REP Dec 20

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vol.28 no.12 • December 2020

Year-End Reality Check Any insights gained after a tough year?

Hard to Beat. Sekisui Diagnostics delivers four point-of-care platforms helping customers keep up with quickly changing healthcare challenges through flexibility, performance, quality, and value. OSOM® Rapid Tests allow your customers to diagnose quickly while the patient is in the office reducing labor and follow-up time to help increase patient satisfaction and improve care. Now that’s impressive speed.





SEKISUI DIAGNOSTICS IS YOUR PARTNER IN HEALTHCARE / 800-332-1042 / WWW.SEKISUIDIAGNOSTICS.COM © 2020 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.


Year-End Reality Check Any insights gained after a tough year?

26 PUBLISHER’S LETTER Enriching the Audience’s Ability to Thrive.................................4

PHYSICIAN OFFICE LAB Changing POL Dynamics POLs are undergoing integration into IDNs............................... 6


Chuck Jensen

Contracting Executive Profile Chuck Jensen, director of sourcing & contracting, Froedtert Health..............12

TRENDS Healthy People 2030 20 targets for your physician customers to meet...................16


No primary care physician is an island … … particularly those in physician-led ACOs


repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2020 by Share Moving Media. All rights reserved. Subscriptions: $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.

December 2020



SALES Tales from the GRIT-Iron A compendium to consider as the calendar closes............................. 42

HIDA GOVERNMENT AFFAIRS HIDA: The Voice for Distributors Throughout COVID-19................ 45

Rep Corner

Everyone Counts Heather Ruszin finds time for everyone – from her customers and vendors to children and families in need.


Healthy Reps

Health news and notes


Quick Bytes

Technology news


NEWS CMS Adds New Telehealth Services to Medicare Coverage Since the beginning of the public health emergency, CMS has added over 135 services to the Medicare telehealth services list............................. 54

Wearing Is Caring Henry Schein Cares Foundation launches “Wearing Is Caring” campaign supported by The UPS Foundation........ 55

Industry news................................... 56 2

December 2020

Windshield Time

Automotive-related news


Committed to Protecting and Saving Lives In this time of crisis, we’re focused on supplying infusion therapy and other life-sustaining products that are vital to patient care. Together with our distribution partners and others across the healthcare supply chain, we support all the healthcare providers who are fighting this battle. Thank you for the sacrifices you are making. Please visit for updated information on how we are responding to the COVID-19 crisis. Š2020 B. Braun Medical Inc., Bethlehem PA. All rights reserved. 10/20


Enriching the Audience’s Ability to Thrive Happy holidays folks.

Well, we did it – we got through 12 issues of Repertoire Magazine in 2020. Interestingly enough, as hard as this year has been and as many obstacles as we’ve faced, I’m excited to share the following Repertoire stats with you. These numbers are YOY vs. 2019, readership and visits to the website and our online tools: ʯ Users grew 260% ʯ Sessions up by 235% ʯ Page views up by 150,000 ʯ Bounce rate down 18% ʯ 2-Minute Drill module views doubled ʯ Repertoire subscriptions grew

Scott Adams

I share these numbers not to brag on Repertoire, but to brag on you, our readership. In other words, during the “new norm,” you and your peers have continued to read and educate yourselves in an effort to better serve the manufacturers, and more importantly, your clients. We are seeing it across all of our brands, the consumption of timely compelling

content which enriches an audience’s ability to thrive, and it is growing at a rate we’ve not known before. Two thoughts as we start to think about 2021: 1. If you are a distribution sales pro-

fessional, I challenge you to continue this trend of consuming content that helps you and the caregivers. 2. If you are a manufacturer, I encourage you to create content or allow us to help you create content that our readers want and need. Either way, we will be writing to them, podcasting to them, and delivering content via print and digital. Have a wonderful holiday season! Merry Christmas, 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:;

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managing editor

vice president of sales

Graham Garrison

Katie Educate

editor-in-chief, Dail-eNews (800) 536.5312 x5271

Alan Cherry art director


Scott Adams

Brent Cashman (800) 536.5312 x5256



Laura Gantert


sales executive

Amy Cochran

December 2020

Brian Taylor

Subscriptions or (800) 536-5312 x5259

2020 editorial board Richard Bigham: Atlantic Medical Solutions Eddie Dienes: McKesson Medical-Surgical Joan Eliasek: McKesson Medical-Surgical Ty Ford: Henry Schein Doug Harper: NDC Homecare Mark Kline: NDC Bob Ortiz: Medline Keith Boivin: IMCO Home Care


Changing POL Dynamics POLs are undergoing integration into IDNs IDN ownership of physician practices is a long-standing trend with over 38% of all physicians employed by hos-

pitals in 2016. In some areas of the country the number is closer to 50%, with younger physician employment by hospitals at over 65%.

Purchase of physician practices by hospitals, and more recently private equity firms, has created new pressures on the physician office lab and increased concerns about consistency of lab results from setting to setting. There were 169,000 labs in 2000, and by 2017 the number has grown to nearly 260,000. As the number of labs has increased over time and the number of POLs owned by IDNs have increased, the need for result standardization has become more obvious and important. While PAMA 6

December 2020


By Jim Poggi

is likely to reduce the number of labs to some degree, standardization of lab results between care settings is a major concern, particularly among larger IDNs. IDNs have taken various approaches to assure quality of care and lab result consistency. Some IDNs have reduced the types of tests


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PHYSICIAN OFFICE LAB permitted to be performed in their physician-owned practices. Others have mandated which testing systems are permitted in the POL. Nearly all have point-of-care coordinators and clinical committees whose objective is to assure availability of the right test at the right time for the right reason. Standards of practice are shaping up intended to govern testing in the core lab, point-of-care settings within the hospital and the POLs owned or affiliated with the hospital. What does this all mean to the distributor sales representative, their suppliers and their physician office customers? It means that, sooner or later, testing in these POLs will be more strictly governed by personnel OUTSIDE of the physician practice. Test menus, personnel qualifications and standards, quality control practices and cost considerations will be determined by the clinical personnel of the practices in collaboration with core lab personnel, hospital risk


December 2020


management and C-suite executives including finance. In short, it means you and your suppliers need to step up your game and recognize that to be a successful player in the changing market for lab testing, you can no longer focus on the needs of your

With customer consolidation comes a smaller number of total customers with greater leverage and more competition for the expanded spend these customers represent.

POL customers, their desire to create a profitable lab and the emergence of new tests to maintain and grow your lab business. The need to be a consultant has never been higher and the number of call points you and your suppliers need to effectively manage has increased substantially. To say that selling lab testing in the market with a high level of IDN oversight is a complex sale is an understatement. How do you succeed in this changing environment? Your strategy needs to change to embrace and work effectively in a more sophisticated and dynamic environment. New thinking and broader teams are required.

Changing call points, needs and sophistication With your POL customer now part of an IDN, more departments and viewpoint than ever before need to be considered and satisfied. The call points you and your suppliers will need to work with now not only include the clinicians and practice managers at the POL, but also the IDN core lab, point-of-care coordinators, finance and other C-suite personnel and logistics. Each customer team will have varying levels of influence and differing needs and opinions. Fundamentally, they all share the same three goals: clinical/laboratory excellence, economic improvement and improved procedural efficiency. As the number and sophistication of your call points increases, the need for more expertise and higher skill sets on your side increases. The need for clinical and technical expertise from your supplier is higher than ever. They must have the resources to effectively engage with core lab pathologists and clinical personnel, C-suite executives as well as IT professionals of the

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PHYSICIAN OFFICE LAB IDN. Scalable instrument solutions with the ability to meet the high throughput core lab needs and provide the same level of result quality for shared tests in the POL can be a very strong selling point. This is especially true in clinical chemistry, hematology, immunoassay and molecular testing platforms. Concerns about data security and management of HIPPA data will be top-of-mind questions posed to you and your suppliers. The ability of lab and clinical stakeholders to view, review and assess patient lab results electronically in real time is a core concern. A strong LIS offering allowing secure access to lab data, QC results, patient test result trends and administrative data including personnel training records and reagent/QC lot tracking is an absolute requirement. From a distributor account manager viewpoint, the hurdle rate increases greatly: You need to be able to effectively discuss your company’s value proposition for lab and on an overall basis. How can you help with consolidation and cost reduction? How can you demonstrate the

IDNs have taken various approaches to assure quality of care and lab result consistency. Some IDNs have reduced the types of tests permitted to be performed in their physicianowned practices. Others have mandated which testing systems are permitted in the POL. ability to manage reagent, control and calibrators lot numbers offered by your key manufacturers? What business review tools do you have to set objectives, manage progress and report results successfully and accurately? The best distributor sales teams involve a variety of experts and management levels to provide a compelling message that resonates with this sophisticated customer. With customer consolidation comes a smaller number of total customers with greater leverage and more competition for the expanded spend these customers represent. Do not underestimate the need to involve

management from high levels in your company to assure the customer has confidence in your offering and understands their importance to your business. The market has changed. There are fewer customers. Customers are larger, represent higher levels of spend, have a greater level of sophistication and a broader number of needs to be satisfied. The well-prepared distributor account manager understands these needs and has developed the strategy with their management and key suppliers to deliver greater value than ever before. Game on.

Best practice thoughts and considerations Technology

ʯ Scalable instrument platforms with broad menus and consistent precision and accuracy ʯ Reliability and ease of use and training ʯ Flexible reagent systems, multiple package sizes, large scale lot manufacturing ʯ Secure IT connectivity ʯ LIS features and flexibility with integration with EMR allowing real time data access, review and management

Commercial business

ʯ High level management involvement from distributor and supplier

ʯ Thoughtful, effective understanding and response to customer needs

ʯ Appropriate consolidation of product availability across lab and other product needs

ʯ Effective tools to manage daily ordering needs and multiple settings and unit of measure needs

ʯ Sophisticated lot tracking and sequester programs ʯ Frequent communication and comprehensive business reviews

ʯ Coordination of expertise (clinical, technical, IT) to meet customer requirements


December 2020

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Contracting Executive Profile Chuck Jensen, director of sourcing & contracting, Froedtert Health About: Chuck Jensen has served as director of sourcing & contracting at Froedtert Health in Wisconsin for the last five years. Within this role, he leads the purchasing team as well as the sourcing/contracting team. Jensen developed and led a major departmental restructuring 18 months ago that dramatically improved the capabilities and results of the department. Previously, Jensen served as director of supply chain at Comanche County Memorial in Lawton, Oklahoma, and director of materials management at McLaren Northern Michigan in Petoskey, Michigan.

Repertoire: What is the most challenging/rewarding project you have worked on in the last 12-18 months? Jensen: For me, personally and professionally, the one thing that has provided me the most satisfaction has

Chuck Jensen


December 2020


been my growth journey (my Hero Quest). A series of events, including new leadership, a major departmental restructuring as well as personal challenges, led me to seek a career coach, which I began working with in the fall of 2018. That fall, the

framework for a year-long engagement was developed. Some early activities in 2019 included baseline data gathering from an employee engagement survey and targeted data from a 360-degree leadership review. The data received provided themes for targeted improvement. The themes were personal connection, communication and respect. The journey led me to a greater sense of self reflection, love and caring for others and recognition of others (putting others ahead of myself ). The results have been nothing less than amazing. My connections with others have increased tremendously. The team – both my leadership and the entire team – has become more engaged. In fact, the score from the 2020 employee engagement represents some of the highest scores within the organization. The benefits go far beyond the department. My interactions with physicians and others I interact with have also strengthened. This was an extremely challenging journey as it requires personal reflection and the willingness to hear feedback that generates emotional responses. This remains the most challenging, but rewarding, experience in my recent history.

Repertoire: What project or initiative are you looking forward to working on? Jensen: I have been a part of developing a Strategic Partner Council (SPC) at Froedtert Health. The SPC is made up of senior leaders from Froedtert Health’s top suppliers as well as key leaders from the supply chain, finance and surgical services teams. The SPC’s goal is to work towards best practice solutions for the mutual benefit of all organizations. I am looking forward to this because the group, although formed and meeting regularly, is between the storming and norming phase in group development. (Editor’s Note: The forming-storming-normingperforming model of group development was developed by Bruce Tuckman, who said these phases are all necessary and inevitable in order for the team to grow, face up to challenges, tackle problems, find solutions, plan work and deliver results.) I am excited to work on team projects. One currently starting is the development of a supplier scorecard. This will be made of metrics developed and agreed by all suppliers with goals and standards also set by the entire council. This will set the standard for how all suppliers will be measured collectively and change how we do business with all suppliers, not just the SPC members. Repertoire: How are you better at practicing your profession than you were 5-10 years ago? Jensen: I have learned patience, the ability to utilize relationships and the value of personal connections. Regarding patience, I am by naturally driven and hardworking. I want to get all my goals (savings, processes and strategies) completed in the first month of the year. But I have learned

to purposely plan for the achievement of goals or a project. This has allowed me to teach my leaders and staff the skills I have and delegate projects to them. This, in turn, speeds up the results and provides learning and accomplishment of others, and then recognition for them. Relationship utilization is a practice that I have developed over time. For me, it involves listening to others perspective and coming up with a decision or pathway that meets the

Jensen: There are a few lessons that I personally have learned and suspect most supply chain leaders also have learned during the COVID-19 pandemic. First, the connections to local businesses and physician partners proved extremely valuable. For example, at Froedtert Health, a handful of local businesses worked with us to develop and quickly change their production lines to produce hand sanitizer, face shields and masks.

I am excited to work on team projects. One currently starting is the development of a supplier scorecard. needs of everyone involved. Five to 10 years ago, I may have approached situations with more stubbornness and my solution or pathway was the one I would hold firm to as the sole choice. My current approach has been rewarded with relationships and positive outcomes from my team and those I work with throughout the health system. Historically, personal connections have not been my strong suit. While I have always been good at relationships with a few close confidants, I have learned to be caring and thoughtful towards all those I work with and interact. I am not always successful, but I realize it when I’m not and look to find ways to strengthen and improve the relationship. Almost always, that involves a face-to-face meeting or phone conversation. Repertoire: What lesson or lessons do you think supply chain leaders will take from the COVID-19 pandemic?

Secondly, we have opened nontraditional channels for sourcing products. Froedtert Health utilized direct purchasing or a broker to secure where our distributor, regional GPO or normal supply partner was not able to meet our PPE or other supply needs. This may translate into longer term relations with those sources that proved reliable and serve as a secondary source moving forward. Finally, communicating key data internally is so valuable. Froedtert Health Supply Chain developed a supply dashboard and distributed it to the organization daily. This dashboard provided a color-coded system to communicate the levels of PPE available. This provided transparency in an environment of fear and information overload from internal rumor and external media on the pandemic. Froedtert Health was fortunate to not have run out of any PPE during this critical time and, in large part, the data and subsequent conservation methods were to credit.

December 2020





*STRATAFIX™ Knotless Tissue Control Device shortened OR time compared to traditional sutures in total hip arthroplasty, based on retrospective analysis of 5958 cases from the Premier Perspective® Hospital Database. † Patients with DERMABOND PRINEO System had lower readmissions than patients with skin staples in a retrospective, observational study using the Premier Healthcare Database in total knee arthroplasty (N=1942), 2012-2015; LOS 2.8 days vs 3.2, P=0.002; discharge to SNF 26% vs 39%, P=0.011; 30-day readmissions 1.8 vs 4.4%, P=0.006. ‡ Plus Sutures were proven in vivo to kill bacteria on the suture known to be associated with SSIs (Staphylococcus aureus, Staphylococcus epidermidis, methicillin-resistant S aureus [MRSA], methicillin-resistant S epidermidis [MRSE], Escherichia coli, Klebsiella pneumoniae) in an animal model. § Compared to traditional sutures based on a retrospective analysis of 7,410 spinal fusion and laminectomy procedures from the Premier Perspective® Hospital Database, using STRATAFIX barbed sutures was associated with lower OR time (P=0.015) and costs (P=0.02) than traditional sutures. || In a meta-analysis of 21 RCTs, 6462 patients, 95% CI: (14, 40%), P<0.001. ¶ Ethicon Plus Antibacterial Sutures (MONOCRYL® Plus Antibacterial [poliglecaprone 25] Suture, Coated VICRYL® Plus Antibacterial [polyglactin 910] Suture, and PDS® Plus Antibacterial [polydioxanone] Suture). ACS/SIS=American College of Surgeons/Surgical Infection Society; CDC=Centers for Disease Control and Prevention; LOS=length of stay; NICE=National Institute for Health and Care Excellence; RCT=randomized clinical trial; RKI=Robert Koch Institute; SNF=skilled nursing facility; SSI=surgical site infection; WHO=World Health Organization.

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

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

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

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

For complete indications, contraindications, warnings, precautions, and adverse events, please reference full package insert. References: 1. Sutton N, Schmitz ND, Johnston SS. Comparing outcomes between barbed and conventional sutures in patients undergoing knee or hip arthroplasty. J Comp Eff Res. 2018;7(10):975-987. doi:10.2217/cer-2018-0047. 2. Sutton N, Schmitz ND, Johnston SS. Economic and clinical comparison of 2-octyl cyanoacrylate/polymer mesh tape with skin staples in total knee replacement. J Wound Care. 2018;27(Sup4):S12-S22. 3. Ming X, Rothenburger S, Nichols MM. In vivo and in vitro antibacterial efficacy of PDS Plus (Polidioxanone with Triclosan) suture. Surg Infect (Larchmt). 2008;9(4):451-457. 4. Storch ML, Rothenburger S, Jacinto G. Experimental Efficacy Study of Coated VICRYL Plus Antibacterial Suture in Guinea Pigs Challenged with Staphylococcus aureus. Surg Infect (Larchmt). 2004;5(3):281-288. 5. Ming X, Rothenburger S, Nichols MM, Rothenburger S. In vivo antibacterial efficacy of MONOCRYL Plus Antibacterial (Poliglecaprone 25 with Triclosan) suture. Surg Infect (Larchmt). 2007;8(2):1-5. 6. Johnston S, Chen B, Tommaselli G, Jain S, Pracyk J. Barbed and conventional sutures in spinal surgery patients: an economic and clinical outcomes comparison. J Wound Care. 2020;29(5):S9-S20. 7. De Cock E, van Nooten F, Mueller K, et al. Changing the surgical wound closure management pathway: time and supplies with PRINEO* vs. standard of care for abdominoplasty surgery in Germany. Poster presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 11th Annual European Congress, November 8-11, 2008; Athens, Greece. 8. Ahmed I, Boulton AJ, Rizvi S, et al. The use of triclosan-coated sutures to prevent surgical site infections: a systematic review and meta-analysis of the literature. BMJ Open. 2019;9:e029727. doi:10.1136/bmjopen-2019-029727. 9. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017;152(8):784-791. 10. WHO Global Guidelines for the Prevention of Surgical Site Infection. Geneva: World Health Organization; 2016. Accessed October 6, 2020. 11. Ban KA, Minei JP, Laronga C, et al. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg. 2016;224(1):59-74. 12. NICE Guideline Updates Team (UK). Surgical site infection: prevention and treatment. NICE website. Accessed April 3, 2020. 13. Prevention of postoperative wound infections. Recommendation of the Committee for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute. Bundesgesundheitsbl. 2018;61(4):448-473.

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


Healthy People 2030 20 targets for your physician customers to meet

Every 10 years, the U.S. Department of Health and Human Services publishes

a 10-year plan for addressing the most critical public health priorities and challenges. Released in August 2020, Healthy People 2030 lists 355 measurable objectives with 10-year targets. Here are 20 that are worth sharing with your physician customers.


December 2020


TRENDS Objective




Increase the proportion of adults who receive appropriate evidence-based clinical preventive services

Access to preventive health care can prevent both disease and early death.

8% of adults aged 35 years and over received all of the recommended high-priority-appropriate clinical preventive services in 2015


Increase the proportion of persons with a usual primary care provider

Having a primary care provider is 76% of persons had a usual priimportant for maintaining health mary care provider in 2017 and preventing and managing serious diseases.

Increase the proportion of adults who receive a lung cancer screening based on the most recent guidelines

Lung cancer screening can help prevent deaths in people at high risk – mostly current and former smokers. But screening rates in this population remain low.

4.5% of adults aged 55 to 80 years received a lung cancer screening based on the most recent guidelines in 2015


Without screening, breast cancer may be diagnosed at a later stage and lead to death.

72.8% of females aged 50 to 74 years received a breast cancer screening in 2018



Increase the proportion of females who receive a breast cancer screening based on the most recent guidelines

Colorectal cancer is one of the most common causes of cancer deaths in the United States, particularly in minority populations

65.2% of adults aged 50 to 75 years received a colorectal cancer screening based on the most recent guidelines in 2018



Increase the proportion of adults who receive a colorectal cancer screening based on the most recent guidelines Reduce the proportion of adults with undiagnosed prediabetes

Millions of people in the United States have prediabetes, but many don’t know it. People with prediabetes are at higher risk for type 2 diabetes, heart disease and stroke.

38% of adults aged 18 years and over, who had not been diagnosed with prediabetes or diabetes, had undiagnosed prediabetes in 2013-16



Reduce the proportion of adults with diagnosed diabetes with an A1c value greater than 9.0 percent

A1c levels above 9% increase the 18.7% of adults aged 18 years risk of complications. and over with diagnosed diabetes had an A1c value greater than 9% in 2013-16


Increase the proportion of adults with diagnosed diabetes who receive an annual urinary albumin test

Screening for high levels of albumin in the urine is to help prevent end-stage kidney disease in people with diabetes.

48.7% of Medicare beneficiaries with diabetes mellitus had urinary albumin testing in 2016

Reduce blood lead levels in children aged 1 to 5 years

Lead can damage children’s kidneys, blood, and brains – and at high levels can cause coma, seizures and death.

3.31 micrograms per deciliter (µg/dL) was the concentration level of lead in blood samples at which 97.5% of the population aged 1 to 5 years was at or below in 2013-16

Reduce hospital-onset Clostridioides difficile infections (CDI)

The number of people who get C. diff has been higher than ever in recent years, and it causes thousands of deaths in the United States each year.

1.00 was the national Standardized Infection Ratio (SIR) for hospital-onset CDI in 2015








December 2020




1.18 µg/dL

0.70 SIR

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TRENDS Objective



Target 0.50 SIR

Reduce hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) infections

MRSA is one of the most common causes of infections that people get in hospitals.

1.00 was the national Standardized Infection Ratio (SIR) for hospital-onset MRSA bacteremia infections in 2015

Reduce the proportion of adults with hypertension

People with high blood pressure are more likely to have coronary heart disease, stroke, heart failure and kidney disease.

29.5% of adults aged 18 years and over had hypertension in 2013-16


Reduce the mean total blood cholesterol level among adults

People with high blood cholesterol are more likely to have heart disease.

190.9 milligrams per deciliter (mg/dL) was the mean total blood cholesterol level for adults aged 20 years and over in 2013-16

186.4 mg/dL

Increase the proportion of persons aware they have chronic hepatitis B

Untreated chronic hepatitis B can cause liver disease, cirrhosis, liver cancer and death.

32.4% of persons with chronic hepatitis B were aware they had chronic hepatitis B in 2013-16



Increase the proportion of persons aware they have chronic hepatitis C

Untreated, chronic hepatitis C can cause liver disease, cirrhosis, liver cancer, and death.

55.6% of persons with chronic hepatitis C were aware they had chronic hepatitis C in 2013-16



Reduce the rate of hospital admissions for urinary tract infections (UDIs) among older adults

UDIs are the second most common type of infection in older adults. When not treated early, UTIs can lead to kidney failure and death.

551.3 hospital admissions for UDIs per 100,000 adults aged 65 years and over occurred in 2016

496.2 per 100,000 hospital admissions

Reduce the rate of emergencydepartment visits due to falls among older adults

Falls are the leading cause of injury in older adults, often due to balance problems, poor vision, or dementia – or if they take several medications.

6,052.2 emergency department (ED) visits for falls per 100,000 adults aged 65 years and over occurred in 2016

5,447 ED visits per 100,000 adults

Reduce the proportion of adults aged 45 years and over with moderate and severe periodontitis

Controlling diabetes and helping 44.5% of adults aged 45 years and over had moderate and people quit smoking can help prevent gum disease, which can severe periodontitis in 2015-16 lead to tooth loss.

Reduce deaths from chronic obstructive pulmonary disease (COPD) among adults

COPD is a group of diseases – including emphysema, chronic bronchitis, and non-reversible asthma – that make it hard to breathe and can cause death.

110 COPD deaths per 100,000 adults aged 45 years and over occurred in 2018

Increase the proportion of adults with symptoms of obstructive sleep apnea who seek medical evaluation

Many people in the United States have obstructive sleep apnea, which increases the risk of heart, brain and metabolic problems.

33.1% of adults aged 20 years and over with symptoms of obstructive sleep apnea sought medical evaluation in 2015-16










107.2 COPD deaths per 100,000 adults


Source: Healthy People 2030, Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services


December 2020



It’s Simple Retinal exams are more accessible than ever to primary care practices

Beginning Jan. 1, your

primary care customers have a green light from Medicare to conduct retinal exams in their office. In doing so, they can improve patient-satisfaction and quality-of-care (HEDIS) indicators, bolster practice revenues, and most important, help their patients avoid a serious eye-related condition – diabetic retinopathy. And Repertoire readers can help by offering Hillrom’s new handheld retinal camera – the Welch Allyn® RetinaVue® 700 Imager and RetinaVue® care delivery model.


December 2020

Most commercial health plans (and Medicare Advantage plans) have covered teleretinal exams in primary care settings for years, explains Thomas Grant, Director of Marketing, Vision Screening and Diagnostics at Hillrom. “The gap has been Medicare fee-for-service.” No longer. The American Medical Association (AMA) has updated CPT® Code descriptions for retinal imaging codes 92227 and 92228 to specify retinal exams performed in primary care settings with remote interpretation. This is important, because Medicare fee-for-service covers about 30% of the patient population. It’s also important because of the fact that an estimated 80% of patients living with diabetes will eventually develop diabetic retinopathy.


% of vision loss due to diabetic retinopathy can be prevented with early detection. What is diabetic retinopathy? The retina detects light and converts it to signals sent through the optic nerve to the brain. Chronically high blood sugar from diabetes is associated with damage to the tiny blood vessels in the retina. Those blood vessels can leak fluid or hemorrhage, distorting vision. In its most advanced stage, new abnormal blood vessels proliferate on the surface of the retina, which can lead to scarring and cell loss in the retina. Severe visual impairment and blindness can result. Diabetic retinopathy often starts with no symptoms, leading individuals with diabetes to fail to attend routine appointments with an eye care provider. (It is estimated that 50% or less of patients with diabetes comply with annual retinal exams.) Unfortunately, once vision loss occurs, it is often too late to reverse its progression. However, 95% of vision loss due to diabetic retinopathy can be prevented with early detection and treatment.

Teleretinal imaging Teleretinal imaging programs allow primary care providers to capture an image of the patient’s retina during a routine appointment using a specialized camera. The retinal images are uploaded and transmitted to a remote eye specialist, who provides a diagnosis to the initiating facility. Patients with signs of diabetic retinopathy are referred for further care with an ophthalmologist.

Care Delivery Model Hillrom’s RetinaVue® Care Delivery Model comprises three components: ʯ Welch Allyn® RetinaVue® 700 Imager ʯ Welch Allyn® RetinaVue® Network Software ʯ Interpretation by board-certified ophthalmologists and retina specialists through RetinaVue,® P.C.

What you should know about CPT® Code updates Recent updates to CPT® Code descriptions for diabetic retinal imaging are designed to more accurately indicate where the exam is performed and how the exam is interpreted. These changes ensure CMS coverage for diabetic retinal exams in primary care settings. ʯ AMA has updated CPT® Code descriptions for retinal imaging codes 92227 and 92228 to specify retinal exams performed in primary care settings with remote interpretation.

ʯ The description for CPT® Code 92250 remains

unchanged, but the AMA has clarified that this code is intended for exams performed in the same place where the interpretation is performed (e.g., in an ophthalmologist’s office).

ʯ The appropriate CPT® Code for teleretinal

programs with physician overread will be 92228 beginning January 1, 2021 with CMS coverage currently proposed at $28.71 per exam (final rates will be published in December) – an improvement over no national coverage policy.

ʯ Although there is always downward pressure

on reimbursement rates, expect commercial coverage rates to remain somewhat stable (approx. $70 on average) for the diabetic retinal exam in primary care settings – ensuring primary care providers are incentivized to continue efforts to close the HEDIS quality gap.

December 2020




A simple and affordable handmanage retinal exam data. To streamRetinaVue® Network held camera designed for primary line documentation, fully integrated, Software offers ® care, RetinaVue 700 Imager capbi-directional interfaces with EMRs, secure transfer tures images automatically with including Allscripts, athenahealth, of encrypted image quality similar to more-expenCerner, Epic, NextGen and many retinal images and sive tabletop cameras used by eye others, are offered. Physicians may specialists. The camera offers an place retinal exam orders and automanagement of automated retina imaging experimatically access diagnostic reports exam data via ence, featuring auto-alignment, autofrom the EMR. HIPAA-compliant, focus and auto-capture, so minimal Through RetinaVue,® P.C., SOC 2 Type II board-certified, state-licensed ophtechnique is required by the user. In certified, FDA-cleared thalmologists and retina specialists fact, a study involving 35 registered interpret retinal images and prepare nurses, licensed practical nurses and software. a comprehensive diagnostic report medical assistants showed that after and referral/care plan generally in a 30-minute practice session, all parone business day, complete with ICD codes, signature, ticipants were able to capture a high-quality retinal image and license number. It is the first tele-ophthalmology of each eye within three attempts. provider to earn The Joint Commission’s Gold Seal of In addition, the RetinaVue® 700 Imager can capture clear images through pupils as small as 2.5 mm, dramatiApproval® by demonstrating continuous compliance with its Ambulatory Care Accreditation Standards. cally decreasing the need for dilating drops. And image capture can be completed in minutes, with minimal disLearn more ruption to busy clinic workflow. ® The convenience and quality of the RetinaVue® Care RetinaVue Network Software offers secure transfer of encrypted retinal images and management of exam Delivery Model, plus the coverage changes from Medidata via HIPAA-compliant, SOC 2 Type II certified, FDAcare, make access to recommended annual diabetic eye cleared software. Providers can meet their workflow and exams convenient for patients and primary care practices administrative needs, including population health manalike. Find out more by talking to your local Hillrom repagement and quality reporting tools, to more effectively resentative or visit

CPT® Codes for retinal imaging Current CPT Code Descriptions (CMS Rate)

Code Changes and New Codes (CMS Rate*)

92250: Fundus photography with interpretation and report (CMS $45.83)

92250: Covers screening/diagnosis or monitoring where the review is performed by a physician in the office where the image was captured (CMS $36.78*)

92227: Screening examination for the asymptomatic patient at risk for a condition such as diabetic retinopathy (CMS $13.71)

92227: Imaging of retina for detection or monitoring of disease; with remote clinical staff review and report, unilateral or bilateral (CMS $15.49*)

92228: Remote imaging requirement for monitoring and management of patients with active retinal disease (CMS $34.65)

92228: Imaging of retina for detection or monitoring of disease; with remote physician or qualified health professional review and report, unilateral or bilateral (CMS $28.71*) 92229 (new): Imaging of retina for detection or monitoring of disease; with point-of-care automated analysis with diagnostic report; unilateral or bilateral (CMS $11.94*)

* Proposed rate pending final approval in December 2020, effective January 1, 2021.


December 2020

SIMPLE AND AFFORDABLE It’s more accessible than ever to provide teleretinal exams to patients living with diabetes during a routine primary care visit. Most commercial healthcare plans provide coverage for diabetic retinal exams in primary care settings1 and Medicare will cover with CPT® Code 92228 beginning January 1, 2021.2

Visit to learn about the Welch Allyn® RetinaVue® care delivery model, a patient-centered solution to help eradicate diabetic retinopathy as the leading cause of blindness in American adults.3

Based on a technical comparison against key market competitors (06-2020). Commercial Coverage Policy data on file. Welch Allyn; 2019. 2 Medicare Program; CY 2021 Payment Policies under the Physician Fee Schedule Proposed Rule [CMS-1734-P], 08/17/2020, 3 Centers for Disease Control and Prevention. Vision Health Initiative (VHI). https://www. Published September 29, 2015. Updated September 29, 2015. Accessed January 30, 2020. * 1

© 2020 Welch Allyn, Inc. ALL RIGHTS RESERVED. APR149201 Rev 1 02-NOV-2020 ENG-US

The Welch Allyn® RetinaVue® 700 Imager— the world's most advanced handheld retinal camera.*

Year-End Reality Check Any insights gained after a tough year? In January, Repertoire published

predictions from several industry people about the year ahead. When we checked back with them this fall, they reported that despite its many challenges, the year 2020 offered sales reps new insights into how they can approach their job better than ever. Do you agree?


December 2020


Ashley Brust, Vice president of corporate sales, West Coast, physician office Medline Industries Comment/Observation


Our ability to show up for our customers every single day via computer screen has given us a chance to connect with everyone from the nursing staff delivering care, to the supply chain directors who will do anything they can to provide PPE, to their teams, and to the executive-level managers who work tirelessly to plan for the future.

This has been the time to learn about the industry and keep up with all of the challenges our customers face in order to provide the support they need as they care for patients.

The COVID experience has brought to light how important it is to be a consultant for our customers. Successful sales reps have learned a lot about lab testing and inventory planning, which ultimately has helped them support their customers in a deeper way. A good sales rep realizes it’s not just about shipping an item to a customer, but it’s about understanding the customer’s structure, goals, patient population and pain points. Understanding the ‘why’ behind a question can completely transform your response. Our ability to see our customers [virtually] and have them ‘step into our homes’ has knocked down barriers, and I feel closer to many of my customers because of it.

Elizabeth Hilla, Senior vice president HIDA Comment/Observation


During the pandemic, distributor sales reps have had to focus on the absolute core of distribution – getting customers the products they need. They have coordinated with their sourcing teams as those teams vetted offers from thousands of suppliers to make sure customers received quality, FDA-approved products. They have helped customers and vendors manage allocations. And they’ve worked to make sure products got to the “hot spots” where they were needed most. The pandemic has taught all of us involved in sales to be more empathic than ever. In good times, we might occasionally rush the pleasantries and jump into our sales pitch. During the pandemic, we instinctively knew not to do that. We asked our customer or prospect how they were doing, and we really listened to their answers. We likely spent much more of our sales time – maybe 100% – addressing the customer’s most urgent needs. I never would have believed that you could forge strong customer relationships via video call, but experience has proved me wrong. I’ve learned that a Zoom meeting is still a face-to-face meeting – in fact, our faces seem closer than in a spread-out conference room. It’s much easier to share visuals and collaborate during a video call: Click to share the screen and everyone can read it without squinting. The customer wants to add something to the agreement? Just type it in. It’s also easier to get decision-makers together at one time, sometimes at short notice, because no one needs to commit to travel time.

In the future, we’ll use in-person meetings more selectively. We’ll find that sales reps are more effective than ever because they spend less time in airports or behind the steering wheel and more time face-to-face with customers.

December 2020


Year-End Reality Check Mark Zacur, Executive vice president and chief commercial officer Owens & Minor Comment/Observation


On-site meetings with customers became less frequent in 2020, but communication between reps and customers actually increased. This flexibility and collaborative approach to doing business will continue as we navigate the next phases of our collective response to COVID-19. At the very beginning of the pandemic, Owens & Minor took swift action to protect our teammates and ensure business continuity for our customers. This included implementing product allocation protocols that ensured we were able to maintain continuity of supply for our customers.

Jos Roach, Senior account manager Concordance Healthcare Solutions Comment/Observation


Because of COVID-19, I have become better at challenging suppliers a bit differently. What we thought were the main sources of a lot of these challenging products, e.g., PPE, were not necessarily the owners of the supply channel. It forced me as a representative to be open to finding any and all supply chains necessary to keep hospitals supplied. During the pandemic, many providers have lost tens of millions of dollars due to the reduction in elective surgical cases. They will be looking at their distributors and manufacturers for answers. The challenge will be finding costsavings in an environment where margins have already been reduced over years of cost-savings initiatives.

Regarding work/life balance, sales reps have to consider their own mental and physical health. If they don’t, they’ll potentially end up reducing their ability to serve their customers.

Mina Rezk, Vice president, Midwest, physician office sales Medline Industries Comment/Observation 2020 has allowed all of us to improve in our professional and personal endeavors. [Virtual calls] are a culture change for many of us who are accustomed to in-person interactions, but with proper time management, we can reach more customers, expand our product knowledge and become a more vital resource to our evolving market. I don’t believe [virtual calls] will permanently replace the need for physical interactions, especially during consultative appointments or product demonstrations. While a video can help communicate the use or need for a product, many customers prefer to physically see, measure and test certain investments.

COVID-19 may present more opportunities for physicians to manage their patients’ vitals remotely. There is always the question of compliance and accuracy, but that will continue to improve.


December 2020


Richard Bigham, director of sales Atlantic Medical Solutions Comment/Observation


Most reps have been required to become adept at communication skills other than face-to-face. Adoption of technology along with increased urgency have drastically altered established routines.

With the onset of product allocations, account management skills proved more valuable than selling skills. Successful reps truly understood the needs of their customers and sought products to meet those needs, many times suggesting alternative solutions to them. Communication skills, whether delivering good or bad news, have become more important than ever.

Rep efficiency will continue to improve with the reduction of travel time. Concise communication will boost productivity while improving customer satisfaction.

Face-to-face time with customers will focus on sales rather than account management. Successful reps will evolve to much more of a consultative sales role.

Mark Morauske, Advanced Product Specialist McKesson Medical-Surgical Comment/Observation


In the environment of COVID, reps have had to pivot and more frequently use technology like Webex, Zoom, etc., as many customers don’t want in-person visits.

2020 has been a very fluid year, and reps have had to learn how to quickly operate in an environment where new products and testing devices/solutions for COVID have been hitting the market at a rapid pace.

Because most products around testing and PPE have been in short supply, reps have had to hone their customer service skills. Dealing with allocations, keeping customers informed, and helping them find alternative solutions have become a way of life over the last 7 months.

Moving forward, reps will be much more proactive with their customers and help them plan how they are going to keep critical supplies stocked.


December 2020




Solving customer problems utilizing distributor and manufacturer partnerships Many distributors and manufacturers want to be superheroes to their customers, solving problems no one else can.

In reality, when we talk to providers about solving a problem, it often involves multiple teams. A collaboration between the distributor, the manufacturer, and the end-user is critical to ensure that the customer has the best experience.

Here are three real-life stories where a good partnership between the distributor, the manufacturer, and the provider made the difference in getting the problem solved effectively and efficiently.

Outfitting a new OR with Supply Carts and Cabinets The problem: A healthcare system in Massachusetts needed to remodel their ORs. All open storage had to revert to closed storage. 30

December 2020


The solution: The CME and Metro account managers met with the Sr. Project Manager for Facilities Planning and the OR staff to review the needs of the facility. The team then reviewed current solutions and brainstormed for new ideas and solutions to meet the new requirements. This included a walk through the space to make sure all the customer needs were being met. Metro provided drawings of the new carts and cabinets, which included Starsys, Flexline, and wire shelf equipment. The CME account manager distributed the drawings

CME carries over

2 Million items from more than 2,000 manufacturers and offers customized services

customer’s old carts, including the components in each cart. Each cart was given a unique CME part number that included all of the elements so that the carts could be ordered from CME with one-part number instead of 10, which really helped simplify the ordering process. All the parts were ordered and shipped to the local CME warehouse. To address the customer’s resource challenges, CME assembled and then delivered the carts to the customer built and ready for use.

Carts Need Immediate Repair

Metro has

80 years, being the world’s leading manufacturer of storage and transport equipment.

and continued to follow-up with the end-users to answer questions, make any changes, and supply detailed quotes for the new equipment. The plans ended up fitting the needs of the client, and CME and Metro partnered to create a new OR storage area to meet the exact needs of the client.

Replacement Carts Customized for Efficiency The problem: A national healthcare system replaced legacy specified carts in Washington State. The original carts were not connected with viable part numbers and were no longer available from the manufacturer. The customer had no resources to assemble these carts and get them to the appropriate rooms. The solution: The CME account manager worked with the customer’s equipment planner to get physical photos of existing carts, descriptions of the carts, and the end-user’s current requirements. There were four different types of carts with various levels of accessorizing needed. CME worked with the Metro account manager to configure the carts based on Metro’s offerings, and that met the customer’s specifications. CME built a database of new Metro drawings cross-referenced with the

The problem: A major health system in Florida had three aging carts that were not locking correctly and needed to be repaired ASAP. The solution: CME is one of the few on-call organizations certified and trained to repair Metro carts. CME acknowledged the request for service same day and dispatched their Florida-based biomedical technician to the site to determined what was causing the issue with the carts. Armed with the information obtained by the CME technician, Metro sent the needed replacement parts, and the CME technician was able to go onsite to install those parts to fix the locking function on the carts. With timely service and efficient processes, the partnership between distributors & manufacturers is a significant aspect of the customer experience. By nurturing the partnership with Metro and CME, both companies can provide a better customer experience. In every instance, customers benefit. CME Corp (CME) is a distributor that focuses on equipment only. Our mission at CME is to help healthcare facilities nationwide reduce the total cost of the equipment they purchase and make their equipment specification, installation, maintenance, and disposition processes more efficient. CME carries over 2M items from more than 2,000 manufacturers and offers customized services that include direct-to-site delivery, biomedical, technical and disposition services. For over 80 years, Metro has been the world’s leading manufacturer of storage and transport equipment. From our innovative wire and polymer shelving lines to the revolutionary Starsys product line to a broad range of healthcare cart solutions including the Lifeline emergency cart, Flexline procedure carts and Lionville series medication carts, Metro puts space to work in healthcare facilities of all sizes.

December 2020



No primary care physician is an island … … particularly those in physician-led ACOs Editor’s note: The following is second in a series about changes occurring among primary care physicians.

Notice anything different about your physician customers these days? Are they thinking more strategically, perhaps?

Taking on a little risk? Collaborating with others, including social workers, nutritionists, physical therapists or mental health professionals? Complaining a bit less about EMRs and analytics? If so, they may be part of a physician-led accountable care organization, or ACO.

ACOs are groups of doctors, hospitals, and other healthcare providers who join together to give coordinated, high-quality care to Medicare patients, according to the Centers for Medicare & Medicaid Services. Their common goal is ensuring that patients get the right care at the right time – cost-effectively, of course – while avoiding duplication of services and preventing medical errors. Those that succeed share some of the savings with the Medicare program. From 2010 to 2015, hospitals or health systems sponsored the majority of new ACOs. But in recent years, the ACO market has seen a shift, as physician group organizations have begun to lead the majority of new ACOs. In 2018, physician-group-led ACOs represented approximately 45% of all ACOs, hospital-led ACOs accounted for 32

December 2020

approximately 25%, and joint-led ACOs represented 30%. Experts believe there is greater market potential for new physician-led ACOs than for those led by hospital systems. COVID-19 has been a big driver, according to David Muhlestein, chief strategist and chief research officer, Leavitt Partners. During the pandemic, practices that were dependent on fee-for-service saw dramatic drops in patient volume, and hence, revenues, says Muhlestein, who focuses on healthcare payment and delivery transformation. But those that were paid on another basis, such as value-based care, didn’t suffer so much. “The difference in the two types of payments is like the difference between getting paid on commission or salary. Commission is great so long as sales are coming in, but if there’s a downturn, salary can be really valuable.”

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TRENDS Size doesn’t really matter Muhlestein says physician-led ACOs may include as few as 15 physicians or as many as a thousand or more. Most commonly, however, they tend to be in the 50-to100-physician range, he says. “Some are in the same market as large hospital systems, some are in rural areas, and some are in mid-size markets where there are no other ACOs. All it takes is someone to say, ‘We want to take care of patients differently, and now there’s a payment model that can accommodate that.’” Third-party companies, referred to as ACO enablers, have arisen to help physician groups manage risk, that is, balance the financial and care-delivery components of an ACO. Kim Harmon, vice president for ACO services for TMA PracticeEdge, a subsidiary of the Texas Medical Association, notes that its client base represents solo and small physician practices who provide care in their local communities. “While ACO size varies, 50 to 150 physicians will typically generate the 5,000 to 7,000 patient lives required by payers for participation in a contract,” she says.

“Low-revenue” ACOs, as physician-led ACOs are increasingly referred to, have performed better than “high-revenue” ACOs, that is, those led by hospitals and health systems, points out CMS Administrator Seema Verma. In 2019, low-revenue ACOs had net per-beneficiary savings of $201 compared to $80 per beneficiary savings for high-revenue ACOs. The trend is the same for ACOs in the new Pathways to Success program, in which low-revenue ACOs had net per-beneficiary savings of $189 while high-revenue ACOs had net per-beneficiary savings of $155. (Introduced in December 2018, Pathways to Success reduced the amount of time an ACO could remain in the program before accepting financial risk along with potential shared savings.) Two factors favoring physicianled ACOs are market size and potential, says Muhlestein. Simply put, physician groups outnumber health systems, and enjoy many more market opportunities. In addition, physicianled ACOs achieve significant cost-savings by reducing inpatient admissions. On the other hand, health-systemled ACOs, whose inpatient facilities

For physicians, it’s moving away from, ‘I am taking care of this patient in front of me,’ to ‘I need to be aware of everything about this patient, and if he or she has needs I can’t provide for, I need to create partnerships or arrangements with other providers.’

Lessons learned Repertoire asked Kim Harmon, vice president for ACO services for TMA PracticeEdge, a subsidiary of the Texas Medical Association, about lessons the organization has learned – and the biggest surprises it has encountered – while forming and nurturing physician-led accountable care organizations. She listed three: 1. Smart growth is important. An ACO doesn’t need every physician in the community to participate. Focus instead on those who are engaged and willing to learn from the data provided.


December 2020

2. Success in value-based care models takes time. Physicians get frustrated when they don’t see immediate results/ rewards. Shared-savings contracts are paid out 6-8 months after the end of the performance year.

The longer physicians participate, the better they become. 3. The biggest surprise has been the number of emergency visits generated by conditions that could easily be treated in

a primary care practice. Many patients do not take the time to establish a medical home. When unexpected health issues arise, they feel compelled to visit hospital emergency departments for a quick (and expensive) fix.



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TRENDS still collect revenues based on admissions, may hesitate to do the same.

No physician ACO is an island In order to provide the total continuum of care for patients, physician-led ACOs must build relationships with other providers. “Physician-led ACOs are responsible for the cost of care at the global level even though they’re unable to directly provide it,” says Muhlestein. Harmon points out that TMA PracticeEdge’s ACOs are composed solely of primary care physicians who serve as medical homes for their patients. “But that doesn’t mean they are an island,” she says. “They identify specialists in their areas who are good communicators and provide cost-effective and quality care. Preferred urgent care centers help them offer after-hours care, and independent hospitalists manage care in the inpatient setting. Around all of this is a group of care coordinators who help with care transition and checking in on patients between office visits.”

‘ Physicians are trained to deal with complex clinical matters, but they have to think about the overall needs of the patient, some of which can be addressed by other professionals.’ Josh Seidman, managing director, Avalere, says that some large practices already include a number of specialists, while others contract with a select set of specialists for particular issues that commonly arise among their patients. Such specialists, e.g., cardiologists or psychiatrists, might spend one or two days a week in the practice, or are just a telehealth visit away, says Seidman, who advises clients on value-based care models with a focus on information technology. Some ACOs form relationships with hospitalists to oversee the care of patients when they are in an inpatient facility or to stay in touch with emergency department physicians when patients are in hospital EDs. The success of these systems rests on good data exchange between the hospitalist and the ACO, including admission/discharge/transfer (ADT) data. 36

December 2020

The long run Culture change like this doesn’t happen overnight. Historically, physicians haven’t been trained to proactively identify patients with needs and figure out how to address those needs in advance of them flaring up, says Seidman. “It’s a big shift in approach. Then there is this idea of physicians operating as a team. Even more important is each person understanding their role within that team. “Physicians aren’t necessarily the best-equipped people to figure out how to help people adopt more healthy behaviors or how to meet a wide array of their social or other needs that have an impact on health,” he continues. “A social worker, health coach or community health worker might be in a better position to do so. Physicians are trained to deal with complex clinical matters, but they have to think about the overall needs of the patient, some of which can be addressed by other professionals.” Medicare data shows that experience matters, says Seidman. “Physician-led ACOs do better over time – not surprising for anything that requires significant effort.” Will ACOs, like many healthcare trends, such as HMOs – be relegated to the ash heap of history? How long can they deliver savings and improve quality of care? “There definitely are things you might call lowhanging fruit in terms of reducing unnecessary hospitalizations and readmissions,” says Seidman. “But shifting your approach in how care teams are organized and social needs are addressed is important for long-term improvements in efficiency and quality.” ACOs may very well succeed where HMOs didn’t, says Muhlestein. Unlike HMOs, ACOs offer patients the flexibility to switch providers. Even more important, HMOs focused almost exclusively on reducing the cost of care, which meant gatekeepers, prior authorizations – in a nutshell, barriers to care. While ACOs share concerns about cutting costs, they also work to meet goals for quality-of-care and patient satisfaction. “If you move away from shared savings models to full delegated risk capitated payment, you can perpetuate these programs,” he says. “Physician groups are starting to accept risk. It’s not for everyone; it’s a dramatically different approach to care. For physicians, it’s moving away from, ‘I am taking care of this patient in front of me,’ to ‘I need to be aware of everything about this patient, and if he or she has needs I can’t provide for, I need to create partnerships or arrangements with other providers.’ It’s management. “Some have already been successful doing this – enough so that many others are now open to the idea.”



PPE Essentials: Gowns What reps need to know about different types, requirements, claims and standards of gowns used in medical settings. By William Bagnasco, ASQ CQA, PMI CAPM, CLSSGB, Director of Quality and Regulatory Affairs, DUKAL Corporation As the novel coronavirus has spread across the globe, Personal Protective Equipment, also known as PPE, has

become the hottest topic in the medical device industry. Along with the increased demand for PPE, came an influx of new suppliers to the market. As new suppliers emerged, so did the questions related to the different types of PPE and various levels of protection that they offer.

Since the onset of the virus in early 2020, the industry has scrambled to secure appropriate product to meet the needs of healthcare workers required to protect themselves and patients from the spread of infection. This article will focus on the different types of gowns, the requirements and claims associated with level rated gowns, and draw attention to the inconstancies between AAMI’s standards and those of the FDA.

from the transfer of microorganisms and body fluids in patient isolation situations,” and “surgical gowns” as “devices that are intended to be worn by operating room personnel during surgical procedures to protect both the surgical patient and the operating room personnel from the transfer of microorganisms, body fluids, and particulate material.” (21 CFR 878.4040)1 The main difference between an isolation gown and a surgical gown

The definitions used in the ANSI/AAMI PB70 standard are inconsistent with those used by the FDA, which has caused confusion in the industry. Types and standards The American National Standards Institute (ANSI) and the Association of the Advancement of Medical Instrumentation (AAMI): ANSI/ AAMI PB70 describes liquid barrier performance and classification of protective apparel and drapes intended for use in healthcare facilities. In 2004, the FDA recognized ANSI/AAMI PB70 as the consensus standard. AAMI PB70 defines an “isolation gown” as an “item of protective apparel used to protect healthcare personnel and patients 38

December 2020

are the critical zones identified for testing and that the back of a surgical gown may be nonprotective. Whereas the back of a level rated isolation gown must offer full back coverage and have a barrier performance of at least a Level 1. The ANSI/AAMI PB70 standard has 4 levels of fluid barrier protection, with Level 1 being the lowest level of protection and Level 4 being the highest. The following is a table showing the different levels of rated gowns, test methods, and the anticipated fluid exposure for each performance level.

AAMI PB70 guidelines ANSI/AAMI PB70 Barrier performance Test method

Test definition


AAMI Level 1

Water resistance: Impact penetration AATCC 42


Measures the resistance of fabrics to the liquid penetration of water by impact

Water impact ≤ 4.5 g Minimal fluid levels

AAMI Level 2

Water resistance: Impact penetration AATCC 42


Measures the resistance of fabrics to the liquid penetration of water by impact

Spray impact ≤ 1.0 g

Water resistance: Hydrostatic pressure AATCC 27

AAMI Level 3

Water resistance: Impact penetration AATCC 42 Water resistance: Hydrostatic pressure AATCC 27

AAMI Level 4


Measures the resistance of fabrics of the liquid penetration of water by impact under constant and increasing hydrostatic pressures


Measures the resistance of fabrics to the liquid penetration of water by impact


ASTM F1671 ASTM F1671, Standard Test Method for Resistance of Materials Used in Protective Clothing to Penetration by BloodBorne Pathogens Using Phi-X174 Bacteriophage Penetraction as a Test System

Anticipated fluid exposure

Low fluid levels

Hydrostatic pressure ≥ 20 cm

Spray impact ≤ 1.0 g Hydrostatic pressure ≥ 50 cm

Moderate fluid levels

Measures the resistance of fabrics to the liquid penetration of water by impact under constant and increasing hydrostatic pressure Measures the resistance Pass of materials used in protective clothing to penetration by blood borne pathogens using a surrogate microbe under conditions of continuous liquid contact.

High fluid levels

Association for the Advancement of Medical Instrumenation. Liquid Barrier Performance and Classification of Protective Apparel and Drapes Intended for use in Health Care Facilities. ANSI/AAMI PB70:2012. Arlington, VA: AAMI.

According to the FDA, both surgical gowns and isolation gowns are considered surgical apparel and are covered under the requirements of 21 CFR 878.4040. Gowns that are not intended for use in a surgical setting are Class I devices. They are intended to protect the wearer from the transfer of microorganisms and body fluids in low risk patient isolation situations. This includes both Level 1 & 2 isolation gowns, as well as non-rated isolation gowns. The agency identifies gowns that are intended to be used in surgery as Class II devices which require a pre-market notification. A pre-market notification, also known as a 510k submission, ensures that a device meets specific performance standards, labeling requirements

and its intended use by demonstrating substantial equivalence to another device which has been shown to be safe and effective.2 The definitions used in the ANSI/AAMI PB70 standard are inconsistent with those used by the FDA, which has caused confusion in the industry. Unlike AAMI, the FDA considers both the level of barrier protection and the terminology used in the marketing and labeling of the device. In 2015, the FDA issued a guidance document clarifying their approach. The FDA considers gowns with moderate to high barrier protection (Levels 3 & 4) to be a higher-risk device than gowns that claim minimal or low levels of fluid protection (Levels 1 & 2, and non-rated gowns). The FDA

December 2020




automatically considers a gown to be a “surgical gown” or “surgical isolation gown” when it has a statement relating to moderate or high-level barrier protection. This means that if a gown is labeled as an AAMI Level 3 or 4, it’s considered a “surgical gown” and is subject to the requirements of premarket notification. This contradicts the ANSI/AAMI PB70 standard that states that surgical gowns can be classified as Level 1-4.3

identified as either AAMI Level 3 or 4. On the other hand, isolation gowns can be rated AAMI Level 1-4 or they can be non-rated. There are non-rated isolations gowns that offer fluid protection which don’t carry a level rating due to the construction features of the gowns, such as having an open back design and/or sewn seams. Any isolation gown that carries an AAMI Level 3 or 4 designation would be considered a high-risk device and would require a premarket notification.

What does this all mean? To simplify it, a “surgical gown” that is marketed in the United States cannot claim to be AAMI Level 1 or 2 because using the word “surgical” on the label or in any marketing material implies that the gown is intended for use in a surgical setting. Any gown labeled or marketed with the words “surgical”, “surgical gown” or “surgical isolation gown” is automatically elevated to a Class 2 device, requires a premarket notification and should be

Now that we have a better understanding of the different types of gowns and the differences between FDA regulations and the ANSI/AAMI standard, we can look at what should be reviewed with regards to claims, prior to purchasing a gown. ʯ Level 1 Isolation Gown: The manufacturer should provide test reports, according to AATCC 42, showing that all critical areas of the gown were tested for fluid resistance and that all test requirements were met. Level 1 gowns offer protection against minimal fluid levels. ʯ Level 2 Isolation Gown: The manufacturer should provide tests reports, according to AATCC 42 & AATCC 127, showing that all critical areas of the gown were tested for fluid resistance and that all test requirements were met. Level 2 gowns offer protection against low fluid levels. ʯ Level 3 & 4 Gown (Surgical and Isolation): A copy of the 510k summary should be reviewed to ensure FDA clearance. Level 3 & 4 gowns offer protection against moderate and high fluid levels respectively. An important thing to remember is that all claims that are made with regards to fluid protection should be made on the final, finished gown including the materials, seams and points of attachment. There are gowns on the market that claim that the “material” is fluid resistant. This is an important factor to consider when trying to select the appropriate gown based on its barrier properties. Having a better understanding of the different types of gowns, the various regulations/standards that cover these gowns and the proper supporting documentation will allow you to select the appropriate gown and ensure that the gown does in fact meet the intended use and labeling claims.

1 Sections 3.13 and 3.31 of the ANSI/AAMI PB 70:2012 (citing 21 CFR 878.4040). 2 3 Guidance document on Premarket Notification Requirements Concerning Gowns Intended for Use in Health Care Settings


December 2020

Let’s make a positive impact together.

DUKAL can be a strong long term partner for you in the personal protection equipment category. We are continuously investing in our capabilities and capacity to bring high quality personal protection equipment to front-line workers. Our PPE products meet or exceed all FDA requirements, holding multiple 510k’s for surgical masks and N-95 respirators. DUKAL also offers AAMI level rated isolation gowns. Let’s make a positive impact together. Contact us at to learn more about how we can be a long term provider of personal protection equipment for you.

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Tales from the GRIT-Iron A compendium to consider as the calendar closes By Sandler Systems This is the season for reflection on the past year, and for consideration of how to

change, improve and grow in the coming year. You’ll likely see many lists of “Top Tens from 2020” types of articles and emails, and also get a lot of suggestions about what you need to do to survive and thrive in 2021. Are you tired of phrases like “new normal” and “selling in a recovery”? We don’t want to give you any rhetoric or shove “musts” down your throat. Instead, we’ve compiled a few real-life stories of sales tips that just plain work. Not just in “crisis mode” but in the everyday world of the sales professional’s struggle. At the end, you’ll see your opportunity to submit your own tale of a solid sales technique for a chance to see your name and story in print!


December 2020

Winners keep score “Last week, my clients and I were talking about how to respond to adversity. If you made it through that message and you still had your head high and your eyes forward, you might be asking the question ‘What do I do now?’ When we say something like, ‘There are people who say there is a crisis and I decided not to participate,’ we’re not being facetious and we’re not putting our head in the sand. What we’re saying is that there are changes in the marketplace, so we’ll make changes in our behaviors that will lead to the accomplishment of our goals.” “Some people believe the appropriate response to the changes we are seeing or hearing in the marketplace – which others have called a crisis – is to stand back and wait until the dust settles. Even though there are people who choose this route, you can respond instead in ways that might increase the probability that you will accomplish your goals.” Some questions you might ask: 1. W hat have been the result of my efforts to develop new clients or to get my salespeople to bring in more sales? Out of ten prospective new clients, how many invited me in for a conversation? 2. Out of my efforts to get new clients – networking meetings, charity boards, email campaigns, direct mail pieces, seminars, calling referrals – how much business resulted? Which behaviors gave me the most new clients or sales? 3. How many referrals am I getting? Where are they coming from? “If you’re frustrated because you don’t have the answers to these

questions, you’re not alone. But as one of my partners in a referral group last week declared: winners keep score! It doesn’t help to keep score if you’re only counting the number of new clients you get or the number of sales your people make. It wouldn’t help a coach to only keep count of the number of touchdowns the team makes, but it does make sense to count the behaviors that lead to those scores; behaviors that, if consistently per-

I said the only thing I could, ‘Three years ago I went to a golf school. They taught me drills and techniques to make my game better. But I don’t have time to practice. I’m just hoping I still remember what they told me.’” “My buddy’s response stung a little. He asked, ‘How is that working for you?’ For some reason, I expected performance without practice, but I know better. Regardless of profession, professionals practice their profession.”

“ Most sales professionals take the inevitable rejection that comes with their work personally, and don’t make the necessary distinction between their role as a salesperson and who they really are.” formed, lead to touchdowns, which lead to victories.” How are you keeping score? What do your numbers look like?

Pros practice too “I like to golf but I’m not a good golfer. When I played with a golf pro buddy of mine and hacked my way out of a sand trap and putted for a 6 on a par 3, he asked me ‘When was the last time you practiced your short game?’ And by practice he meant really working to systematically improve my technique through repetition and measurement of results.” “It was clear that I hadn’t taken an honest look at what I was doing or put together a systematic approach to becoming measurably better. So

“About a week later I was talking to a business owner buddy of mine. He told me about the sales struggles he had been having recently. Sensing an opportunity, I asked the question I had been waiting to ask, ‘How much time do you spend practicing sales?’ He said the only thing he could, ‘I took some training a couple of years ago. They taught me some systems and techniques designed to help grow my sales. But times are tough now, the market has changed, my competitors are better than they were, and I don’t have time to practice. I’m just hoping I still remember what they told me.’” “I hope my response stung a little when I asked him, “How is that working for you?”

December 2020


SALES When selling gets physical “According to the American Journal of Epidemiology, today’s economy is stressing people out, and stress has been linked to a number of illnesses such as heart disease, high blood pressure and increased risk for cancer.” “Some stress is understandable, but also unnecessary. If you’re in sales,

a sales system can help you reduce the pressure you’re under in a big way and will help you stop confusing your ‘real self ’ with your ‘role self.’” “Most sales professionals take the inevitable rejection that comes with their work personally, and don’t make the necessary distinction between their role as a salesperson

“ It doesn’t help to keep score if you’re only counting the number of new clients you get or the number of sales your people make.”

and who they really are. But those who can make that distinction – and it takes practice to do it – find that they worry less, and that makes them more effective. They’re happier and healthier, sales increase, and the confidence they show inspires others to have confidence in them.” “A sales system will also help you adjust the goals for your prospecting efforts. Your only goal should be to determine if your prospect has any interest in your product or service and, if they do, to set up an appointment for a later date. This is not the time to talk about features or benefits or price. All you should try to do is schedule the appointment. This takes the pressure off you, and also off your prospect, and he or she won’t have to think about putting up a defensive wall. “When you get your prospect on the phone, be up front about what you want. Make sure they understand that all you are trying to do is to determine if they have any interest in what you’re selling and, if they do, to set up a time to talk further. That’s it. A sales system will lighten your stress, and theirs too, helping you remain productive in challenging times.” To schedule a complimentary 30-minute advisory session on account planning, goal-setting, a system to sell, or sales management, send your request and contact information to with “30-minute Free Consultation” in the subject line. Include your OWN tale of a solid sales technique for a chance to see YOUR name and story in print!

About Sandler Training With over 250 local training centers around the globe, Sandler is the worldwide leader for sales, management, and customer service training. We help individuals and teams from Fortune 500 companies to independent producers dramatically improve sales, while reducing operational and leadership friction. ©Sandler Systems, Inc. All rights reserved.


December 2020


HIDA: The Voice for Distributors Throughout COVID-19 HIDA has been driving legislation and collaborating

with policymakers and other stakeholders to ensure that medical products distributors are included in the nation’s pandemic response. HIDA’s work on the issue during 2020 is highlighted below.

Driving Legislation on Capitol Hill In the U.S. House February: HIDA works with Rep. Debbie Dingell (D-MI) on a letter to her colleagues advocating emergency preparedness funding April: Rep. Dingell and Rep. Jackie Walorski (R-IN) introduce the Medical Supplies for Pandemics Act (H.R. 6531), which includes HIDA’s proposals May: HIDA’s language included in the Heroes Act, which the House passes July: H.R. 6531 is included in the Strengthening America’s Strategic National Stockpile Act, H.R. 7574 August: House Republicans include HIDA proposals in their Second Wave Project for U.S. pandemic response

September: HIDA testifies before International Trade Commission on pandemic supply chain issues

Educating Policymakers June/July: 6,500 emails to House and Senate staff highlighting policy positions and educating the trusted role of distribution July: HIDA Board Chair Chris Fagnani of Lynn Medical testifies before House Small Business Committee on supply chain resiliency July: HIDA President & CEO presents PPE demand projections to Defense Department conference August: HIDA white paper “A More Robust Supply Chain” amplifies distributors as trusted partners in pandemic response

In the U.S. Senate May: HIDA proposals are included in bipartisan legislation, S. 3827 June/July: HIDA policies are included in Sen. Lamar Alexander’s pandemic preparedness bill, S. 4231, based on his earlier released white paper also referencing HIDA’s work

Advocating with Federal Agencies February: HIDA provides input with the Department of Health and Human Services, Strategic National Stockpile, and the Centers for Disease Control and Prevention on product demand and availability. March: U.S. Trade Representative provides tariff relief for critical personal protective equipment (PPE) April: HIDA and the American Health Care Association co-sign a letter to the Federal Emergency Management Agency (FEMA) highlighting the urgent PPE needs of post-acute providers. May: HIDA President & CEO Matthew J. Rowan advocates at FEMA meeting for broad industry inclusion to distribute pandemic supplies under Section 708 of the Defense Production Act

Working in the States April/May: HIDA engages with states that were proposing policies to commandeer PPE located within their state borders June: HIDA and AdvaMed advocate jointly for industry inclusion in purchasing consortium for pandemic supplies July: HIDA provides input to National Governors Association’s Second Wave document August: HIDA works with stakeholders on recommendations to states for stockpile management and distribution September: HIDA recommendations added to California stockpile legislation, signed into law

December 2020



Everyone Counts Heather Ruszin finds time for everyone – from her customers and vendors to children and families in need. By Laura Thill

What began as an after-school part-time job eventually led to a passionate lifetime career for Heather Ruszin.

The owner of Stellar Health Services and a longtime volunteer at Media, Pennsylvania-based Every Child Counts, Ruszin has always been drawn to helping those in need.

Heather Ruszin and her husband

“My sophomore year of high school, I took a parttime job at our local drug store to help my mom – a single mother of four – pay the bills,” she recalls. “I quickly became aware of how important it is to help others – especially the elderly.” During college, she took a full-time position with a closed-door pharmacy, working closely with nursing home patients. In the years that followed, Ruszin gained additional experience in retail, long-term care, hospital care and medical billing. Then, in 2000, she met Brian Steltz, a licensed pharmacist and owner of King of Prussia Pharmacy Services (KPPS), while covering a shift for a home infusion company. “Given our combined experience, we agreed that if we could secure a contract with a nursing home, I would come work for Brian’s company,” she says. Not long afterward, she discovered a nursing home 46

December 2020

looking for a new pharmacy provider. “We set up a meeting with the director of nursing, signed a pharmacy contract one week later, and I joined KPPS. Today, KPPS continues to service that nursing home.” KPPS was the first of several pharmaceutical ventures for Ruszin. Together with Steltz, she co-founded Stellar Pharmacy Services in 2013. Stellar Pharmacy Services delivers point-of-care education and medications (including asthma, family planning/Long-Acting Reversible contraception (LARC), NARCAN® nasal spray for opioid overdoses, as well as other medications) to patients in physician offices, clinics and hospitals. A unique company, Stellar Pharmacy Services is known to deliver pointof-care medications using a high-tech patented dispensing system called the XpeDose™ machine – a secure unit that allows providers to obtain, administer or educate patients in the doctor’s office/clinic/hospital on how to use medications. “Stellar developed the XpeDose™ unit and technology in 2013 when a managed care organization in Pennsylvania asked us to pilot its point-of-care asthma program,” Ruszin explains. The ability to teach patients how to administer their medication in the doctor’s office or hospital can help prevent return trips or, worse, emergency hospital visits, she points out. “For instance, we can ensure asthmatic children know how to use their inhalers or nebulizers before they leave the doctor’s office,” she says, noting there’s nothing scarier than for parents to witness their children being unable to breathe and racing them to the ER. “Running these companies has required round-theclock dedication to my staff and customers, 365 days each year,” she says. “In addition, I’ve had to learn how to balance my family life. I’ve had some great mentors through the years and it’s been a blessing to have helped so many people these past 30 years.”

Changes and challenges In her early days as a business owner in the pharmaceutical industry, Ruszin faced her share of challenges. In fact, it used to be difficult for small distributors to secure product contracts, she says. “When I launched my family planning business, I was denied three times,” she recalls. “But, I didn’t give up, and in 2017, I was approved to carry family planning medication and could offer a full array of solutions for women.” This was a great step forward, given how important it is for patients to have a choice in their care and the products they use, she notes. “By giving patients a choice, and then educating them on the products and how to use them while they’re still at the doctor’s office or the hospital, we can prevent return visits and wasted time,” she says. “When you believe in yourself and refuse to give up, you’ll see the reward is worth the hard work!” Securing product lines is only half the battle, of course. Growing a strong client base is equally important. “The most important strategy I have relied on to stay connected with my customers has been to establish – and build – long-lasting relationships, and to be committed to the patients and their outcomes,” she says. “Being accessible and dependable are key. I give my phone number out to everyone and let them know I am available 24/7. It’s also important to be genuine and sincere so that clients and vendors alike can remain confident they can rely on me both professionally and personally.”

Every Child Counts Fifteen years ago, Ruszin and her husband were looking forward to moving into a new home, in time to welcome their firstborn child who was due soon afterward. Their dreams quickly turned into what could have been a nightmare, had it not been for an astute nurse and an attentive pediatrician. “Our son, JJ, arrived a few weeks early (before they could move into their new home, due to an unforeseen delay). “Our first pediatric appointment was scheduled for 10 days following his birth. Soon after leaving the hospital, I noticed he wasn’t very active and called the pediatrician’s office to see if I could move up JJ’s first office visit. The office staff told me not to worry – that I was a typical new mom and I should keep my scheduled appointment.” Fortunately, Ruszin had a home visit scheduled with a nurse the following day. “As soon as the nurse saw JJ, I could tell by the look in her eyes that something wasn’t right,” she says. “The nurse asked me for the name of our pediatrician, Dr. Messam, who took care of him in the

hospital, and immediately called her office.” Based on the nurse’s observation, Dr. Messam ordered a bilirubin test. “Shortly afterward, the nurse called to instruct me to meet Dr. Messam on the pediatric floor. Due to his high bilirubin levels, JJ needed to be admitted immediately for phototherapy. The effects of bilirubin toxicity are often devastating and irreversible, so for JJ, we had to react quickly. Because we all worked together, JJ’s levels dropped and he was discharged a few days later – a healthy baby boy.” Since then, despite the hour-long drive there and back, Ruszin’s family has stayed with Dr. Messam’s practice. Furthermore, they have been active in family charities, including the pediatrician’s non-profit, Every Child Counts. “Since our scare with JJ, my family has been contributing to children and families in need,” she says. “When Dr. Messam founded Every Child Counts, a charity dedicated to improving the lives of children from birth to 18 years old living in high risk situations, she asked me to be the vice president. I gladly accepted and have been honored to be part of such an amazing team for many years.

ECC Board members.

December 2020


REP CORNER Every Child Counts collects donations and applies for annual grant money to support four programs: ʯ New Beginning. ECC partners with Wesley House Emergency Shelter in Chester, Pennsylvania, to provide Welcome Kits for families who are seeking emergency shelter at this facility. The kits/supplies are helpful to the families when they move to transition homes and, eventually, more permanent housing. ʯ Helping Hands at Holidays. The program provides Thanksgiving and Christmas dinners to less fortunate families with children under 18 years. It is supported by community donations, and food baskets generally include a turkey or ham with all of the trimmings. In addition, the program provides Christmas presents for low-income and/or high-risk families with children under 11 years old. ʯ Operation Graduate. This program provides first generation and high-risk students in Delaware

Dr. Messam and the Bright Future Scholars 2019.

County, Pennsylvania, with essential college supplies. Eligible students are matched with community mentors who assist them in achieving their goals for graduation from College. Funding for this program is supported by community donations and, in the future, the non-profit expects to procure grant funding. ʯ Thriving After Adversity. This program serves children who are victims/survivors of trauma. Currently, talk therapy is offered by numerous organizations in the United States for victims/survivors of trauma. Every Child Counts is planning a program that will provide alternatives to talk therapy with a trauma-informed focus. In addition, a healing garden (a peaceful space) will be provided for victims, survivors and their families to visit when they feel the need. Ruszin’s husband and children, JJ and Jalyn, volunteer with Every Child Counts as well. “We organize through my workplace, our relatives, friends and neighbors to collect food for the Thanksgiving and Christmas dinners,” she says. “And during the Christmas season, we collect books, stuffed animals and unwrapped toys and donate them to Dr. Messam’s office for families in need. Our goal each year is to make sure all of the children at Every Child Counts have gifts to open on Christmas morning. This has been a very successful program and a rewarding experience for my family.” Laura Thill is a contributing writer to Repertoire.


December 2020

Looking forward This year has given all of us a new perspective on how we understand the day-to-day challenges of distributor reps. MedPro, a contracted sales organization that offers continued support to distribution representing world-class manufacturers in acute and non-acute spaces, has remained committed to our customers by:

> Creating new revenue opportunities > Increasing your GP potential > Helping providers realize better outcomes


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 Shopping via Instagram According to CNBC, Facebookowned Instagram will start testing shopping through its short-form video feature Reels later this year in an effort to monetize the recently launched TikTok clone. The Verge reported that eventually, these IGTV videos will also be available through Instagram Shop, a dedicated page for shopping within the app. Viewers can just tap through an IGTV video and purchase the items they’re interested in through Instagram checkout or the seller’s website.

Apple announces Fitness+ Apple announced plans to enter the health and fitness industry this fall by unveiling Fitness+, the first fitness experience built for Apple Watch, arriving later in 2020. Apple Fitness+ incorporates metrics from Apple Watch for users to visualize right on their iPhone, iPad, or Apple TV, offering a first-of-its-kind personalized workout experience. Everyone from beginners to committed exercisers can access studiostyle workouts delivered by inspiring world-class trainers and underscored by motivating music from renowned artists, making it easier and more rewarding for customers to exercise, whenever and wherever they like. Apple Fitness+ delivers personalized recommendations to help customers quickly get to their next workout, 50

December 2020

and uses Apple Watch to provide an engaging, immersive experience to help them stay motivated throughout. Using a custom recommendation engine, Fitness+ considers previously completed workouts and intelligently suggests new options that match the workouts users select most often, or something fresh to balance their current routine. Customers can also use an intuitive filtering tool to choose what is most important to them when looking for a workout, whether it’s the work-

out type, the trainer, the duration, or the music. For Apple Music subscribers, favorite music from Fitness+ workouts can also be easily saved and listened to later, whether in a workout or otherwise. When a workout is selected and started on iPhone, iPad, or Apple TV, the correct workout type will automatically start on Apple Watch. During the session, the metrics from Apple Watch are shown on the screen and come to life for moments of inspiration. For example, when the trainer says to check heart rate or begins a countdown timer, those numbers will animate on the screen. And for customers who like to push themselves with a little healthy competition, the optional Burn Bar shows how their current effort stacks up against anyone who has done the same workout previously. The familiar Activity rings from Apple Watch also appear on screen, highlighting the wearer’s progress and launching an animated celebration as they close. With Activity Sharing, users can enable friends and family to see Fitness+ workouts completed, and workouts can also be shared to their favorite social media channels. At launch, customers can conveniently find Fitness+ in the tab located in the new Fitness app on iPhone, which will also arrive on iPad and Apple TV.

Mobile Adjustable Height Lead Acrylic Window Barrier With the same great protection you get from a Wolf barrier, this model features the ability to position the clear lead at any level between 45.25” and 74” for the ultimate in patient and operational visibility. It’s great for dozens of applications. Best of all, the internal counter balance mechanism makes it easy to lift or lower…it requires minimal •

Overall width: 30.5”

Opaque portion of the shield has .8mm lead equivalent protection

Clear panel provides .5mm lead equivalent protection

25” legs with casters provide strength, durability and easy transport within the clinic

The perfect right size solution for any environment: OR, ER, CT, X-ray, Urology, Pain Management, and Surgical Centers

When lowered allows rapid transport to any location in hospital or clinic and easy-to-store

Mobile Adjustable Height Lead Acrylic Window Barrier


Product Weight: 176 lbs


Health news and notes Protect your immune system

ʯ Get a flu shot. “Getting a flu shot during the

It’s critical to protect your immune system as we face both the COVID-19 pandemic and the 2020-2021 flu season, according to a Piedmont Living Better blog. Jemese Richards-Boyd, MD, a Piedmont primary care physician, shared ways you can boost your immune system and protect your health: ʯ Exercise. “Moderate exercise can boost immunity by increasing blood flow and helping to reduce chronic stress,” says Dr. Richardson-Boyd. ʯ Proper diet. “In general, a poor diet and lack of nutrients can interfere with the activity of your immune cells and possibly even the production of different immune cells,” she says. “If you lack the necessary nutrition and become exposed to an infection, your body may not be able to mount the response it needs to fight the infection.” ʯ Sleep. “Lack of sleep can negatively impact your immune system,” says Dr. Richards-Boyd. “It is important to practice good sleep hygiene to make sure you avoid common pitfalls that disrupt your ability to get restful sleep.”

pandemic is important because it is possible to get both influenza and COVID-19, as they are two separate viruses,” she explains. ʯ Wash your hands regularly. ʯ Stay home if you are sick. Read the full recommendations at: living-better/how-to-boost-your-immunity-during-covid

Where it hurts Looking for a healthcare-related podcast? Kaiser Health News and St. Louis Public Radio launched a podcast about the often painful cracks in the American health system that leave people frustrated – and without the care they need. Each season, the podcast examines an overlooked part of the country, to a community suffering because of gaps in care, to a failing sector of the health care industry. Season one of the podcast, ‘No Mercy’ explores the fallout after Fort Scott, a small town in Kansas, loses its hospital. To listen to the podcast, visit

Sniffing out COVID A recent Time article highlighted how dogs might play a role in detecting COVID-19 infections. One hint – their noses. Steve Lindsay, a public health entomologist at Durham University, along with collaborators at the London School of Hygiene & Tropical Medicine (LSHTM) and the U.K.-based nonprofit Medical Detection Dogs, are working on a U.K. governmentfunded study that will test dogs’ ability to detect COVID-19. Their goal: to train coronavirus-sniffing dogs, which could then be deployed at schools, airports and other public venues to reinforce existing nasal swab testing programs. A similar study is underway at the University of Pennsylvania. “We’re not just doing the proof of concept work, we’re also working out actively how to deploy this and scale it up as well, because we want to hit the ground running once we’ve gotten our results,” says James Logan, the head of LSHTM’s Department of Disease Control and the project lead on the U.K. study. Read about the studies at: 52

December 2020


Automotive-related news

Tesla finishes third quarter on record-breaking pace According to Car and Driver, Tesla announced that it had delivered a record-breaking 139,300 vehicles in the thirdquarter ending on September 30. Overall it built 145,036 vehicles during that time. Since the beginning of 2020, Tesla has sold 318,000 vehicles. It’s likely that number would have been higher had it not been that its Fremont, California, and Shanghai, China, facilities were temporarily shut down due to the coronavirus pandemic.

Good news, bad news with U.S. traffic deaths Traffic deaths decreased nationwide during 2019 as compared to 2018, according to data released by the U.S. Department of Transportation’s National Highway Traffic Safety Administration. There were 36,096 fatalities in motor vehicle traffic crashes in 2019. This represents a decrease of 739 (down 2%) from the reported 36,835 fatalities in 2018, even though vehicle miles traveled increased by nearly 1%. As a result, the fatality rate for 2019 was 1.10 fatalities per 100 million VMT – the lowest rate since 2014, down from 1.14 fatalities per 100 million VMT in 2018. Fatalities decreased in most major traffic safety categories in 2019: ʯ Passenger vehicle occupants (down 2.8%) ʯ Motorcyclists (down 0.5%) ʯ Pedestrians (down 2.7%) ʯ Pedalcyclists (down 2.9%)

NHTSA also released preliminary fatality estimates for the first half of 2020. The second quarter of 2020, during the height of the COVID-19 public health emergency, showed a continued decline in overall traffic fatalities. The FARS data indicate that an estimated 8,870 people died in motor vehicle traffic crashes in the second quarter of 2020, a decrease of about 3.3% compared to the second quarter of 2019, which translates into 302 fewer fatalities as compared to the same period in 2019. At the same time, at the height of the COVID19 public health emergency, the total traffic volume decreased by more than 16% in the first six months of 2020. Because traffic volumes decreased more significantly than did the number of fatal crashes, the traffic fatality rate per 100 million VMT is projected to increase to 1.25 in the first half of 2020, up from 1.06 in the same period in 2019. “Road safety is always our top priority, and while we are encouraged by today’s reports showing a continued decline in total fatalities in 2019 and into the first half of 2020, we are concerned by the trend since April showing an increased fatality rate,” said NHTSA Deputy Administrator James Owens. “Now, more than ever, we should be watching ourselves for safe driving practices and encouraging others to do the same. It’s irresponsible and illegal to drive under the influence of drugs or alcohol, taking risks not only with one’s own life, but with the lives of others.”

December 2020



CMS Adds New Telehealth Services to Medicare Coverage Since the beginning of the public health emergency, CMS has added over 135 services to the Medicare telehealth services list. services delivered via telehealth to Medicaid and CHIP has expanded the list of telehealth services that Medicare beneficiaries between March and June of this year, repFee-For-Service will pay for during the coronavirus disease resenting an increase of more than 2,600% when com2019 (COVID-19) Public Health Emergency (PHE). pared to the same period from the prior year. The data CMS is also providing additional also shows that adults ages 19-64 support to state Medicaid and Chilreceived the most services delivered dren’s Health Insurance Program Medicare will begin via telehealth, although there was (CHIP) agencies in their efforts to substantial variance across both age paying eligible expand access to telehealth. groups and states. practitioners who For the first time using a new To further drive telehealth, CMS expedited process, CMS is adding 11 furnish these newly is releasing a new supplement to its new services to the Medicare teleState Medicaid & CHIP Telehealth added telehealth health services list since the publicaToolkit: Policy Considerations for services effective tion of the May 1, 2020, COVID-19 States Expanding Use of Telehealth, Interim Final Rule with comment COVID-19 Version that provides immediately, and period (IFC). Medicare will begin numerous new examples and insights for the duration paying eligible practitioners who into lessons learned from states of the PHE. furnish these newly added telehealth that have implemented telehealth services effective immediately, and changes. The updated supplemenfor the duration of the PHE. tal information is intended to help states strategically think through how they explain and These new telehealth services include: clarify to providers and other stakeholders which policies ʯ Certain neurostimulator analysis and are temporary or permanent. It also helps states identify programming services services that can be accessed through telehealth, which ʯ Cardiac and pulmonary rehabilitation services. providers may deliver those services, the ways providers may use in order to deliver services through telehealth, as Since the beginning of the public health emergency, well as the circumstances under which telehealth can be CMS has added over 135 services to the Medicare telereimbursed once the PHE expires. health services list – such as emergency department visits, The toolkit includes approaches and tools states can initial inpatient and nursing facility visits, and discharge use to communicate with providers on utilizing telehealth day management services. for patient care. It updates and consolidates in one place With the latest action, Medicare will pay for 144 serthe Frequently Asked Questions (FAQs) and resources for vices performed via telehealth. states to consider as they begin planning beyond the temCMS also announced that in an effort to provide porary flexibilities provided in response to the pandemic. greater transparency on telehealth access in Medicaid To view the Medicaid and CHIP data snapshot and CHIP, it is releasing, for the first time, a preliminary on telehealth utilization during the PHE, please visit: Medicaid and CHIP data snapshot on telehealth tion during the PHE. This snapshot shows, among other medicaid-chip-beneficiaries-COVID-19-snapshot-datathings, that there have been more than 34.5 million through-20200630.pdf. The Centers for Medicare & Medicaid Services (CMS)


December 2020

Wearing Is Caring Henry Schein Cares Foundation launches “Wearing Is Caring” campaign supported by The UPS Foundation The Henry Schein Cares Foundation (HSCF), in part-

nership with The UPS Foundation, launched in October “Wearing is Caring,” a public health awareness campaign designed to raise awareness of healthcare disparities in underserved communities, the need for social distancing, and the importance of wearing face coverings to help reduce the spread of COVID-19. The campaign is aligned with guidance from the U.S. Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) that encourages the use of cotton or cloth face coverings in public spaces to reduce community spread. To help promote access to healthcare, HSCF and The UPS Foundation will provide financial support to long-time partners – the National Network for Oral Health Access (NNOHA), the National Association of Free and Charitable Clinics (NAFC), the CDC Foundation, National Urban League, and others. Funds will provide support to critically important health care programs in communities most in need. In addition, Henry Schein, Inc. also will donate and distribute cloth face coverings to NNOHA and NAFC. The organizations will select community health clinics within COVID-19 hot spots as the recipients, helping to improve public health safety. To help address the health disparities that have impacted communities of color, Henry Schein, Inc. will also donate face coverings to local safety-net health systems and other local partners in support of CDC Foundation’s Crush COVID initiative, of which support of health equity and investing in communities disproportionately impacted by coronavirus is a key pillar. “As we continue to support pandemic relief efforts, we’re bringing our understanding of the people who are most impacted into action,” said Eduardo Martinez, President of The UPS Foundation and UPS Chief

Diversity and Inclusion Officer. “We’re honored to collaborate with the Henry Schein Cares Foundation on their ‘Wearing is Caring’ campaign, as our collective efforts will help expand access to care in communities where help is urgently needed.” “Philanthropic and private sector support is critical for use alongside government funding to meet needs that arise in rapidly evolving situations where speed and flexibility are paramount to saving and protecting lives,” said Dr. Judith Monroe, President and CEO, CDC Foundation. “Henry Schein Cares Foundation’s

‘Wearing is Caring’ campaign showcases the supportive role that corporations can enhance health equity and help protect diverse communities during the COVID19 pandemic.” “When the coronavirus pandemic first hit the U.S., the National Urban League sounded the alarm on racial disparities in terms of public health and economic consequences,” said Marc Morial, President and CEO, National Urban League. “Public-private partnerships like this are urgently needed to bring support where it is most needed. Thanks to the foundations within Henry Schein, UPS and the CDC, that support is being delivered.”

December 2020



Industry News Mercury Medical announces new EVP – Sales & Marketing Mercury Medical (Clearwater, FL) announced the appointment of Raymond L. Mundy to the newly created position, EVP – Sales and Marketing. In this role, Mundy will be responsible for the continued sales growth of Mercury’s products throughout the United States and the global marketRaymond L. Mundy place. Mundy joins Mercury from Medtronic plc including companies that were subsequently acquired by the firm, such as Covidien, during his tenure. “I am very pleased to be joining Mercury Medical as their new Executive Vice President of Sales and Marketing. The opportunities that exist both at the company and the markets they serve are tremendous. There has never been a more critical time to ensure access to Mercury’s respiratory and airway management technologies,” said Mundy. “We are excited to have Ray join the company at a time when, more than ever, the treatment of respiratory disease demands innovative new products and solutions. Ray is a 17-year veteran in our industry, with a diverse clinical and commercial background bringing a wealth of sales and operations expertise to our company,” said CEO, John Gargaro, MD.

DETECTO partners with MedPro Healthcare Sales for nationwide clinical sales Detecto, the division of Cardinal/ Detecto that manufactures medical scales and other healthcare products, has teamed up with MedPro Healthcare Sales Solutions for contract sales in both the acute and non-acute markets. Detecto offers a broad portfolio of scales, including physician, pediatric, wheelchair, chair, stretcher and bariatric to name few, in addition to medical carts, waste receptacles, glove box holders, and many other medical products. The company said MedPro’s footprint in both acute and non-acute spaces “makes them the perfect solution to get DETECTO products into medical facilities of all kinds.” 56

December 2020

“We are very excited to partner with MedPro,” said Detecto President Matthew Stovern. “They have a proven track record of driving distributor sales and providing great customer service.”

LeeSar/CSF announces new executive appointments LeeSar and Cooperative Services of Florida, Inc. (CSF) have named Junette Grant as executive director of sourcing and contract administration for Cooperative Services of Florida (CSF). In this role, Grant will be responsible for the development of the group purchasing organization (GPO) value model, member collaboration strategies, portfolio performance, and supporting analytics. She also leads the sourcing and contracting teams that serve CSF’s four member healthcare organizations.

Junette Grant

Jennifer Tokash

Prior to joining CSF in April 2019, Junette was the Division Director of Contracting and Supplier Diversity for HCA East Florida Division. The companies also named Jennifer Tokash as executive director of process excellence. Tokash will have responsibility to work with leadership and associates to build a culture of business excellence through implementation of Lean principles and process performance metrics. In this role, Jennifer will be instrumental in the achievement of LeeSar/CSF’s strategic imperatives designed to support members in reducing costs and increasing the overall value of services provided. Tokash most recently worked at OhioHealth (Columbus, OH).

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