REP Jan 21

vol.29 no.1 • January 2021

repertoiremag.com

Staying on the Mark COVID-19 forces sales reps to meet their customers exactly where they are

Virtualize Thyself.

There was a time when maybe you wished you could conduct business meetings in your pajamas but we never really thought it would happen.

Our experienced sales and service teams are still here for you and committed to continue as your trusted selling partner. We can help ensure your success by providing the diagnostic products still critical to you and your customers.

Until we can work together in the field again, SEKISUI Diagnostics will be here for you in any other way possible. Because we understand, every result matters. ®

POINT-OF-CARE READER

IMMUNOASSAY SYSTEM

RAPID DIAGNOSTICS

SEKISUI DIAGNOSTICS IS YOUR PARTNER IN HEALTHCARE 800-332-1042 / sekisuidiagnostics.com © 2021 Sekisui Diagnostics, LLC. All rights reserved. Acucy® and OSOM® are registered trademarks of Sekisui Diagnostics, LLC. Because every result matters™ is a trademark of Sekisui Diagnostics, LLC. FastPack® is a registered trademark of Qualigen Inc.

JANUARY 2021 • VOLUME 29 • ISSUE 1

PUBLISHER’S LETTER

Staying on the Mark

Hello 2021...............................................4

PHYSICIAN OFFICE LAB Respiratory Testing: New Horizons As physician office customers begin undertaking diagnosis and care of COVID-19 patients, there are a lot of questions they’ll need help answering........ 6

COVID-19 forces sales reps to meet their customers exactly where they are

IDN OPPORTUNITIES Breadth of Services Regional service center. Drug manufacturer.

Group purchasing organization.

Disaster response planning. LeeSar and Cooperative Services of Florida check a lot of boxes for members...........10

16 Jennifer Reverendo

TRENDS Vendor Credentialing Very Much Active Vendor credentialing companies have remained busy during the pandemic, and they expect to stay that way even after the worst has passed...............26

INFECTION PREVENTION Infection Prevention: More and Less Physician practices adopt creative solutions, and sales reps adapt.................28

Trends

New Entrants Challenge Independent Practices

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Reps face a new landscape as well

repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2021 by Share Moving Media. All rights reserved.

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JANUARY 2021 • VOLUME 29 • ISSUE 1

SALES Winning Enterprise Business Eight unique challenges in enterprise selling................................ 36

HIDA GOVERNMENT AFFAIRS COVID-19 Substantially Impacts All Market Segments............................................. 40

Healthy Reps

Health news and notes

42

Quick Bytes

Technology news

LEADERSHIP Maximize Potential

Addressing the confidence gap............... 48

44

Rep Corner

Well-Grounded ‘Three Pillars’ guide Ricky Bustamante’s career – and life – path

50

Automotive-related news

NEWS Industry news................................... 52 2

January 2021

Windshield Time

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PUBLISHER’S LETTER

Hello 2021 I’m not sure I’ve ever felt happier to turn the page on a year than I am right now. Last

January, I wrote about Warby Parker and “Seeing Clearly in 2020.” Well, I’m not sure any of us saw 2020 coming, or the fact we would all be trying to flatten the curve for 9 months, but here we are on the dawn of a new year.

2020 found us in the spotlight in the eyes of everyday Americans. The fact healthcare workers and facilities in parts of the country were overrun with COVID patients and in dire need of PPE made our industry as important as ever. Amid the chaos, suppliers across our industry found a way to overcome adversity and put us back on track. As we head into a new year, my hope is that we never forget the lessons learned from 2020.

Not only the supply lessons, but the life lessons that we’ve all been through this year.

For me, I realize how much I don’t really need to survive and be happy. I also learned how valuable each of you are to me. Going almost an entire year without seeing you guys at meetings or dinners has made me appreciate you even more. I’m looking forward to seeing each of you in the months to come.

Last month, I turned 50, and as always, I wrote down my goals for the coming year.

I must admit they look very different than in years’ past. I don’t really care about losing weight or self-improvement. I’m focused on appreciating what truly matters and being thankful for my friends, our great country, the wonderful industry we work in, and most importantly my family. As you think about the coming year, step back and ask yourself what really does matter. My guess is we’ve all got a different take going into 2021 than we did 2020.

Scott Adams

Here’s to 2021 being the year we all want to remember.

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.com; www.sharemovingmedia.com

editorial staff editor

Mark Thill

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managing editor

vice president of sales

mthill@sharemovingmedia.com

Graham Garrison

Katie Educate

editor-in-chief, Dail-eNews

keducate@sharemovingmedia.com (800) 536.5312 x5271

ggarrison@sharemovingmedia.com

Alan Cherry

acherry@sharemovingmedia.com art director

publisher

Scott Adams

Brent Cashman

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circulation

founder

bcashman@sharemovingmedia.com

Laura Gantert

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sales executive

Amy Cochran

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Brian Taylor

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2021 editorial board Richard Bigham: Atlantic Medical Solutions Eddie Dienes: McKesson Medical-Surgical Joan Eliasek: McKesson Medical-Surgical Ty Ford: Henry Schein Doug Harper: NDC Homecare Mark Kline: NDC Bob Ortiz: Medline Keith Boivin: IMCO Home Care

PHYSICIAN OFFICE LAB

Respiratory Testing: New Horizons As physician office customers begin undertaking diagnosis and care of COVID-19 patients, there are a lot of questions they’ll need help answering.

As the 2020/2021 respiratory season unfolds, we have a very different environment from

By Jim Poggi

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prior seasons. We have a new respiratory pathogen, SARS CoV-2. In addition to being new, it occurred off cycle from typical respiratory season pathogens. It is also far more contagious than influenza, group A strep and RSV. As of November, 2020, it has created a worldwide pandemic, with over 54 million infections and 1.3 million deaths worldwide. In the United States, we have experienced 11 million cases and 246,000 deaths as of press time. And its severity is less predictable on the individual patient than influenza and other well-known respiratory pathogens.

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The current pandemic has had a dramatic negative years. Traditional physician office testing is just beginning impact on economies around the world. Preventive meato become more widespread based on availability of eassures including avoidance of social settings has had an ier to use and more familiar antigen diagnostic tests from unexpected impact on emotional health and well-being well-established lab manufacturers. related to isolation and lack of typical social contact. As As our physician office customers begin undertaking a result, the pressure on prevention, diagnosis and treatdiagnosis and care of COVID-19 patients, there are a lot ment has reached unprecedented levels. In this article we of questions coming your way. This information, along will focus on lab diagnosis. with ongoing communication with Testing for the virus has changed your key respiratory test kit manuthe face of respiratory testing in funfacturers is intended to help you Traditional damental ways. In the early days of answer some of those questions and the pandemic, many physician pracenhance your value as a consultant to physician office tices closed to help blunt the spread our customers. testing is just of the disease. In addition, the first Which tests are out there and diagnostic tests for SARS CoV-2 beginning to what is their primary use? used RT-PCR technology, which is become more For past respiratory seasons, while technically complex and not widely we have had visually read lateral available in physician office laborawidespread based flow tests, followed by reader based tories. So, for most of the first eight on availability lateral flow tests and more recently months of the pandemic, physician molecular tests for influenza, strep practices were not highly involved of easier to use and RSV, we always had diagnostic in diagnosis or patient care. Hosand more familiar tests. We did not have tests specifipitals and new testing sites such as cally intended to detect antibodies “drive through� testing locations antigen diagnostic in patients with previous infections. performed most of the early testing. tests from wellFor COVID-19, both diagnostic and The emphasis on safety and reducing antibody tests are important and for the spread of COVID-19 has had a established lab different reasons. Diagnostic tests far greater impact on testing sites manufacturers. fulfill their traditional purpose: to than any respiratory disease in recent

Test Methodology

Detects?

Used for

Sensitivity

Specificity

Test format

Applicability in POL?

RT-PCR

The RNA of the virus

Diagnosis of COVID-19 infection

High

High

Instrument/ reagent

Limited

Antigen Tests

Viral antigens

Diagnosis of COVID-19 infection

Moderate

High

Reader/reagent ELISA/reagent

High

Antibody Tests

Antibodies produced as a result of a previous infection

Determination of community spread; population prevalence of the disease

Moderate; varies by antibody

Moderate; varies by antibody

Instrument/ reagent Reader/reagent Lateral flow visual read

Moderate/high

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PHYSICIAN OFFICE LAB inform the caregiver whether the patient is currently infected. The new antibody tests are used by public health and large healthcare systems to determine the spread and prevalence of the infection in our communities and country as a whole.

The range of test types, testing technologies and intended use of these tests has increased rapidly this year.

There are more than 200 total tests approved under Emergency Use

positive tests being reported in the press and peer reviewed literature.

It’s clear that we are just beginning to understand how well current tests are performing. Manufacturers are stepping up to the plate to provide far more data in the instructions for use for these tests, including limits of detection and performance expectations related to disease prevalence.

This more comprehensive data set is likely to filter into IFU documents for other infectious disease tests as well and provide better guidance than previously available.

It’s clear that we are just beginning to Your manufacturer rep and understand how well current tests are the data their company provides is performing. Manufacturers are stepping the best, most complete and accurate source of this information. up to the plate to provide far more data With concerns about quality of test results high and questions about in the instructions for use for these “which test types and manufactests, including limits of detection and turers provide best results?”, your customers are sure to ask you for performance expectations related to advice and help. Here is some quick, disease prevalence. simple to understand guidance: Sensitivity and specificity are inherent elements of the specific test Authorization as of November, 2020 and the list is growand are not impacted by disease prevalence. Positive predicing daily. As noted in a previous column, we have never tive and negative predictive values, on the other hand, seen as many sample types with nasal and nasopharyngeal are dependent on disease prevalence and as a result, when swabs used, along with whole and capillary blood, saliva disease prevalence is high, positive predictive value (true and stool samples. positives) is high and false negatives are low. When disease prevalence is low, positive predictive value drops Understanding test performance and and false negatives are observed. High sensitivity fosits relationship with disease prevalence ters improved true positives and rises with increased There is new emphasis being placed on understanding levels of prevalence. High specificity helps reduce false how well the new COVID-19 tests are preforming. The positives and improves with increased levels of prevareasons include the proliferation on new suppliers and lence. The perfect assay would be close to 100% for tests as well as the use of Emergency Use Authorizaboth; with lower incidence diseases, specificity is the tions in place of the more rigorous 510(k) process. Given more important measure. the speed of spread of COVID-19 and the large range You and your key respiratory test kit manufacturers of new test types, there has been insufficient time and have the most daunting challenges yet this respiratory effort devoted to comparisons of tests within each type season. You need to balance test performance, ease of of testing technology. As a result, there’s a good deal of use, availability of instruments and reagents and provide confusion about how well tests are diagnosing COVIDsound consultative advice to physician practices needing 19 in general, as well as the inherent performance of to provide a safe, patient friendly and effective program specific tests. The data is just being generated, and there for diagnosis and treatment of COVID-19. We are all are a number of claims of both false negative and false counting on you.

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Let’s make a positive impact together.

DUKAL can be a strong long term partner for you in the personal protection equipment category.

We are continuously investing in our capabilities and capacity to bring high quality personal protection equipment to front-line workers. Our PPE products meet or exceed all FDA requirements, holding multiple 510k’s for surgical masks and N-95 respirators. DUKAL also offers AAMI level rated isolation gowns.

Let’s make a positive impact together. Contact us at sales@dukal.com to learn more about how we can be a long term provider of personal protection equipment for you.

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IDN OPPORTUNITIES

Breadth of Services Regional service center. Drug manufacturer. Group purchasing organization. Disaster response planning. LeeSar and Cooperative Services of Florida check a lot of boxes for members.

Distribution Center

When trying to describe what solutions that LeeSar and Cooperative Services of Florida (CSF) bring to its mem-

bers, an elevator pitch doesn’t do the organization justice.

For starters, LeeSar is a unique, boutique regional service center for its four members in both the regional service provider for pharmacy and medical surgical distribution. With distribution, LeeSar has a 300,000 square foot facility in Fort Myers, and approximately another 100,000 square feet in numerous locations for individual functions. CSF, meanwhile, is a Safe Harbor regulated regional group purchasing organization.

“Our purpose is to remove supply chain costs from within our members’ locations,” said Bob Boswell, president and CEO of LeeSar and CSF. “For instance, the more custom services we provide our members, the less footprint they need to have for supply chain within their own facility. That means less inventory, less staging area on their docks, less contracting and less purchasing. There’s 10

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a certain amount of efficiency that we can gain by doing this in a consolidated service model, where we’re delivering supplies in low units of measure, on a cart ready to be delivered to the point of care. There’s no staging, no unpacking, no de-casing. Our objective is to work with our members to minimize steps in the process and the supply chain resources required at each of our members.”

However, the services don’t end there. The organization also does: ʯ 503B drug manufacturing, sterile to sterile, all robotic ʯ Nuclear pharmacy compounding ʯ Pharmaceutical distribution and prepackaging ʯ EMS supplies distribution ʯ Custom Sterile Surgical Packs ʯ Record retention ʯ Tray exchange program (LeeSar builds and replenishes anesthesia trays, crash cart trays, epidural trays and pediatric trays for its members) using automated camera reading technologies. ʯ A culinary, cook and chill process for Lee Health (LeeSar provides over 18,000 meals a day out of a facility on a cook and chill process) ʯ Central Sterile Processing for Lee Health “The breadth of services has evolved to be somewhat unique of any other regional distribution center or consolidated service center,” said Boswell. “Our purpose is helping our members transform to a value-based healthcare market. Our new mission, vision, values and strategic imperatives all focus on providing quality custom services at the lowest possible costs.”

A little history In 1996, Lee Health and Sarasota Memorial Healthcare System developed LeeSar and Cooperative Services of Florida, Inc. (CSF) as a means to reduce costs for medical goods and services while providing safe, high quality patient care. Additional health systems have since joined, each having representatives on the Board of Directors.

acute-care hospital beds and 120 long-term care, sub-acute rehabilitation and hospice beds LeeSar is the operations component of this partnership, while CSF is the corporate entity for product research, negotiation and contract management. By working together, LeeSar/CSF is comprised of two distinct companies with a combined mission: “Advance the missions of our members to improve the health of the patients and communities we serve.”

Contracting tailored to their needs As a regional group purchasing organization or GPO, CSF’s objective is on reducing operational expenses associated with pharmaceuticals, supplies, capital, and purchase services for its members. “We really focus Jennifer Reverendo that effort on using governance with our members that put rules of engagement around participating, accountability, etc.,” said Jennifer Reverendo, vice president of CSF. “We also employ a clinical integration model, which provides our membership with some infrastructure across the collaborative, both in a clinical nature and financial nature as far as establishing medical advisory boards to get key physician leaders together to vet clinical strategies.”

LeeSar and CSF membership includes: ʯ Lee Health, the largest and only communityowned healthcare system in SW Florida with a total of 1,457 beds. ʯ Sarasota Memorial, a full-service health system with 819 beds; specializing in heart, vascular, cancer, and neuroscience services, and one of the highest rated public health systems in Florida. ʯ Central Florida Health Alliance, which includes Leesburg Regional Medical Center (605-bed acute care hospital ), The Villages Regional Hospital (198-bed acute care hospital which has more than tripled in size since opening in 2002), and Leesburg Rehabilitation Hospital ʯ Jupiter Medical Center, a not-for-profit 327-bed regional medical center consisting of 207 private www.repertoiremag.com

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IDN OPPORTUNITIES

Nuclear Pharmacy

CSF recently entered into a unique relationship with Vizient that provides access to tools through the national GPO as well as to aggregated peer contracts. CSF is a member of Vizient, but its four members, the four health systems, are not. “Members access Vizient through CSF,” said Boswell. “Aggregation allows CSF to access highest tier categories with many Vizient agreements, but many of CSF contracts are custom agreements with Vizient for

Centralized Purchasing

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Disaster response Due to its location at the end of a peninsula in Florida, disaster response is a unique need for members. “We have hurricane season response plans that we have developed with our members,” said Boswell.

“Every year, we refresh these plans. We iden-

tify the stocking levels, both at LeeSar and at member locations, and the staffing model that needs to be maintained at the LeeSar facility. We also work with local and county law enforcement to ensure truck access when roads may otherwise be closed.

the benefit of our members only. We also contract for pharmaceuticals, and because CSF qualifies as a regional aggregation model, we can access the pharmacy aggregation tiers from Vizient. There’s also benefit in that.”

In addition to being a traditional GPO, the CSF sourcing team acts on behalf of its members directly, meaning they serve as the sourcing team for each of the member organizations in varying degrees. “CSF has created a diverse portfolio based on member needs and opportunities to leverage committed spend. If a member’s needs fall outside of that, CSF works with them to ensure contract coverage,” said Reverendo. “CSF also works with members independently to meet unique needs.”

Interconnectivity Previously, Boswell worked for an IDN in Ohio that was a few years further along in reducing costs through supply chain integration, physician engagement, stronger market share and aggregation contracting. When Boswell arrived at LeeSar, hospitals and health systems in the South Florida

Top photo by Kat Velez

CSF employs “strategically flexible sourcing strategies,” said Reverendo. “We want to engage our members in the right mix of market share consolidation strategies and opportunities that allow them to optimize category spend individually where it makes sense. Ultimately we are hoping to engage members in strategies focused on reducing unnecessary variation.” CSF structures agreements in a way that leverages the value of members aggregating volume as a virtual IDN, providing options for those members to optimize contracts in their own shops while still working within approved guidelines.

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IDN OPPORTUNITIES

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costs for members, better distribution fees for LeeSar, and greater allocations from our manufacturers.”

Indeed, it’s a lot of moving pieces, and LeeSar and CSF are working hard to craft their services and solutions with a focus on providing value to members. “It’s a new day for LeeSar and Cooperative Services of Florida,” said Boswell. “As our members transform, we’re in the process of transformation ourselves. There are challenges and at times we are not progressing as quickly as we would like.

But these are really exciting times.”

Healthcare solutions Pharmaceutical – Customized compounding and nuclear pharmaceuticals, EMS services, and pharmaceutical repackaging and distribution in unit dose.

Culinary – Customized solutions for catering and high-quality meals for hospital systems.

Surgical Custom Packs – Custom or standard kits reduce time gathering product for procedures.

Sterile processing – Off-site sterile processing.

Supply distribution – Medical and surgical supply distribution in bulk and low unit of measure.

Photo by Kat Velez

region were not as progressive in these areas. “When we started benchmarking our costs, they weren’t as good as what our members thought they were based on what they were being told before,” he said. “We have made very good progress in improving access to and consolidation of member data, identifying opportunities, and documenting member contracted savings.”

LeeSar is supporting its members’ transition to valuebased care. Reducing costs is one of the ways. But the member organizations are also growing. For instance, Sarasota is building an additional new hospital in Venice, Florida and an oncology tower at their current location. Lee Health recently opened a new outpatient facility in Estero, Florida and a 216-bed addition to their Gulf Coast facility. LeeSar continues to work with members relative to supply distribution plans for these initiatives.

Reducing operational clinical variability, complexity and cost, is another goal, aided by the interconnectivity of the GPO and the regional service center. “The number of SKUs we stock in our distribution warehouse is totally dependent on how standard our members are with specific product categories,” said Boswell. “Isolation and surgical gowns, gloves, and masks are several examples.

If members are not standardized on these products, we have more SKUs, more stocking, and it’s tougher to get that allocation during times of COVID or any other time.

Jennifer and the GPO are working to reduce the variation on similar products resulting in SKU reduction in our own distribution center. This positions us to negotiate better

Staying on the Mark COVID-19 forces sales reps to meet their customers exactly where they are

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Selling is never easy. And selling during a pandemic – or, as one expert

describes it, a “time of overwhelm” – is tougher still. Healthcare providers have a lot of things on their mind, not the least of which is the survival of their practices. Nevertheless, distributor reps can embrace the opportunity to demonstrate their relevance to their customers – during the pandemic, and after.

Physician practices are concerned about PPE, but they almost always face deeper issues as well – problems they may not even be aware of, says Mace Horoff, Sales Pilot Medical Sales Performance, Boynton Beach, Florida. For sales reps, that’s where opportunities exist.

“Reps are almost spring-loaded to approach customers with products,” he says. “That’s what they do and that’s how they get paid.” But taking that approach during a pandemic is a mistake.

them, especially if it can be automated and reduce the workload for the practice.”

Horoff uses selling analogies to make his point. For example, an automobile dealer may try to interest a customer in an extended warranty, unaware that the customer has recently lost her job. The car is important to the customer, but at the moment, she has more pressing things on her mind.

Another example: A rep in the restaurant industry may try to sell a customer on a new piece of equipment

“Everybody is talking about the ‘new normal.’ But what is normal today won’t be normal a month from now.”

– Mace Horoff, Sales Pilot Medical Sales Performance

“Reps have to look at the products and services they sell in a different lens now,” he says. “They need to ask, ‘How can [my product or service] address some area of value that is being impacted by the prospect’s current situation?’ In a time of ‘overwhelm,’ is there something my products can do to make practices more efficient, to make it easier for them to care for their patients?

“An obvious thing we’re seeing today is telemedicine. If you have a product with a telemedicine component or one that can be monitored virtually, that is relevant to

even as that customer’s clientele has shrunk due to the pandemic.

“Rather than sell the product, the rep can share how other restaurant owners have been successful with takeout or catering,” says Horoff.

“If you’re a restaurant owner facing these kinds of issues, that rep will get your attention.

“Healthcare providers don’t automatically know what’s relevant in their business,” he adds. “That’s the value of the medical rep who can connect the dots for them.”

Even after the pandemic has passed, successful reps will continue www.repertoiremag.com

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Staying on the Mark to identify and deal with whatever is relevant to their customers in the moment, says Horoff. “Everybody is talking about the ‘new normal.’ But what is normal today won’t be normal a month from now. It’ll be something different.

Reps need to analyze what’s happening in the marketplace and look at their products differently – through a lens that allows them to position product relevance.”

Laser-focused Adam Kohut, senior manager, regional accounts, Healthcare Services, Henry Schein, believes that in order to have successful and meaningful discussions about customer needs amidst COVID-19, sales reps should address two main areas: the future of patient encounters, and revenue optimization.

“By staying laser-focused on taking care of the immediate needs that today’s challenges present, and the foresight to take a consultative approach, success can still be achieved.”

– Adam Kohut, senior manager, regional accounts, Healthcare Services, Henry Schein

“Ask providers or networks if they have discussed their plans for what an average patient visit will look like pre- and post-pandemic,” he says. Offer solutions such as patient self-scheduling, virtual check-in, touchless payments, telehealth, remote monitoring for chronic care patients, digitally integrated diagnostic devices, and UV disinfection options.

Reps should also ask their customers how they plan to navigate changes in the financial landscape while still providing the best patient care, Kohut adds. Tools to help them do so include point-of-care testing for disease state management, molecular testing at the point of care, diagnostic equipment that keeps the patient and reimbursement in-house, digital imaging and clinical trial matching.

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“By staying laser-focused on taking care of the immediate needs that today’s challenges present, and the foresight to take a consultative approach, success can still be achieved.”

Clean and safe “Many offices don’t want to see salespeople, except for urgent needs, so prospecting for new business is very challenging right now,” says Albert Sands, vice president, non-acute care, MedPro Healthcare Sales Solutions. PPE has been dominating conversations, making it difficult for reps to introduce new products, he says. “We’ve been trying to reintroduce ‘normal’ products into the system, but it’s challenging. We want to be respectful of customers’ needs, not our ‘wants.’”

That said, the demand for monitoring equipment has remained fairly steady throughout the pandemic, not to mention diagnostics for COVID-19 and flu, he says. In addition, more and more products seem to be surfacing that are designed to limit patient contact.

Distributor reps can help physician practices signal to their patients that they are open and offering their services in a safe and sterile environment, says Michael Einhorn, president, Dealmed, Brooklyn, New York. They can do so by introducing products – everything from sanitizers to signage – that convey that message. “It’s about going back to basics, making sure patients know that the office is clean and secure, that their [primary care] doctor can take care of them, that they can be tested for COVID in the office, and they can receive all of their traditional testing once they are there.”

Victor Amat III, president, American Medical Supplies & Equipment in Miami, reminds his sales reps to broaden discussions about PPE to the more-encompassing issue of safety. “Ask the clinician, ‘What are you doing to maintain a clean environment in your facility?’” he says.

“We can then offer UV light disinfection equipment, air filtration equipment, smoke evacuators, etc. By shifting the conversation away from PPE items, we get back to selling and not just order-taking.”

Sales reps can help customers make the connection between COVID-19 and equipment they may need, he says.

“A post-COVID patient may have cardiopulmonary issues.

Spirometry, Holters, stress systems and ECG machines are vital for those with post-COVID side effects – not to mention they have a good reimbursement rate.”

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TRENDS

New Entrants Challenge Independent Practices Reps face a new landscape as well Editor’s note: The following is third in a series about changes occurring among primary care physicians.

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Independent physician practices are facing competition from all sides, including health systems, retailers and

insurers. Med/surg reps can help them respond to the threats, but reps have much to offer the new competitors too.

Based on data from an AMA physician survey, the American Medical Association estimates that in 2018 about 200,000 physicians worked for a medical practice that was owned or partially owned by a hospital or health system.

Nick Hernandez, CEO of ABISA, a healthcare consultancy firm in Valrico, Florida, draws a line between the Affordable Care Act and health systems’ appetite for primary care practices. The ACA encourages preventive medicine, and health systems want to tap into that revenue, he says. Furthermore, as referring physicians, primary care doctors cultivate good relationships with specialists, another valued customer base for hospitals.

Insurers such as Humana and UnitedHealth Group are formidable competitors as well. It’s true that insurers have always had an impact on physicians with whom they contract, “but to employ them, that’s the coup de grâce,” says Hernandez.

When insurers employ physicians, things change – patient choice, provider compensation and the clinical behavior of primary care doctors and specialists, he says.

Outside forces aside, the wants and needs of today’s doctors are increasingly responsible for shifts in practice ownership, says Hernandez. “Some younger physicians value the comfort level and security that large employers provide,” he says. Consequently, owners of small practices are finding it difficult to recruit young physicians, making succession planning difficult.

Independent practices can still make a go of it, but not without effort, adds Hernandez. “First and foremost, they have to make sure that patient satisfaction is at its utmost.” That’s true for primary care doctors as well as specialists: When patients give high marks to their endocrinologist, cardiologist or oncologist, their primary care doctors will continue to refer patients to them.

Second, practices have the option of remaining independent by contracting with management services organizations or forming joint ventures with health systems to take care of payroll, recruiting, IT, marketing, etc. “It’s like having ‘big brother’ on your side as opposed to being out there alone.”

The role of the rep By acquiring practices, hospital systems gain some control and predictability over referrals for inpatient care, says Michael Abrams, co-founder and managing partner,

Numerof & Associates, a business management consulting firm in St. Louis.

And even though hospital systems have been expanding through mergers and acquisitions for years, COVID19 is pushing them to truly centralize decision-making, he says. “If these systems don’t take advantage of their size, they miss one of the reasons they acquired these organizations in the first place. “Decision-making will occur at a different level, the stakes will be higher, and a different set of skills will be called for on the part of medical device and pharmaceutical sales representatives to close deals.”

If we approach ‘selling’ as an opportunity to consult, reps can recall solutions that served traditional practices and customize them according to the customers’ needs.

Hernandez believes med/surg reps can play a role in supporting their independent practice customers. Margins on med/surg products and equipment are already low, so there’s not much room for further price cuts, he says. But suppliers can offer modified payment terms – something that has been especially important during COVID-19, as some practices have faced difficulty paying rent or meeting payroll. And when their customers do merge with other practices, distributors should proactively extend the volume discounts that the physicians seek and probably expect.

Sales reps can even play an important role with retail clinic and insurer customers, says Scott Wakser, senior vice president, Medline. “If we approach ‘selling’ as an opportunity to consult, to understand differentiating variables and to listen to individual needs, reps can recall solutions that served traditional practices and customize them according to the customers’ needs,” he says. Advising on project management, inventory management, insurance billing, specialized product knowledge, contracts and negotiations can contribute to reps’ success and value in new markets. www.repertoiremag.com

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TRENDS What are independent practices up against?

Editor’s note: Independent physician practices have more than a few competitors. Here’s a quick look at some of them. And this doesn’t even include mentioning health-system-owned practices.

Name

Description

Amwell (formerly American Well), Boston

Carbon Health (San Francisco, CA)

Publicly traded telehealth company, said to work with 55 health plans and 150 health systems

ʯ Private-equity-funded ʯ 27 clinics across six states. ʯ Offers primary care, urgent care, virtual care. ʯ Building out specialty programs ʯ Plans to grow clinic footprint to 1,500 by 2025.

ChenMed (Miami, FL)

Privately owned company operating more than 75 concierge-style primary care medical practices for seniors in 10 states.

CVS Health (Woonsocket, RI)

1,100 MinuteClinic convenient care clinics, 90 Coram infusion and enteral care sites and Omnicare specialized long-term care pharmacy services Plans call for up to 1,500 HealthHUB locations to operate throughout the U.S. by the end of 2021.

HealthHUBs feature: ʯ Education and counseling for patients with chronic conditions. ʯ Pharmacist-led diabetes education counseling ʯ Expanded services at MinuteClinic including annual diabetic exams, sleep assessments. ʯ Wellness rooms for group events.

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Doctor on Demand (San Francisco, CA)

Private-equity-backed telehealth firm accessible through smartphone, table or computer.

Humana Partners in Primary Care (Louisville, KY)

Insurer-owned, senior-focused primary care medical centers

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Strategy/news

ʯ October 2019: Cleveland Clinic and American Well create joint venture company The Clinic, offering virtual care from Cleveland Clinic specialists through American Well’s digital platform ʯ September 2020: Amwell raises $742 million in IPO

ʯ Nov. 10, 2020: Secured $100

million funding led by Dragoneer Investment Group and existing investors.

Said to be provider of choice for 20 Medicare Advantage plans

ʯ August 2020: Targeting employ-

ers with more than 101 employees, the Aetna Connected Plan with CVS Health is set to launch Jan. 1, 2021, and offer $0 copay at local HealthHUB and MinuteClinic locations and 20% discounts on health-related items in-store and online.

ʯ October 2019: Walmart announces pilot program in which employees can access video visits from Doctor On Demand for $4. ʯ May 2020: Doctor On Demand announces it has made medical services available to 33 million Medicare Part B beneficiaries with no copay.

ʯ February 2020: Humana and

private equity firm Welsh, Carson, Anderson & Stowe announce they are launching a $600 million joint venture to develop primary care centers to treat seniors insured by Medicare Advantage plans.

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TRENDS

Name

Description

Oak Street Health (Chicago, IL)

Value-based managed care model with more than 65 primary-care centers for adults on Medicare.

Strategy/news

ʯ August 2020: IPO raises $328 million.

Offers transportation to the centers and a 24/7 call line for support.

One Medical (San Francisco, CA)

Membership-fee-based primary care platform with digital health and in-office care in 17 markets Private-equity-backed

ʯ Part of UnitedHealth Group ʯ 49,000 primary care providers and 9,000 advanced

Optum

practice clinicians ʯ 200+ surgical facilities ʯ 8,000+ affiliated surgeons and physician partners Paladina Health (Denver, CO)

Operates 120 direct-care health clinics in 19 states located at or near the facilities of its employer, union and other benefit sponsor clients.

Teladoc Health (Purchase, NY)

Telehealth services provider. After 2020 merger with Livongo (at-home monitoring devices and chronic disease management), the company is said to provide artificial intelligence, health coaches and boardcertified physicians on call.

Walgreens Boots Alliance

Plans call for 500 to 700 “Village Medical at Walgreens” primary care clinics in more than 30 U.S. markets within five years.

Walmart Health

ʯ Six Walmart Health locations

(as of September 2020). ʯ Primary and urgent care, labs, X-ray, diagnostics, counseling, dental, optical and hearing services

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ʯ August 2018: One Medical receives an investment of up to $350 million from private equity firm The Carlyle Group. ʯ January 2020: IPO raises $245 million.

ʯ January 2017: UnitedHealth Group

agrees to buy Surgical Care Affiliates for $2.3 billion. ʯ June 2019: Acquires DaVita Medical Group for $4.3 billion.

ʯ June 2018: Paladina is acquired

by New Enterprise Associates for $100 million ʯ August 2018: Paladina Health raises $165 million in growth equity funding round.

ʯ July 2015: Teladoc shares close at

$28.50 on first day of trading on the NYSE. ʯ July 2019: Livongo Health raises $355 million in its IPO (Nasdaq) ʯ October 2020: Teladoc Health completes its merger with Livongo, with expected 2020 pro forma revenue of $1.3 billion.

ʯ October 2019: Walgreens

announces it is closing roughly 160 in-store clinics the company runs itself, while keeping 220 clinics run by local health systems. ʯ July 2020: Walgreens and VillageMD announce Walgreens will be the first national pharmacy chain to offer full-service doctor offices co-located at its stores.

ʯ September 2019: Opened first

Walmart Health in Dallas, Georgia

ʯ October 2020: Partners with insurer Clover Health to offer Medicare Advantage plans

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TRENDS

Vendor Credentialing Very Much Active Vendor credentialing companies have remained busy during the pandemic, and they expect to stay that way even after the worst has passed.

In interviews with nearly 100 providers, GHX/Vendormate found that nearly 88% believe compliance controls

will increase, and almost 76% expect all reps or a combination of on/offsite reps will be credentialed, Chrystie Leonard, general manager, credentialing and managed services, told Repertoire in mid-November. “We expect vendor credentialing to expand rapidly due to heightened security requirements and new market norms.”

Throughout the pandemic, GHX/ Vendormate worked closely with the American Hospital Association and the Association for Healthcare Resource & Materials Management to vet more than 900 non-traditional PPE vendors, she says. Meanwhile, providers had to make decisions about how they would screen those reps who were allowed into the facilities – primarily those involved in supporting patient care.

In May, AdvaMed, the Association of periOperative Registered Nurses (AORN) and AHA released “Re-entry Guidance for Health Care Facilities and Medical Device Representatives” in which they recommended against testing asymptomatic reps for COVID-19.

“Most of our provider customers are currently following this guidance,” Leonard said. “In fact, we recently evaluated more than 200 COVID19-related health system vendor policies and found only 5% of providers require viral (i.e., molecular or antigen) or serology (i.e. antibody) testing for representatives.”

GHX/Vendormate added COVID-19 screening and several other services and capabilities to its credentialing offerings to help 26

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hospitals re-open safely, she said. “Providers have put in place parallel COVID-19 requirements to re-enter their facilities – including badging requirements and wellness screening tests. GHX/Vendormate is working to integrate these elements into our comprehensive badging process to serve as a single solution to establish and implement policies.”

The company introduced a digital wellness screening declaration based on Centers for Disease Control and Prevention guidelines that outline the requirements for representatives to be able to gain access to healthcare facilities.

Representatives are prompted to respond to questions on a mobile phone or tablet prior to arriving at a health system facility. Questions include whether the individual has recently been out of the country, whether they have been in contact with anyone who is sick, and whether they are running a fever, she said. “These declarations can be set at the department, facility and/or system level and are based on information GHX has compiled from hundreds of healthcare facility policies within our network,” Leonard said.

Respiratory fit testing In the pandemic’s early months, GHX/Vendormate introduced a Vendor Access Policy template for healthcare providers to customize and share with vendor representatives.

“This gives representatives a document that clearly outlines the provider’s COVID-19 policies so they can better understand what they need to do to re-engage with providers safely and successfully,” Leonard said. The company has continued to update the document throughout the pandemic to adapt to evolving dynamics. Among suggested items included are: ʯ Appointment policy. ʯ Pre-screening questions (addressing symptoms that might indicate the coronavirus). ʯ Hand hygiene requirements. ʯ Personal protective equipment requirements (department-specific, if possible). ʯ Respiratory fit testing.

Navigating new and evolving PPE requirements and accessing N95-mask fit testing were among the top challenges among providers who responded to a GHX poll.

Consequently, in October, the company announced an arrangement with Mobile Health – a New York-based provider of employee screening and occupational health services – to make respirator fit tests available as part of Vendormate credentialing. “Our relationship with Mobile Health provides our customers guidance on where they can go for mask fit testing and help them return to healthcare facilities to safely resume operations,” said Leonard.

During fit tests, an individual wears a respirator such as an N95 mask, and the tester applies a series of test agents to indicate the level of sensitivity for each candidate, according to a GHX/Vendormate press release.

Then a more concentrated agent is used to assess if the mask is properly sealed with the face of the wearer. Results are typically made available via encrypted email either the same day or the following business day. Upon receipt of test results, individuals may upload their attestation that they completed their fit test to their Vendormate profile.

An analysis of GHX/ Vendormate’s badging data found an average of 10,500 visits per weekday prior to COVID-19 stay-at-home orders in mid-March. Such visits dipped to an all-time low during the height of the pandemic in April, to 1,750 visits per workday.

“The arrangement is new, but we have already seen several vendors register for testing,” said Leonard. “The cost for the representatives to get the fit testing depends on the market and location they select. When the representative then visits the provider location, they will be able to work with the provider to get the appropriate mask fitted to their needs.”

Rep visits fluctuate As of mid-November, hospitals were still limiting vendor visits to essential representatives, said Leonard. “In the short term, virus-related hospitalizations continue to be high, and vaccines in development are not yet available to the general public. As a result, vendor visits fluctuated.”

An analysis of GHX/Vendormate’s badging data found an average of 10,500 visits per weekday prior to COVID-19 stay-at-home orders in mid-March. Such visits dipped to an all-time low during the height of the pandemic in April, to 1,750 visits per workday. But by mid-November, there were approximately 7,500 to 7,700 badging visits per weekday, illustrating a rebound to about three quarters of the norm, she said. www.repertoiremag.com

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INFECTION PREVENTION

Infection Prevention: More and Less Physician practices adopt creative solutions, and sales reps adapt What Repertoire readers are witnessing in their customers’ offices during this pandemic may not be entirely new.

The guidelines for infection prevention were agreed-upon by infection prevention professionals years ago. (See the Centers for Disease Control and Prevention’s Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care.) But changes are afoot, and they already are affecting everyone associated with outpatient care, including physicians and office staff, patients and their families, and visitors, including sales reps.

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From this point forward, infection prevention will be a matter of “more and less.”

More: ʯ PPE ʯ Emphasis on hand hygiene. ʯ Wiping down hard surfaces. ʯ Patient screening. ʯ Attention paid to ventilation systems. ʯ Telehealth.

Less:

ʯ Face-to-face visits of all kinds. ʯ Lunch-and-learns with vendors. ʯ Waiting room traffic. ʯ Breakroom camaraderie among staff.

Creative solutions “Masks, handwashing and social distancing are important in communities, and they are important in doctors’ offices as well,” says Amy Mullins, M.D., medical director for quality and science for the American Academy of Family Physicians.

Some practices are scheduling visits through telemedicine/telehealth technology, she says. But if choosing to see the physician face-to-face, patients will be asked to alter the normal way they move through the office. Some offices have implemented temperature checks as well as questions to determine a patient’s risk of exposure (e.g. recent travel or known exposures).

“Patients may be asked to wait in their car instead of the waiting room, or they may be asked to come alone or with only one other person,” says Mullins. “But as the weather turns colder, asking patients to wait outside or in their cars instead of a warm waiting room will be challenging. Physicians may need to think creatively about

solutions, such as calling patients in advance of their visit to let them know how long their wait will be.”

The infection-prevention practices each healthcare organization takes depends a lot on where it is located, says Diane Cullen, MSN, RN, MBA, CIC, associate director, Standards Interpretation Group, The Joint Commission.

State and county public health departments are taking varying approaches to directing facilities and issuing mandates, so sales reps should be aware of what is happening locally.

“ The patient’s perception is reality. If the rugs are tattered or stained, or if things don’t look like they’ve been welltaken-care-of, patients get the impression the office isn’t safe.”

That aside, “there have been a lot of changes in ambulatory settings – many are similar to those that have taken place in hospitals,” she says. Some healthcare organizations are staggering the number of individuals in waiting rooms at one time, and even relocating chairs to facility hallways to lower the risk of inadvertent exposure. Others are labeling chairs with “Xs” to physically distance patients from one another.

Hand hygiene and disinfection of surfaces have always been important infection prevention strategies, but now they are receiving more attention than ever, says Cullen.

Patients may be asked to clean their hands with alcohol sanitizer or have their temperature taken upon arrival.

Accessing personal protective equipment and cleaning supplies remains a challenge. “Products that healthcare

PPE spending by physician practices 64% of practice owners said that summertime spending on PPE was up from pre-pandemic. Average increase in PPE spending was 57%.

ʯ 13% said PPE spending increased by 1-25% ʯ 12% said PPE spending increased by 25-49% ʯ 14% said PPE spending increased by 50-74% ʯ 25% said PPE spending increased by at least 75%

ʯ 15% said PPE spending remained the same ʯ 2% said PPE spending decreased ʯ 19% said Don’t know

Source: www.ama-assn.org/system/files/2020-10/covid-19-physician-practice-financial-impact-survey-results.pdf, American Medical Association. (Survey of 3,500 physicians administered from mid-July through end of August 2020.)

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INFECTION PREVENTION organizations might have used previously may not be available from their distributor, because of high demand,” says Cullen. The challenge for facilities is this: Staff has historically used, say, one brand of disinfectant, and now they must use another brand. Now, staff must be retrained, as contact time or considerations about exposure to skin may be different. “Providing that extra training can be significantly challenging for small organizations.”

New protocols At each of its two locations in Sarasota and Venice, Florida Cardiac Consultants has positioned screening nurses at folding tables to check the temperature and blood oxygen levels of patients. “We ask each patient about 15 questions, such as, ‘Have you traveled lately?’ or ‘Have you been exposed to someone with COVID-19?’” says practice administrator Mark Spetsios. The protocol is new since COVID-19, and it is a way of protecting staff while giving patients a sense of safety, knowing the practice is taking the pandemic seriously. But it comes with a financial cost. “We have had to hire two additional people for the sole purpose of manning the screening tables,” he says.

“ People get tired of social distancing and wearing face masks. And we get that. But it’s going to be the reality for a while.”

A year ago, 12 or 15 people might be seated in the waiting rooms of the practice’s offices, but now the practice limits it to two. Patients wait in their cars until called to come in, and with some exceptions, they are not allowed to bring companions with them. “No one is permitted in the office unless they’re a patient,” says Spetsios. “Pharmaceutical reps can drop off samples or literature at the screening tables. And if a vendor wants to talk to me, I’ll meet them outside, where we have a parking garage.”

Silver linings Ann Marie Pettis, RN, BSN, CIC, FAPIC, director of ambulatory infection prevention and control for Highland Hospital in Rochester, New York, says one thing is certain: “Because of COVID-19, the focus on infection prevention has escalated, and that’s a good thing.” Pettis 30

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is president-elect of the Association for Professionals in Infection Control and Epidemiology (APIC), and is responsible for infection prevention in all ambulatory settings at Highland Hospital and approximately 30 ambulatory locations.

“We have never taken our hands off the wheel” in terms of monitoring infection prevention practices at the health system’s outpatient settings, she says. “This is not a one-and-done thing. We have been steadily auditing the practices.” Because of COVID, Pettis has instituted weekly conference calls with the outpatient facilities to share knowledge and best practices.

“Since March, we have learned how to do things better than ever,” says Pettis. Scheduling may be the most important one. “You have to be vigilant in how you schedule, so patients aren’t sitting in waiting rooms.” Having patients wait in their cars until called for their appointment works in warm weather, but is more difficult in cold-weather climates. “And telehealth will be much more important, probably in perpetuity.”

As of November, sales reps were still discouraged from visiting Highland practices except in cases of emergency. But business is being conducted. One vendor – a maker of hand sanitizer – inserviced all the practices virtually on a new product. “Across the board, we recognize the importance of working with our vendors,” says Pettis.

“Thankfully, we have technology to help us do that.”

Pettis says she tries to emphasize one more thing with the hospitals’ practices: The patient’s perception is their reality. “If the rugs are tattered or stained, or if things don’t look like they’ve been well-taken-care-of, patients get the impression the office isn’t safe.” Some practices have gone the extra mile by displaying signage indicating if a stall is clean and ready for use.

The human factor Financial, logistical and training issues aside, the biggest challenge to proper infection prevention might be human behavior.

“People get tired of social distancing and wearing face masks,” says Spetsios. “And we get that. But it’s going to be the reality for a while.” Vendor lunches are on hold, and staff members no longer congregate in the breakroom.

“You lose some of that collegial environment,” he says.

“People like to gather,” says Pettis. “It’s who we are.

But now is not the time to let our guard down. We remind staff that not only do we want to be safe for our patients, but for each other too. If one of them becomes sick or is quarantined, who will take care of their patients?”

INFECTION PREVENTION

Checklist to Prepare Physician Offices for COVID-19 Editor’s note: Below are some provisions of the American Academy of Family Physicians’ Checklist to Prepare Physician Offices for COVID-19. Amy Mullins, M.D., medical director for quality and science for the AAFP, cautions that the use of the checklist and its implementation may vary among offices depending on their particular workflow and the level of virus spread in their community. Local public health offices are excellent resources for information on number of cases in the community as well as particulars on infection control practices in that community.

Office preparedness

ʯ Design a COVID-19 office management plan

that includes patient flow, triage, treatment and design. ʯ Consider designing and installing engineering controls to reduce or eliminate exposures by shielding staff and other patients from infected individuals. ʯ Provide hand sanitizer, approved respirators, face shields/goggles, surgical masks, gloves, and gowns for all caregivers and staff to use when within six feet of patients with suspected COVID-19 infection. Provide training for staff on respirators to ensure fit and appropriate use. ʯ Ensure adherence to standard precautions, including airborne precautions and use of eye protection. Assume that every patient is potentially infected or colonized with a pathogen that could be transmitted in a healthcare setting. ʯ Implement mechanisms and policies that promptly alert key facility staff – including infection control, healthcare epidemiology, facility leadership, occupational health, clinical laboratory, and frontline staff – about known suspected COVID-19 patients.

Keep updated lists of staff and patients to identify those at risk in the event of an exposure. ʯ Staff should follow the CDC guidelines collecting, handling and testing clinical specimens from suspected COVID-19 patients. ʯ Prepare for office staff illness, absences, and/or quarantine. ʯ Cross-train staff for all essential office and medical functions. ʯ Review proper office and medical cleaning routines. Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings, including those patient-care areas in which aerosol- generating procedures are performed. Products with emerging viral pathogens claims are recommended for use against SARS-CoV-2.

Triage and patient flow systems

ʯ Distribute respiratory prevention packets consisting of a disposable surgical mask, facial tissues, and cleansing wipes to all symptomatic patients.

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ʯ Develop a triage protocol for your practice based on patient and community outbreak.

ʯ Recommend that patients with respiratory

symptoms and fever call the office before arrival.

ʯ Implement alternative patient flow systems. ʯ Attempt to isolate all patients with suspected

symptoms of any respiratory infection using doors, remote office areas, or negative-pressure rooms, if available. ʯ Evaluate patients with acute respiratory illness (ARI) promptly. ʯ After delivering care, exit the room as quickly and directly as possible (i.e., complete documentation in clean area). ʯ Clean room and all medical equipment completely with appropriate cleaning solutions. ʯ When possible, reorganize waiting areas to keep patients with respiratory symptoms a minimum of 6 feet away from others and/or have a separate waiting area for patients with respiratory illness. ʯ Consider arranging a separate entrance for symptomatic patients. ʯ Schedule patients with ARI for the end of a day or at another designated time. ʯ Provide no-touch waste containers with disposable liners in all reception, waiting, patient care, and restroom areas. ʯ Provide alcohol-based hand rub and masks in all reception, waiting, patient care, and restroom areas for patients with respiratory symptoms.

Always keep soap dispensers stocked with handwashing signs. ʯ Discontinue the use of toys, magazines, and other shared items in waiting areas, as well as office items shared among patients, such as pens, clipboards, phones, etc. ʯ Dedicate equipment, such as stethoscopes and thermometers, to be used in ARI areas. This equipment should be cleaned with appropriate cleaning solutions for each patient. Consider the use of disposable equipment when possible (e.g., blood pressure cuffs).

Other topics covered in the Checklist are education of staff; additional options to prevent community transmission; referral or transfer of patients; waste disposal; and required equipment/supplies.

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Association for Vascular Access and B. Braun Partner to Raise Standards and Enhance Training for IV Placement New curriculum will be provided free of charge to medical, nursing, respiratory therapy, and other allied healthcare schools in the United States to improve instruction on peripheral IV access

On October 5, 2020 the Association for Vascular Access (AVA) and B. Braun Medical Inc. (B. Braun) announced a

long-term collaboration to improve training on the placement of peripheral intravenous catheters (PIVCs). Together the organizations will develop and provide a new series of online courses free of charge to medical, nursing, respiratory therapist, and other allied healthcare schools – the first of which is being piloted at several leading nursing schools.

Vascular access is the most common invasive procedure performed in healthcare, with more than 380 million PIVCs placed in patients annually in the United States.1 However, between 33-69% of PIVCs fail before the completion of treatment and more than 50% of adults describe insertion as moderately painful or worse. Collectively, this 34

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can lead to serious implications for patients, including increased costs and length of treatment.2 In addition to jointly developing the “Fundamentals of Peripheral IV Access” eLearning module series to increase the vascular access skills of healthcare professionals, AVA and B. Braun will create a certificate program for students who complete the

courses that will attest to their foundational knowledge in dexterity required to navigate the equipment, patient emoPIVC placements with future employers. tions, and for that matter, the student’s anxiety required a “Studies have proven that current training programs calm and keen eye for multiple physical and emotional are not consistent across schools in how or when they cues,” said Christine Vandenhouten, PhD, RN, chair and teach future clinicians about the professor of nursing and health studies insertion, care and maintenance of at the University of Wisconsin-Green 3 peripheral catheters. Our intent is to Bay. “The PIV curriculum will elevate The eLearning offer a solution to standardize trainthe knowledge and skill of nursing stumodule will feature ing in this area, which we believe dents and nurses across the U.S. and interactive graphics will make long-term improvements beyond. I am thrilled to incorporate and hi-definition in healthcare in the years to come,” this evidence-based curriculum into videos in addition to our pre-licensure BSN program.” said Judy Thompson, MSNEd, RN, VA-BC™, AVA director of clinical “Our partnership with AVA and the necessary text education. “We are proud to partner the academic institutions that are critical to enhancing with B. Braun to offer free access to piloting the ‘Fundamentals of Periphthe PIVC education this best-in-class curriculum to stueral IV Access’ curriculum gives us the in healthcare. dents at hundreds of universities and opportunity to make a big impact on medical schools. It is also fitting that an area of patient care that is ripe for this new curriculum – which helps improvement,” said Stephen Withadvance AVA’s mission to protect patients and improve ers, RN, director, clinical support and services, B. Braun. lives by creating evidence-based innovations in vascular “The failure rate of PIVC insertions is not acceptable. We access – is being announced on the second annual Vascubelieve this program is an important step to change that by lar Access Specialty Day.” increasing students’ skill sets on a practice that for many The eLearning module will feature interactive graphwill become a part of their daily care routine.” ics and hi-definition videos in addition to the necessary Several pilot studies of the curriculum will be context critical to enhancing the PIVC education in healthducted through the rest of the year, and the program is care. It will focus on key aspects like proper device placeexpected to be broadly released during the 2021 academic ment, assessment, and insertion to instill confidence in year. Additional information on the “Fundamentals of students of all skill levels.

Peripheral IV Access” curriculum, including details about “In my early years of teaching, I worked with thouhow to participate in the pilot program, is available at sands of students to start their first PIVC. The manual www.avainfo.org/PIVEducation.

ABOUT The Association for Vascular Access (AVA) was founded in 1985 to promote the emerging vascular access specialty. Today, AVA stands at the forefront of protecting and saving lives via establishing best practices and promoting patient advocacy. AVA’s multidisciplinary membership advances research, provides professional and public education to shape practice and enhance patient outcomes, and partners with the device manufacturing community to bring about evidence-based innovations in vascular access. To learn more or join, visit www.joinAVAnow.com.

B. Braun Medical Inc., a leader in infusion therapy and pain management, develops, manufactures, and markets innovative medical products and services to the healthcare industry. Other key product areas include nutrition pharmacy admixture and dialysis. The company is committed to eliminating preventable treatment errors and enhancing patient, clinician and environmental safety. B. Braun Medical is headquartered in Bethlehem, PA and is part of the B. Braun Group of Companies in the U.S., which includes B. Braun Interventional Systems, Aesculap® and CAPS®.

Globally, the B. Braun Group of Companies employs more than 64,000 employees in 64 countries. Guided by its Sharing Expertise® philosophy, B. Braun continuously exchanges knowledge with customers, partners and clinicians to address the critical issues of improving care and lowering costs. To learn more about B. Braun Medical, explore our website.

1 iData Research. (2020). US Market Report Suite for Vascular Access Devices and Accessories.

2 Cooke, M., Ullman, A., Ray-Barruel, G., Wallis, M., Corley, A., Rickard, C. (2018). Not “just” an intravenous line: Consumer perspectives on peripheral intravenous cannulation (PIVC).

An international cross-sectional survey of 25 countries. Plos One. https://doi.org/10.1371/journal.pone.0193436 3 Hunter, et al. (2018). Addressing the silence: A need for peripheral intravenous education in North America. JAVA. 23(3). pp 157-165. https://doi.org/10.1016/j.java.2018.06.001

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SALES

Winning Enterprise Business Eight unique challenges in enterprise selling

By Sandler Sales Training Imagine a client roster filled with the biggest and best of the country’s hospitals and health

systems with names like HCA, Ascension, Trinity Health, Tenet and Bon Secours.

Now imagine working with those clients every day, delivering great service and growing the relationships over time.

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Winning “enterprise business” presents unique challenges to selling teams and selling organizations in general. First, you need to understand how selling to large systems differs from the less complex world of selling to small and medium-sized practices and organizations.

It takes time, energy, commitment and money – but the payoff can be huge.

Here are eight challenges we at Sandler see every day in serving our clients selling into the enterprise space, and how to overcome them: No. 1: The competition is sophisticated and relentless Your competition for enterprise business will be sophisticated, strategically focused and absolutely relentless. They will come prepared.

The solution: Conduct focused territory planning so you maximize your chances to do what you do best where you’re most likely to be successful. Profile all of the accounts in your portfolio so you can customize account planning and map your resources as relevantly as possible.

Use collaborative account planning to ensure that you go after winnable accounts. Save resources by reusing assets effectively so you’re not recreating solutions.

Pursuing an enterprise client requires a significant financial commitment as well as human, managerial and logistical resources. And the opportunity costs connected with enterprise pursuits can handcuff an organization’s ability to take advantage of other initiatives.

The solution: Don’t make the mistake of underestimating them. Understand their who, what, where, when and how. Research their history, relationships and track record with the account you’re targeting. Understand not only their business models, strategies and offerings but the customized value propositions that they are likely to present in a specific pursuit. Act on what you learn. It may drive your Go/No-Go decision about whether to accelerate a pursuit or exit early.

No. 2: The sales cycle can be lengthy When selling to enterprise clients, prepare to learn patience.

The sales cycle can take months and, in some cases, years.

The solution: Know the buyer network so well at the account you’re targeting that you’re informed about its time frames. Have the right people on your pursuit team to ensure effective and timely solution development. Gain your client’s fingerprints on how you plan on proceeding every step of the way. Establish a systematic process for driving Go/No-Go decisions and use it consistently.

No. 3: The investments can be significant Pursuing an enterprise client requires a significant financial commitment as well as human, managerial and logistical resources. And the opportunity costs connected with enterprise pursuits can handcuff an organization’s ability to take advantage of other initiatives.

No. 4: The buyer networks are wide and diverse The buying centers of enterprise clients are comprised of a wide variety of functions that may include purchasing, supply chain/operations, accounting, and legal. It can be a little overwhelming and make you long for the days when you sold to a single supply manager across a desk.

The solution: Use your advocates on the inside of the account to understand how the various functions in its buyer network collaborate. Understand the impact of every individual user. Expect the unexpected and be prepared to deal with new influences over the course of the long sales cycle because they’ll surely come.

No. 5: The necessity of a cross-functional sales team is a given The buyer networks of enterprise clients encompass many functions, and so should your sales team. Since enterprise organizations buy in teams, organizations seeking their business must typically sell in teams as well.

Without question, it makes the sale more complicated but it’s an absolute necessity.

The solution: When it comes to landing an enterprise client, everybody in the selling organization is on the www.repertoiremag.com

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SALES selling team. So tap into the expertise of your co-workers for help in mapping to subject matter experts at your target accounts. Having corresponding representatives on your team will show the strength and substance that enterprise clients demand.

No. 6: The decision structures are complex In traditional selling, decisions are typically made quickly and based on price versus performance. In the enterprise world, however, the decision process can be complex, multi-layered and lengthy.

portfolio complexity, depth and breadth of distribution, and globalization issues.

The solution: Enterprises are marketplaces unto themselves, so do your research to understand the complexities and opportunities they present. Effective and collaborative account planning combined with a logical framework of pursuit management will position you to gain clarity.

No. 8: The focus on business value is laser-like With the enterprise client, the business value of the solutions you develop and implement must be unassailable or winning their business will be impossible. The pains and needs of the client, not your product or service, must completely drive the value.

Enterprise clients don’t present simple and direct structures to your selling team. They differ from smaller entities in their complex structures, multiple business lines, portfolio complexity, depth and breadth of distribution, and globalization issues.

The solution: Get a clear picture early in the process of the decision structure and financial models used in the client’s buying decision process. Understand the requirements of the deal and allow that to drive dynamic Go/No-Go decisions. Clearly understand an opportunity’s potential rewards and risks, and work to mitigate those risks as a key component of the pursuit.

Your success in this area is critical to the decision to accelerate or exit.

No. 7: The organization and its footprint are incredibly diverse Enterprise clients don’t present simple and direct structures to your selling team. They differ from smaller entities in their complex structures, multiple business lines,

The solution: Build your client intimacy from account planning through service delivery. Your deep understanding of the pains driving your customer’s needs earns you the right to build a customized solution with an integrated value proposition, highlighting specific and measured business value over time.

Winning profitable business from enterprise organizations comes with complications that make it more challenging than selling to smaller entities.

The Sandler Enterprise Selling (SES) Program addresses the needs of organizations selling to enterprise accounts.

The result is a highly strategic system that will help you win business with enterprise clients, serve them effectively and expand the relationships over time.

Learn more about Sandler Enterprise Selling. To schedule a complimentary 30-minute advisory session on Enterprise Selling, negotiating skills at the enterprise level, or other sales and sales management challenges, send your request and contact information to SalesTips@repertoiremag.com with “Free Consultation” in the subject line.

About Sandler Training With over 250 local training centers around the globe, Sandler is the worldwide leader for sales, management, and customer service training. We help individuals and teams from Fortune 500 companies to independent producers dramatically improve sales, while reducing operational and leadership friction. © 2020 Sandler Systems, Inc. All rights reserved.

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HIDA GOVERNMENT AFFAIRS

COVID-19 Substantially Impacts All Market Segments The Health Industry Distributors Association (HIDA)

has been closely tracking the effect of COVID-19 in key health industry market segments. HIDA’s 2020 Market Reports take a look at how the pandemic has affected the landscapes of physician offices, hospitals and health systems, and home care.

Physician office The physician and clinical services market was valued at $750 billion in 2019, with more than 1 million active physicians offering patient care throughout the United States.

But COVID-19 has driven large volume and revenue declines. Nearly 90% of medical groups reported revenue declines of 26% or more during the first several months

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of the pandemic. Through the end of 2020, in-person visits were expected to remain at least 30% below baseline. Telehealth took off in 2020, a bright spot for many patients and caregivers. Physicians and health officials saw 50 to 175 times the number of patients via telehealth than pre-pandemic. Some experts estimate that a previously $3 billion telehealth industry could blossom into a $250 billion industry.

Hospital and Health System Average Volume Reduction from Baseline, June, 2020

Home care The home-based medical market is expanding. The segment, which includes hospice, home health, home infusion, and durable medical equipment, is valued at more than $211 billion and is projected to grow 35% to about $286 billion by 2025. COVID-19 has resulted in reduced demand for home health agency services. Three months into the pandemic, 90% of agencies reported a decline in admissions. But there have been bright spots; medical researchers with the Visiting Nurse Service of New York have been studying how home health can benefit COVID patients when new infections are high and hospital beds are in short supply. Upon being admitted to home health, most patients had multiple comorbidities including hypertension, diabetes, and heart disease. After home health services were delivered, 88% of the patients studied were discharged without any adverse health events, such as re-hospitalization.

Home-Based Market Worth $211.6 Billion in 2020

Hospitals and health systems U.S. expenditures on hospital services are expected to reach $1.32 trillion in 2020 and increase to $1.75 trillion by 2025. In an industry already operating with -9.3% Medicare margins, hospitals and health systems are expected to lose at least $323 billion in 2020 due to COVID-19. During the first several months of the pandemic, both operating room and emergency department volumes at short-term acute care hospitals decreased 35% and 42%, respectively. Additionally, 43% of hospital executives expressed concern in 2020 of continuing cost and shortages of medical supplies.

Percent Change in Primary Care Visit Volume, 2020

HIDA’s 2020 Market Reports are available at HIDA.org.

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HEALTHY REPS

Health news and notes Heat or ice for pain?

Virtual care skyrockets

Cleveland Clinic offers these tips to keep in mind when deciding between ice or heat for aching muscles and joints.

Whether you’ve pulled a muscle in your calf or back, it’s best to start off with ice to ease inflammation and numb the pain. Only after the inflammation resolves is it a good idea to switch to heat; this can help relieve any muscle stiffness at the injury site. Tendinitis? Ice is the preferred method, as it can ease the inflammation and help numb the pain. And for acute injuries, avoid heat, because extra heat can increase inflammation and delay proper healing.

The number of virtual services used by Anthem’s affiliated Medicare Advantage members in March through May 2020 was 136 times greater than in the same months the year before, increasing from 4,400 to 600,000. Mental health conditions and substance use disorders comprised the largest group of primary diagnoses treated virtually, with year-over-year growth in services of more than 5,000%.

Digital solution for alcohol use disorder Swedish pharmaceutical and digital therapeutic company Orexo launched a digital solution for alcohol use disorder called vorvida, with the help of Accenture’s INTIENT Patient platform, reports Healthcare IT News. Once it gathers the user’s consumption information, vorvida helps manage their alcohol use by assisting in recognizing habits, changing thought patterns, adjusting everyday consumption and preparing for the future. The system adjusts over time through weekly questionnaires about mood and usage. Digital interventions for alcohol use disorder are becoming more common and are typically effective in decreasing consumption, according to a report from the National Library of Medicine.

Yep, smoking causes wrinkles Nicotine, other chemicals in cigarettes, smoking behaviors and other factors may contribute to wrinkles and premature aging of the skin, reports Mayo Clinic. Here’s why: 1) Nicotine causes blood vessels to narrow, reducing oxygen flow and nutrients to skin cells; 2) a number of chemicals trigger molecular events that remodel or damage structures necessary for skin elasticity and health; 3) repetitive squinting and lip pursing contribute to lines around the mouth and eyes; and 4) heat and un-inhaled smoke may dry and damage the surface of the skin. These same factors may also result in decreased ability of the skin to repair wounds, such as cuts or scrapes. The damage to skin from smoking can’t be reversed. But quit smoking now and you will no longer accelerate the problem and may prevent worsening of the damage.

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Breastfeeding good for babies’ dental health Children who were exclusively breastfed for six months were less likely to have dental disease, according to data presented at the virtual American Public Health Association Annual Meeting and Expo, reports Healio Primary Care. Researcher Nastocia Bafford, MPH, a fellow at Nemours Children’s Health System, and colleagues studied the association between exclusive breastfeeding and the risk for dental disorders in 24,655 children aged six months to five years whose parents or guardians had completed the National Survey of Children’s Health in 2011 or 2012. Results showed that children who were breastfed exclusively for six months were 28% less likely to have dental tooth decay, cavities or toothaches than children who were never breastfed.

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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.

Amazon’s Echo Frames glasses

Technology news Google: Keeping everyone honest Google plans to add a new section on the Chrome Web Store where extension developers can disclose what user data they’re collecting and what they plan to do with it, reports ZDNet. The new section was set to go into effect on Jan. 18, and will appear as a “Privacy practices” button 44

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on each extension’s Web Store listing.

Google’s new “data usage” dashboard will ship with a limited set of preset options, which will effectively prohibit Chrome developers from certain data practices, such as: 1) the bulk sale of user data, 2) the use or transfer of user data for personalized advertising, and 3) the use or transfer of user data for creditworthiness or any form of

lending qualification and to data brokers or other information resellers.

‘Alexa start my run’ At press time, Amazon was preparing to roll out fitness-tracking features to its Echo Buds headphones, reports CNBC. Echo Buds can track the duration of a workout, the number of steps taken, estimated calories burned,

Ireland, and Canada, would be able to search the platform using keywords.

Before, they could only search for hashtags or accounts. Instagram said only certain terms will be searchable, though. “The search is limited to general interest topics and keywords that are within Instagram’s community guidelines,” a spokesperson said.

iPad Air is a winner: Reviewer A SlashGear reviewer writes that he is struggling to figure out why people would pass up the new iPad Air (2020) in favor of the iPad Pro. “The middle ground between the entrylevel iPad and Apple’s Pro series has always been a tricky one, but this latest Air nudges so close to what 90% of users are likely to need, it makes an instant case as the go-to Apple tablet right now,” writes Chris Davies. It starts at $599 for the WiFi 6-only model with 64GB of storage; there’s a 256GB version for $749,

while integrated 4G LTE cellular is $130 extra.

Echo Frames for anyone!

Amazon’s Echo Frames glasses are available for anyone to purchase, reports CNBC. The new Echo Frames – which were previously available on an invitation-only basis – cost about $250. The lenses are clear but Amazon said customers can get prescription lenses put in at a Lens Crafters store. Among the updates are up to 40% longer battery life; an auto off feature to maximize battery life when the glasses aren’t in use; an upgraded “VIP Filter,” which not only lets users prioritize notifications from certain apps and contacts, but also calendar alerts and group messages; as well as an “Auto Volume” feature that automatically adjusts the device’s volume based on the noise level of a user’s surrounding environment.

and how fast or how far you walk or run. It also takes into account a user’s height, entered into the workout profile. Echo Buds owners can start a workout by saying “Alexa start my run.” Alexa can also pause a workout, end a workout and update your pace on request.

Instagram search upgrade Instagram users’ ability to search is getting an upgrade, reports The Verge.

The company announced in November that English-speaking users in six countries, including the UK, US,

Apple iPad Air

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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 Long-distance EVs Tesla CEO Elon Musk says that some of the vehicles in the company’s current lineup could hit more than 430 miles of range and that the company is working on a 621-mile-range vehicle, reports Car and Driver. “We even have some under development that could do 1,000 kilometers [621 miles],” Musk was quoted as saying during the European Battery Conference. Musk said the longterm goal would be to bring down the battery pack’s cost per kilowatt-hour. Experts believe that getting battery pack costs down to $100 per kWh would bring the cost of EVs down to gas-powered vehicles’ levels.

After a month, however, the Volvo drivers were more likely to redirect their focus or to remove their hands from the steering wheel than were the Land Rover drivers. But this only happened when the Volvo drivers used both adaptive cruise control and lane-centering assistance at the same time. “This study supports our call for more robust ways of ensuring the driver is looking at the road and ready to take the wheel when using Level 2 systems,” said IIHS Senior Research Scientist Ian Reagan. “It shows some drivers may be getting lulled into a false sense of security over time.”

Sit-down scooters The third option in the City of Seattle’s Scooter Share Program hit the streets in November as Wheels started deploying its sit-down electric scooters, reports GeekWire.

The company was granted a permit, along with Lime and LINK, as part of a micro-mobility program authorized by the Seattle City Council in September. Wheels emerged from the selection process as the “most accessible option” because of its seated scooter. Unlike traditional stand-up models, the Wheels model is intended to offer greater stability because of its lower center of gravity. Twenty percent of the scooters in Seattle will come with an integrated helmet, with the intention of scaling to the entire fleet. The helmets, attached to the back of the scooter, come with removable biodegradable liners to assure sanitary use from one rider to the next.

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Look out!

Hope this doesn’t happen to you, but if it does …

A small study suggests that as drivers learn to trust automated driving technologies, they take their hands off the steering wheel and engage in distracting behavior more often, reports J.D. Power. For the study, 20 volunteers spent a month driving vehicles with ADAS (advanced driver assist systems). Researchers recorded instances when the driver removed both hands from the steering wheel or directed their attention to their smartphone or the center console controls. Ten of the volunteers drove Land Rover Range Rover Evoques equipped with Level 1 ADAS (adaptive cruise control), and 10 drove Volvo S90s with Level 2 ADAS (Pilot Assist with adaptive cruise control and lanecentering capability). At first, researchers discerned no difference between the drivers of the two different models.

What to do if a tire blows out while driving? The goal in any blowout is to keep the vehicle balanced and controllable, according to the National Highway Traffic Safety Administration. Any overreaction – including slamming on the brakes or abruptly removing your foot from the accelerator – can result in a loss of control over the vehicle.

Instead, take the following steps: 1) Hold the steering wheel with both hands; 2) maintain your vehicle speed if possible and if it’s safe to do so; 3) gradually release the accelerator; 4) correct the steering as necessary to stabilize your vehicle and regain control, and look where you want the vehicle to go and steer in that direction; and 5) once your vehicle has stabilized, continue to slow down and pull off the road where and when you judge it’s safe to do so.

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TAKING LEADERSHIP TO THE NEXT LEVEL

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LEADERSHIP

Maximize Potential Addressing the confidence gap

By Lisa Earle McLeod Organizations are filled with un-

tapped potential, undermined by the thousands of small slights that erode the confidence of anyone who doesn’t “fit in.” This is costly to everyone because when people aren’t confident, they’re not fully present and they don’t contribute as well as they could.

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Why confidence erodes over time It’s easy to say, “Be Confident!” Yet how confident would you feel if every day of your working life, someone told you, directly or subtly, you don’t belong here? What if whenever you spoke in front of a group people, questioned your credentials or paid more attention to your appearance than your content? Sadly, this has often been the case for many women, and it’s even worse for people of color.

Over time, it becomes harder and harder to rally yourself. Even if it’s not happening right now, the baggage from past experiences puts you on guard. It’s like a death by a thousand cuts. Several years of an insult here, second-guessing there, makes it hard to walk into a room as your best self.

How you can help people show up as their best selves

when that CEO’s words gave me a boost. If they’re the only “whatever” in the room, your words can help them put forth their best ideas.

Set people up for success (in advance) Years ago, I adopted a technique to spotlight people who might not otherwise take center stage. It’s something anyone can do. When I do a keynote or run a training program, I interact with the audience. It can be an opportunity for people to shine. Yet I consistently notice, when women and people of color are in the minority, as they typically are in a corporate setting, they rarely speak up.

You can help people feel more confident by asking for their help in advance. I’ll find someone who I think might

When someone who might be feeling less than confident enters a meeting, saying, “I’m glad you’re here” can mean the world to them. Sitting back in judgment waiting for them to prove themselves, erodes their confidence, and it keeps you from getting their best ideas.

I’ll never forget a meeting several years ago when I was presenting to an Executive team. They were all men, and all (seemingly) Type-A. The old drip, drip, you don’t belong here, you’re not good enough was ignited.

Yet as I entered the room, the CEO stood up, shook my hand, gave me a big smile, and said, “I’m really intrigued by your work, and we’re delighted you’re here.” That was all it took, I no longer had to pretend to be confident, I was confident!

This is something every single one of us can do. When someone walks into the room or joins the Zoom call, it may be just another agenda item for us, yet for them, it’s a high stakes situation.

Avoid sitting back in judgment When someone who might be feeling less than confident enters a meeting, saying, “I’m glad you’re here” can mean the world to them. Sitting back in judgment waiting for them to prove themselves, erodes their confidence, and it keeps you from getting their best ideas. Even a seemingly confident exterior may be covering some inner fears.

I was 45 years old and had already authored two books

not speak up, and say, “I’m going to ask a question about X during the session, if you’re comfortable, could you raise your hand to answer?” This gives them time to think about their answer and the option to say no. They almost always say yes, because people don’t want the speaker to experience an awkward silence. They’re helping me get all the voices into the room, and in the process, they can shine in front of their peers.

Helping other people feel more confident is the nice thing to do. It’s also the smart thing to do. When everyone feels seen and heard, you produce better results, and you have more fun.

Lisa Earle McLeod is a leading authority on sales leadership and the author of four provocative books including the bestseller, “Selling with Noble Purpose.” Companies like Apple, Kimberly-Clark and Pfizer hire her to help them create passionate, purposedriven sales organization. Her NSP is to help leaders drive revenue and do work that makes them proud.

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REP CORNER

Well-Grounded ‘Three Pillars’ guide Ricky Bustamante’s career – and life – path Ricardo (Ricky) Bustamante, account representative for American Medical Supplies & Equipment in Miami,

Florida, speaks about the “Three Pillars” of his life, that is, three men who helped shape his values, his work ethic, his career path, his devotion to family and his love of medical sales.

Pillar No. 1: His father, Sergio R. Bustamante, who worked as a handyman after emigrating from Cuba in 1990. “I would help him install and remove shutters, paint, do carpentry and various other tasks,” says his son.

“From my father I learned to work hard and to sacrifice.”

Pillar No. 2: His uncle, Hernan Bustamante, who worked in American Medical’s accounting department for 21 years.

“A father figure, he was just as crucial to my upbringing.”

and stocking merchandise, memorizing product numbers, loading trucks and vans, and performing deliveries.

Even back then, he had an idea he would end up selling one day. “I ran into one of my brother’s clients at church,” he recalls. “He was talking about the expense of needles and syringes. So I suggested he go with an economical syringe but a really good needle – one that wouldn’t prick patients. That’s when I realized I might have a knack for selling.”

Tough career decision The part-time hours turned fulltime as he worked between college courses. But in 2010, he made what he describes as the toughest career decision he ever made – to leave American Medical. “Many things ran through my head, and I had sought counsel from my role models, but ultimately the decision was mine,” he recalls. “If I wanted to become what I wanted to and reach all my goals, I needed to experience corporate America and adopt the tools they provided for success.” And with a young daughter, Sofia, he now had a family to support. So he followed his older sister, Teresa Vazquez, into banking.

He started as a teller, with the goal of eventually becoming part of management. But his aspirations soon changed, as he discovered he really enjoyed interacting with customers and placing them in front of the right banker. “So I left the management mindset behind and thought more about sales.” And opportunities presented themselves.

The industry was growing, with branches opening up throughout South Florida. Six months after starting

The Bustamentes (clockwise from upper right): Ricardo, Sofia, Wendy, Elise.

Pillar No 3: His older brother, Sergio, a veteran sales rep for American Medical. “He started in the warehouse and is now arguably one of the best – if not THE best – medical rep in South Florida,” says Ricky. “From a very young age he was always just the type of guy whose footsteps you’d like to follow.”

For the Bustamantes, American Medical is all about family.

Ricky started working there in summers at age 13, picking 50

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as a 20-hour teller, he became a sales and service associate, serving as an assistant to the private banker. Three months later, he became a personal banker himself, and was a top producer for the firm. But more than awards was the wisdom he gained from the job.

“I encountered many people from management, to colleagues, to customers, who helped sharpen me and teach me one of the most important lessons: A good rep or salesperson will never sell an item a day in their life if they do the right thing and service the customer in the right way.”

Back home He returned to American Medical in 2019 all the wiser.

“My plan had always been to return to the medical sales industry. It’s what I grew up around, it was that lost love that awaited me. And to work alongside my brother once more and return to the culture that prepared me for life and gave me the work attitude and personality that made me successful in all the positions I’ve held? It was a no brainer.”

Banking and selling medical supplies and equipment may be like night and day, yet they share one thing in common – service, says Bustamante. “When you do the right thing for your customer, your recommendations hold value. Banking had a lot of goals and service scores. Yet as a medical rep, we create our own goals, and our service is reflected through our success.”

The financial knowledge he gained in banking helped make him a better medical sales rep, he adds.

Understanding the client’s business as they plan a buildout, including budget and goals, helps Bustamante guide them toward sound decisions. “You can’t put power tables all over a startup office when they’re grinding their pennies. It’s tough, but you can put something together that’s feasible and will help them be successful.”

Pandemic About a year after he returned to medical sales, the industry found itself grappling with COVID-19. “I think during this pandemic, American Medical and myself were tested in more ways than one,” says Bustamante. “In any catastrophe, we have two options: We can let ourselves be defeated, or we can rise above it. We never closed our doors, we never failed to answer our customers’ phone calls, and we never gave them an answer of uncertainty.

We held meetings every day and we found solutions to problems.

“Our greatest advantage has to be that to our customers, we’re not just reps – we’re partners, and we were treated as such. I reached out to everyone personally and told them we were here for them, that we wanted them to continue providing healthcare, and that together, we would get through this. None of our customers failed.

“The relationships we created before the pandemic just got stronger.”

The perfect swing: It’s a matter of confidence Ricky Bustamante played a lot of baseball during high school and after. He still puts on batting clinics for younger kids in the neighborhood where he grew up.

One thing he teaches them is there is no such thing as the “perfect swing.”

“The perfect swing is different for everyone,” he says. “It starts from when you get up in the morning till you end your day. It’s your rhythm that makes you unique. There’s no need to copy anyone else.” Some of the most successful hitters – Gary Sheffield, Craig Counsell, Kevin Youkilis, Ichiro Suzuki, Jeff Bagwell and others – had unorthodox swings, he points out. “Use what makes you feel comfortable. Create your habit. It doesn’t matter what the pitcher is bringing; the perfect swing is your creation and no one else’s.”

Yankee legend Yogi Berra said that baseball is 90% mental, and Bustamante agrees. “It’s no secret that you need to have the fundamentals down pat,” he says. With practice, good habits become second nature. “But it’s the mental part that has kept so much potential from stepping closer to ‘The Show.’

“Most kids will step up to the batter’s box scared to fail, when the odds actually favor them over the pitcher. As a batter, you get a minimum of three pitches to an infinite number to look at, while the pitcher needs to get you to bite or stare at three pitches. You need to step in with confidence, stare back into the pitcher’s eyes and let him know he’s in trouble.

“The home run will come to you, but don’t force it. Get your hits up the middle and eventually you’ll surprise someone with a shot to deep center.”

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NEWS

Industry News Midmark honored as a Healthiest Employer in Ohio and Michigan Midmark Corp., has been recognized as one of the Healthiest Employers of Ohio and Michigan. The awards program, powered by Springbuk, was created to honor people-first organizations that prioritize the well-being of their employee population. These companies were recognized because of their commitment to workplace wellness and their exceptional health and benefits offerings. Award applicants were evaluated across six key categories: Culture and Leadership, Foundational Components, Strategic Planning, Communication and Marketing, Programming and Interventions, and Reporting and Analytics. Completed assessments were ranked with the proprietary Healthiest Employers Index, a 1-100 rubric for wellness programming.

“Wellness has not only become very educational for our teammates, but they also enjoy group participation, challenges and contests hosted by our ‘FIT’ team,” said Sue Hulsmeyer, vice president, human resources and corporate communications. “We are currently building and remodeling our Versailles campus, and our teammates are looking forward to a new fitness center and outdoor track that will be part of our facilities.”

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syringes for their injectable drugs – including complex biologics, vaccines and small molecules.

The six current manufacturing facilities for BD Pharmaceutical Systems that will see a portion of this investment include facilities in: ʯ Columbus, Nebraska ʯ Cuautitlán, Mexico ʯ Fukushima, Japan ʯ Le Pont-de-Claix, France ʯ Swindon, United Kingdom ʯ Tatabánya, Hungary “Since 2018, BD has added 350 million units of manufacturing capacity for glass barrel pre-fillable syringes, and this new commitment will invest in additional upgrades at all of our Pharmaceutical Systems manufacturing facilities and across multiple product categories,” said Eric Borin, worldwide president of BD Pharmaceutical Systems. “In addition, this investment positions BD to have the needed surge capacity for increased pre-fillable syringe demand during times of pandemic response or periods of significant growth of new injectable drugs and vaccines.”

BD to invest $1.2B in pre-fillable syringe manufacturing capacity over next 4 years

Dale Medical Products implements new sales strategy

BD (Becton, Dickinson and Company) (Franklin Lakes, NJ) announced plans to invest approximately $1.2 billion over a 4-year period to expand and upgrade manufacturing capacity and technology for pre-fillable syringes (PFS) and advanced drug delivery systems (ADDS) across its six global manufacturing locations and add a new manufacturing facility in Europe.

The new manufacturing facility in Europe is expected to be operational by the end of 2023.

BD says that the investment will also fund capacity expansion, new product innovations, manufacturing technology enhancements and business continuity improvements across its existing network. All of the investments are designed to maximize supply and reduce risks for pharmaceutical companies that rely on ready-to-fill

Dale Medical Products, Inc., announced it has selected MedTech MedCare (MTMC) to lead Dale’s sales efforts within the United States, effective Jan. 1, 2021. Jack Moran, Managing Partner at MTMC stated “MTMC has developed an effective, efficient team of sales professionals representing leading brands nationwide. Dale’s product portfolio is well aligned with MTMC’s core competencies and we will be able to leverage their brand recognition in generating further market expansion for Dale.”

John Brezack, Dale’s President, commented: “Dale has been growing steadily for the entire history of the company. We have made the decision to focus on expanding our reach, and ultimately provide our products on a larger scale in order to support clinicians and improve patient outcomes and satisfaction.”

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MidmarkÂŽ Workstations + Telehealth Enabling Healthcare from Anywhere

It was predicted that there would be 1 billion telehealth visits in the US in 2020, yet as of January 2020, 76% of healthcare organizations in the US lacked a virtual care program.1 We can help. Midmark Workstations are made to order with customization that can assist with the integration of technology at the point of care, wherever that may be.

Learn more at: midmark.com/carefromanywhere

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1 https://go.forrester.com/press-newsroom/us-virtual-care-visits-to-soar-to-more-than-1-billion/ Š 2021 Midmark Corporation, Miamisburg, Ohio USA

Don’t Be Fooled

By Imitators

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