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vol.28 no.2 • February 2020

Site Neutrality and Your Physician Customers Medicare reimbursements may be changing soon, but not everybody in healthcare is happy about it.

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FEBRUARY 2020 • VOLUME 28 • ISSUE 2

Site Neutrality and Your Physician Customers

18 Health Focus

Heart Disease: Talking Points

22 Post-Acute Care

Wound Care in the Year of the Nurse

Start a conversation with your physician customers by sharing news from the most recent American Heart Association’s Scientific Sessions Conferences

PUBLISHER’S LETTER Make it Happen in 2020..............4

PHYSICIAN OFFICE LAB PAMA Two Years Later What do we know?...................................6

SALES Questioning Strategies to Help You Close the Sale How to uncover the emotional gap between where your prospect is right now … and where he or she really wants to be.......... 10

IDN OPPORTUNITIES How Well Do You Know Your Customers?............. 14

TRENDS Trending Upward

Urgent care center growth up 6%........... 32

Physician Productivity Physician compensation is up. But productivity isn’t.............................. 34

38 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.

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February 2020

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FEBRUARY 2020 • VOLUME 28 • ISSUE 2

POST ACUTE CARE Wound Care New selling strategies for a new reimbursement environment........... 40

Age-Friendly Care Are any of your customers among the 162 hospitals and healthcare practices recognized this past fall as an Age-Friendly Health System? If so, offer them congratulations..................... 42

Line of Sight Remote monitoring can reduce costs, readmissions..................... 43

LETTER TO THE EDITOR

HIDA Smart Selling: Distributor Sales Strategies

The Value of NOT Knowing It All

How curiosity can be an asset in your sales efforts

Clarifying Employer Requirements under the OSHA Bloodborne Pathogens Standard ...................54

44

INDUSTRY NEWS News ........................................................55

Healthy Reps

Health news and notes

46

Windshield Time

Automotiverelated news 2

February 2020

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Quickbytes

48

Technology news

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PUBLISHER’S LETTER

Make it Happen in 2020 We are one month into 2020. How are those New Year’s resolutions holding up?

Each year I try and set some goals and resolutions on my birthday, December 30, so basically the New Year. After I wrote mine for 2020, I asked several people about theirs, and was surprised how many folks don’t believe in them. Which led me to talk to both my sons about theirs. Here’s what I wrote to them: Gentlemen, Each year on my birthday I wake up early, and over a cup of coffee, write out where I’d like to be by my next birthday. I also look back at what I wrote the year before, so that I can measure what I accomplished. I do this by categories:

Scott Adams

1. Decisions in my life that

2. Personal goals for myself

3. Business goals for the

in the upcoming year: a. Fitness b. Spiritual c. Fun

upcoming year: a. Engagement b. Mentoring c. Learning

need to be made within the upcoming year: a. Personal b. Business c. Long-term

Yes, February is an odd time to write about this topic, but it was on my mind for each of you as we start the new year. Plus, I’m not much of a fan of February holidays (I’m looking at you Valentine’s Day). My dad always taught me that if you want to make something happen, you need to write it down and then measure it. If you don’t, it’s just simply talk. So, my first-quarter challenge for us all is where do we want to be a year from now? Take a few minutes over a cup of coffee and write down a few things you want to do in 2020. Then, keep that list where you can open it up over the course of the year as you move towards accomplishing the things you wrote down. Dedicated to the industry, R. Scott Adams

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

editorial staff editor

Mark Thill

vice president of sales

Katie Educate

keducate@sharemovingmedia.com (800) 536.5312 x5271

mthill@sharemovingmedia.com managing editor

Graham Garrison ggarrison@sharemovingmedia.com

sales executive - East

Lizette Anthonijs

Lizette@sharemovingmedia.com (800) 536.5312 x5266

editor-in-chief, Dail-eNews

Alan Cherry acherry@sharemovingmedia.com art director

Brent Cashman bcashman@sharemovingmedia.com

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sales executive - West

Amy Cochran

acochran@sharemovingmedia.com (800) 536.5312 x5279

publisher

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

Brian Taylor

Subscriptions

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2020 editorial board Richard Bigham: IMCO Eddie Dienes: McKesson Medical-Surgical

btaylor@ sharemovingmedia.com

Joan Eliasek: McKesson Medical-Surgical

circulation

Doug Harper: NDC Homecare

Ty Ford: Henry Schein

Laura Gantert

Mark Kline: NDC

lgantert@ sharemovingmedia.com

Bob Ortiz: Medline Keith Boivin: IMCO Home Care


PHYSICIAN OFFICE LAB

PAMA Two Years Later What do we know? PAMA is now entering its third year as a major factor in the lab testing market, particularly for

the POL and smaller, regional reference laboratories. In this article, I will review PAMA’s history and possible future course. Together we will review the factors leading up to its implementation, discover PAMA’s impact to date, understand the position of its advocates and opponents, and finally examine the actions we need to consider to manage and maintain our lab business at the point of care.

By Jim Poggi

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What were PAMA’s original objectives?

What has PAMA’s impact been?

PAMA’s original intent was to reduce Medicare spending for lab tests to bring it in-line with the lower rates paid by private insurance. The Office of the Inspector General indicated that Medicare was paying a premium of about 20% compared to private insurance with Medicare’s lab spend in 2016 as $6.8 billion, or 2% of all Part B Medicare payments. PAMA legislation was intended to reduce Medicare lab spending by $2.5 billion over a 10-year period. In addition to adjusting rates downward by up to 10% annually in 2018-2020 with reductions of up to 15% if needed in 2021-2023, PAMA also made other changes. It created a single unified fee schedule, replacing the 57 local fee schedules previously utilized. It also eliminated the Sustainable Growth Rate factor and eliminated individual test discounts for tests typically performed as part of a larger test panel, such as the Comprehensive and Basic Metabolic panels.

PAMA’s impact has been both controversial and substantial from several viewpoints. It reduced Medicare reimbursement across most CPT codes. Of the approximately 1,130 CPT codes impacted by PAMA’s changes, 880 have been reduced by the maximum of 10% annually, 114 other CPT codes have been reduced by a lesser amount and only 135 CPT codes have experienced no change or an increase in reimbursement. The tests that have not been reduced are primarily newer MultiAnalyte with Algorithm (MAAA) tests for various cancers and other genomic tests. From a financial viewpoint, PAMA’s impact in 2018, its first year, has been estimated at between $300 and $670 million, far more than originally estimated. In addition, PAMA has galvanized opinion across the laboratory and clinical communities which have strongly opposed the cuts in reimbursement as too deep and not

February 2020

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PHYSICIAN OFFICE LAB rates, and also expressed concerns that eliminating the having a uniform impact depending on where the tests bundled rate previously paid on individual tests typically are performed. CMS has responded to widespread critiperformed as part of panel needed to be re-instituted. cism of its data collection scope and method by expandCMS has only agreed to broaden laboratories eligible to ing labs eligible to report data under PAMA to include provide data in response to the GAO report. hospital outreach labs for the coming reporting period. It Reaction to PAMA in Conalso lowered the Medicare payment gress resulted in the introduction of amount to permit reporting by labs PAMA has galvanized H.R. 3584, The Laboratory Access with lower Medicare spend amounts. opinion across the for Beneficiaries Act (LAB) by Rep. Both moves were intended to palliate Scott Peters of California and five concerns that initial cuts were based laboratory and other representatives in June 2019. on only 1% of the labs performing clinical communities If passed, key provisions of this bill lab testing. In addition, legislation which have strongly would be to delay reporting of prihas been introduced in the House of opposed the cuts in vate pay reimbursement by one year Representatives to amend PAMA. reimbursement as too to delay further reimbursement cuts deep and not having and to refine the number and type of What can we expect in 2020? a uniform impact labs that will report data in the future. This year is the third and final year depending on where The bill is in both the house Energy in which cuts of up to 10% are the tests are performed. and Commerce and Ways and Means expected. Approximately half of the committees, but neither committee current CPT codes are expected to has taken action to move it forward. experience reimbursement cuts this year. Data collection between laboratories reporting reimbursement rates to CMS is scheduled to take place in the What are customers and the industry saying? first quarter of 2020 based on payments to them for lab Clinical laboratory organizations including the National tests in the first half of 2019. The results of CMS analysis Independent Laboratory Association (NILA) and Ameriof this data will be used to set rates for the three succeedcan Association for Clinical Chemistry (AACC) have ing years of PAMA, 2021-2023. expressed their concerns and in addition to supporting HR 3584 have encouraged their members to support the bill with their legislators. More than 50 other professional What are the key areas of organizations including pathology and medical care procontroversy surrounding PAMA? vider organizations have also expressed their concern. At PAMA has been met with widespread criticism on three the same time, the customer input I have become aware specific fronts by the clinical and laboratory communities: of has indicated some customers are reducing testing as a ʯ With only 1% of labs performing tests reporting result of “reimbursement concerns” but they are typically data for the initial collection period, concern is that not specifically mentioning PAMA as the reason. the largest laboratories’ data skewed market-based reimbursements toward the lower end of the scale ʯ The depth of cuts estimated as high as $670 million What should we consider doing to support our by CMS is substantially higher than estimated and clients’ lab testing and health care objectives? impact POL and other lower volume laboratories As always, making sure we have the important three-way diafar more than the larger reference laboratories logue with our key manufacturers and key customers is critical to assuring appropriate testing. Be sure to focus on clinical ʯ Access to care reductions, especially in rural areas value, keep your eyes and ears open for signals of concern, is a possibility use customer business reviews wisely and look for “scale up” opportunities to keep costs in line where needed. Stay alert The General Accounting Office, in a November 2018 and agile. PAMA is here, and your planning and focus are report, also challenged CMS to assure all eligible labokeys to maintaining and growing your lab business and supratories reported data, requested that CMS re-set future porting our customer needs for better patient care. rates based on actual payment rates rather than maximum

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SALES

Questioning Strategies to Help You Close the Sale How to uncover the emotional gap between where your prospect is right now … and where he or she really wants to be. By Sandler Systems, Inc.

Are you a salesperson who has been hearing too many “We’ll think it over,” “Get back to me,” and “We’ll let you know” responses? If so, you’re in good company. The key to closing more sales is uncovering pain – that is, uncovering a level of emotional discomfort on the prospect’s part that’s sufficient to inspire action to change what isn’t working. Notice that you’re not creating this discomfort. You’re shining a spotlight on something that already exists. In this second part of a two-part series, we will examine questioning techniques that will help you uncover the emotional gap between where your prospect is right now … and where he or she really wants to be. Part one (Repertoire January 2020) examined Reversing, and an introduction to the Pain-O-Meter. This article will examine the Pain-O-Meter in more detail.

To advance the needle to the “Second-Level pain,” as shown on the Pain-O-Meter, ask a question like, “How does

that affect your family [or group, team, department, or company]?”

That’s good progress on the Pain-O-Meter. But notice that you still don’t really know for sure if there is emotional pain! This could simply be an intellectual assessment of the situation. Remember: Pain is an emotional gap between where this person is and where he or she wants to be.

Relive to relieve

For example, a financial planner who has uncovered the First-Level pain of underperforming investments would ask, “So, how does that affect your family?” The prospect might respond, “Well, because my investments aren’t performing well, my retirement fund doesn’t look very good for the two of us. Also, my kids won’t be able to go to the colleges they want.”

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In order to relieve the pain, you must get the prospect to relive the pain on a personal level. Reliving pain makes prospects become emotionally involved, and that may compel them to “fix” the problem. In this case, they would do that by contracting for financial services. To advance the needle to the “Third-Level pain,” ask, “How does this impact you personally?” The prospect might respond with something like this: “Well, I’ve been working longer hours, and it looks like I’ll have to continue to do that, but even that isn’t really getting me where I need to be financially. Unless something changes, I’m going to have to tell my kids they can’t go to the colleges they want. I would hate to have to do that to them.”


With that answer, the needle has moved to the far right, and the prospect is emotionally involved and feeling pain. This is no longer an intellectual exercise.

The Buying Zone To finally move the conversation into the “Buying Zone,” the financial planner can ask, “How would that affect you?” or “How would you feel about that?” The prospect may respond, “I’d feel terrible about that!” Eureka! Pains have been uncovered and the prospect is in the Buying Zone. You can now start asking questions about the person’s budget and the decisionmaking process.

Costing Out the Financial Impact of the Problem Costing out the problem (COP) is an advanced sales technique in which you use logical and proven statistics, facts and numbers to help prospects discover exactly what there is costing them, in hard dollars and cents … and then using that expense to leverage into action the prospect’s emotional pain with the current situation. Consider this example. A major utility company wanted to improve the adoption rate of its energy savings

recommendations to homeowners. The grid could only provide so much energy, and on hot days there were brownouts when people used a lot of resources. The energy company successfully promoted and ran free energy audits for homeowners. Yet, despite great recommendations as a result of the audits, not enough homeowners actually implemented the recommendations from the audits. To improve adoption rates, the company tested a couple of different ways to present the findings of the home energy audits. One group of auditors told homeowners that if they implemented the suggestions as a result of the home energy audit, they would save 10% on their total bill. The other group told homeowners that if they didn’t implement the suggestions as a result of the home energy audit, it would cost them an additional 10% every month. Which group do you think had the higher adoption rate? The one that heard of an additional cost! When people see their problem in terms of how much money it is costing and will continue to cost them, that bothers them. Bother is a negative emotion. Negative emotions fall into the category of pain. Pain compels people to buy. While people are motivated by gain, pain is more powerful. Since people buy emotionally, the way you express your value is very important. You want to express value as a quantifiable financial loss … and uncover how the prospect feels about that loss. In fact, if you don’t start using COP, you will lose sales. Your choice not to take action will end up costing you a whole lot of money. (Did you see what we did there?) The Sandler Selling System® methodology offers an effective, proven and measurable way to improve sales performance, creates sustainable success over time with real-world tactics for prospecting, qualifying, making the deal, closing the sale and generating referrals. Learn more about increasing sales and success with a proven, systematic approach to selling by emailing us at salestips@repertoiremag.com.

About Sandler 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. © 2020 Sandler Systems, Inc. All rights reserved. S Sandler Training (with design) and Sandler Selling System are registered service marks of Sandler Systems, Inc

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IDN OPPORTUNITIES

How Well Do You Know Your Customers? Editor’s note: Do you know what your IDN customers’ priorities are? Do you, your products and services meet their needs today? How about tomorrow? Repertoire offers readers a “crash course” in health system supply chain by presenting a few highlights from the 2019 “Ten People to Watch in Healthcare Contracting,” an annual feature in Repertoire’s sister publication, The Journal of Healthcare Contracting.

Adrian Wengert Position: Vice president, supply chain and procurement, Saint Luke’s Health System, Boise, Idaho In the past two years: “We completely overhauled the supply chain department – added 17 FTEs; deployed category management; and changed GPOs, distributors and wholesaler, which put $60 million in savings to the bottom line for our health system. We recognized that category management would provide a structured approach to supply spend, purchased services, IT and more. It would allow us to gain insights and drive alignment with our stakeholders.” On the docket: “We are completing the feasibility study to build a consolidated service center to improve cost, quality and our capabilities.”

Thoughts on the practice of supply chain management: “To be a great supply chain practitioner, you need to be well-versed in process improvement, project management and data analysis. To be a great servant leader, you need to use influence and develop meaningful relationships to build trust and sustain results.” Future challenge for the profession: “Supply and demand forces will affect salaries and talent, and not-for-profit health systems will have difficulty paying market rates when the competition for these professionals across industry is high. We should be using the same strategies being deployed to address the nursing shortages, which would include targeting feeder schools, growing programs and tracks, offering incentives and providing formalized career growth opportunities.”

Anand Joshi, M.D., MBA Position: Vice president, procurement and strategic sourcing, NewYork-Presbyterian Hospital, New York. In the past two years: “The opening of our David H. Koch Ambulatory Care Center was the first time supply chain leadership was able to design a lean, end-to-end supply

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chain within a new center, and we were able to show how that design should be the model for all our sites.” On the docket: “I am the executive sponsor for our HERCULES Non-Labor Expense (NLE) Reduction efforts. We have more than 20 cross-campus teams across every major operational area of the


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IDN OPPORTUNITIES hospital – led by specific vice presidents and facilitated by my sourcing team leaders – that are focused on driving down non-labor expense within their scope of operations.”

Successfully meeting those challenges depends almost exclusively on continuing to identify, recruit and retain the most talented professionals possible to address whatever situation arises.

Thoughts on the profession of supply chain management: “Early in my career I had found that too often, physicians’ and supply chain executives’ stereotypical views of each other were getting in the way of effective collaboration in driving down supply costs. As a result, over the past 10-15 years I have stressed throughout our sourcing and supply chain organizations

that our team focus on engaging physicians closely in our work and building trust-based working relationships with them.”

Future challenge for the profession: “The next generation of supply chain professionals will face many of the same challenges that we are facing today – but quite likely on a greater scale, and at a faster pace. Successfully meeting those challenges depends almost exclusively on continuing to identify, recruit and retain the most talented professionals possible to address whatever situation arises.”

Ed Hisscock Position: Senior vice president, supply chain management, Trinity Health, Livonia, Michigan In the past two years: “The most challenging work on our plate lately has been changing our relationships with our supply base. These relationships are traditionally transactional, and it will be in everyone’s best interest if we shift that to something more collaborative – and lean. For instance, there are tremendous opportunities to drive costs out of our suppliers’ Selling General and Administrative (SG&A) expenses. Industry sector benchmarks suggest there could be as much as 15-20% waste in the way we currently do business in this area.” On the docket: “Trinity Health’s clinical informatics team is working with supply chain on a bill-ofmaterials, so we can understand what products are used on which patients for which procedures. As our studies become more robust, we can give our clinicians richer data.”

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“I advise the next generation of supply chain professionals to challenge themselves to bigger ideas related to trade relationship efficiencies and waste, business continuity risks, and ways to promote change – specifically, standardization.

Thoughts on the practice of supply chain management: “I stay on top of my own continuous improvement by remaining constantly curious and completely engaged. I went back to school to become an expert in my field. I stayed involved with that institution as a guest lecturer, and I make sure I am always open to learning from the bright and capable people I serve with at Trinity Health. I try to experience the healthcare supply chain from as many perspectives as I can.” Future challenge for the profession: “I advise the next generation of supply chain professionals to challenge themselves to bigger ideas related to trade relationship efficiencies and waste, business continuity risks, and ways to promote change – specifically, standardization. They will be accountable for finding new ways to lean out our relationships with suppliers and intermediaries, as well. This will require education in supply chain fundamentals, inventory, finance, lean and procurement.”


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Site Neutrality and Your Physician Customers Medicare reimbursements may be changing soon, but not everybody in healthcare is happy about it. By Mark Thill

Health-system-based outpatient-care providers are nervous that Medicare may soon reimburse them the same

amount of money for clinic visits it reimburses independent physician practices and ambulatory facilities. Physician practices, on the other hand, can’t wait.

Medicare’s wheels continue to move slowly, but inexorably, in the direction of “site neutrality,” that is, bringing payments to health-system-based clinics in line with those paid to independent practices. The reason is, site neutrality will probably save the feds money. Traditionally, Medicare and its beneficiaries have paid more for a clinic visit in the off-campus hospital outpatient setting than in the stand-alone physician office setting. In 2017, the Medicare Hospital Outpatient Prospective Payment System (OPPS) rate for “evaluation/ management of a patient” (the most common service billed under the OPPS) was $184.44 for new patients and $109.46 for established patients, while the Physician Fee Schedule rate for the comparable service at a physicians’ office was $109.46 for a new patient and $73.93 for an established patient. The hospital industry has argued that the arrangement is just, given the hospital’s role as a safety net provider and the more comprehensive licensing, accreditation and regulatory requirements hospitals must meet. But the Centers for Medicare and Medicaid Services is concerned about “unnecessary increases in the volume of covered hospital outpatient department services,” particularly as health systems continue to acquire physician practices and other outpatient providers. In fact, the volume of hospital outpatient department services increased by 47% over the decade ending in the calendar year 2015; and in the five years from 2011 to 2016,

combined program spending and beneficiary cost-sharing (copayments) rose by 5%, from $39.8 billion to $60 billion. That’s why in November 2018, CMS announced that Medicare would apply a Physician-Fee-Schedule-equivalent payment rate for all clinic visit (E/M) services. “This change would result in lower copayments for beneficiaries and savings for the Medicare program and taxpayers estimated to be $800 million for 2020,” CMS said in a statement one year later, on Nov. 1, 2019. “With the completion of the two-year phase-in, the cost sharing will be reduced to $9, saving beneficiaries an average of $14 each time they visit an off-campus department for a clinic visit in CY 2020.”

A difference of opinion The Alliance for Site Neutral Payment Reform applauded CMS’ moves. In September 2019, one of its members – the American Academy of Family Physicians – wrote to CMS Administrator Seema Verma that “CMS should not pay more for the same service in the inpatient, outpatient or ambulatory surgical center setting than in the physician office setting. The AAFP encourages CMS to create incentives for services to be performed in the most costeffective location, such as a physician’s office.” Although not part of the Alliance, the Medical Group Management Association believes that site neutrality offers an opportunity to reduce healthcare expenditures, says Mollie Gelburd, associate director of government affairs.

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Site Neutrality “CMS should not pay more care, especially in rural and other “Site neutrality offers an opportunity for the same service in the vulnerable communities, but it goes for independent physician practices inpatient, outpatient or against clear congressional intent and ambulatory centers that can furambulatory surgical center to protect the majority of clinic nish services at a lower cost than the setting than in the physician services.” (Nickels was referring to hospital,” she says. office setting. The AAFP the Bipartisan Budget Act of 2015, But not everyone welcomes such encourages CMS to create which enacted site-neutral payments an opportunity. incentives for services to be for newer off-campus providerIn December 2018, the Ameriperformed in the most costbased outpatient departments.) can Hospital Association filed suit effective location, such as a There is bipartisan consenagainst the Department of Health physician’s office.” sus that site-of-service differentials and Human Services, arguing that can be eliminated without affecting – The American Academy the department overstepped the of Family Physicians patient safety or quality of care, says authority granted to it by the BipartiGelburd. “That said, the [September san Budget Act of 2015 by equalizing 2019] District Court decision shows payments for off-campus providerthat in order for CMS to get the requisite authority to based entities and physician offices. Litigation continues. implement site neutrality more broadly, additional conOne year later, Tom Nickels, executive vice presigressional effort is required. dent of the American Hospital Association, issued a “I think the policy is here to stay, but there are roadstatement saying that “continued payment cuts for hosblocks along the way that have to be addressed.” pital outpatient clinic visits not only threaten access to

Site-neutrality timetable November 2015: The Bipartisan Budget Act of 2015 requires Medicare to pay for services at newer off-campus hospital outpatient departments (that is, those that were acquired by a health system or newly built as of Nov. 2, 2015) based on the Physician Fee Schedule rather than the higher-paying Medicare Hospital Outpatient Prospective Payment System. November 2018: The Centers for Medicare and Medicaid Services issues a Final Rule effective Jan. 1, 2019, equalizing (over the course of two years) the payment rate for evaluation/management services (HCPCS code G0463) provided by all off-campus provider-based departments, that is, those operating before and after Nov. 2, 2015, and physician offices. December 2018: The American Hospital Association files suit against the Department of

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Health and Human Services, arguing that the department overstepped the authority granted to it by the Bipartisan Budget Act of 2015 by equalizing payments provided by all off-campus PBDs and physician offices. September 2019: United States District Judge Rosemary M. Collyer rules in favor of the AHA by granting its motion for summary judgment and vacates the November 2018 CMS rule impacting evaluation/management services. Specifically, Judge Collyer’s decision agrees with AHA that CMS exceeded its statutory authority when it cut the payment rate for clinic services at all off-campus providerbased clinics. Where we stand today: CMS intends to continue implementing site neutrality in 2020, despite ongoing litigation.


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HEALTH FOCUS

Heart Disease: Talking Points Start a conversation with your physician customers by sharing news from the most recent American Heart Association’s Scientific Sessions Conferences

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E-cigarettes match traditional smoking in some heart risks E-cigarettes may be perceived as safer than traditional cigarettes, but two studies say they are just as dangerous, or even worse, for your heart. One study found vaping can worsen several heart disease risk factors – cholesterol, triglycerides and glucose levels – at levels equal to traditional cigarettes. A second study found e-cigarettes decrease blood flow in the heart even more than traditional cigarettes. The preliminary findings were presented at the American Heart Association’s most recent Scientific Sessions meeting, held in November 2019 in Philadelphia. In the first study, which included 476 healthy adults, e-cigarette users had higher “bad” LDL cholesterol and lower overall cholesterol compared to nonsmokers. In people who both vaped and smoked, “good” HDL cholesterol was lower. The second study analyzed heart blood flow in 19 smokers, ages 24 to 32, immediately before and after using either e-cigarettes or traditional cigarettes. Blood flow was measured while participants were at rest and again as they performed a handgrip exercise. Study co-author Dr. Susan Cheng, director of public health research at Cedars-Sinai Medical Center, said the finding that heart blood flow was reduced in e-cigarette users while at rest was a surprise. “Providers counseling patients on the use of nicotine products will want to consider the possibility that e-cigs may confer as much and potentially even more harm to users and especially patients at risk for vascular disease,” she said.

Dr. Lara Kovell, an assistant professor of cardiology at the University of Massachusetts Medical School in Worcester, presented preliminary findings of the study at the American Heart Association’s Scientific Sessions in Philadelphia. Kovell and her colleagues analyzed data collected on 8,740 women ages 20 to 50 taking part in a national health and nutrition study from 2001 to 2016. They found that 22.4% had high blood pressure. Researchers scored how healthy the women ate and how much salt they consumed compared to guidelines set out in the Dietary Approaches to Stop Hypertension – or DASH – diet. It is recommended for all adults with high blood pressure. They found that 7% of the women who had high blood pressure were adhering to a DASH-like diet, while 10% with normal blood pressure were.

Nearly 40% of maternal deaths from any cause are associated with hypertension. Women who go into a pregnancy with high blood pressure are at risk of having a baby who has a low birth weight or is born premature.

High blood pressure, unhealthy diets in women of childbearing age One in five women of childbearing age has high blood pressure, and a new study shows that few of them are on a diet that could help them – and their babies – reduce their risk for health problems. Nearly 40% of maternal deaths from any cause are associated with hypertension. Women who go into a pregnancy with high blood pressure are at risk of having a baby who has a low birth weight or is born premature.

People who follow DASH eat foods low in salt and that contain high levels of nutrients to help lower blood pressure, such as potassium, magnesium and calcium. These foods include fresh fruit and vegetables, beans and lentils, and whole grains.

HIV could increase risk of death from heart failure After a heart failure diagnosis, people who are HIV-positive are more likely to be hospitalized or die of any cause than those not infected with HIV, new research shows. The study is the largest to date to look at how HIV status affects people diagnosed with heart failure, a chronic condition in which the heart is unable to pump enough blood and oxygen that cells need.

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HEALTH FOCUS “We found that people with heart failure who are HIV-positive are more likely than those who are HIVnegative to be smokers, have heart and liver disease, and have depression or abuse drugs,” said lead study author Dr. Sebhat Erqou, an assistant professor of medicine at Brown University in Providence, Rhode Island. He also is a cardiologist at the Providence VA Medical Center and Lifespan Cardiovascular Institute. “But even after taking this into account, people with HIV still have worse outcomes than people who don’t have HIV.” Erqou and his colleagues analyzed data on 5,747 HIV-positive and 33,497 HIV-negative veterans with heart failure being cared for from 2000 to 2018 in the Veterans Affairs Health Care System. The study found

triglyceride levels; or low levels of HDL, the “good” cholesterol – or if they took medicine for diabetes, high blood pressure or cholesterol. Researchers used magnetic resonance imaging and tests of thinking skills to evaluate more than 2,100 women and men ages 37 to 55. Compared with the healthiest participants, those who were metabolically unhealthy, obese or both showed evidence of brain decline. The preliminary study was presented in November at the American Heart Association’s Scientific Sessions in Philadelphia. Participants were part of the Framingham Heart Study, a decades-long investigation of cardiovascular disease risk. None had diabetes or neurological conditions such as stroke or dementia. Among people who were metabolically unhealthy, MRIs revealed lower total cerebral brain volume – in essence, a smaller brain – than was measured in metabolically healthy people. Lower cerebral brain volume is a sign of injury throughout the brain that leads to the loss of neurons and supporting cells, said lead researcher Dr. Rebecca Angoff, clinical fellow in medicine at Harvard Medical School’s Beth Israel Deaconess Medical Center in Boston. “Aging, decreased blood flow and diseases like Alzheimer’s can lead to a smaller brain.” Participants who were both metabolically unhealthy and obese showed the most signs of subtle injury to the brain’s white matter – tissue that provides crucial connections throughout the brain. These injuries, which have been linked to early Alzheimer’s disease, result from blood vessel abnormalities and may be due to risk factors such as high blood pressure and diabetes, Angoff said. On the cognitive tests, obesity was linked to poorer scores. Specifically, those who were obese but metabolically healthy performed worse on a combination of six tests of thinking skills, and on individual tests that measured verbal memory and abstract reasoning. Participants who were obese and metabolically unhealthy scored lower for abstract reasoning and on a test measuring visual details and spatial memory.

Almost one-quarter of adults have metabolic syndrome, a set of factors that in combination amplify a person’s risk of heart disease, diabetes, stroke and other illnesses. 30.7% of HIV-positive veterans with heart failure died from any cause, compared with 20.3% of HIV-negative veterans with heart failure. Hospital admission rates for any cause were 50.2% for those with HIV compared with 38.5% for those without.

Obesity, other factors may speed up brain aging The brains of middle-age adults may be aging prematurely if they have obesity or other factors linked to cardiovascular disease, new research has found. Almost one-quarter of adults have metabolic syndrome, a set of factors that in combination amplify a person’s risk of heart disease, diabetes, stroke and other illnesses. In the research, participants were considered metabolically unhealthy if they had two or more such factors: high blood pressure; high blood sugar; high blood

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HEALTH FOCUS Could mammograms screen for heart disease? By screening for breast cancer, mammography has helped save hundreds of thousands of lives. Using the test to also screen for heart disease might someday help save many more. Besides revealing masses that may be tumors, digital mammography – a technique in which low-dose X-ray images are captured and enhanced using computer technology – can reveal buildup of calcium in the arteries in the breast. About 13% of women are estimated to have this buildup, called breast arterial calcification, or BAC, including about 10% of women in their 40s and around half of women in their 80s. Early studies so far have found BAC’s presence appears to signal an elevated risk for heart attack, stroke and other cardiovascular consequences. Research has begun to reveal a link between calcium buildup in the breast and coronary artery calcification, an established measure that helps predict cardiovascular disease risk. At the American Heart Association’s Scientific Sessions conference in November 2019, Dr. Quan Minh Bui, general cardiology fellow at the University of California, San Diego, and his UCSD colleagues presented preliminary research examining the utility of BAC in predicting existing or future heart failure, a condition in which the heart is weakened and doesn’t pump properly. The study looked at records from 2006-2016 for 278 middle-aged and older women who had both a mammogram and coronary calcium test within a one-year window. Almost one-third of the women had BAC, and 7% had heart failure. Even after accounting for age, diabetes and high blood pressure, all heart failure risk factors, women with calcium buildup in the breast arteries had 2.2 times the odds of having or developing heart failure.

Meth use producing younger, harder-to-treat heart failure patients Widespread methamphetamine use is creating a unique form of severe heart failure, according to research that shows these patients tend to be younger and have poor outcomes, according to the American Heart Association. “This is a strikingly different type of patient,” said Dr. Isac Thomas, an assistant professor at the University of California, San Diego School of Medicine, and lead author of a study released at the American Heart Association’s Scientific Sessions conference in Chicago in November 2018.

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In the study, Thomas and his colleagues reviewed electronic health records for patients treated at UC San Diego Health between 2005 and 2016. They identified 4,470 patients with methamphetamine abuse; 20,576 patients with heart failure; and 896 patients with both meth abuse and heart failure. Compared to the average 67-year-old heart failure patient in the study, people with heart failure who use meth were 17 years younger and predominantly male. They also were more likely to have other substance abuse or psychiatric problems, such as mood and anxiety disorders. Even though meth-using patients were younger, they had a higher five-year hospital readmission rate for heart failure.


The good news is, other studies suggest that if meth users with heart failure go through a treatment program and stop using the drug, depending on the amount of inflammation and scarring, there is the potential to reverse some of the heart damage. The challenge, says Thomas, is for doctors to identify these patients, who can mistrust healthcare providers and don’t always disclose drug use.

Coronary calcium test could help clarify heart disease risk – and control cholesterol When doctors are sorting out what to do about a patient’s cholesterol, a key calculation is the patient’s future risk for

developing heart disease. But what if that risk is uncertain? Cholesterol guidelines released in November 2018 suggest a coronary artery calcium test (CAC) can help identify patients between 40 and 75 years who will benefit from statins when risk status is uncertain. The CAC takes cross-sectional images of the vessels that supply blood to the heart muscle, to check for the buildup of calcified plaque. The measurement can help a doctor identify who is at risk for heart disease before a person has signs or symptoms. The test isn’t recommended for everyone, but according to the guidelines, some groups where CAC testing may be useful are:

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HEALTH FOCUS ʯ People reluctant to begin statin therapy and who want to understand their risk and potential benefit more precisely. ʯ People concerned about restarting statin therapy after stopping treatment because of side effects. ʯ Men ages 55 to 80 or women 60 to 80 with few risk factors who question whether they would benefit from statin therapy. ʯ People ages 40 to 55 with an estimated 10-year risk for developing heart disease between 5% and 7.5%, and risk factors that increase their chances of heart disease.

Heart attacks are becoming more common in younger people, especially women Heart attacks are increasingly occurring in younger people, especially women, according to a study presented at the 2018 American Heart Association’s Scientific Sessions meeting.

“Traditionally, coronary artery disease is seen as a man’s disease, so women who come to the emergency department with chest pain might not be seen as highrisk,” said Dr. Sameer Arora, the study’s lead author and a cardiology fellow at the University of North Carolina School of Medicine. “Also, the presentation of heart attack is different in men and women. Women are more likely to present with atypical symptoms compared to men, and their heart attack is more likely to be missed.”

People with diabetes need to monitor cholesterol For people with diabetes, blood sugar isn’t the only important measurement. The most recent cholesterol guidelines, issued in November 2018, suggest the more than 110 million U.S. adults with diabetes or prediabetes also should manage their cholesterol. The guidelines suggest doctors consider prescribing cholesterol-lowering drugs (statins) to people with diabetes who are age 40 to 75. The guidelines also give other recommendations for people with diabetes based on age and other risk factors. The reality has been scientifically clear for a while, but many people are not aware of the connection: Middle-age adults with diabetes are usually considered at moderate to high risk for cardiovascular disease. More than 30 million people in the United States have diabetes, although one in four doesn’t know it, according to Centers for Disease Control and Prevention. Another 80 million have prediabetes, a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as Type 2 diabetes. Over the past 20 years, the number of adults diagnosed with diabetes has more than tripled as the population has aged and become more overweight or obese. There are well-established risk factors for heart disease, such as smoking, high blood pressure and high blood sugar. There also are what the new cholesterol guidelines call “risk-enhancing factors” such as family history, chronic kidney disease and metabolic syndrome. Metabolic syndrome is a cluster of at least three diagnosed conditions, including high blood pressure, high blood sugar, excess body fat around the waist and abnormal cholesterol levels.

Among women having heart attacks, the increase in young patients went from 21-31%, a bigger jump than in young men. Past research has shown heart attack rates in the U.S. have declined in recent decades among 35- to 74-yearolds. But in a more recent study, researchers wanted to look specifically at how many younger people were having heart attacks. They included data from a multi-state study of more than 28,000 people hospitalized for heart attacks from 1995 to 2014. The results showed 30 percent of those patients were young, age 35 to 54. More important, they found the people having heart attacks were increasingly young, from 27% at the start of the study to 32% at the end. Among women having heart attacks, the increase in young patients went from 21-31%, a bigger jump than in young men. Researchers also found that young women had a lower probability than men of getting lipidlowering therapy, including antiplatelet drugs, beta blockers, coronary angiography and coronary revascularization.

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HEALTH FOCUS

Medicare adds coronary angioplasty to ASC coverage

The Centers for Medicare & Medicaid Services added six coronary intervention procedures to its list of ambulatory-surgery-center-covered surgical procedures. Effective Jan. 1, the following three coronary intervention procedures, and three associated add-on procedures, were to be covered by Medicare: ʯ CPT code 92920 (Percutaneous transluminal coronary angioplasty; single major coronary artery or branch). ʯ CPT code 92921 (Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (list separately in addition to code for primary procedure). ʯ CPT code 92928 (Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch). ʯ CPT code 92929 (Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure). ʯ CPT code C9600 (Percutaneous transcath-

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eter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch). ʯ CPT code C9601 (Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) to the ASC CPL. “While we acknowledge that a majority of Medicare beneficiaries may not be suitable candidates to receive these procedures in an ASC setting due to factors such as age and comorbidities, we believe it is important to make these procedures payable in the ASC setting, in order to ensure access to these coronary intervention procedures for those beneficiaries who are appropriate candidates to receive them in an ASC setting,” wrote CMS in its Final Rule (https://www.federalregister. gov/documents/2019/11/12/2019-24138/ medicare-program-changes-to-hospital-outpatient-prospective-payment-and-ambulatorysurgical-center)


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TRENDS

Trending Upward Urgent care center growth up 6% The Urgent Care Association reports industry growth of almost 6% in 2019, with 9,279 urgent care centers in the

United States as of June 2019, up from 8,774 in 2018 and 8,125 in 2017.

In a recently updated white paper, “The Essential Role of the Urgent Care Center in Population Health,” the association reports that urgent care centers handle more than 112 million patient visits per year, representing 23% of all primary care visits and 12.6% of all outpatient physician visits. UCA’s membership includes more than 3,000 urgent care centers. The association defines urgent care services as: ʯ A medical examination, diagnosis and treatment for non-life or limb threatening illnesses and injuries that are within the capability of an urgent care center which accepts unscheduled, walkin patients seeking medical attention during all posted hours of operation and is supported by on-site evaluation services, including radiology and laboratory services. ʯ Any further medical examination, procedure and treatment to the extent they are within the capabilities of the staff and facilities available at the urgent care center. The UCA’s database does not include retail clinics housed inside retail operations and typically alongside inhouse pharmacies, or traditional primary care practices with extended hours for their patients. Patient volume: In the UCA’s 2018 Benchmarking Report, representing 2017 data, respondents reported a median patient volume of 35 patients per day. Urgent care volume can be seasonal, typically spiking during late fall and winter. Patient profile: Depending on the year of the UCA benchmarking survey, 25-40% of urgent care patients lack a primary care physician. A large demographic that often chooses urgent care for their acute needs are young,

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healthy adults devoid of chronic health conditions, according to UCA. Ownership: Urgent care centers emerged largely as a physician or physician group strategy. In an early UCA Benchmarking Report based on the calendar year 2008, 54.1% of centers were physician owned while hospitals represented 24.8% of the total. But by 2014, physician ownership had dropped to 40% and hospital (or healthcare system) ownership had increased to 37% of respondents. Many multisite urgent care centers have taken on private equity partners, according to the association. Typical services: Non-life- or-limb-threatening illnesses and injuries typically seen in urgent care centers include, but are not limited to: ʯ Allergies. ʯ Asthma. ʯ Burns, minor. ʯ Cough/cold/influenza. ʯ Conjunctivitis (pink-eye). ʯ Dermatological conditions (rashes, infections, including incision and drainage as a procedure). ʯ Dehydration. ʯ Ear infections. ʯ Fractures. ʯ Gastrointestinal disorders. ʯ Gynecological infections and disorders. ʯ Headaches/migraines. ʯ Influenza. ʯ Lacerations, including suturing. ʯ Pharyngitis (sore throats). ʯ Sprains/strains. ʯ Upper respiratory infections. ʯ Urinary tract infections. ʯ Work-related illness, injury, screening and wellness. ʯ Detection of complications of chronic illness.


TRENDS

Physician Productivity Physician compensation is up. But productivity isn’t. Value-based incentives for physicians are growing, but they still constitute a small percentage of total cash com-

pensation for most specialties, reports Chicago-based SullivanCotter, a consulting firm in the assessment and development of rewards programs for the healthcare industry and non-profit sector. What’s more, even as market supply-and-demand for physicians continues to drive increases in compensation, physician productivity is stagnant.

From 2018 to 2019, the prevalence of value-based incentives, which rewards performance on measures such as clinical quality, patient experience and access, increased by 5-7% across all four major specialty categories: ʯ For primary care, the prevalence of value-based incentive components in plan design was up 5% from last year, with 62% of organizations incorporating these incentives into their physician compensation programs. ʯ Medical, surgical and hospitalbased specialties all fell in the range of 55-57%. The actual amounts paid for value-based performance remain relatively small, at 6.2% of total cash compensation across all specialties at the median, according to the firm. However, this is up from 5.6% in 2018. Primary care is highest at 7.0% of total cash compensation, with hospital-based specialties following at 6.3% and medical and surgical specialties at just below 6.0%. “We expect to see continued growth in value-based incentives as organizations work to further develop and refine these programs to ensure they have credible measurement and reporting systems in place before moving forward,” said Mark Ryberg, principal, SullivanCotter.

Productivity stagnant Despite continued year-over-year increases in median compensation across all major specialty categories, productivity remains relatively flat and in many cases is even declining.

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From 2014-2019, median total cash compensation for primary care physicians increased by 14.7% (reflecting a growing demand for primary care providers by healthcare organizations), but work RVU (wRVU) productivity declined by 0.2%, according to SullivanCotter. (Work RVU reflects the relative time and intensity associated with furnishing a Medicare Physician Fee Schedule service.) Over the same five-year time period, hospital-based physicians saw the largest growth in median wRVU productivity at 5.2%. This was the only major specialty group to see an increase greater than 1.5%. “With growing concerns regarding provider supply and demand, organizations are evolving their compensation programs to align with an increasingly competitive talent market,” said Dave Hesselink, principal, SullivanCotter, in a statement. “With a looming physician shortage placing pressure on organizational recruitment and retention strategies, this demand continues to push physician compensation upwards without being supported by corresponding gains in productivity or reimbursement – resulting in higher levels of organizational investment per physician.” Released in December, SullivanCotter’s “Physician Compensation and Productivity Survey” is now in its 27th year. With data from nearly 700 organizations on more than 206,000 individual physicians and advanced practice providers, this survey is intended to provide insight into base salary, total cash compensation, and productivity data and ratios, including wRVUs, collections, patient visits and panel sizes.


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Facing the Challenges of Weighing Immobile Patients and the Need for an Accurate and Efficient Solution

Acquiring a critical or immobile patient’s weight is not

easy. It takes time, and disrupts clinical workflow. Despite the difficulties in obtaining weight measurements, a patient’s body weight is a critical measurement in calculating the appropriate dosage of life-saving drugs. In addition to providing patients with the proper drug dosage, drugs need to be administered quickly, as in some

cases every minute is a factor in a patient’s outcome. Faster treatment is also a goal of Process Improvement teams as hospitals across the country are focused on shortening door to needle times to meet American Heart Association 2020 credentialing guidelines and to be designated as a “Stroke Honor Roll Elite Plus” certified institution.

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Traditional options Currently, the three most commonly used options for weighing time-critical, immobile patients are weighing beds, hoist scales, and estimation. However, these methods are problematic as they are difficult to use, time-consuming, inaccurate, and uncomfortable for the patient. Typically most emergency rooms or stroke centers will weigh immobile patients using a stretcher or bed with a weighing scale inside of it. This is not a reliable solution – weighing beds are not always available, as they are often in use or have been moved. Clinicians are not confident in the use of weighing beds as they can be inaccurate due to not being calibrated regularly or properly zeroed before use. In some instances using a weighing bed can increase the number of patient transfers. In the case of an immobile stroke patient, the patient is transferred from an EMS stretcher, to a weighing bed and then to a CT scanner. This extra transfer is a risk to the patient’s safety and a burden on staff ’s physical health. Lastly, weighing beds can be very expensive, costing over $15,000 in many cases. Another less common option to weigh immobile patients is to use a hoist scale. Hoist scales lift patients from a bed to obtain a weight measurement. These scales are not a popular choice as they are difficult to use, time-consuming as well as being uncomfortable and stressful for the patient. Obtaining a weight using a hoist often involves several steps to set up the scale and properly position the patient. And as previously stated, these patients need to be treated quickly and every minute counts. A third method used to obtain the weight measurement of an immobile patient is estimation. Staff can estimate weight by what is told to them by the patient or by a visual estimate. But estimation is not accurate and can be very dangerous when weight is used to determine drug dosing. The drugs commonly used in the ICU are dosed based on precise patient weight, and an over or underestimated weight measurement can lead to fatal drug levels or inadequate treatment. Weight estimation should only be considered as a last resort when time is critical to providing life-saving treatment.

It is evident that a more efficient and accurate method of weighing immobile patients would provide better patient outcomes, enhance workflow, and reduce the burden on staff.

The Patient Transfer Scale As a leading manufacturer in the healthcare market, Health o meter Professional Scales focuses on developing and introducing healthcare products that can make marked improvements on patient care and outcomes. To help healthcare facilities overcome the challenges of weighing immobile patients, Health o meter Professional Scales now offers the Patient Transfer Scale. The new PTS-1000KL is an innovative piece of equipment that

All departments in the hospital can benefit from the Patient Transfer Scale, particularly Stroke Units, the Emergency Room, ICU, and Radiology. In addition to the practical benefits, the Patient Transfer Scale is also an effective cost-saving alternative to other weighing options.

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combines a transfer board with a weighing scale inside, allowing clinicians to quickly and accurately weigh immobile patients without changing their workflow. This easyto-use scale can be quickly zeroed for immediate use, is always available using its convenient wall-hanging stowing system, and decreases the number of patient transfers. All departments in the hospital can benefit from the Patient Transfer Scale, particularly Stroke Units, the Emergency Room, ICU, and Radiology. In addition to the practical benefits, the Patient Transfer Scale is also an effective cost-saving alternative to other weighing options. Talk to your accounts about their need for the Patient Transfer Scale and explain the importance of an inexpensive, easy to use, effective way to obtain a weight for an immobile patient. When choosing the right brand, choose the brand that makes it weigh easier for you, the customer and the patient, Health o meter Professional Scales.


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POST-ACUTE CARE

Wound Care in the Year of the Nurse

The newly implemented Patient-Driven Payment Model is already affecting how your acute-care customers are

being reimbursed for the prevention and management of their residents’ wounds, including pressure ulcers, diabetic foot ulcers, arterial wounds and other skin-related conditions. This spring and summer offer many opportunities to get up to speed on the subject.

In fact, 2020 is a good time for Repertoire readers to learn more about wound care and about those who are most often on the front lines: nurses. That’s because the World Health Association has designated 2020 – the bicentenary of the birth of the founder of modern nursing, Florence Nightingale – The Year of the Nurse and the Midwife. The American Health Care Association announced “Sharing Our Wisdom” as the 2020 theme for National Skilled Care Nursing Week, which will be held May 10-16. Established by the AHCA in 1967, NSNCW, formerly known as National Nursing Home Week, recognizes the essential role of skilled nursing care centers in caring for America’s frail, elderly, and disabled. NSNCW promotional materials can be downloaded at www.ahcancal.org/NSNCW. Here are other wound-care-related events and conferences to be held in 2020.

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The American Association of Post-Acute Nursing (www. AAPACN.org) will host its 2020 Conference – The Year of the Nurse – from April 15-17 in Atlanta. AAPACN represents more than 17,000 long-term and post-acute care nurses and professionals working in more than 5,750 facilities through its subsidiary associations, the American Association of Nurse Assessment Coordination (AANAC) and the American Association of Directors of Nursing Services (AADNS). Among the pre-Conference workshops will be “ICD10 CM Coding Certificate Program for SNFs,” taught by Carol Maher, RN-BC, RAC-MTA, RAC-MT, CPC, Hansen Hunter & Co. The Patient-Driven Payment Model (PDPM) has increased the importance of accurate ICD10-CM diagnoses by shifting Medicare payments from therapy volume to resident characteristics, says AAPACN.


ICD-10-CM codes and diagnoses will impact the OT, PT, SLP, NTA, and nursing components under PDPM. Maher will walk attendees through the process for using the ICD-10-CM Manual, from identification of the main term through the final code selection, and review coding and chapter-specific guidelines. The National Association of Directors of Nursing Administration in Long Term Care (www.NADONA.org) will hold its 33rd National Conference June 14-17 in Niagara Falls, New York. NADONA says the conference is the largest annual meeting of nurse executives working in long-term and post-acute care. The organization has 35 state chapters. Wound Ostomy and Continence Nurses Society (www.WOCN. org) will hold its 2020 educational event – WOCNNext – June 7-10 in Cleveland, Ohio. With more than 60 speakers and over 50 sessions to choose from, attendees will leave WOCNext with diverse knowledge and insights into how to best identify, care for, and overcome some of the most challenging issues facing their patient populations, according to WOCN. The education at WOCNext will be presented under the following healthcare themes: ʯ Wellness: Behaviors, actions and interventions to promote health and well-being. ʯ Symptom science: Understanding pathophysiology and manifestations of acute and chronic illness. ʯ Quality: Measures of patient-centered, safe, effective, timely, efficient and equitable care. ʯ Clinical care innovations: Advancing practice through the integration of education and research. The 2020 Post-Acute Care Symposium (www. pacsymposium.com) will be held May 15-16 in San Diego, California, and will be co-located with the Symposium on Advanced Wound Care Spring/Wound Health Society (SAWC Spring/WHS) Conference. The symposium is designed to provide professionals in post-acute facilities the tools they need to meet dayto-day challenges with a curriculum that focuses on the strategies necessary for implementing clinical practice guidelines, protocols, and care pathways for wound and incontinence interventions. This year’s meeting will be a multidisciplinary approach and focus on reimbursement changes with PDPM and the PatientDriven Groupings Model (PDGM, the new home care case-mix classification system.

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POST-ACUTE CARE

Wound Care New selling strategies for a new reimbursement environment Do changes in post-acute-care reimbursement (i.e., the Patient-Driven Payment Model, or PDPM) call for chang-

es in how distributor representatives sell wound care products and equipment? Repertoire asked Bob Miller, executive vice president of sales and vendor relations, Gericare Medical Supply.

Repertoire: In your opinion, how will PDPM affect the way post-acute-care providers assess and treat patient wounds (i.e., pressure ulcers, diabetic foot ulcers, leg ulcers, surgical wounds, etc.)? Have you seen any signs of this change occurring already? Bob Miller: Post-acute-care providers have always provided excellent care for their patients. As far as that goes, it’s business as usual. But it’s true that they are closely assessing more complex patients because of the additional ICD-10 categories. They have done an excellent job of transitioning to PDPM, primarily because they were very prepared. I believe this goes back to the Centers for Medicare & Medicaid Services giving them ample time to get ready. Repertoire: How has this It will affected the types (or quantity) of wound-carebe very related products or serimportant vices your customers are for homes seeking from you? to have a Miller: Some post-acute facilities are ordering more qualified high-quality wound care wound care products for their patients nurse on with complex wounds. They hand. are doing so for two reasons: First, they are receiving more reimbursement for them, and second, these products allow nurses to really make an impact in healing wounds quickly, especially in the first five days. (That’s the way it should be anyway.) There is another reason: Post-acute providers are going to be scrutinized and measured more closely on how they treat patients with wounds. It will be very important for homes to have a qualified wound care nurse on hand.

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Repertoire: Does the post-acute provider have any incentive to prevent wounds from developing among its resident population? If so, is this reflected in the type of products they are seeking from their suppliers? Miller: The patient getting better faster is always a positive for the patient, the home, and the hospital who sent the patient. You ask how? The discharge person sees that the hospital sent multiple people with complex wounds to this account, and all are doing well. This speaks volumes about the care that is being received at this home. The home strengthens its reputation with the hospital, and it will probably get more referrals because of it. The facility will grow in confidence, knowing they can handle more complex patients. What’s more, other residents will notice. Repertoire: Any recommendations for distributor sales reps on how they should discuss wound care topics (including products and equipment) with post-acute providers? Miller: Their first approach should be to ask more questions. Examples: ʯ What wound care products are you currently using for your complex patients? ʯ What types of patients are you seeing that you haven’t seen before (e.g., trachs, TPN)? I can help by providing respiratory experts, products for TPN, etc. ʯ Do you use reusable cloth briefs or disposables? (Disposables can wick fluid away, which might be more advantageous when using a wound care product.) Most important, have a conversation with your key people and let them know you want to learn more about PDPM, so you can help them better.


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POST-ACUTE CARE

Age-Friendly Care Are any of your customers among the 162 hospitals and healthcare practices recognized this past fall as an Age-Friendly Health System? If so, offer them congratulations.

The Institute for Healthcare Improvement (IHI) recently recognized 85 hospitals and healthcare practices for

their commitment to excellent care for people over age 65.

“Age-Friendly Health Systems” is an initiative of The John A. Hartford Foundation and IHI in partnership with the American Hospital Association and the Catholic Health Association of the United States. Agefriendly care focuses on four essential elements, called the 4Ms Framework: ʯ What matters to older adults. ʯ Medication, if needed, that is age friendly. ʯ Attending to mentation, including delirium, depression, and dementia. ʯ Mobility to maintain function. “It is often difficult for hospitals and primary care practices to reliably deliver evidence-based care to older adults,” Leslie Pelton, MPA, senior director at IHI, said in a statement. “This can be disheartening to our health professionals and, of course, causes harm to older adults and their family caregivers.

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“What’s drawn health professionals to the AgeFriendly Health Systems movement is that it offers an organizing framework of evidence-based care that can be practiced reliably. And it all starts with knowing and acting on what matters to the older adult.” The hospitals and health systems are practices recognized as “Age-Friendly Health Systems – Committed to Care Excellence” that have shown exemplary alignment with the elements of the 4Ms Framework by reporting the number of older adults reached with the 4Ms over at least a three-month time period, according to IHI. Additionally, more than 300 other hospitals and healthcare practices are taking steps to implement age-friendly care through participation in Action Learning Communities or other collaborative programs offered by IHI and the initiative’s partners. For a list of “Age-Friendly” providers, go to www.ihi.org/Engage/Initiatives/Age-Friendly-HealthSystems/Pages/Background.aspx.


Line of Sight Remote monitoring can reduce costs, readmissions Health technology firm Royal Philips and insurer Humana Inc. announced a collaboration in patient monitoring,

which they believe will improve care and health outcomes for select high-risk Medicare Advantage members.

Medicare Advantage Plans – sometimes called “Part C” or “MA Plans” – are an “all in one” alternative to Original Medicare. Offered by private companies approved by Medicare, these “bundled” plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually, Medicare prescription drug (Part D). Humana is identifying at-risk members and offering them the Philips Lifeline medical alert service, including Auto Alert, a fall-detection technology supported by Philips CareSage predictive analytics. Early referrals of patients with chronic conditions, and those at risk of falls, can help enable timely care and interventions, according to Humana. It can also help reduce unnecessary and costly hospital readmissions. In addition, Philips CareSage predictive analytics, which collects and analyzes data from multiple sources including Philips Lifeline, will give care teams a line-of-sight into seniors’ wellbeing upon discharge, when the risk of readmission is high. By identifying patients who are at risk for emergency transport in an upcoming 30-day period, predictive analytics can help identify early intervention opportunities and thereby enable the delivery of proactive care to help reduce avoidable emergency admissions. Research shows 57% of Medicare patients are released from the hospital without any direct monitoring by a healthcare professional, contributing to an annual cost of unnecessary readmissions of $17 billion for Medicare patients alone.

Through the collaboration, Humana has deployed Philips’ remote member monitoring solution and connected measurement devices to select members with congestive heart failure (CHF), allowing care managers to monitor and understand meaningful changes in a member’s condition.

Humana is identifying a pilot group of members with severe CHF. Philips will provide them with kits that include an interactive tablet that syncs data from connected measurement devices via wireless technology. These devices, including a weight scale, blood pressure monitor and pulse oximeter, allow members to self-manage their condition, and share health information with their care manager daily. This data will be used to support Humana care teams in making informed and proactive care decisions with the pilot group in an effort to help reduce unnecessary readmissions.

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HIDA

Smart Selling: Distributor Sales Strategies

The Value of NOT Knowing It All How curiosity can be an asset in your sales efforts Elizabeth Hilla, Senior Vice President, Health Industry Distributors Association

If you’re like me, you like to be well-prepared for a sales call. You check out your prospect’s LinkedIn page, study

their corporate website, and review all your own product information before you meet with the customer.

All this knowledge is valuable – but there’s a risk to it as well. It’s hard to resist spouting all the information you have during the sales call. And what happens? You do all the talking, instead of using that valuable faceto-face time to hear from your customer.

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If you think about it, sometimes your ability to admit what you don’t know can be even more valuable than your ability to use what you do know. Of necessity, I got really good at this during my first job out of college. I landed a position as a television


news reporter at a tiny station in eastern North Carolina. I was 21 years old, both naïve and somewhat ignorant. Every day, I was assigned to do a news report on something about which I had no prior knowledge whatsoever. I covered the opening of the tobacco markets even though I knew nothing about agriculture, reported on advances in medicine even though I had only taken two science courses (physics and meteorology!) in college, and interviewed government leaders about civic issues in towns I had never visited before. There was no internet available at the time, so I had neither the resources nor the time to read up on these topics before heading out to cover them. Instead, I had to admit my ignorance and ask the folks that I was interviewing to educate me. Happily, most people were very willing to talk.

Use ignorance as a selling tool?

ʯ Training sessions and other meetings: Let’s say the leader uses an acronym you don’t know. Chances are other people in the room are wondering what it means too. Why not take one for the team by raising your hand and asking the trainer to back up and define the term. “Cara, you said the new competitive bidding program applies to CBAs. What are those?” “Todd, what did you say your company sells? CGMs? What does that stand for?”

Sometimes your ability to admit what you don’t know can be even more valuable than your ability to use what you do know.

I’ve found in my career since then that my willingness to confess that I’m unfamiliar with a particular topic or issue has become a very valuable professional tool. I ask a lot of questions, and as a result I gain useful information. What’s more, most people love to talk about their work or their expertise, so asking questions is a great tool in building relationships. Here are a few ideas for turning your own areas of ignorance into potential advantages, along with my own personal examples: ʯ Networking: When you meet people at a professional function, ask them about their jobs or their organizations. If they describe a challenge or a business process that’s unfamiliar, don’t nod your head and pretend to understand. Ask them to explain. “Hi Josh, nice to meet you. I have to admit I’m not familiar with Healiant – can you tell me about your company?” “Bruce, you said that you’re responsible for category management at your health system. I always thought of category management as something that suppliers do – what does it mean in a hospital?”

ʯ Sales calls: Don’t assume you know what the customer needs. Ask questions at every stage of the call, and ask follow-up questions as appropriate. You’ll need to read the customer so as not to overdo it and annoy them, but most folks will be happy to know that you really want to understand their situation and meet their needs. “Charlie, you guys said you want to grow your business in the post-acute market – how do you define that exactly?” “Maureen, you referred to your company as an MRO distributor. I’m not familiar – what’s that?” It’s a good thing that people don’t like know-it-alls, because we as salespeople definitely don’t know it all. However, by turning our ignorance into curiosity about the customer and his or her needs, we can make it an asset in our sales efforts.

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HEALTHY REPS

Health news and notes

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Chill

Give your lymphatic system a boost

Research tells us that there’s a relationship between patience and well-being, according to the Mayo Clinic staff. Various studies have found that people who are more patient experience less low mood, are more empathetic and feel greater gratitude. Your level of patience may even be related to your level of happiness. Patience is a skill, one that you can learn and practice. These three practices have been shown to help build mindfulness and improve patience: ʯ Mindfulness-based stress reduction, which has been shown to strengthen areas of the brain used to regulate emotions and process learning and memory ʯ Meditation, which has been shown to contribute to larger volumes of gray matter in the areas of the brain that regulate response control ʯ Mindful movement, such as yoga, aikido, tai chi and qigong.

Your body relies on your lymphatic system to remove waste, like bacteria, viruses, toxins and abnormal cells, which can lead to cancer. And every step you take helps it do its job. That’s because the lymphatic system lacks an organ like the heart to pump fluid around your body. Lymph fluid relies on movement and the contraction of your muscles to make it flow. “The lymphatic system is stimulated by moving your muscles and getting your heart rate up,” says MD Anderson Senior Physical Therapist Sarah Cleveland. The contraction of your muscles becomes the pump that helps the fluid get around your body. Exercise can help the lymphatic system flow more effectively and potentially help prevent infections and other diseases, like cancer. “Any exercise is helpful for the lymphatic system,” says Cleveland. “Exercise under water is especially helpful because of the pressure from the water.”

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Women who developed pregnancyrelated AKI were more likely to be older (mean age, 40 vs. 30 years) and black (0.25% vs. 0.07% for white women).

however, if you had a total hysterectomy for a noncancerous condition. Your age matters, too. Doctors generally agree that women can stop routine Pap test screening after age 65 – whether you’ve had a hysterectomy or not – if you have a history of regular screenings with normal results and if you’re not at high risk of cervical cancer.

Infants susceptible to measles earlier than previously thought Infants are often assumed to be immune to measles through maternal antibodies transferred during pregnancy and, in many countries, receive their first measlescontaining vaccine at 12 to 15 months. But it turns out immunity may wane before this time in measles-eliminated settings, placing infants at risk for measles and complications, according to research published in November by the American Academy of Pediatrics. Most infants in the study were found to be susceptible to measles by three months of age. “Our findings inform important policy discussions relating to the timing of the first dose of measles-containing vaccine and infant postexposure prophylaxis recommendations.”

Acute kidney injury in pregnancy Are Pap tests still needed after hysterectomy? It depends. If you had a partial hysterectomy – when the uterus is removed but the lower end of the uterus (cervix) remains – your doctor will likely recommend continued Pap tests, says Doctors Mayo Clinic physician Tatnai generally Burnett, M.D.. Similarly, if you agree that had a partial hysterectomy or women can a total hysterectomy – when stop routine both the uterus and cervix are Pap test removed – for a cancerous or screening precancerous condition, regular after age 65 Pap tests may still be recom– whether mended as an early detection you’ve had a hysterectomy tool to monitor for a new canor not. cer or precancerous change. In addition, if your mother took the drug diethylstilbestrol (DES) while she was pregnant with you, regular Pap tests are recommended, since DES exposure increases the risk of developing cervical cancer. You can stop having Pap tests,

The rate of women hospitalized for acute kidney injury during pregnancy has increased in recent years and is associated with high rates of in-patient mortality, according to research presented at ASN Kidney Week, reports Helio Nephrology. The risk for pregnancy-related AKI is greatest for women with diabetes, according to the study. Although the incidence of AKI during pregnancy-related hospitalizations was low, the rates increased almost three-fold between 2006 and 2015. After identifying 15,550,459 hospitalizations, researchers found the rate of pregnancy-related hospitalization involving AKI was 0.1%, subsequently increasing from 0.09% in 2012 to 0.12% in 2015. Women who developed pregnancy-related AKI were more likely to be older (mean age, 40 vs. 30 years) and black (0.25% vs. 0.07% for white women). Silvi Shah, M.D., FACP, FASN, assistant professor in the division of nephrology at the University of Cincinnati, speculates the finding of increasing rates of AKI during pregnancy-related hospitalizations is likely due to greater awareness and detection of AKI during pregnancy, although she said further research is needed. In addition, the reasons for racial and ethnic differences in AKI rates remain unclear. She encourages clinicians to routinely check renal panels during in-patient hospitalizations.

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

Automotive-related news Best laid plans Adaptive cruise control maintains a safe distance between vehicles on the highway by automatically accelerating or slowing down without the driver’s help, while lanekeeping-assist technology helps drivers stay in their lane by gently tugging the wheel when the car starts to drift. Great ideas. But they also lull drivers into letting their guard down, which puts them at greater risk of crashing, according to a recent study by the AAA Foundation for Traffic Safety. The study underscores the depths of the safety challenges faced by the auto industry as it continues its transition from traditional vehicles to self-driving cars.

Vehicle-to-vehicle communication German auto giant Volkswagen unveiled the latest generation of its Golf compact passenger car, whose new features includes Car2X, a vehicle-to-vehicle (V2V) and vehicle-to-infrastructure (V2I) communication technology. Car2X uses WLANp, a communication standard similar to Wi-Fi, to allow vehicles to communicate information between other vehicles and their environment. The technology will enable eligible Golf models to communicate road hazards or incidents with other Car2X-enabled vehicles or sensors within half a mile. VW isn’t the first to implement inter-vehicle communication. But by deploying Car2X technology in the Golf, VW is likely attempting to build its case for making Car2X the preferred standard of vehicle-toeverything (V2X) communication.

Night rider

Drive-thru dining

Is your night vision dimming just a little? The Lanmodo Color Night Vision Camera system is a 8.2-inch screen that uses light amplification to give a visual range of about two football fields ahead, according to a report in The New York Times. The camera lens needs a view of the pavement, of course. It’s $500 on Amazon, and a coupon drops it by $100.

Select BMW owners can now order Nekter Juice Bar and Portillo’s from their cars with the push of a button, part of a test conducted by food ordering platform Olo. Eligible customers can order, and are then given driving directions to pick up their food, reports Restaurant Business Online. Consumers can log on to the BMW Labs website to check their eligibility and preconfigure an order. The service allows drivers to order favorites and repeat orders. The move is the latest in tech-enabled ordering from chain restaurants. Chipotle recently announced that customers can order via Amazon’s voice-enabled Alexa devices. And Wingstop announced a partnership with online-gaming site Twitch that lets players and streaming-video watchers place an order.

Tired of mainstream music? Is your Internet radio station sounding too mainstream? Pandora’s “Modes” feature fixes that by letting you fine-tune the song selection, reports Fast Company. You can play the hits, focus on deep cuts, or emphasize discovering similar artists, and with a Pandora Premium subscription, you can

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limit stations to a single artist as well. It’s not an entirely new idea – the oft-forgotten Slacker Radio has offered finetuning for years. But it’s one that should be available on every music service.

February 2020

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

Technology news

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Getting by in the Internet of Things

ʯ Passwords should be as long as possible and

What do all these things have in common: Digital assistants, smart watches, fitness trackers, home security devices, thermostats, refrigerators, light bulbs, remote-controlled robots, games and gaming systems, interactive dolls and talking stuffed animals? They all send and receive data. But do you know how that data is collected? Hackers can use these innocent devices to do a virtual drive-by of your digital life, the FBI writes in a recent alert. Unsecured devices can allow hackers a path into your router, giving them access to everything else on your home network that you thought was secure. Here’s how to build a digital defense: ʯ Change the device’s factory settings from the default password. A simple Internet search should tell you how – and if you can’t find the information, consider moving on to another product.

unique for IoT devices. ʯ Many connected devices are supported by mobile apps on your phone. These apps could be running in the background and using default permissions that you never realized you approved. Know what kind of personal information those apps are collecting and say “no” to privilege requests that don’t make sense. ʯ Secure your network. Your fridge and your laptop should not be on the same network. Keep your most private, sensitive data on a separate system from your other IoT devices. ʯ Make sure all your devices are updated regularly. If automatic updates are available for software, hardware, and operating systems, turn them on.

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If you have been victimized by a cyber fraud, be sure to report it to the FBI’s Internet Crime Complaint Center at ic3.gov or call your local FBI office.

UL rates security of connected devices

if a phishing site is created and used for attack moments later, even the quickest scanners can’t warn people fast enough. But from its experience detecting phishing sites, Safe Browsing’s insights can now make predictions about risks in real time, according to the company. Google says it is using its experience detecting phishing sites to test new predictive phishing protections in Chrome. Soon, when users type their Google account password into a suspected phishing site, Google will add additional protections to ensure the account isn’t compromised. Those protections will apply even if you use a different browser afterwards. Google says it plans to expand predictive phishing protection to all other passwords saved in Chrome’s password manager, and enable other apps and browsers that use Safe Browsing technology, like Safari, Firefox and Snapchat, to use it as well.

How secure are your connected devices? Underwriters Laboratories offers an IoT Security Rating to help you make an educated decision about which devices to use. The security standards come in five tiers: diamond, platinum, gold, silver and bronze, according to CNET. They are given based on seven requirements: software updates, data and cryptography, logical security, system management, customer identifiable data, protocol security, and process and documentation. Each requirement has its own checklist of security practices. For example, to get the bare minimum verification under data and cryptography, your device can’t have default passwords. To get the diamond verification, your device would need Soon, when users type their Google account to be protected from brute-force password into a suspected phishing site, attacks – when hackers spam passGoogle will add additional protections to word attempts until the correct one is chosen. ensure the account isn’t compromised.

iPod nostalgia?

Those protections will apply even if you use a different browser afterwards.

If you’ve always wanted an iPod click wheel on your iPhone, a new app is helping to bring Apple’s iconic music player back into the modern touchscreen era, reports The Verge. The app – Rewound – is a basic music player app that’s available in Apple’s App Store. It uses downloadable skins to transform the app into an iPod or more, and it syncs to an Apple Music library. It even includes haptic (i.e., touch) feedback, so it looks and feels like a classic iPod. Rewound’s developer, Louis Anslow of Rethought agency, worked on the app for a year. The idea is to bring back the idea of buttons and the nostalgia of devices like the iPod. “You can program physical appearance of a device,” he says. “It could become anything.”

Real-time phishing protection Google Safe Browsing has helped protect Chrome users from phishing attacks for over 10 years, and now helps protect more than 3 billion devices every day by showing warnings to people before they visit dangerous sites or download dangerous files, reports Google. Safe Browsing has always scanned the web for dangerous sites. But,

Hey! I’m talking to you! When making a FaceTime call, a user naturally wants to look at the screen – at the person they are conversing with. On the other end, the recipient of the call just sees the caller looking down. When the caller looks at the camera, the recipient sees this as the caller looking them in the eye – a much more natural point of view. However, the caller is no longer looking at the recipient on the screen at that point, which means they can only count on their peripheral vision to see the other person’s reactions, rather than a clearer image when viewing normally. With the third beta of iOS 13, Apple has added a new toggle for FaceTime Attention Correction, which aims to make it appear as though you are looking directly at a friend during FaceTime call when you’re actually looking at the screen, reports Apple Insider. It creates a 3D face map and depth map of the user, determines where the eyes are, and adjusts them accordingly. The functionality is limited to the iPhone XS and iPhone XS Max.

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SOME DECISIONS REALLY ARE LIFE AND DEATH Six reasons why your customers need AEDs

Sudden cardiac arrest (SCA) occurs when an electrical malfunction of the heart causes it to suddenly stop beating properly. There are no warning signs and it can happen to anyone, anywhere. A victim’s best chance of survival is immediate treatment with cardiopulmonary resuscitation (CPR) and an automated external defibrillator (AED). The safety of your customers and their employees is important. Do they have the necessary resources available in case of an emergency? Someone’s life may depend on it. Here are six compelling reasons for them to install an AED in their building, facility or office:

01

SCA can happen to anyone at any time. SCA doesn’t discriminate. It can affect children and adults of all ages and isn’t exclusive to those with a history of heart problems.

02

90% of out-of-hospital cardiac arrests are fatal1 According to the American Heart Association (AHA), 10,000 cases of SCA happen at work each year2. If employees aren’t trained to act, a victim’s chance of survival is very low. Rapid response, CPR, and AED use are absolutely critical for a positive outcome.

03

70% of bystanders feel helpless during an SCA event3 Many witnesses aren’t sure what to do. Others assume a peer will step in and act. But a victim’s chance of survival drops nearly 10% every minute without intervention4. After 10 minutes, their chances are practically zero.

04

Immediately performing CPR and using an AED can double or triple a victim’s chance of survival3 Good chest compressions are essential for moving blood throughout the body and protecting vital organs. The AHA recommends a compression depth of 2-2.4 inches at a rate of 100-120 compressions per minute to deliver high-quality CPR. Only 50% of SCA victims will initially need a defibrillating shock, but all will need high-quality CPR. If treatment is administered right away, a victim’s chance of survival can increase to about 60%2.

05

Many workplaces aren’t prepared to handle an SCA emergency According to the American Heart Association, 55% of employees report that their companies don’t offer first aid, CPR, or AED training5. Furthermore, half said they couldn’t even locate the AED in their workplace5. Training increases confidence during an SCA event, so the more employees know ahead of time, the more they can do to help save a life.

06

SCA is a leading cause of unexpected death in the U.S. More than 350,000 Americans were victims of SCA in 2016. The overall survival rate was just 12%1. Research shows a fivefold increase in survivability – from 5% to 24% – when an AED was used. Sadly, the same research shows that an AED is only available 2% of the time6. SCA is unexpected and frightening, but it can be treated. Do your part to prepare your customers, talk to them about outfitting their workplace with ZOLL® AEDs. The ZOLL® AED Plus® with Real CPR Help® provides rescuers with real-time feedback to ensure the best possible CPR and will deliver a shock to the victim if necessary. In matters of life and death, you can help save a life. Make ZOLL® your AED rescue partner. For help finding the right AED for your customer, call 800-804-4356.

“How CPR is changing (and saving) lives.” American Heart Association. http://bit.ly/2Km8GNQ Accessed 19 November 2018. “Saving Sudden Cardiac Arrest Victims in the Workplace.” Occupational Safety & Health Administration. https://www.osha.gov/Publications/3185.html Accessed 19 November 2018. 3 “CPR Statistics.” American Heart Association. http://cprblog.heart.org/cpr-statistics/ Accessed 20 November 2018. 4 “Every Second Counts: Rural and Community Access to Emergency Devices.” American Heart Association & American Stroke Association. http://bit.ly/2PJYSn7 Accessed 20 November 2018. 5 “American Workers Unprepared for Workplace Cardiac Emergencies, Surveys Find.” American Heart Association 2017 Jun 19. http://bit.ly/2FxELUa 6 “CPR & First Aid: Emergency Cardiovascular Care.” American Heart Association. https://bit.ly/2vS7480 Accessed 21 November 2018. 7 Weisfeldt ML, et al. J Am Coll Cardiol. 2010;55(16):1713–20. 1

2

Copyright © 2020 ZOLL Medical Corporation. All rights reserved. AED Plus, Real CPR Help and ZOLL are trademarks or registered trademarks of ZOLL Medical Corporation in the United States and/or other countries. All other trademarks are the property of their respective owners.

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MCN PP 1810 0356


EMPOWER RESCUERS

WITH UNRIVALED SUPPORT

A sudden cardiac arrest (SCA) victim’s best chance of survival is immediate CPR and a rescuer equipped with an AED. The ZOLL AED Plus® with Real CPR Help® can help make the difference between life and death. REAL CPR HELP provides integrated, real-time feedback on CPR compression rate and depth. FIVE-YEAR BATTERY AND PAD LIFE means fewer replacements and a low cost of ownership. DESIGNED TO BE DURABLE, the AED Plus can be used in various environments.

For more information visit www.zoll.com/aedplus ©2018 ZOLL Medical Corporation. All rights reserved. AED Plus, Real CPR Help, and ZOLL are trademarks or registered trademarks of ZOLL Medical Corporation in the United States and/or other countries. MCN PP 1810 0354


LETTER TO THE EDITOR

Clarifying Employer Requirements under the OSHA Bloodborne Pathogens Standard Thank you for publishing such an important article on sharps safety and protecting healthcare personnel from

needlesticks (“The truth about sharps injuries? They still happen.” December 2019 Repertoire). Reading the piece provides a great opportunity to clarify the requirements under the Bloodborne Pathogens Standard and the impact the Needlestick Safety and Prevention Act (NSPA) had on the standard and on the regulated public.

non-managerial healthcare workers in identifyThe original OSHA Bloodborne Pathogens Standard ing, evaluating and choosing effective engineer(BPS) was promulgated in 1991 with the requirement for ing and work practice controls. employers to comply with all of its provisions in 1992. The original standard included, among many other things, The revised standard was in place with these addimandating making and maintaining an Exposure Control tional requirements in 2001 and was then enforceable Plan, the use of engineering controls and safe work pracduring inspections in April in Federal OSHA States tices, use of personal protective equipment (PPE), hepaand in July in OSHA State Plan States. Enforcement titis B vaccine, annual training, labeling biohazard waste, relative to the standard stays consistent over time and more. The standard was then and is today the most (Mitchell, 2019). cited standard during inspections in healthcare facilities (https://www.osha.gov/pls/imis/ citedstandard.naics?p_esize=&p_ state=FEFederal&p_naics=62). More than 25% of all injuries occur to non-users

of devices. This means that failure to safely

In 2000, the Needlestick Safety use, activate, and dispose of a sharp device is and Prevention Act was passed responsible for causing injuries in co-workers and unanimously by Congress. The Act colleagues. This must stop. required OSHA to update its standard to include additional provisions for better protections of healthcare It is important for healthcare employers to know workers, specifically related to preventing sharps injuthat compliance with the BPS is mandatory. This ries. This happened for many reasons, including high rates includes not only the elements of the original 1991 of sharps injuries occurring despite better, safer medistandard, but also the 2001 standard. A critical piece of cal device designs available on the market. OSHA needed protecting healthcare personnel from sharps injuries and renewed focus to prevent ongoing exposures to blood, needlesticks is not only the use of safer medical devices body fluids, and other potentially infectious materials. The with sharps injury prevention features, but also the safe additional provisions (https://www.osha.gov/SLTC/ activation of those features and immediate disposal into bloodbornepathogens/bloodborne_quickref.html) included: ʯ OSHA’s requirement for employers to identify, a sharps container. This works to protect not only them, evaluate and implement safer medical devices such but any employee downstream. In fact, more than 25% as needleless systems and sharps with engineered of all injuries occur to non-users of devices (EPINet sharps protections. 2018). This means that failure to safely use, activate, and ʯ Additional requirements for maintaining a dispose of a sharp device is responsible for causing injusharps injury log and for the involvement of ries in co-workers and colleagues. This must stop. Use 54

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of safer medical devices is a crucial piece of protecting the health and safety of all personnel in setting where they are used. 2020 is the 20th anniversary of the NSPA and we still have a long way to go to make safer work environments for those providing patient care. Injuries from disposable syringes and sutures continue to be unacceptably high. It

is important for healthcare institutions to carefully measure their injury and exposure incidents so they can put controls in place to prevent them in the future. Amber Hogan Mitchell, DrPH, MPH, CPH President / Executive Director International Safety Center

References

Mitchell et al. Bloodborne Pathogens Standard Enforcement at the Occupational Safety and Health Administration: The First Twenty-Five Years. New Solutions; A Journal of Environmental and Occupational Health Policy. March 2019. https://journals.sagepub.com/doi/abs/10.1177/1048291119840077 International Safety Center. EPINet Report for Needlestick and Sharp Object Injuries. 2018. https://internationalsafetycenter.org/wp-content/uploads/2019/07/Official-2018-US-NeedleSummary-FINAL.pdf

Industry news Henry Schein celebrates 21st annual Holiday Cheer for Children program with families around the world Henry Schein, Inc. (Melville, NY) and its employees around the world joined more than 1,200 underserved children, families, and seniors to celebrate the company’s 21st annual Holiday Cheer for Children program in December 2019, a flagship corporate initiative that helps participating families enjoy a fun and festive holiday season. “The Holiday Cheer for Children program exemplifies our Company’s mission to support the communities in which we live and work, and the joy of celebrating with new friends and families each year only serves to reinforce our

NEWS

commitment to giving back,” said Gerry Benjamin, Henry Schein’s executive vice president and chief administrative officer. “It is especially rewarding to see the friendships that have formed between our TSMs, our social service agency partners, and the families we serve, and we look forward to making many more new friends in the years to come.” Holiday Cheer for Children takes different forms depending on the location, with employees often collecting and donating gifts and food to local nonprofit organizations, or purchasing gifts for participating children and delivering them at company events. Henry Schein partners with local social service agencies to identify children and families who would most benefit from participating in the program.

Owens & Minor names David Myers as SVP and chief procurement officer Owens & Minor, Inc. (Richmond, VA) has hired David Myers as SVP and chief procurement officer. In this role, Myers will be responsible for leading global procurement, supplier relations, supplier effectiveness, category management, and the company’s GPO team. Prior to joining Owens & Minor, Myers spent 20 years at Seneca Medical, which later became Concordance Healthcare Solutions (Tiffin, OH), where was president and COO. Myers is a current board member and past board chair with the Health Industry Distributors Association (HIDA). Myers will succeed Mark Zacur as EVP and CPO. Zacur was recently promoted to EVP and chief commercial officer. www.repertoiremag.com

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NEWS MTMC announces new partnership MTMC is pleased to announce a new partnership: MTMC-IS (MTMC Inside Sales). The new company will be in partnership with and led by Joanne Wills. Joanne is the founder of Calling Works, a leader in B2B outsourced inside sales solutions (www.callingworks.com) MTMCIS will be providing inside sales solutions to the existing portfolio of MTMC supplier partners as well as other medical suppliers that value the service.

start their patients on the most precise, appropriate treatment regimen based on their clinical and genetic profiles. Therapeutic regimens that align to NCCN guidelines, including those matched with the results of the broadpanel gene sequencing tests, will automatically receive prior authorization approval, speeding time to start of the therapy for patients. The strategy is enabled by an innovative collaboration with Tempus, a technology company advancing precision medicine through the practical application of artificial intelligence in healthcare.

CVS Health launches “Transform Oncology Care” program

Midmark names Nancy Stapp as VP, finance

CVS Health (Woonsocket, RI) announced its “Transform Oncology Care” program. The company says the program is “anchored on a first-of-its-kind precision medicine strategy for payors.” It will use genomic testing results at the point-of-prescribing to help patients start on the best treatment, faster and will match eligible patients to clinical trials. The precision medicine strategy, delivered in close coordination with oncologists, uses results of broad-panel gene sequencing tests and the latest National Comprehensive Cancer Network (NCCN) treatment and supportive care guidelines to help oncologists identify and

Midmark Corp. (Dayton, OH) announced that Nancy Stapp was promoted to VP, finance. Stapp will lead the Midmark board of directors’ audit committee and be the primary interface for key discussions. She will also be responsible for driving Enterprise Risk Management (ERM) for Midmark. This includes leading the ERM internal cross-functional team, overseeing insurance evaluation and purchasing efforts, coordinating third party risk evaluations and managing the risk mitigation efforts for the company. Additionally, she will lead the communications of these activities with the Midmark Board of Directors.

Products to Watch Masimo receives FDA clearance for neonatal RD SET Pulse Oximetry Sensors Masimo (Irvine, CA) announced that RD SET sensors with Masimo Measure-through Motion and Low Perfusion SET pulse oximetry have received FDA clearance for improved oxygen saturation (SpO2) accuracy specifications for neonatal patients (< 3 kg). The company says that the updated RD SET sensors’ SpO2 accuracy specifications have improved significantly, from 3% to 1.5% ARMS (at 1 standard deviation), in conditions of motion and no motion, providing clinicians with even greater confidence when monitoring the oxygenation status of neonates. With this clearance, the improved performance specifications, which were incorporated into RD SET sensors for patients > 3 kg in 2018, are now available to all patient populations in the U.S.

Sysmex launches gene-testing kit for blood cancer (ipsogen JAK2 DX reagent) Sysmex Corporation announced the launch of the ipsogen JAK2 DX reagent. The product is a gene testing kit that measures the JAK2V617F mutation quantitatively, used in the diagnosis of certain hematopoietic tumors generally referred to as blood cancers, specifically polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), the company said.

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