define “device manufacing to diagnose, treat and manage disease, as well as share turers.” What’s the issue? accountability for achieving better outcomes and managTerry Chang M.D.: In sum, the discussion by the OIG ing costs. HHS’s proposed anti-kickback-statute changes about defining “device manufacturer” is about two issues: in particular would help make that happen.

1) the perceived risk of abuse and 2) the role and value of The preamble in particular recognized that some device manufacturers in care coordination and management. manufacturers of traditional medical devices also manMore specifically, OIG seeks input on whether there ufacture care-coordinating type “health technologies.” is a way to exclude manufacturers of traditional mediHowever, there did not appear to be an appreciation for cal devices (e.g., implants) from final rule safe harbor the substantial overlap that exists.

Many manufacturers of DMEPOS Today’s medtech companies don’t just produce [durable medical equipment, prosthetics, orthotics or supplies] and devices and diagnostics that save and improve lives. “traditional medical devices” also They provide solutions that comprise a range of manufacture “health technologies” products and services to improve care coordination that are valued for their capabilities and promise to advance the coorand management, and patient outcomes. They are dination and management of care, true partners working to diagnose, treat and manage improving clinical outcomes, and disease, as well as share accountability for achieving reduce costs. potential importance to suppliers. Terry Chang, M.D., vice president, assistant general counsel, director, legal and medical affairs, responded in writing.

better outcomes and managing costs. HHS’s proposed anti-kickback-statute changes in particular would help make that happen. protections, while preserving the inclusion of manufacturers of medical technologies that have an obvious and promising role in care coordination and management, through the way that “device manufacturer” is defined for the purposes of exclusion.

References to remote patient monitoring, mobile health and digital technologies make it clear that such technologies are very much included (see Section III.B.5.b.

Health Technology Companies).

OIG is considering excluding all device manufacturers from safe harbor protection based on 1) historic enforcement experience with manufacturers of implantable devices in fee-for-product arrangements (assuming an increased risk of abuse that would not be safeguarded against in the proposed frameworks) and 2) the assumption

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Share Moving Media: As things stand today, are manufacturers barred from entering into arrangements with providers in which the manufacturer can be rewarded for improved outcomes associated with its device or equipment?

Chang: As things stand today, manufacturers are deterred from entering into value-based arrangements (centered around achieving a clinical and/or economic outcome target) due to the risk, time and cost associated with developing value-based arrangements (VBAs) to fit within today’s volume-based guardrails. We want to modernize the Safe Harbors to enable manufacturer engagement in more comprehensive, patient-centric VBAs, in a simpler, less time consuming, and less costly fashion.

The federal Anti-Kickback Statute (AKS) is exceptionally broad and criminalizes offering or providing anything of value to induce or reward the utilization of any item or service covered in part by a federal health

example, through additional modifications, the warranties care program. The enormous breadth of this prohibisafe harbor could also protect outcomes-based pricing tion understandably left providers and suppliers uncertain arrangements, where the net price is determined by the about the applicability of the statute, and in order to address actual outcome relative to the targeted outcome. this confusion, Congress amended the statute in 1987 to mandate OIG’s promulgation of regulatory safe harbors Share Moving Media: Simply put: What would the (Safe Harbors). The 28 safe harbors created to date were proposed changes – if incorporated into the final designed with volume-based guardrails for a fee-for-service rule – allow manufacturers to do that they cannot and fee-for-item payment framework. do today?

Aspects of VBAs at tension with the AKS include: 1) Chang: We are still exploring the implications of the language the bundled infrastructure and services needed to develop in the proposed rule. The topline change is that potential and operationalize a VBA (data collection, tracking, analyavenues for device manufacturer engagement in value-based sis, reporting); 2) the bundled services and technology that arrangements would be opened. In addition to providing the are part of the solution to achieve the targeted outcome; framework to contribute to value-based care, utilizing proand 3) elements of outcomes-based pricing, risk-sharing, tected arrangements would remove deterrents to VBAs. and warranties. (E.g., rebates, performance payments, penalty withholds, and underperformance payments can be considered to have value that induces or rewards As things stand today, manufacturers are deterred from referrals or utilization of an item or entering into value-based arrangements (centered service covered in part by a federal around achieving a clinical and/or economic outcome health care program.)

target) due to the risk, time and cost associated with

Share Moving Media: HHS sugdeveloping value-based arrangements (VBAs) to fit gests it might change existing within today’s volume-based guardrails. safe harbors for warranties. What is the issue?

Chang: Previously, the Warranties Again, today’s medtech companies don’t just produce Safe Harbor only applied to a warranty on single items devices and diagnostics that save and improve lives, they against product failure. provide solutions that comprise a range of products and The modified warranties safe harbor in the proposed services to improve care coordination and management, rule expands the protection to cover more than one item and patient outcomes. and also cover related services bundled with an item or items against a warranted clinical or cost outcome. The Share Moving Media: What does AdvaMed think protection for bundles is limited – the federally reimthe final rule should allow manufacturers to do bursable items and services subject to the warranty must that the proposed changes do not address? be reimbursed by the same Federal health care program Chang: We are still studying the implications of the proand in the same Federal health care program payment. posed rule and do not have a complete assessment of Another important limitation is that the warranty remedy the limitations in the protections provided in the prois capped at the cost of the items and services under the posed rule relative to AdvaMed’s proposals. Ideally, the warranty. Lastly, this safe harbor only protects services final rule would protect the same scope of arrangements when they are bundled to an item (i.e., there is no covercovered under the AdvaMed proposals, including valueage for standalone services). based pricing arrangements, to enable outcomes-based The discussion regarding potential future rulemaking pricing of items and services (i.e., protecting arrangeon additional modifications to the warranties safe harbor ments that provide for price adjustments based on the is about another potential way that OIG may address purachievement of a pre-identified, measurable clinical or chase/sale arrangements for covered items and services, cost outcome targets). which are not addressed in this set of proposed rules. For

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POST-ACUTE CARE

Respiratory Care PDPM implications for post-acute providers

Recent regulatory changes could lead to greater reim-

bursement for post-acute-care operators that provide respiratory care to their residents – and, consequentially, a greater demand for respiratory therapy equipment and supplies.

Under the Patient Driven Payment Model (PDPM), implemented Oct. 1, providers that treat people with greater clinical complexity – and whose care is especially resource-intensive – will be compensated for that care.

PDPM replaces the prior reimbursement system, RUG-IV, which calculated reimbursement for post-acutecare providers based largely upon the number of hours they spent providing physical therapy, occupational therapy or speech/language pathology therapy.

An uphill battle The need for respiratory care in the post-acute-care setting was high prior to PDPM, said Michael Hess, president of the Michigan Society for Respiratory Care, an affiliate of the American Association for Respiratory Care, in an email to Repertoire.

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“Unfortunately, the U.S. healthcare system doesn’t seem to be making much progress with these conditions, particularly in the post-acute setting,” said Hess, referring to respiratory illness. A recent study published in “JAMDA: The Journal of the Society of Post-Acute and Long-Term Care Medicine” found approximately 20% of people in long-term care had a diagnosis of chronic obstructive pulmonary disease, or COPD, he said.

“Data from the National Heart, Lung, and Blood Institute’s ‘Learn More, Breathe Better’ program suggests that roughly half of those people with symptoms go undiagnosed, so the number of people dealing with breathing problems in the post-acute setting is likely to be much higher,” especially factoring in other respiratory conditions, such as asthma, pulmonary fibrosis, pneumonia and lung cancer.

“The JAMDA article also supports other research that tells us that people with respiratory issues tend to have a variety of comorbid conditions, adding to the complexity of their care and markedly increasing their risk of readmissions and complications, and the overall cost of their care.

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POST-ACUTE CARE

Respiratory care: A technology-centric practice “Respiratory therapy continues to advance at the speed of technology across the healthcare continuum, and the SNF setting is no exception,” says Michael Hess, president of the Michigan Society for Respiratory Care, an affiliate of the American Association for Respiratory Care.

“Clinicians in this setting are called upon to manage ventilators (both invasive and noninvasive) to improve quality of life and assist breathing; monitor high-flow oxygen systems to facilitate respiration; administer a variety of nebulized medications; perform chest physiotherapy with high-frequency chest wall oscillation vests and cough-assist devices; and a variety of other highly specialized modalities using advanced technologies. This will absolutely continue into the next decade, as healthcare research continues to push the

“Finally, the JAMDA article highlights an issue that plagues chronic disease management in many other outpatient settings, i.e., the fact that many clinicians are unfamiliar with best practice recommendations and/or don’t have the time or resources needed to implement them,” said Hess.

“If an operator can offer ventilator and tracheostomy services, it has a much greater chance of capturing all 100 days of Medicare eligibility for skilled nursing coverage, as not all operators in a given market typically can accept such patients,” she says.

Reimbursement changes

Moreover, other respiratory modalities also boost a resident’s overall payment score in the nontherapy ancillaries (NTA) category. (Per CMS, “nontherapy ancillary services” refers to any ancillaries a provider uses other than therapy services, such as drugs, supplies and equipment – but not labor.) According to Sabo, residents with respiratory conditions and services could see increased NTA points for: • Ventilator or respirator post-admit care.

• Asthma, COPD, chronic lung disease.

• Cystic fibrosis.

• Tracheostomy care post-admit.

• Respiratory arrest.

• Pulmonary fibrosis and other chronic lung disorders.

• Suctioning post-admit.

“Ventilator and tracheostomy care automatically put residents in the highest reimbursement case-mix groups for the Nursing component of PDPM,” explains Melissa Sabo, chief operating officer, Gravity Healthcare Consulting, Cumberland, Maryland. In the “Special Care High” nursing case-mix group, either one of the following would qualify a resident for the second-highest nursing reimbursement under PDPM, she says: •C OPD with shortness of breath while laying flat.

•R espiratory treatment seven days per week, with a minimum of 15 minutes of face-to-face time provided each day by a respiratory therapist or an RN with respiratory training.

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boundaries of what is possible outside the hospital, and as established technologies become even more portable.”

The need for skilled respiratory therapists in post-acute-care settings will increase, Hess predicted.

“By recognizing respiratory therapy as resource-intensive and requiring a unique, specialized skill set (and enhancing reimbursement accordingly), PDPM will empower SNFs to bring in dedicated respiratory therapists, rather than asking other clinicians to work outside their normal scopes of practice,” he said.

“This is a win-win that will improve patient outcomes, enhance satisfaction (both patient and employee), and create vast new opportunities for interprofessional collaboration, all while reducing the cost burden on the SNF.”

December 2019

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POST-ACUTE CARE interventions that need to be pro“More and more providers are “If an operator can offer vided outside of the time that the showing interest in pursuing a variventilator and tracheostomy ety of ancillary services under PDPM services, it has a much greater respiratory therapists are onsite or available.” Many respiratory vento help drive appropriate and accurate chance of capturing all 100 reimbursement, improve the quality of days of Medicare eligibility for dors provide inservicing to staff to improve the clinical acuity and capaservices being provided to residents, skilled nursing coverage. ” bility of the onsite nursing teams, promote outcomes, and help reduce – Melissa Sabo she adds. liability and risk through improved docIt’s true that caring for residents umentation completed by the experts with a higher clinical acuity, including from the ancillary service vendors,” says respiratory conditions, can result in increased reimburseSabo. “Respiratory therapy is a key ancillary service that many ment, says Sabo. “However, quality continues to be at the providers are pursuing under PDPM with a renewed focus.” forefront of successful organizations. So communities Some providers rely on third-party respiratory venmust be able to treat efficiently, prevent rehospitalizadors to help. tions during and after the skilled stay, and facilitate a safe “Often, [respiratory vendors] are onsite for four to and effective transition to the next level of care for these eight hours per day, unless ventilators are being used, in higher acuity residents. which case the facility must have a respiratory therapist “One of the best things about PDPM is that it does onsite at all times,” says Sabo. a great job of fairly reimbursing the ‘good ones’ in our industry,” she says. “Putting the resident first has always Quality first been the right choice, and under PDPM, this approach “However, in either case, the nursing team must also usually leads to increased reimbursement as well.” be educated and equipped to handle the treatments and

How PDPM works In the patient-driven payment model (PDPM), each patient is classified into one group for each of five case-mix-adjusted components: physical therapy (PT), occupational therapy (OT), speech/language pathology (SLP), nontherapy ancillaries (NTA) and Nursing. In other words, each patient is classified into a PT group, an OT group, an SLP group, an NTA group, and a Nursing group.

For each of the case-mix adjusted components, patients are assigned to one group, based on the relevant MDS 3.0 data for that component. There are 16 PT groups, 16 OT groups,

12 SLP groups, six NTA groups, and 25 nursing groups. PDPM classifies patients into a separate group for each of the case-mix adjusted components, each of which have their own associated case-mix indexes and base rates.

Additionally, PDPM applies variable per diem payment adjustments to three components – PT, OT, and NTA – to account for changes in resource use over a stay. The adjusted PT, OT, and NTA per diem rates are then added together with the unadjusted SLP and Nursing component rates and the non-case-mix component to determine the full per diem rate for a given patient.

Source: PDPM Calculation Worksheet for SNFs, Centers for Medicare & Medicaid Services, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/SNF_ PDPM_Classification_Walkthrough_20190208_508.pdf

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HIDA

HIDA’s Streamlining Expo & Business Exchange:

Where the Industry Meets

The word on the street is that as

the supply chain gets more complex, distributors are increasingly playing a vital role in creating cohesive partnerships. The “street” is the corridors and meeting rooms of HIDA’s Streamlining Healthcare Expo & Business Exchange.

It’s where leaders from over 300 distributor, manufacturer, group purchasing, and provider organizations met in Chicago to advance excellence throughout the healthcare supply chain.

More than 1,200 businessto-business meetings took place during the September event, along with educational sessions, an Innovation Expo, Independent Distributors Summit, and many networking opportunities. It brought together a great mix of distributors, GPOs, and health systems to tackle today’s pressing problems, prepare for what’s looming on the horizon, and share best practices to help elevate the industry as a whole.

Attendees and educators took a deep dive into these recurring themes: The healthcare supply chain is getting more complex. Health system leaders who attended the expo described the challenges they face as their companies merge with other systems and look for new ways to manage non-acute sites. Providers are asking their GPO and distributor partners to provide more complex services.

Cohesive partnerships are essential. It’s imperative that distributors, manufacturers, GPOs, and providers work closely together. GPO participants shared actionable advice for improving pricing accuracy. Providers detailed

how distributors help supply chain operations run smoothly and health system leaders meet strategic targets.

Distributors play a vital role in streamlining operations. Participating health systems and GPOs need help improving their contracting processes and implementing strategic initiatives. Many manufacturers seek assistance in reaching potential customers. All parties identified a need for common practices and standard definitions. Distributors are well-positioned to help partners in the supply chain meet these needs.

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TRENDS

The Needlestick Safety Discussion The truth about sharps injuries? They still happen.

By now, who doesn’t know about the hazards of sharps

injuries in the healthcare setting? After all, the Needlestick Safety and Prevention Act has been in effect almost 19 years.

Yet healthcare workers continue to sustain sharps injuries (though exactly how many such injuries occur every year is a difficult statistic to pin down). Why? Perceived higher costs of protective devices, time pressures, habit, or simply the attitude, “This won’t happen to me.”

Repertoire asked two product experts about healthcare workers and sharps-safety devices: • J onathan Roberts, national sales manager, Terumo Medical Corp.

• Cheryl Wozniak, product director, vascular access, B. Braun Medical.

Repertoire: The Needlestick Safety and Prevention Act went into effect in April 2001. How would you characterize 1) awareness of sharps safety and 2)

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adherence to safety procedures, including use of engineering controls, on the part of healthcare providers?

Jonathan Roberts: Some misunderstandings still exist because of the perceived grey areas in OSHA law language. The language regarding the employer’s responsibility to “evaluate and use” effective, safer technologies [OSHA1999b] is often interpreted by medical practices that as long as a healthcare provider evaluates safety devices, they are in compliance with the law. Many believe that if they don’t prefer using safety devices, they aren’t mandated by law to use them. This is an expressed perception I have heard in the field many times.

It has been our observation that complex medical groups and health systems understand sharps safety law, but that among smaller or more rural medical practices, sharps safety remains misunderstood or, in some cases, not taken as seriously. I would surmise it is due to a greater degree of emphasis on risk-management/liability, more dedicated resources for enforcing compliance and

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TRENDS workplace safety, greater financial implications for noncompliance, as well as a more competitive environment between larger health systems.

The adherence to safety procedures and protocols is directly related to the versatility and ease of use of the safety device. Additionally, training resources are important to give the healthcare professional the best chance of successfully using safety-engineered medical devices.

Cheryl Wozniak: Awareness of safety sharps today is very prevalent in both the hospital and outpatient markets. Safety engineered devices are the expected standard of care for peripheral IV safety catheters and needleless connectors. There is also growing awareness in the healthcare market that adherence to safety requirements is ensured by using products with engineering controls that

Healthcare providers have put a higher degree of importance on compliance.

Wozniak: Certainly healthcare workers have grown more aware of the risks associated with needlesticks. The focus of the discussion today is moving healthcare providers towards devices that passively activate and automatically engage, without reliance on human intervention to activate the devices. With respect to peripheral IV catheters, we are seeing a strong and growing movement to reduce exposure to blood during the IV procedure. This has led to rapid growth in the use of blood control safety IV catheters.

Repertoire: What are the greatest impediments to compliance with sharps-safety regulations among healthcare providers?

Roberts: Weak federal enforcement of the law, unclear language in OSHA law leaving room for interpretation, increase in cost from conventional to safety, lack of options for how to activate a device, difficulty with device activation, time/efficiency pressures, and pain of change.

Two audiences that we see becoming more involved with vetting equipment service providers are infection prevention and risk management.

These audiences are looking at ways to minimize risk exposure for patients, staff and the broader organization. automatically engage without reliance on the clinician to activate the safety mechanism so it cannot be bypassed or inadvertently activated by the clinician. This type of safetyengineered device mechanism is known as passive safety.

Repertoire: How has the discussion about sharps safety evolved since the Needlestick Safety and Prevention Act went into effect in 2001?

Roberts: There was a spike in interest and awareness 5-6 years ago, after OSHA imposed heavy fines in various regions. Additionally, the consolidated marketplace has driven the need for a higher degree of compliance to internal standards, not just to federal regulations.

This increased the need for larger groups to be more aware of OSHA law and to design protocols around it.

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Wozniak: One of the greatest impediments to compliance is time pressure placed upon healthcare workers today.

Clinicians are tasked with multiple responsibilities, and their time limitations can lead to failure to engage a device’s safety mechanism.

Repertoire: How can distributor sales reps help their provider customers address these impediments?

Roberts: Communicate not only the law, but educate your customers on the risks and implications associated with noncompliance. Cite any known local instances of OSHA fines.

Help medical groups understand important considerations, such as the average cost of a needlestick (medications for injured staff, potential financial impact of litigation, staff attrition, etc.) and how those factors impact their system.

Wozniak: Distributors can best assist by helping to inform their customers of the sharps safety engineering controls available to clinicians to provide the best safety platforms that ensure compliance.

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TRENDS

Sharps safety: Some re-energizing needed Perioperative team members are acutely aware of sharps injuries, as the OR has the highest percentage of injuries in healthcare facilities, says Mary Ogg, MSN, RN, CNOR, senior perioperative specialist, Association of periOperative Registered Nurses (AORN). But their awareness of and adherence to sharps safety appears to be lagging.

After OSHA’s release of the Bloodborne Pathogens Standard [in 1991] followed by the Needlestick Safety and Prevention Act, “safety-engineered devices were developed, work practice controls were instituted, and personal protective equipment (PPE) – especially gloves – were worn anytime there was a potential for exposure to blood or other potentially infectious material,” says Ogg. “With these measures in place there was a precipitous drop in sharps injuries. … and hope that sharps injuries would continue to decline and one day be virtually eliminated.

However, the epidemiological data from the last several years demonstrates that the number of sharps injuries remains the same with very Mary Ogg little to no improvement.”

That’s true for several reasons, says Ogg. “Safety devices cost more than a conventional device, but money can be saved with decreased injuries and the costs associated with treatment and follow-up,” she says. What’s more, “the perioperative team is faced with the time pressures of doing more and more procedures in less time and turning over rooms quicker.

“But the resistance to change is the most difficult to overcome,” she says. “For example, safety scalpels may have been tried when they first came on the market. They did not feel like a traditional scalpel handle and blade. The disposables were lightweight and the blades were often of inferior quality. Now, even though the

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safety scalpels have greatly improved, it is difficult to reintroduce them as an option.”

Yet the OR team can draw upon many evidence-based interventions to reduce sharps injuries, says Ogg. “Double gloving rates have increased over the past several years,” she says. “Recent evidence suggests that using a perforation indicator system (i.e., a pair of colored surgical gloves worn under a standard pair of surgical gloves) when double gloving increases the detection of perforations.”

The neutral-zone or hands-free technique is very effective in reducing sharps injuries by ensuring that the surgeon and scrub person do not touch the same sharp instrument at the same time, she adds. “This technique is accomplished by establishing a designated neutral zone on the sterile field and placing sharp items within the zone for transfer of the item between scrubbed personnel. The resistance to this technique is that it takes a few seconds longer than passing a sharp instrument hand-to-hand.”

Today, healthcare professionals such as Ogg are seeking ways to re-energize the efforts to eliminate sharps injuries. And she believes distributors can help.

“During the annual OSHA-required evaluation of appropriate, commercially available and effective safer medical devices, they can provide their customers with the latest and improved devices for consideration and product evaluation,” she says.

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HEALTHY REPS

Health news and notes

58

Keep walking, even with osteoarthritis

Not to put a damper on the holidays …

It might seem hard to believe that walking with a painful joint could actually help reduce pain. But movement helps mitigate the pain and damage of osteoarthritis in a number of ways, according to a report in NPR. For starters, building up surrounding muscles helps stabilize the hurting joint and also increases lubrication of the cartilage. The fluid inside the joint flows into and out of the cartilage like a sponge, so all the nutrients in the joint fluid get into the cartilage and help slow any degradation there. Furthermore, neuroscientist Benedict Kolber with Duquesne University in Pittsburgh says exercise may also cause changes in the brain that can damp down pain. Exercise engages the endogenous opioid system, so our bodies make opioids to decrease pain, he says.

Most of us know one of the best health moves we can make is to skip junk food and eat a nutritious, wellbalanced diet, points out the National Institutes of Health. But how are we doing at putting that knowledge into action? Not so great, according to a new analysis that reveals Americans continue to get more than 50 percent of their calories from low-quality carbohydrates and artery-clogging saturated fat. In their analysis of the eating habits of nearly 44,000 adults over 16 years, NIH-funded researchers attributed much of our nation’s poor dietary showing to its ongoing love affair with heavily processed fast foods and snacks. But there were a few bright spots. The analysis also found that, compared to just a few decades ago, Americans

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HEALTHY REPS are eating more foods with less added sugar, as well as more whole grains (e.g., brown rice, quinoa, rolled oats), plant proteins (e.g., nuts, beans), and sources of healthy fats (e.g., olive oil).

Your child and ADHD The American Academy of Pediatrics (AAP) updated its guidelines for treating children with Attention Deficit /Hyperactivity Disorder for the first time since 2011, changing some criteria for diagnosis, updating current medications, and emphasizing the need to rule out other causes of symptoms. According to national data, about 9.4% of U.S. children ages 2-17 have been diagnosed at one time with ADHD, with hyperactive and impulsive symptoms that tend to decline during adolescence and lead to inattentiveness. Boys are more than twice as likely as girls to be diagnosed with ADHD. Both boys and girls with the disorder typically show

co-occurring conditions, such as depression, anxiety, substance use, autism and trauma.

Vaccinations safe during pregnancy Influenza and whooping cough can be deadly, especially in a baby’s first few months of life, according to the Centers for Disease Control and Prevention. Vaccinating women against these diseases during each pregnancy helps protect them and their babies. Studies show flu and whooping cough vaccines are safe for pregnant women and developing babies. Some statistics: • Women with influenza are more than twice as likely to be hospitalized if they are pregnant.

• Sixty-nine percent of reported whooping cough deaths occur in babies less than two months old.

• Only one in three U.S. pregnant women receive both flu and whooping cough vaccines.

Exercise and cancer Evidence suggests that exercise should be a part of standard treatment for most people with cancer, according to a report in the New York Times. Researchers also found that exercise should be considered a means to substantially drop the risk of developing cancer in the first place. Research published in “Medicine & Science in Sports & Fitness Exercise” and “CA: A Cancer Journal for Clinicians” reports that physically active people have as much as 69% less risk of being diagnosed with certain cancers than sedentary people. Exercise seems to be especially potent at lessening the likelihood of developing seven common malignancies: colon, breast, endometrial, kidney, bladder, esophageal and stomach cancers. Recommendations also point out that, in multiple recent studies, exercise changed the trajectory of cancer once it began. In animal experiments cited in the reviews, exercise altered the molecular environment around some tumors, stalling or even halting their growth. And in people, exercising during and after cancer treatment was associated with longer subsequent life spans.

Influenza and whooping cough can be deadly, especially in a baby’s first few months of life, according to the Centers for Disease Control and Prevention. Vaccinating women against these diseases during each pregnancy helps protect them and their babies. symptoms of an additional mental disorder and may also have learning and language problems. Treatments for ADHD have remained essentially the same, but AAP emphasizes the need for ongoing medical care and coordination with others from the school and community.

Parent training in behavior management is recommended as the first-line treatment for preschoolers. The AAP recommendations include guidance to help providers rule out other causes of ADHD-like symptoms and identify

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AMY COCHRAN 770-263-5279 e-mail: acochran@sharemovingmedia.com

LIZETTE ANTHONIJS

770-263-5266 e-mail: Lizette@sharemovingmedia.com

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

Technology news Google’s privacy tools Google celebrated Cybersecurity Awareness Month (October) by rolling out tools to give customers greater control over their privacy when using Google Maps, YouTube and Google Assistant, reports The Verge. Google confirmed that it was launching incognito mode for Maps, which was scheduled to appear on Android in October before expanding to iOS “soon.” When you turn on incognito mode, your Maps activity on that device, like the places you search for, won’t be saved

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to your Google Account and won’t be used to personalize your Maps experience. As for YouTube, Google said it was introducing the same rolling auto-delete feature that can already automatically clear out your location history and web data at an interval of your choosing. And last, Google is letting you wipe recent voice commands or questions to Google Assistant without opening an app on your phone. Just say “Hey Google, delete everything I said to you the last week.” (Unfortunately, you can’t delete more than a week’s worth of history.)

“When your AirPod batteries finally go, even Apple’s employees are confused about your options,” according to the writer.

intelligence that powers the system is said to automatically adjust the speed and intensity of the motion to keep the user in deep sleep cycles.

Hold the phone!

Tired of listening to bad “hold” music? DoNotPay, the app, launched a new feature, “Skip Waiting On Hold,” that does the listening for you, reports Tech Crunch. “Just type in the company you need to talk to, and DoNotPay calls for you using tricks to get a human on the line quickly,” according to the report. “Then it calls you back and connects you to the agent so you never have to listen to that annoying hold music. And in case the company tries to jerk you around or screw you over, the DoNotPay app lets you instantly share to social media a legal recording of the call to shame them.”

Skip Waiting On Hold comes as part of the $3 per month DoNotPay suite of services.

‘My AirPods are dying’ AirPods are comfortable, convenient and popular, but each of them contains a rechargeable battery marching toward an untimely death in as little as two years, according to an article in the Washington Post. “When your AirPod batteries finally go, even Apple’s employees are confused about your options,” according to the writer. “Across three separate support encounters in the store and online, they told me I had to buy a replacement pair for $138, nearly the price of a whole new set.” But here’s the straight story: If your AirPods are less than a year old and performing poorly, an Apple store will replace them at no cost. You can buy an extended warranty for $29; it covers the battery – but only for two years. And if your AirPods are out of warranty, you’ll pay $49 per stick – or $98 per head.

Lost and found

Sleep tight Big presentation tomorrow? Get a good night’s sleep with Adiva One, a set of modular bed legs that can be attached to any standard bed frame, reports Digital Trends. The legs move in a pattern to give the bed a gentle rocking motion while you sleep. The manufacturer, Adiva, cites research that found an oscillatory motion improved the length and quality of sleep of participants in the study. Two motion sensors clip to the mattress to provide integrated sleep tracking. The artificial

Apple is rumored to be making a tracker tag similar to Tilesmart trackers, reports CNET. And since Apple debuted new ultra wideband or UWB technology in its iPhone 11 models, speculation heated up that the company could release its Tile-competitor before the end of 2019. Reports suggest the tags will be battery-powered and able to attach to items like keys, a purse or a backpack, and could then be used to help you find them if the item is lost. The tracker tags can reportedly pair with your iCloud account by proximity to an iPhone or other Apple device, according to CNET. Users would get notifications when the device gets too far away from the tag, so you wouldn’t lose things. If the tagged item is in a location that the user has set as a safe place, users won’t be notified by the app.

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

Automotive-related news

What do you do when the battery dies?

One of the biggest concerns regarding hybrid vehicles – especially as they age and move into the used-car market – is the cost of replacing the battery pack, writes Christopher Smith in Motor1.com. Barring unexpected failure, the packs will eventually diminish to a point where they need replacing, and that usually comes with an exceedingly steep price tag of several thousand dollars.

To alleviate some of the concern, Toyota announced it is offering buyers of its hybrid vehicles a new extended battery warranty. Starting with 2020-model-year vehicles, Toyota will cover batteries in its entire hybrid lineup for 10 years or 150,000 miles, whichever comes

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first. That’s up from the previous 8-year / 100,000-mile warranty, and it’s also good for those who buy a used Toyota hybrid on the secondhand market. In normal driving conditions, Toyota’s updated warranty covers the generally accepted lifespan of modern hybrid batteries, which is around 10 years and 150,000 to 200,000 miles on average, reports the magazine. As such, it would appear Toyota is keen on capturing more usedcar shoppers in the years ahead.

SUVs cancel out fuel savings Here’s the good news: Fuel efficiency improvements in smaller cars save over 2 million barrels of oil a day, and

electric cars displace less than 100,000 barrels a day.

And the bad news? Around 40% of annual car sales today are SUVs, compared with 20% a decade ago.

That’s about 200 million SUVs operating around the world, up from about 35 million in 2010. Net result: SUVs were responsible for all of the 3.3 million barrels a day growth in oil demand from passenger cars between 2010 and 2018, while oil use from other type of cars (excluding SUVs) declined slightly, reports the IEA. If consumers’ appetite for SUVs continues to grow at a pace similar to that of the last decade, SUVs would add nearly 2 million barrels a day in global oil demand by 2040, offsetting the savings from nearly 150 million electric cars.

GasBuddy must go: Popular Mechanics GasBuddy lets you compare prices at nearby gas stations, wherever you are. But it does so by gathering loads and loads of location data on you. That’s why Popular Mechanics has named the app one of the “7 Apps You Should Delete from Your Phone Right Now.” The reason? The company told its users about a privacy policy change through an email and a push notification: “If you access the Service through a mobile device, and if your preferences are set to permit collection of the information, we will also automatically collect information about your driving habits, including, but not limited to, driving distance, speed, acceleration and braking habits.” Says Popular Mechanics: Users surrender a lot of information for any service that uses geolocation, “but explicitly collecting data on your whereabouts in the background all the time feels like a full-on manifestation of Big Brother.”

Stop-and-stop The average American commute grew to just over 27 minutes one way in 2018, a record high, according to data released this fall by the U.S. Census Bureau, reports the Washington Post. The average American has added about two minutes to their one-way commute since 2009, the data shows. “That may not sound like a lot, but those numbers add up: The typical commuter now spends 20 more minutes a week commuting than they did a decade ago,” reports the newspaper. “Over the course of a year, it works out to about 17 additional hours commuting.”

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NEWS

Oral medication for type 2 diabetes approved Some people with type 2 diabetes can achieve their target blood sugar levels with diet and exercise, while betes. Rybelsus (semaglutide) is the first glucagon-like many others take medications, including metformin peptide (GLP-1) receptor protein treatment approved for (often the first drug of choice), SGLT2 (sodium-glucose use in the United States that does not need to be injected. cotransporter 2 ) inhibitors, GLP-1 agonists and insulin.

The approval of Rybelsus was granted to Novo Nordisk GLP-1, which is a normal body hormone, is often in September. found in insufficient levels in type 2 diabetes patients, Until now, GLP-1s have only been available as injectsays the FDA. Rybelsus slows digestion, prevents the liver ables, said Louis H. Philipson, M.D., PhD, FACP, presifrom making too much sugar, and helps the pancreas prodent of medicine & science at the American Diabetes duce more insulin when needed.

Association and the director of the Kovler Diabetes Cen“Recent studies have shown GLP-1 agonists achieve ter at the University of Chicago, where he is also the James positive insulin secretion; can induce weight loss, which tends C. Tyree Professor of Diabetes Research and Care in the to be a good thing for many people with type 2 diabetes; and departments of Medicine and Pediatrics. “The impact of may have a positive effect on heart disease,” said Philipson.

[Rybelsus] could be very high, if it is as effective as other “So we’re in a very new space in the diabetes world. Now GLP-1 agonists,” he told Repertoire. And early indications we have two classes of drugs for people with type 2 diabetes are, it is. “This could really change the game.” that are considered beneficial for heart disease and weight In placebo-controlled studies, Rybelsus as a standloss – GLP1 agonists and SGLT2 inhibitors. alone therapy resulted in a significant reduction in blood “That’s a very positive development.” sugar (hemoglobin A1c) compared with placebo, said Rybelsus® will be competitively priced within the GLP-1 the FDA. category, a Novo Nordisk spokesperson told Repertoire. “Novo Nordisk is committed to working with health GLP-1, which is a normal body hormone, is often insurance companies and pharmacy found in insufficient levels in type 2 diabetes patients, benefit managers to ensure broad coverage and patient access for Rybelsus. says the FDA. Rybelsus slows digestion, prevents the In addition, a comprehensive Rybelsus liver from making too much sugar, and helps the savings card program will be available to reduce copays for eligible commerpancreas produce more insulin when needed. cially insured patients.”

Rybelsus is approved for oncedaily use in two therapeutic doses, 7 More than 30 million Americans (about one in 10) mg and 14 mg, and will be available in the U.S. beginning have diabetes, and 90% to 95% of them have type 2 in Q4 2019, according to Novo Nordisk. The FDA is still diabetes, according to the Centers for Disease Control reviewing Novo Nordisk's new drug application (NDA) and Prevention. Type 2 diabetes most often develops in for Rybelsus seeking an additional indication to reduce people over age 45, but more and more children, teens, the risk of major adverse cardiovascular events, such as and young adults are also developing it. Type 2 diabetes heart attack, stroke, or cardiovascular death, in adults with occurs when the pancreas cannot make enough insulin to type 2 diabetes and established cardiovascular disease. keep blood sugar at normal levels.

The manufacturer expects a decision in Q1 2020.

Patients have a new oral option to treat their type 2 dia®

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NEW PAMA CPT codes now available in the app

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

CPT 80048/QW 80053/QW 80051/QW 80076 80061/QW 80069/QW

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

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

Change -10% -10% -10% -10% -10% -10%

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

82040/QW 82042/QW 84075/QW 84460/QW 85576/QW 84450/QW 82248 82247/QW 83880/QW 82553 82550/QW 82977/QW 83615 82043/QW 82044/QW 84155/QW 84484/QW

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

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

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

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

83718/QW 83721/QW 82172 82465/QW 84478/QW

$11.24 $13.09 $21.26 $5.97 $7.88

$10.12 $11.78 $21.09 $5.37 $7.09

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

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

82985/QW 82962 82952/QW 82951/QW 82947/QW 83036/QW

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

$18.61 $3.28 $4.84 $15.89 $4.85 $11.99

-10% 2% -10% -10% -10% -10%

Renal Function Tests BUN Creatinine Creatinine (Urine)

84520/QW 82565/QW 82570/QW

$5.42 $7.03 $7.10

$4.88 $6.33 $6.39

-10% -10% -10%

Individual Tests Amylase Calcium Ferritin Iron

82150/QW 82310/QW 82728 83540

$8.89 $7.08 $18.70 $8.88

$8.00 $6.37 $16.83 $7.99

-10% -10% -10% -10%

Find the new codes in The Black Book

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

repertoiremag.com

January 2018

2 Minute Drill Videos

Podcasts

PAMA: The Stage is Set — How will the new rates impact providers, distributors and manufacturers?

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The Stage is Set

How will the new rates impact providers, distributors and manufacturers?

Twitter

NEWS

Industry News Midmark names Monique McGlinch vice president, customer engagement and corporate Agile center of excellence

operations management from Wright State University, as well as an MBA with a finance focus.

Midmark Corp., announced that Monique McGlinch was promoted to vice president, customer engagement and corporate Agile center of excellence. In this new key role, McGlinch will oversee project management which will be centered on Monique McGlinch the Agile framework, customer experience, guest services and facilities.

McGlinch most recently held the position of vice president, information technology and project management office. Throughout her 14 years with Midmark, she has also led the project management office (PMO), customer service, technical service, sales operations, digital marketing, supply chain and logistics across the following three industries: healthcare, building products and transportation. McGlinch is a current board member of Technology First, a member of Professional Women in Healthcare, the National Association of Professional Women, the Dayton CIO Council and other organizations within her community. She holds a Bachelor of Science degree with a concentration in management information systems and

Premier launches new e-commerce marketplace Premier Inc. has launched stockd., an e-commerce marketplace for healthcare and business supplies, to meet the procurement demands of providers in the non-acute care space. stockd is designed to meet the needs of small- to mediumsized healthcare businesses. Through stockd., alternate-site healthcare providers can access better pricing for everyday items, such as office, personal and medical supplies, including gloves, apparel, linens and cleaning products. The stockd. marketplace unites national and entrepreneurial sellers, bringing reliable, innovative manufacturers into the alternate-site supply chain on a single online purchasing platform, the company said. stockd. delivers products from reputable manufacturers and distributors, with transparent pricing listed directly on the site. Premier plans to leverage the stockd. marketplace for philanthropic causes. In October, to dovetail with National Breast Cancer Awareness Month, stockd. has partnered with Medgluv to donate 5% of Medgluv’s Pink Glove sales made on its platform to the Breast Cancer Research Foundation. The stocked. marketplace is open to purchasers outside of healthcare as well as those within a GPO.

Share Moving Media welcomes Amy Cochran as sales executive for the west medical territory Share Moving Media (SMM) is proud to announce Amy Cochran has joined the company as Sales Executive for the West Medical Territory. In this role, Amy will be responsible for expanding SMM’s medical titles from Chicago westward, including Repertoire magazine and The Journal of Healthcare Contracting.

She will be based in San Diego, California. Previously, she was the West Coast Sales Manager at Integrated Media Solutions (IMS) and founder of a full-service boutique insurance agency. She has extensive experience creating tailored marketing solutions including product launches, creating brand awareness, and providing continuing education for companies in the dental market. Her depth of experience will be an asset to SMM and its customers.

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December 2019

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