REP-March19

vol.27 no.3 • March 2019

repertoiremag.com

the Three inductees into the Medical Distribution Hall of Fame represent entrepreneurship at its nail-biting finest: Roger Benz, Gerry LoDuca and Bill Sparks.

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MARCH 2019 • VOLUME 27 • ISSUE 3

PUBLISHER’S LETTER Celebrating the Medical Distribution Hall of Fame Inductees................ 6

PHYSICIAN OFFICE LAB Respiratory Testing

The game keeps changing. Are you?....................................8

Updated Clinical Lab Testing and CPT Codes

Updated information available in RepConnect app....... 12

IDN OPPORTUNITIES

Medical Distribution Hall of Fame HEALTH FOCUS: IFOBT

16

Contracting Executive Profile Jennifer McPherren Vice President, Procurement Services, Supply Chain Management, Northwestern Memorial HealthCare, Chicago, Illinois................................... 14

Colorectal Cancer Growing concern among young Americans

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

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

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MARCH 2019 • VOLUME 27 • ISSUE 3

HEALTHY REPS

LEADERSHIP

Health news and notes

The Conflict Trap

Why avoiding conflict often prolongs it................... 40

TRENDS Small Guys Finish Last

Small practices lag behind big ones under MIPS.... 47

WINDSHIELD TIME

48 QUICK BYTES

Automotive-related news...........................50

HIDA GOVERNMENT AFFAIRS UPDATE Key Supply Chain Rules Take Effect This Fall......................................................... 58

REP CORNER

Technology 54 news 4

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John Kropf: Getting better at getting better.................................................60

INDUSTRY NEWS News........................................................................................... 66

You Keep Us Going Some things are essential to win the day. For us, it’s distributors like you who sustain and fuel our success. And we want to thank you. Thank you for providing the high-quality products critical to healthcare professionals’ needs.

Because of you, B. Braun is a leading healthcare provider.

B. BRAUN AND YOU

Sales representatives in your area are ready to discuss how to further improve your customer experience.

B. Braun Medical | Bethlehem PA | 1-800-227-2862 | BBraunUSA.com ©2018 B. Braun Medical Inc., Bethlehem PA. All rights reserved.

PUBLISHER’S LETTER

Celebrating the Medical Distribution

Hall of Fame Inductees

Entrepreneur – A person who organizes and operates a business, taking on greater than normal financial risks in order to do so.

The theme of this year’s Hall of Fame is just that. The three individuals being inducted

this year are great entrepreneurs. They’re also visionaries, risk takers, problem solvers, and are a smaller and smaller breed of businesspeople in today’s world of mergers and acquisitions.

I won’t go into too much depth on each individual in this publisher’s letter given the wonderful work Mark Thill has done capturing their stories, but I will say a few words.

While I do not know Roger Benz personally, it’s easy to see that the man believed in hard work, expected to succeed, and always looked for something new to try. The short story in Mark’s article by Lisa Hohman seems to sum up who Roger was his entire career.

One personal note, in my 25-year career I have never been successful selling Roger’s company anything. Hey Roger – how about a little bit for the effort on your way out? Congrats on your success and your induction into the Hall of Fame!

Scott Adams

I have known Gerry LoDuca for more than 15 years, and as I read his story, there were no surprises at the reoccurring themes in how he approaches people and business.

He stressed fairness in every business deal so that there was mutual success by both parties. That’s a concept our government should most certainly learn. On a personal note, Gerry is one of the kindest people in our industry, and if I had to compare him to another Hall of Famer it would be Rob Saron. Gerry, you truly deserve this award.

And finally, Billy Sparks. Relationships are the core of who Sparky is. In the 20 years I have known and done business with him, the relationship always came before the business. From a personal side, my life and career wouldn’t be the same had I not met him. Congratulations on this induction Billy.

I started this publisher’s letter on entrepreneurship, but I’d like to close with three life themes from this year’s inductees: 1. W ork hard, expect to win, and don’t be afraid to try – Roger Benz 2. T reat everyone fairly and work toward mutual success – Gerry LoDuca 3. Grow, own, and value relationships – Billy Sparks I’d say those themes are what every great company in the world should be founded on. We hope to see you at the Hall of Fame this year.

Dedicated to the industry, R. Scott Adams

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

editorial staff editor

Mark Thill lthill@sharemovingmedia.com managing editor

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

Alan Cherry acherry@sharemovingmedia.com

Jessica McKeever jmckeever@sharemovingmedia.com (800) 536.5312 x5271

publisher

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

sales executive

Lizette Anthonijs Lizette@sharemovingmedia.com (800) 536.5312 x5266

founder

Brian Taylor

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

btaylor@ sharemovingmedia.com

Joan Eliasek: McKesson Medical-Surgical

circulation

Doug Harper: NDC Homecare

Ty Ford: Henry Schein

art director

Laura Gantert

Mark Kline: NDC

Brent Cashman

lgantert@ sharemovingmedia.com

Bob Ortiz: Medline

bcashman@sharemovingmedia.com

6

vice president of sales

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Keith Boivin: IMCO Home Care

Even the smallest detail can have a big impact.

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PHYSICIAN OFFICE LAB

Respiratory Testing The game keeps changing. Are you?

By Jim Poggi You may be asking yourself, “Why is Poggi offering a

review of flu/respiratory tests in March? Most respiratory seasons peak by now.� While the timing is unusual, I have a couple of good reasons. First, your customer experience is fresh on their minds: Did the solution you provided work effectively? Were they satisfied with test results and workflow? Did they wish they had EMR connectivity? Were there unexpected back orders?

Second, the number of choices in respiratory testing has increased dramatically in the past few years and picking the right solution can be confusing. Asking the right questions of your customers in the coming months should solidify your recommendations during the summer when our suppliers offer special customer incentives to be ready for the peak season in the fall and winter. I intend to give you a few thoughts to mull over as you prepare to consult for your customers in the coming season.

Range of choices Less than 10 years ago, influenza and strep were the common waived respiratory testing choices in primary care. There were no molecular tests practical for our customers, no lateral flow test readers, no connectivity options and a narrow field of available tests, test methods and manufacturers.

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Now the range of choices in methods, level of automation, connectivity and supplier options has dramatically increased. To put it into perspective, for flu tests alone there are currently 18 waived lateral flow flu kit choices with seven different reader options, including private label variations. On the molecular side of things, there are eight waived molecular tests on the market, with a total of 24 waived or moderate complexity molecular choices!

Molecular instrumentation adds options for scalability and connectivity. But, even in the lateral flow flu test kit world, there are sophisticated reader options including connectivity and result reporting for flu incidence surveillance available to customers. The range of available respiratory tests has expanded to include RSV and pneumonia assays along with several other bacteria and viruses, notably human metapneumovirus, adenovirus and multiple species of parainfluenza and coronavirus.

So, how do you effectively evaluate the available choices and properly consult with your clients to provide the optimal solution for them? This article will summarize general test methodologies, with some focus on special features your customers may find valuable. In addition, it will offer additional considerations that will make a difference to certain customers. It will describe how PAMA (remember PAMA?) has leveled the Medicare reimbursement for molecular flu tests are raised the reimbursement

She probably needs an antibiotic.

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Visit go.roche.com/treatwithconfidence to download patient education materials, watch videos and get more information.

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PHYSICIAN OFFICE LAB Product landscape General Methodology

Waived?

Time to Result

Reader

LIS/EMR Special Features* Connectivity

Rapid lateral flow

Yes; most

<15 min.

Some

A few

Anonymous result surveillance reporting

Rapid Molecular

Yes; about Yes; some one-third 15-30 min. are very of available sophisticated methods

Nearly all

Scalability; very wide range of available tests; anonymous result surveillance reporting

Immunofluorescence

No

Yes

Direct and indirect methods are available

1-4 hours

Yes

* Special features and overall respiratory test menu vary by manufacturer and model.

Be sure to consult with your respiratory kit manufacturer for ALL the pertinent details. level in the former lower reimbursement states. Finally, it includes my thoughts on “how and when do we know we have tested enough causes of respiratory illness”?

Additional customer considerations include overall test kit performance (sensitivity and specificity), scalability and desired respiratory test menu.

from lateral flow, lateral flow with readers and molecular options. So, it is possible to solve many individual customer needs with a single supplier’s solutions. Finally, some suppliers offer a choice of single test and multiple test analyzers which give the customer choices if they believe their testing volume will grow.

Overall kit performance

How PAMA helped

Rapid lateral flu kit performance has been improved by the requirements imposed by the CDC in 2017 regarding sensitivity and specificity for both flu A and B. As a result, if a good swab is collected (not always a great assumption), performance of lateral flow assays for flu is solid overall, and typically improves when a reader is used. For strep, molecular assays typically offer a “no need to confirm negative results” benefit that improves confidence in results as well as speeding up reporting of negative results. These benefits strongly support antibiotic stewardship. For RSV testing, since it is so important to avoid false negatives, the highest “negative predictive value” is an important consideration and molecular methods have the advantage here.

When the molecular flu Medicare CPT code was subject to individual carrier payment decisions, several carriers had rates below the average. With the current unified Medicare reimbursement under PAMA all states offer the same reimbursement for molecular influenza, CPT code 87502/QW.

Scalability and work flow From a work flow perspective, lateral flow has traditionally been faster since early readers had “one sample at a time” constraints. However, many readers offer batch testing capabilities that make them effective work flow solutions in practices where multiple samples need to be tested at the same time. In addition, most manufacturers now offer multiple respiratory method choices

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Test to know As the number of available respiratory tests continues to increase, your customers will need to decide which tests to offer to aid in diagnosis and effective patient treatment. The most common thought process tends to be for clinicians to require tests that allow them to quickly and effectively diagnose and treat the patient condition.

Since many respiratory infections tend to be self-limiting in otherwise healthy patients, you can expect your customers to have varying opinions about the importance of offering some of the newer assays where treatment options are usually limited to supportive treatment.

So, do your homework now and learn from your customers’ input and experience during the past two seasons.

Use this input as well as guidance from your respiratory testing suppliers to be fully prepared for the coming respiratory season. Respiratory testing is changing. Are you?

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PHYSICIAN OFFICE LAB

Updated Clinical Lab Testing and CPT Codes Updated information available in RepConnect app

The Clinical Lab Testing and CPT Codes

portion of the RepConnect app has been updated for 2019. RepConnect equips Distribution Reps with an easy to use, efficient solution for storing and sharing product brochures, white papers, and rep lists. With this revolutionary tool, Reps can share information and documents with their accounts in just a few clicks The updated information includes the test name, CPT Code, and then reimbursement information for 2019, as well as a look at the difference between 2019 and 2018.

The categories covered include: • Tests – Panels • Cardiac/Liver/Other tests • Lipid tests • Diabetes tests • Renal Function tests • Individual tests, including Amylase, Calcium, Iron, Vitamin D and more • Therapeutic Drug Monitoring tests • Drugs of Abuse Screening • Thyroid tests • Pregnancy tests • Infectious Disease tests • Urinalysis/Microscopic/ Miscellaneous tests • Hematology tests To download the app on your mobile device, search for “repconnect” as one word in your app store. For more information, visit http://www.repertoiremag.com/ resources/repconnect

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NEW PAMA CPT codes now available in the app

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

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

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

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

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

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

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

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

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

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

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

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

$11.24 $13.09 $21.26 $5.97 $7.88

$10.12 $11.78 $21.09 $5.37 $7.09

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

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

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

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

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

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

Renal Function Tests BUN Creatinine Creatinine (Urine)

84520/QW 82565/QW 82570/QW

$5.42 $7.03 $7.10

$4.88 $6.33 $6.39

-10% -10% -10%

Individual Tests Amylase Calcium Ferritin Iron

82150/QW 82310/QW 82728 83540

$8.89 $7.08 $18.70 $8.88

$8.00 $6.37 $16.83 $7.99

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

Find the new codes in The Black Book

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

repertoiremag.com

January 2018

2 Minute Drill Videos

Podcasts

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

PAMA: Jim Poggi, Tested Insights, LLC

The Stage is Set

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

Twitter

IDN OPPORTUNITIES

Contracting Executive Profile Jennifer McPherren

Vice President, Procurement Services, Supply Chain Management, Northwestern Memorial HealthCare, Chicago, Illinois

Since joining Northwestern Memorial HealthCare more than 15 years ago,

Jennifer McPherren’s role has encompassed support services operations, outsourced contract labor management and corporate supply chain. As vice president of procurement services, she has oversight of the $2B procurement arm of Northwestern Medicine’s supply chain, including strategic sourcing, value analysis, performance analytics, contract management, medical capital procurement and clinical engineering. McPherren was born in Rock Springs, Wyoming, and raised in Yreka, California.

About Northwestern Memorial HealthCare Northwestern Memorial HealthCare is the corporate parent for the Northwestern Medicine health system, whose medical staff of more than 4,000 includes more than 1,000 residents and fellows and over 1,500 employed physicians who are part of the Northwestern Medical Group, Northwestern Medicine Regional Medical Group, Kishwaukee Medical Group or Marianjoy Medical Group. The health system serves patients at over 100 diagnostic and ambulatory sites across the greater Chicago market, including seven hospitals.

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Repertoire: Can you describe the most challenging and/or rewarding supply-chain-related project in which you have been involved in the past 12-18 months?

Jennifer McPherren: Northwestern Medicine (NM) is on a growth trajectory, rapidly expanding the number of hospital affiliates in our healthcare system. A natural byproduct of such mergers is the change management activity tied to assessing legacy structures. NM’s supply chain mission is to advance a comprehensive clinical and business integration procurement platform that balances academic medical center needs yet promotes decisionmaking inclusive of all affiliate entities. For the past year our supply chain team has been on a journey to completely overhaul the way our diverse constituents consider and select products for patients. We’ve launched a collaborative program designed by physicians for physicians, which empowers clinicians to make decisions on behalf of their peers across all 10 affiliates in a relatively rapid fashion.

While all the correlating metrics of the new program are promising (product standardization up 200 percent, new products approved down 30 percent, decision participants consolidated by 85 percent), the most

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rewarding change has been the evolution in partnership between the clinicians and the supply chain team.

Repertoire: Please describe a project you look forward to working on in the next 12 months.

McPherren: NM is in the early stages of deploying a new medical equipment management program. In collaboration with our CFOs, supply chain has been charged with executing a five-year capital procurement strategy that takes advantage of economies-of-scale pricing, deploys modality standardization, transitions to a “right-size service selection” platform, and consolidates clinical engineering across the NM continuum. With over 60,000 assets spread across 150 locations featuring 142 different modalities from over 200 distinct suppliers, supply chain is excited to partner with our clinicians on this capital management asset opportunity. A central repository housing NM’s fleet information will afford our clinicians proactive visibility across multiple sites. It will inform deployment decisions as to when and where we should be investing our limited funds to carry out our organization’s mission.

Repertoire: How have you improved the way you approach your profession in the last five to 10 years?

Did you have any help doing so, or was there any particular incident that was particularly significant?

McPherren: Healthcare supply chain management is an emerging profession. It has progressed from a back-office

support function to an integral component of the healthcare continuum. As managers of the second largest expense category following human capital, supply chain executives who can swiftly effect change will continue to be a strategic force in improving the delivery of cost-effective care. NM’s supply chain approach to managing to the ever-changing needs of the business is to hire and retain exceptional talent. The foundation of our program is built on sourcing clinicians versed in products, engineering analysts skilled at uncovering compelling business cases through data, attorney negotiators trained in advocacy, and a management team that can compel decision-making.

Repertoire: In your opinion, what will be some of the challenges or opportunities facing the next generation of supply chain professionals? What should they be doing now to prepare to successfully meet those challenges and opportunities?

McPherren: Technical skills such as artificial intelligence, data mining, dynamic programming and lean principles will be in high demand. The next generation will likely have the luxury of seamless purchase and charge data integration, predictive preference card management and instant product utilization change alerts. However, from my perspective, we’ll always be in the change management business. Likable professionals who can influence laterally, persuade a broad range of constituents and drive consensus quickly will always be in high demand.

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MEDICAL DISTRIBUTION HALL OF FAME

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March 2019

â&#x20AC;¢

www.repertoiremag.com

the Three inductees into the Medical Distribution Hall of Fame represent entrepreneurship at its nail-biting finest: Roger Benz, Gerry LoDuca and Bill Sparks.

www.repertoiremag.com

â&#x20AC;˘

March 2019

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Sofia 2 Lyme FIA: CLIA-waived Results in minutes, not days.

Diagnosing Lyme disease is hard. Symptoms are broad and generic, mimicking many other conditions. Patients feel horrible and want answers. It doesn’t help that current testing methods may take hours or days for results. Not anymore! Sofia 2 Lyme FIA uses a fingerstick whole blood sample to provide accurate, objective and automated results in as few as 3 minutes, getting doctor and patient on a path to treatment much sooner.

Sofia 2 Lyme FIA is the only rapid, near-patient testing solution that provides IgM and IgG differentiated results in a single test. It has demonstrated accuracy on par with current testing methods — all with less than 1 minute hands-on-time. And as you’ve come to expect from Sofia 2, our Lyme assay functions in WALK AWAY and READ NOW modes, providing flexible workflow options based on your needs.

To have your customer ready for Lyme Season with our CLIA-waived Sofia 2 Lyme FIA, contact your Quidel Account Manager at 800.874.1517

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Medical Distribution

H A L L O F FA M E

Roger Benz: Hay baler He’s not above any task

I

f there’s a flannel shirt in your closet, there’s a good chance you would enjoy working for Roger Benz, a founder of Seneca Medical in Tiffin, Ohio, and soon-to-be retired co-CEO of Concordance Healthcare Solutions.

Located about 50 miles southeast of Toledo, Tiffin has a population of about 18,000. It has 12 one-way streets, 22 beautiful parks and 65 miles of sewer pipe.

It is a city of hay balers, says Benz, who is being inducted into the Medical Distribution Hall of Fame. And Concordance is a company full of them.

Roger Benz

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When diagnosing hypertension, accurate blood pressure readings are non-negotiable.

Under new American Heart Association guidelines,¹ nearly half of American adults have high blood pressure—and many don’t know it.² The Welch Allyn line of digital blood pressure solutions can help providers confidently identify, diagnose and manage hypertensive patients inside and outside the office.

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Medical Distribution

H A L L O F FA M E

Benz can talk about hay balers, because he was one, as a kid on the family farm in central Ohio. “We baled a lot of hay because that’s what grew on our land.” And he’s proud of it.

“You look around here, and you see that this Midwest agricultural, rural workforce knows how to work: They grew up baling hay for the old man. A lot of our success

Alco was selling its non-core assets, including its med/surg business, explains Benz. “Bill said, ‘I’d like to consider buying it. Would you be interested?’

“You rarely hear opportunity knock,” says Benz. “I said, ‘Sure, let’s try it.’”

On the ride back home, Benz told his wife what he and Schultz had talked about. “I’m in,” she said, with little hesitation. “We decided, if we lose it all, we could start over,” he recalls. “At 32, you’re young enough to roll the dice.”

Tiffin, like many Midwestern towns, had lost industry and jobs during the 1970s and ’80s. “We were one of the few people moving there for a job,” he says. But – Roger Benz move they did, in December 1989.

In February 1990, Alco transferred the med/surg assets of its business to the new company, Seneca Medical.

Nine months later, on a Friday afternoon, Benz asked Schultz in a quiet moment, “Why did you ask me to do this? You’re in the industry and I’m a controller at a hospital. What brings me to this table?”

“I didn’t know who else to ask,” responded Schultz. (Later, Schultz admitted it was much more than that, namely, the fact that he and Benz shared similar attitudes about how to work with people.)

“ Did we foresee this being hugely successful? No. But we knew we would have to work hard as hell to make it work.” is due to a bunch of great people who work their butts off. They don’t do it because they’re paid to do it or to get recognized. They do it because it needs to be done.”

Opportunity knocks Benz was a 32-year-old controller at Greene Memorial Hospital in Xenia, Ohio, in 1989 when he and his wife, Deb, and their two kids (one and four years old at the time) drove to Tiffin for a Memorial Day visit with Deb’s brother, Bill Schultz, and family. On Sunday morning, Schultz asked Benz to go for a ride with him.

At the time, Schultz was finance officer for Alco Health Services in Tiffin, a med/surg distributor and drug wholesaler, which was founded in 1937 as Meyers & Co.

Swimming upstream “I thought we had a chance,” says Benz, speaking about Seneca. “Did we foresee this being hugely successful? No. But we knew we would have to work hard as hell to make it work.” In other words, bale a lot of hay. And they would ask their employees – many of whom came over from Alco – to do the same.

The landscape at the time didn’t bode well for small distributors.

Consolidation was well under way in 1990. “We would be swimming upstream as a little guy.”

Warehouse space was short in Tiffin, so Schultz and Benz rented space

“ A lot of our success is due to a bunch of great people who work their butts off. They don’t do it because they’re paid to do it or to get recognized. They do it because it needs to be done.”

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Medical Distribution

H A L L O F FA M E

So, the corporate goal became in a 300,000-square-foot foundry in growth, and it pretty much rethe middle of a cornfield. The building mained that way for the next seven had at one time housed Hays-Albion, to 10 years. (Ultimately, however, the which manufactured castings for the acute-market came to dominate the automotive industry. Some foundry company’s business. In fact, at the work was still being done there. time of the merger of Seneca, Kreisers “It was a 45,000-square-foot and MMS—A Medical Supply Comroom, which had become an internal pany in 2016 to form Concordance, junkyard for the foundry,” he says. more than 90 percent of Seneca’s sales The room was littered with debris, were in acute care.) including an International HarvestIt was Schultz’s idea to create a er dump truck, all covered in black profit-sharing program for Seneca soot. Upon seeing the space, one of – Mike Carver employees, to help them feel a sense Seneca’s new employees is said to of ownership in their new company. have gone home and told his wife, “I About nine months after the program began, employthink I just threw away my career.” ees received their first profit-sharing check – about nine At any rate, the room was cleared and swept – many bucks. But those checks grew in size from there. Later, in times – so as to house inventory. Sterile items were stored 1998, Seneca Medical instituted an employee stock ownerin a clean room, but most of the boxes and cases lay on ship plan, or ESOP, “so our people weren’t just sharing in pallets or on the floor. Boards were laid over big circuthe profits, but in ownership of the company,” says Benz. lar sinks where foundry workers had once washed their He credits both programs with helping Seneca Medical hands, forming desks for the accounts payable team. enlist its employees’ loyalty and hard Because the foundry was still opwork through leaner times. erating, a faint haze descended on In 2001, opportunity knocked the warehouse every day, necessiagain, when AmeriSource Medical tating a daily dusting.

Supply (which had acquired Alco in Eight months later, Seneca moved the early 1990s) sold its med/surg into a newly built, 68,000-squarebusiness to Seneca Medical, includfoot warehouse. (Today, it stands at ing two warehouses – in Knoxville, 310,000 square feet.)

Tennessee, and Ripley, West Virginia.

At the time, Seneca was a $140 milStrategy lion company. The AmeriSource acAlco had been in multiple markets quisition pushed it over $200 million.

– retail pharmacy, doctors, hospiAfter that, the company grew tals. The company even had a sports organically rather than by acquimedicine piece, which, in Tiffin and sition, opening warehouses in surrounding counties, really meant Shelbyville, Indiana, in 2005, and furnishing high school football teams.

Kalamazoo, Michigan, five years “On Day 1, we sat down and later. (Ironically, Seneca inhabited asked ourselves, ‘What’s our stratan old foundry in Kalamazoo, as it egy? What should we focus on?’” had in Tiffin, while a new building says Benz. “We decided we couldn’t was being constructed.) In 2011, the afford to get out of any of those company opened up operations in markets. We either had to grow this – Dave Myers Mocksville, North Carolina. thing or die.”

“Roger wants the first words out of his mouth to be ‘Yes, let’s try it.’”

“Roger is a leader who’s willing to take on the big players in the industry, to fight hard for what’s right, and to not be greedy along the way.”

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Medical Distribution

H A L L O F FA M E

Still, Benz believed Seneca needed to stretch even farther geographically, and he discussed merger opportunities with several regional distributors. In 2014, he and Tom Harris, CEO of MMS, began serious discussions.

Dave Larson of Kreisers Inc. in Sioux Falls, South Dakota, joined, and the three announced the formation of Concordance Healthcare Solutions in late 2015. They closed the deal in March 2016.

“The synergies of these three companies were perfect,” says Benz.

Bill Schultz retired in 2001, but Benz still sees him from time to time in Tiffin. “He’s probably the most humble human being I have ever met,” says Benz. “He believes in people, he believes in honesty, he knows how to motivate people. He’s a great leader.

I just admire that.

“He showed me that when you hire someone, you give them the tools they need to do the job and let them go.”

No better way to handle a hay baler.

Speaking of Roger Benz Dave Myers, president and chief operations officer, Concordance Healthcare Solutions “Roger is an entrepreneur. Nothing can’t be done. He helped start Seneca Medical, now Concordance, and that took a ton of moxie. He understands the ‘risk-reward’ equation, and he’s willing to ‘let it all ride’ if the odds are in his/our favor or even if it’s just his gut supporting a decision. His role in supply chain? I’d say it’s being a leader who’s willing to take on the big players in the industry, to fight hard for what’s right, and to not be greedy along the way. He likes to call himself a bean counter, because he’s a hell of an accountant and did grow up around bean fields, but he’s willing to give away part of the farm in a customer negotiation…always listening to what the customer or marketplace is asking, and then doing it.”

Lisa Hohman, CEO, Concordance Healthcare Solutions “Roger has always believed that he is not above doing any task. I was working late one night, trying to get a bid completed. I was in the conference room collating the bid, and he walked by on his way out and asked if I needed help. I had been with the company only a year or so, and couldn’t believe the CFO was asking if he could stay late and help. Even though

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I reassured him that I was fine and that he didn’t need to stay, he sat down on the floor and started placing the bid into binders. This is classic Roger.”

Mike Carver, corporate accounts director for medical distribution, GOJO Industries “Roger is a very transparent leader. He wants the first words out of his mouth to be ‘Yes, let’s try it.’ He not only thinks outside the box, he implements ‘outside the box.’ He is extremely loyal, not only to his team, but also to his partners in the industry who work with him. Two characteristics that you will never see out of Roger Benz: arrogance and greed.”

Tom Harris, CEO emeritus, Concordance Healthcare Solutions “We had recently completed the merger [to create Concordance], and Roger was asked to appear on a distributor panel at HIDA. The Big 3 proceeded to describe their long legacies in serving the healthcare industry. Very impressive stories. When it was Roger’s turn to describe the newly formed Concordance Healthcare Solutions, he proceeded to say, ‘We are like teenagers, with pimples and braces, and you better watch out because you just don’t know what we are going to do next.’ It brought the house down.”

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Medical Distribution

H A L L O F FA M E

Gerry LoDuca: Family man “Gerry has been a leader in partnership-driven business practices in our industry,” says Heather Llorca-Kropp, vice president of marketing and channel management for DUKAL. “He has emphasized ethical and transparent relationships while bringing our distributor partners new, innovative and competitive products every year. He values the friendships and promises he makes and is widely respected for it.”

Adds John Brezack, president and CEO of Dale Medical Products, “Gerry is the patriarch of a wonderful family and a terrific company, whose employees adore him. He is revered throughout the industry, and is quick to help anyone who seeks his advice or assistance.”

The $149 calculator

Gerry LoDuca

G

erry LoDuca, an inductee into the Medical Distribution Hall of Fame, founded and built DUKAL Corp. into a $100+ million company selling high-quality, low-cost medical commodities and disposables. And he did it using one principle above all others: Treat people like family, whether they are employees, distributors or contract manufacturers, and whether they are in Long Island, California or China.

“Everybody likes a good life, no matter who they are or where they live,” he says. “They want to be treated fairly, they love their families, and they want to be treated with respect, care and understanding.”

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LoDuca was born and raised in Malverne, Long Island. His father, Arnold, started working in the photo engraving/printing business after the eighth grade, and didn’t retire until he was 73. Gerry’s mother, Helen, a stay-at-home mom, was the driving force behind the family’s move from Brooklyn to Long Island. “She didn’t like the environment, the density or the horse racing” in the borough.

After graduating from St. John’s University in 1976, LoDuca decided to pursue a career in sales. But he knew he needed Sales 101 experience before landing a job in an industry that would suit him long-term. So he became a salesman for Beta Business

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Medical Distribution

H A L L O F FA M E

Products, a distributorship for business machines, such as Sony dictating machines (which sold for $270 at the time), transcribers ($1,195) and Texas Instruments four-function calculators ($149). He – like the other reps – received $150 for two weeks, then went on straight commission. “I met some real characters” among the Beta reps, he says.

“I learned a lot about selling, how to treat people.”

One year later, he took a job with IPCO Hospital Supply, which distributed medical products to hospitals

and nursing homes in the New York area. It turned out to be a good fit.

The entrepreneur “I fell in love with the industry,” he says. He was exposed to a vast number of products, from dietary, to central supply, sterilization, infection control, medical/surgical, textiles. And unlike the calculator business, in which sales tended to be of the oneand-done variety, medical sales offered an opportunity to build

Speaking of Gerry LoDuca John Brezack, president and CEO, Dale Medical Products “Gerry is warm and reaches out to everyone he knows, no matter what the setting. He will quickly share a story and a drink, or play his guitar and reminisce about his days in a rock band. Gerry will not just give you advice, but will write you a referral, recommend you to his associates, or loan you one of his staff if needed. He has always been open and helpful to me and my family, and to all Dale employees who have interacted with him.”

Heather Llorca-Kropp, vice president of marketing and channel management, DUKAL Corp.

“What makes Gerry unique is his sense of humor and his ethics. Anyone who knows Gerry would tell you that. He is one of those people who sees the joy and laughter in life and work, and has built an incredible family culture at DUKAL.”

Jack Addicks, president, Keystone Consulting Associates, LLC “Gerry is one of the most credible and genuine individuals that I have had the pleasure of working with during my 50 years in business. A good role model for ‘early professionals’ – Work hard, hire good talent to help run a business, have your thumbprint on the business, yet get out of the way and let them contribute to its success.”

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Mark Seitz, president and CEO, NDC “What makes Gerry LoDuca unique is the magnitude of his passion for his family, his employees, his friends and our industry. The evolution of DUKAL Corp. under Gerry’s leadership should be a business school case study as to how a strong culture combined with talented leadership translates into commercial success. DUKAL, through Gerry, has made investing in the industry a priority. Whether it’s the Health Industry Distributors Association, the HIDA Educational Foundation, Healthcare Manufacturers Management Council or Professional Women in Healthcare, Gerry and the DUKAL team are always present and always participatory. Gerry LoDuca lives a life of commitment – to family, to friends and to the industry he truly loves.”

Rob Saron, senior vice president, global distribution, Symmetry Surgical “Gerry both listens and cares about the people he does business with. Every body listens, but he REALLY listens. He appears to be friends with everyone in distribution. What is not to like?”

Mike Racioppi, senior vice president and chief merchandising officer, Henry Schein “Gerry enjoys life and he works hard. You don’t grow from zero to what DUKAL’s sales are today without a lot of hard work. He knows how to run a business, manage profits, reduce expenses.

He’s also very good at the relationship side of the business. He is genuinely interested in people.”

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Medical Distribution

H A L L O F FA M E

long-term relationships with customers. “I still have friends I talk to today who I met then,” he says.

One day, while sitting in a customer’s office at Maimonides Medical Center in Brooklyn, LoDuca ran into another salesman, Joe Meringolo, who had started a manufacturing company called Medical Action Industries (now part of Owens & Minor). The two hit it off and ultimately, Meringolo asked LoDuca to join him at Medical Action. With the help of some wedding-gift cash (he had just married Donna Glover), LoDuca bought into the company in 1979. At the time, sales were about $400,000.

“I stayed there 11 years; we made every mistake possible; but we built the business one hospital at a time.” When they took the company public, sales had reached $25 million. (By

including the quality and regulatory requirements of producing for the American market. And he spoke to them about the competition their products would face in the U.S. “I always tried to speak in the spirit of partnership and mutual success, that is, emphasizing what we – together – needed to do to in order to compete and build a successful market,” he says. That approach built trust and long-lasting relationships. In fact, one of DUKAL’s top suppliers today is the son-in-law of the company’s very first supplier. Since the early days of the company, LoDuca has traveled to China more than 80 times. Of DUKAL’s 110 suppliers in 11 countries, 80 are in China.

Gerry and Donna worked well past midnight many nights, expanding DUKAL’s product line and breadth, and customer base. (DUKAL began in 1991 with one product; today, it carries about 3,000.)

“Customers would ask us, ‘Have you ever thought of selling this product at a better price?’” he says. He would take samples to China to see if his suppliers could produce a similar product at the right quality and price, and capacity. “It’s always nice to have someone willing and ready to buy the product – my cornerstone customers,” he says.

Donna remains active in DUKAL, serving as vice president of human resources. Their daughter Aimee joined the company in 2017 as creative director, after working in branding and advertising for 10 years.

LoDuca grew the company by acquisition as well, its first significant one being Hermitage Hospital Products in 2005. Others followed, including certain assets of Donovan Industries (2012) and American White Cross (2016).

Not only did the acquisitions grow the company’s footprint and product portfolio, but they also brought new talent and skills to DUKAL, including Chris Brooks (who currently is DUKAL’s vice president of sales) and John Grasso, who revamped the company’s warehousing and distribution strategy.

“ I always tried to speak in the spirit of partnership and mutual success, that is, emphasizing what we – together – needed to do to in order to compete and build a successful market.” the time the company was acquired by Owens & Minor in 2014, net sales were close to $290 million.)

LoDuca’s responsibilities included traveling to China, where he built relationships with the country’s import/export companies. “That was how all business was done there at the time,” he says “The factories were owned by the government, the import/export companies were governmentcontrolled too. But they were happy to sell to me.”

In 1991, given his knowledge of medical sales and manufacturing, along with his experience working with suppliers in China, LoDuca decided to start his own company – DUKAL Corp. He sensed an opportunity to sell good-value, good-quality, less-expensive wound care products for the nursing home and physician markets.

Growth He spent many hours explaining the American medical products industry to potential suppliers in China,

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Distribution ties A member of the Health Industry Distributors Association Educational Foundation Board, and 2018 recipient of HIDA’s John Sasen Leadership Award, LoDuca has always valued his relationships with distribution. He has also served as a member of the vendor advisory council of ROi, the supply chain organization of Mercy; and as president of the Healthcare Manufacturers Management Council.

He takes very seriously DUKAL’s program mentoring students in the Business Plan Competition and

Executive-in-Residence program at his alma mater, St. John’s University (where one of his professors of 50 years ago still works).

“I let the students know that the uncertainties they are facing are no different than those of the generations before them,” he says. “I tell them, ‘If there’s uncertainty in your lives, don’t be afraid. You will face tremendous successes and failures in your lives. This is normal. Set your own goals, work hard and diligently.

“And treat people how you want to be treated.”

An airport encounter

By Donna LoDuca A good portion of Gerry LoDuca’s life has been in and around airports traveling for both work and pleasure. At home there is always a suitcase, duffel or tote in some stage of packing or unpacking. His favorite suitcase proudly carries an American Airlines luggage tag showing that he is in the 5 Million Mile Club … and don’t think he doesn’t throw this around any time he gets before a ticket or gate agent.

My best travel memory of Gerry was when we were flying out of a Florida airport and were passing through security (this was pre-TSA Precheck). The lines that day were horribly long and my son, in one of his usual Mickey Mouse t-shirts, was harassing us and others around him when we noticed a group of young servicemen being escorted through security rather quickly. Many people on the security line made a special effort to thank these soldiers for their service, which we thought was a bit unusual until we realized that most of the men had some form of physical combat injury that they were dealing with.

My husband at that point became a man on a mission. When we finally made it through TSA and realized we had some time before our flight, Gerry dragged us through the airport to find the soldiers so he could speak with them

and buy them lunch. He opened his wallet and took out his remaining cash, handing it to the captain, who was speechless.

My son and I were talking to a twenty-something private from Pennsylvania who had lost part of his leg and arm overseas, and Gerry sat in the middle of the rest of the troop listening to everyone’s story. These young soldiers were travelling to Walter Reed Army Hospital in Washington, D.C., to continue their recovery and assimilation into society and each had a heartbreaking and heartwarming story to share.

When the soldiers’ plane was ready to board, the captain turned to Gerry and said thank you, and my husband replied, “I wish I could have done more for your today.” And while Gerry was wishing everyone a safe flight and wonderful life, all of the emotions built up talking with these wonderful men just spilled over and he started to sob like a baby.

After they left, Gerry and I were talking and he said to me, sarcastically, “Well, that went well?! I wanted to give them some joy and all I did was cry with them!” After a good laugh we realized that he indeed did change their lives, even if it was only to see a man cry happy tears, not sad tears.

Donna LoDuca is Gerry LoDuca’s wife

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Medical Distribution

H A L L O F FA M E

Bill Sparks: Goalie-oriented With nerves of steel, he built a national rep firm – twice Sparks is being recognized for his pioneering work in developing not one, but two national independent rep firms.

Eagle River

Bill Sparks

B

ig sales. Big success. Big reputation. But in person, Bill Sparks – a 2019 inductee into the Medical Distribution Hall of Fame – hides it all pretty well.

“Bill had been with Welch Allyn for probably six months or so before we met in person at a national sales meeting,” recalls Brian Taylor, cofounder of Repertoire (who started his career at Welch Allyn). “I had seen the unbelievable orders he was writing with his dealers in the Upper Midwest, which dwarfed the orders of those of us with urban dealers. So when I met him, I expected this larger-than-life personality.

“But my first impression of Bill was like that of many who meet him for the first time – ‘Wow, such a quiet guy!’”

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Sparks was born and raised in Eagle River, Wisconsin, which is located in the northern part of the state, just a few miles south of Michigan’s Upper Peninsula. The city calls itself the Snowmobile Capital of the World®, and is home to the Wisconsin Hockey Hall of Fame.

“I had a wonderful childhood,” says Sparks, who today lives in the mountains west of Denver. “We were outside all the time.”

His father, Bill, was a detective for the county. To support the family, he worked off-hours as an electrician. And he took time out to coach his two sons in their sports activities.

Summer vacations often consisted of Bill Sr. and his wife, Edna, taking the kids to hockey summer camp.

“My brother and I were very fortunate to grow up in Eagle River,” recalls Sparks. “My dad was a hard worker; we never lacked for anything. He took his job seriously.

And in our house, there was always a clear right and a clear wrong.”

He attended St. Mary’s College (now St. Mary’s University) in Minnesota, where he was goalie on the hockey team. There he met his wifeto-be, Ann. In fact, the two got married in his senior year.

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Medical Distribution

H A L L O F FA M E

Ann’s father worked for American V. Mueller, selling surgical instruments primarily to the Mayo Clinic in Rochester, Minnesota. It was he who suggested that his son-inlaw look into medical sales. It so happened that the local Welch Allyn rep had recently left the territory. Sparks interviewed and got the job.

“I wasn’t sure I was cut out for sales,” he says. “Giving presentations to distributor groups wasn’t my gig.”

But he learned, and he enjoyed his years with Welch Allyn, ultimately moving to California to become the company’s western regional manager.

A national firm After some time, Sparks sensed an opportunity to differentiate himself as an independent rep – focusing on the

distributors he didn’t previously know. And it allowed him to exercise one of his strongest suits – coaching.

“I was able to make reps and managers comfortable,” he says. “I think I had a knack for figuring out their issues and helping them solve them. And they trusted me. Once you earn people’s trust, and you make an effort to learn something about their families, you’re at a whole different level.” The approach proved itself out. “Over the years, very few people have left on their own,” he says.

With its larger scope, MedTech attracted big, socalled “A” manufacturers. “Having a national sales force allowed us to present a different angle,” he says. The fact that MedTech reps carried multiple lines only increased their importance to distributors – and hence, to manufacturers that used distributors.

Sparks eventually sold MedTech.

“I thought I was on my retirement path, but I miscalculated – we had six kids going through college.” In 2006, when GE asked him to put together a team of reps to call on the acutecare market, he started MedPro. Today, MedPro has an acute care division with 20 reps plus a management –Manny Losada team, and a team of 24 reps and a management team covering the physician and long-term-care markets.

“ Sparky’s vision was to build professionally trained sales organizations that are an extension of manufacturers to reach these markets through the distribution channel.” equipment sales skills he had developed at Welch Allyn.

With encouragement from DeWight Titus, the owner of a well-respected California distributor (which Titus later sold to General Medical, now McKesson Medical-Surgical), Sparks began his new career in 1984. It was a big move, considering he and Ann had several children and, now, outstanding loans too.

It wasn’t Sparks’ intent to make MedTech Associates a national firm. What happened was much simpler: “I got too busy,” he says. Unable to service a growing customer list on his own, he brought on a couple of salespeople and grew the company’s territory in Northern and Southern California, and then Arizona. He recognized a bigger opportunity – to expand the company nationally, and began buying small rep firms and picking up geography.

“The big difference for me was when I gave up my territory,” he says. Freed from the day-to-day grind of servicing accounts, Sparks was able to develop his growing sales team around the country. Plus, he met a lot of

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True professionalism “Sparky’s vision at both MedTech and now MedPro was to build professionally trained sales organizations that are an extension of manufacturers to reach these markets through the distribution channel,” says Manny Losada, president and CEO of Optimal & MedPro Associates. “The core of our business today remains his vision. His message to both distribution and manufacturers reps is, pick up the phone, meet the person on the other end, and start a personal relationship that will ultimately build your business.”

“Bill’s contributions to the industry are huge,” says Taylor. “He brought true professionalism to the independent rep part of the industry. He was the first to convince the ‘A’ suppliers that independent reps made good economic sense. And he had the vision that an organization could be national in scope and still maintain the quality needed by top-flight suppliers.

“Bill was always fair with distributors, and suppliers valued his insight into how to work closely with major distributors.”

Still a consummate hunter and fisherman, Sparks is fearless “and has the nerves of a gambler,” says Taylor.

“He has a subtle sense of humor and he loves to have fun while doing his job.”

In fact, having fun is just one of the many things he learned from the man he identifies as his mentor – DeWight Titus.

“DeWight taught me that even if you’re the owner, president or CEO, you don’t have to be inaccessible,” says Sparks. “He always had time for me – as he did for his

own people, whether they were management, sales or in the warehouse. He always returned phone calls. And he taught me it’s OK to poke fun of yourself, and that a sense of humor is always important.”

A family man (six children and, at press time, 13 grandkids), Bill and Ann for years took in infants and kids in need of emergency shelter homes. They were usually kids born into unfortunate circumstances, waiting for custody hearings. “We probably took in 500 kids over the years,” he says.

Providing emergency shelter was not only good for the kids themselves, but for the Sparks family. “I think our kids saw a different side of the world, which they wouldn’t have seen otherwise.”

Speaking of Bill Sparks Brian Taylor, co-founder of Repertoire “I was never surprised when I would hear a story about Bill’s successes (or failures), because I knew that he always found a way to work things out for all parties involved. I always attributed his fearlessness to the fact that he had been a hockey goalie in college. Talk about the last line of defense. Bill was willing and able to tackle anything thrown his way.”

Manny Losada, president and CEO, Optimal & MedPro Associates “When you first run into Sparky, you see someone who could easily be playing backup fiddle in the Charlie Daniels band. His long hair throws you back to a kind of Renaissance man. In fact, many have mistaken him for the famous ‘most interesting man in the world’ commercial. All very true, but to have the privilege of shaking one of the industry’s most trusted handshakes and to become a partner and lifelong friend is hard to describe from a first impression. What I can say from first impressions is, once you have the conversation, you know immediately you are dealing with the truth. Good or bad, you will hear it. It no-nonsense back-to-the-basics

business, do what you say you are gonna do, and if you screw up, get back on the horse and try again.”

Mark Seitz, president and CEO, NDC “Bill was quick to recognize that [for his company] to be successful, his people had to spend many hours on the road, away from friends and family. At Christmas time, Bill provided gifts and wrote notes to the spouses of his team members to ensure that the families of his reps understood that he recognized and appreciated the sacrifice the families were making.”

Scott Adams, publisher, Repertoire “What would the industry miss had Bill Sparks never been a part of it? For starters, hundreds of young men and women would have never made it to the industry. Bill has employed, trained and mentored many reps. Second, we would have missed an old school ‘give someone your word and live by it’ businessman, who grew an independent rep group nationally, not once but twice. He and the MedTech guys shaped what the independent manufacturer community looks like in healthcare today.”

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Medical Distribution

H A L L O F FA M E

Medical Distribution Hall of Fame Inductees 2001 • George Blowers, Welch Allyn • Jim Stover (William T. Stover), National Distribution & Contracting • DeWight Titus, F.D. Titus & Sons 2002 • Bob Barnes, Durr-Fillauer • Karl Bays, American Hospital Supply • Pat Kelly, PSS • Ron Stephenson, Indiana University 2003 • John McGuire Sr., Colonial Hospital Supply • Haworth Parks, Parks Inc.

2011 • Scott Fanning and Don Kitzmiller, Midmark Corp.

2012 • Ted Almon, Claflin Co. • Cindy Juhas, Hospital Associates 2013 • Rob Saron, Bovie Medical Corp.

2014 • Bill McLaughlin, IMCO • Yates Farris, IMCO

2004 • B ill McKnight, McKnight Medical Communications • George Ransdell, Ransdell Surgical

2015 • Brian Taylor, Medical Distribution Solutions Inc.

2005 • Max Goodloe, General Medical

2016 • Brad Connett, Henry Schein Medical

2006 • Gil Minor III, Owens & Minor

2017 • Dick Moorman, Midmark • Mike Carver, GOJO Industries • Tony Melaro, Welch Allyn

2007 • Elliot Werber, Kendall Corp., F. D. Titus & Sons, Bergen Brunswig 2008 • Bill and Lew Allyn, Welch Allyn 2009 • John Sasen, PSS

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2010 • John Moran, Welch Allyn

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2018 • Paul Julian, McKesson Corp.

2019 • Roger Benz, Concordance Healthcare Solutions • Gerry LoDuca, DUKAL Corp.

• Bill Sparks, MedPro

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LEADERSHIP

The Conflict Trap Why avoiding conflict often prolongs it

By Lisa Earle McLeod Do you like conflict? Most people donâ&#x20AC;&#x2122;t. But sometimes, trying to keep the

peace simply prolongs the problem.

I was working with a leadership team who had problems with the IT department. They were reluctant to openly express their frustrations to the IT leader (their peer) because he was a strong personality who was close to the big boss. Reluctant to risk an uncomfortable conversation, the rest of the team avoided discussing the issues openly, grumbling and complaining on the sidelines instead.

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The problems continued while frustration grew. By attempting to keep the peace, the leadership team fell into three dangerous (and common) conflict avoider traps:

1. False assumptions about intent When the IT leader said, “we have other priorities,” the team made all kinds of assumptions. Their story was: “He doesn’t care about the rest of the business. He’s trying to build a fiefdom.” But that was their story; in truth they didn’t know why he had chosen those other priorities.

It’s like the classic orange conflict. Two people fighting over an orange who both want the whole thing. Yet when asked why they want it one replies, “I need all the juice to make my cake.” The other replies, “I need all the zest from the peel to make my frosting.”

What seems to be a conflict; might not be. When I coached the leadership team to ask questions like, “Tell us more about how this will play out?” The IT leader showed surprising understanding about operations, but he didn’t have much information about the client market. His priorities weren’t wrong, they were simply based on what he thought would be best.

With greater shared understanding the team could make better decisions.

2. Mistaking enthusiasm for attachment The IT leader was confident and articulate. But because he was clear in his priorities, the team assumed he was inflexible. Frankly, I encounter this

problem a lot in my own life. I get excited about things quickly. I start talking a mile a minute; I come up with a plan, set goals and am ready to move fast. It can be overpowering for some people. They often assume because I’m so excited about my ideas, I’m unwilling to consider anything different.

But confronting a dominant personality doesn’t have to be combative. I taught the team how to keep things neutral and ask questions.

Instead of saying, “This won’t work,” they asked, “Tell me about this part, I don’t understand.” As it turned out, the IT leader was attached to some

One of the big reasons people avoid conflict is because they doubt their own ability to guide a conversation. They assume it’s going to be an argument and they’ll lose. The thought process goes something like this: “He wants this, and I want that, there’s no way to resolve it, so I’ll just avoid.” things, but on several other elements, he was really open to new ideas.

3. Lack of confidence One of the big reasons people avoid conflict is because they doubt their own ability to guide a conversation. They assume it’s going to be an argument and they’ll lose. The thought process goes something like this: “He wants this, and I want that, there’s no way to resolve it, so I’ll just avoid.”

But disagreements don’t mean death; they’re just disagreements.

Over time, the leadership team was able to see that healthy disagreement is crucial for innovation. As they became more confident in the ability to work through issues, they addressed them sooner and worked through them more quickly.

Avoiding conflict only keeps you trapped in it. When you address issues early without angst or malice, you save yourself a lot of grief.

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, purpose-driven sales organization. Her NSP is to help leaders drive revenue and do work that makes them proud.

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HEALTH FOCUS: iFOBT

Colorectal Cancer Growing concern among young Americans

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Rates of colorectal cancer are rising for the under-50

crowd, but declining for those over 50 to 55. Those findings, reported by the American Cancer Society in its May 2018 Colorectal Cancer Screening Guideline, caused ACS to recommend that average-risk adults aged 45 years and older undergo regular screening with either a high-sensitivity stool-based test (e.g., iFOBT) or a structural – visual – exam, based on personal preferences and test availability.

As a part of the screening process, all positive results on non-colonoscopy screening tests should be followed up with timely colonoscopy, according to ACS. True, the Society calls its most recent guideline a “qualified recommendation,” whereas its prior recommendation for regular screening in adults aged 50 years and older remains a “strong recommendation.” Nevertheless, ACS issued its recommendation based on a systematic evidence review of colorectal cancer screening literature and modeling analyses.

Not every professional group is completely onboard with the ACS recommendation. The U.S. Multi-Society Task Force (MSTF) on Colorectal Cancer – which represents the American Gastroenterological Association, American College of Gastroenterology, and the American Society for Gastroenterological Endoscopy – is standing by its 2017 recommendations, which call for screening for colorectal cancer beginning at age 50 years in averagerisk people, except in African-Americans, in whom some evidence supports screening at 45 years. Nevertheless, MSTF recognizes that earlier screening may improve early detection and prevention of colorectal cancer. At the very least, the Task Force acknowledges that the ACS recommendation will stimulate discussion and further research on the risks and benefits of earlier screening.

Onset among the young Colorectal cancer (CRC) is the fourth most commonly diagnosed cancer among adults in the United States, reports the ACS. Over 140,000 Americans were expected to be diagnosed with it in 2018. It is the second leading cause of cancer death, leading to over 50,000 deaths annually. The highest incidence and mortality rates are among African-Americans, American Indians, and Alaska Natives.

Risk factors associated with a Western lifestyle that have been shown to increase CRC risk include: cigarette smoking; excess body weight; diet, including high consumption of alcohol and red and processed meat and

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HEALTH FOCUS: iFOBT low consumption of fruits/vegetables, dietary fiber, and dietary calcium; and physical inactivity, says ACS. The risk for developing colorectal cancer is associated with several identified hereditary conditions, including family history; medical conditions, including chronic inflammatory bowel disease and type 2 diabetes; and a history of abdominal or pelvic radiation for a previous cancer.

Among adults younger than 55 years, the incidence of colorectal cancer increased 51 percent from 1994 to 2014, and mortality increased 11 percent from 2005 to 2015.

“Young onset rates of colorectal cancer are absolutely rising, and we as clinicians need to be cognizant of that when we see our young patients in the office who present with digestive complaints of concern,” says Sophie M. Balzora, MD, FACG, who is chair of the American College of Gastroenterology’s Public Relations Committee and of the NYU School of Medicine. It is not clear why colorectal cancer is increasing in this population, she adds.

While Balzora could not comment on ACG’s behalf on the American Cancer Society’s newest recommendations,

“what I can say is that the recognized increased rate of rectal cancer in those under age 50 has sounded an alarm, and heightens the importance of informing patients in this age group to not ignore their digestive symptoms and to seek the care of their physician sooner, rather than dismissing symptoms. This is something we have always stressed, but this message is more important now than ever.”

The good news If there is good news to report, it is this: Colorectal cancer incidence and mortality among adults aged 55 years and older have shown a decline for several decades, which accelerated around 2000, particularly among adults aged 65 years and older, according to ACS. Although changes in exposure to risk factors account for an estimated onehalf of the reduction in incidence and one-third of the reduction in mortality before 2000, subsequent accelerated declines in incidence and mortality since 2000 are largely attributable to increased screening, with improved treatment also contributing to mortality reduction.

U.S. Multisociety Task Force on Colorectal Cancer: Statement regarding new recommendations The MSTF has previously recommended that colorectal cancer screening for average-risk persons (persons who do not have a family history of colorectal cancer in a first-degree relative) begin at age 45 years in African Americans and age 50 in other groups. The MSTF has reviewed the recent recommendation from the American Cancer Society (ACS) to lower the age to begin screening from 50 to 45 years in all Americans. This change was a qualified recommendation based largely on a modeling study utilizing updated data on the incidence of colorectal cancer in younger people.

Evidence from screening studies to support lowering the screening age is very limited at this time. Based on the modeling study used to support the ACS recommendation, the MSTF

recognizes that lowering the screening age to 45 may improve early detection and prevention of CRC. The MSTF expects the new ACS recommendation to stimulate investigation that will clarify the benefits and risks of earlier screening.

As the MSTF has previously noted and discussed, rates of colorectal cancer are increasing in Americans down to age 20 years.

Beginning screening at 45 years addresses only part of the increasing risk of colorectal cancer in young persons. For all persons under 50 years, it remains critical to promptly assess symptoms consistent with colorectal cancer.

In particular, rectal bleeding and unexplained iron deficiency anemia have substantial predictive value for colorectal cancer and should be thoroughly evaluated.

Source: U.S. Multisociety Task Force on Colorectal Cancer, June 14, 2018, https://www.gastro.org/ press-release/statement-from-the-u-s-multisociety-task-force-on-colorectal-cancer

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HEALTH FOCUS: iFOBT “Screening saves lives, and this group [those aged 55 and over] has been heavily targeted, which is fantastic to see,” says Balzora.

“The ‘Katie Couric Effect’ was a true phenomenon that increased colorectal cancer screening rates tremendously,” she says, referring to the efforts of the journalist and author.

“Having her colonoscopy nationally broadcast on live television in March 2000 was an innovative and extremely successful method of driving home the importance of colorectal cancer screening.

“As gastroenterologists, we strive to prevent colorectal cancer over detecting it, which is why we feel colonoscopy

is the best test, as it can truly prevent colorectal cancer, as well as detect it,” says Balzora.

Stool-based, noninvasive testing – such as iFOBT, or FIT – does not prevent colorectal cancer, because its primary goal is to detect colorectal cancer, and not precancerous polyps, she says.

“But ultimately, the best test is the one that gets done (properly)!”

FIT testing is an excellent noninvasive alternative to colonoscopy, assuming that patients follow through by getting a colonoscopy should the FIT test return positive, says Balzora.

“FIT has a significant advantage over FOBT testing, as it is specific to lower intestinal bleeding, and is a better, more accurate test overall compared with FOBT testing.”

American Cancer Society Guideline for CRC Screening, 2018 The American Cancer Society recommends that adults aged 45 years and older with an average risk of colorectal cancer (CRC) undergo regular screening with either a highsensitivity stool-based test or a structural (visual) examination, depending on patient preference and test availability. As a part of the screening process, all positive results on non-colonoscopy screening tests should be followed up with timely colonoscopy.

The recommendation to begin screening at age 45 years is a qualified recommendation.

The recommendation for regular screening in adults aged 50 years and older is a strong recommendation.

The ACS recommends that average-risk adults in good health with a life expectancy of greater than 10 years continue CRC screening through the age of 75 years (qualified recommendation).

The ACS recommends that clinicians individualize CRC screening decisions for individuals aged 76 through 85 years based on patient preferences, life expectancy, health status, and prior screening history (qualified recommendation).

The ACS recommends that clinicians discourage individuals over age 85 years from continuing CRC screening (qualified recommendation).

Options for CRC screening Stool-based tests: • F ecal immunochemical test every year.

•H igh-sensitivity, guaiac-based fecal occult blood test every year.

• Multitarget stool DNA test every 3 years.

Structural examinations • Colonoscopy every 10 years.

• CT colonography every 5 years.

• Flexible sigmoidoscopy every 5 years.

Source: Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society, CA: A Cancer Journal for Clinicians, https://onlinelibrary.wiley.com/doi/ full/10.3322/caac.21457#caac21457-tbl-0001

Resources:

American Cancer Society Colorectal Cancer Screening Guideline (2018), https://www.cancer.org/health-care-professionals/american-cancer-society-prevention-earlydetection-guidelines/colorectal-cancer-screening-guidelines.html Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer, July 2017, Gastroenterology (https://www.gastrojournal.org/article/S0016-5085(17)35599-3/fulltext)

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TRENDS

Small Guys Finish Last Small practices lag behind big ones under MIPS

Small and rural medical practices

didn’t fare nearly as well as their bigger, non-rural counterparts in the first year (2017) of the Quality Payment Program of the Centers for Medicare and Medicaid Services, researchers reported in Health Affairs.

Many large practices qualified as exceptional performers (mean and median CPS – composite performance score – of 74.37 and 90.29, respectively), while most small practices did not (mean and median CPS of 43.46 and 37.67, respectively). On average, rural practices performed worse than large practices (median CPS of 75.29 versus 90.29, respectively).

Nearly one in every five small practices (19 percent) in MIPS received negative payment adjustments compared to 5 percent of program participants overall. This could have occurred for a number of reasons, including limited ability to shoulder program reporting burden or a combined effect of inadequate risk adjustment in MIPS and high clinical or social complexity at smaller practices, according to the researchers.

Further research should examine why smaller practices appear to be at a systematic disadvantage, and policymakers should consider measures to avoid unfairly penalizing these practices in MIPS, they concluded.

Implemented through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), QPP is a value-based payment program

with two participation options: the MIPS track and the Alternative Payment Model (APM) track.

For MIPS, physicians earn a payment adjustment based on evidence that they provided high-quality, efficient care supported by technology. To do so, they must submit information in the following categories: • Quality (50 percent of final score), which measures health care processes, outcomes, and patient care experiences.

• Promoting interoperability requirements (25 percent of final score), which promotes patient engagement and electronic exchange of information using certified electronic health record technology.

2017 MIPS CPS By Practice Setting And Size

• I mprovement activities (15 percent of final score), a category that gauges participation in activities that improve clinical practice, such as expanding practice access, improving care coordination and promoting patient safety.

•C ost (10 percent of final score). This category – new in 2018 – measures resources that clinicians use to care for patients, and the Medicare payments for care (items and services) given to a beneficiary during an episode of care.

Note because the “cost” category was new in 2018, it was not considered in the 2017 performance data.

Source: Health Affairs, Jan. 18, 2019

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HEALTHY REPS

Health news and notes Get happy Being active can help you improve your health and feel better, says the Department of Health and Human Services. It can lower your blood pressure and reduce your risk of chronic diseases, like type 2 diabetes and certain cancers. Physical activity can also boost your mood and help sharpen your focus. In its new Physical Activity Guidelines for Americans, HHS says that adults need at least 150 minutes of moderate-intensity physical activity per week. You can start with just 5 minutes at a time.

Swim, garden, walk the dog, dance, or bike your way to

feeling better. Strengthening your muscles is important too. At least two days each week, do some push-ups or lift weights. Children ages three to five should be physically active for at least three hours throughout the day. Kids six through 17 need at least one hour per day. All of your physical activity adds up. Moving more often throughout the day can help you get enough activity.

said Petra Hanson, MBChB, MRCP, AFHEA, a clinical research fellow at Clinical Sciences Research Laboratories, University Hospitals Coventry and Warwickshire, U.K. “Mindfulness taught in such a setting can also improve patients’ confidence and ability to manage weight in the long term. It is a very scalable intervention that can be applied to everyone.”

Housework for brainiacs Now there’s no excuse for not doing more housework.

Even simple housework, like cooking and cleaning, may make a difference in brain health, according to researchers at Rush University Medical Center in Chicago. In the last years of research before death, each participant in the Rush study wore an activity monitor called an accelerometer, similar to a Fitbit, which measured physical activity around the clock – everything from small movements, such as walking around the house, to more vigorous movements, like exercise routines.

Researchers collected and evaluated 10 days of movement data for each participant and calculated an average daily activity score.

The findings showed that higher levels of daily movement were linked to better thinking and memory skills, as measured by the yearly cognitive tests. And when researchers analyzed brain tissue under a microscope, this finding turned out to be the case even for individuals with at least three signs of Alzheimer’s disease, such as amyloid plaques and neurofibrillary tangles. Even though these individuals might have been diagnosed with Alzheimer’s, 30 percent of them had “normal” cognition at death.

Pay attention Adults with obesity who attended group sessions teaching mindfulness-based eating techniques lost an average of 2.85 kg more than similar adults who attended group classes without mindful eating strategies, according to findings published in The Journal of Clinical Endocrinology & Metabolism and reported by Helio.com. “Our study has shown that mindfulness techniques can improve eating behavior and facilitate weight loss in patients with obesity attending specialist weight management service,”

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What to do about vaping?

Health authorities agree: Teen vaping is an epidemic that affects some 3.6 million underage users of Juul and other e-cigarettes, reports the New York Times. But no one seems to know the best way to help teenagers who may be addicted to nicotine. E-cigarettes heat a liquid solution that usually contains nicotine into an inhalable vapor. Federal law prohibits sales to those under 18, though many high schoolers report getting them from older students or online. In recent

months, government officials have rolled out a series of proposals aimed at keeping the products away from youngsters, including tightening sales in convenience stores and online.

In November, vaping giant Juul voluntarily shut down its Facebook and Instagram accounts and pulled several flavors out of retail stores. But there’s been little discussion of how to treat nicotine addiction in children as young as 11 years old. Physicians who treat young people now face a series of dilemmas: The anti-smoking therapies on the market – such as nicotine patches and gums – are not approved for children, due to lack of testing or ineffective results. And young people view the habit as far less risky than smoking, which poses another hurdle to quitting.

We make needles that make everyone comfortable.

Unhappy meal A hamburger a week, but no more – that’s about as much red meat people should eat to do what’s best for their health and the planet, according to a report by EAT, a Stockholmbased nonprofit, and published in the medical journal Lancet, reports the New York Times. Eggs should be limited to fewer than about four a week, and dairy foods should be about a serving a day, or less. The report from a panel of nutrition, agriculture and environmental experts recommends a plantbased diet, and encourages whole grains, beans, fruits and most vegetables. Added sugars should be limited, as should refined grains, such as white rice, and starches, like potatoes and cassava. It says red meat consumption on average needs to be slashed by half globally, though reductions would need to be more dramatic in richer countries like the United States.

Older adults: Mind your protein Older adults need to eat more protein-rich foods when losing weight, dealing with a chronic or acute illness, or facing a hospitalization, according to a growing consensus among scientists, reports Kaiser Health News. During these stressful periods, aging bodies process protein less efficiently and need more of it to maintain muscle mass and strength, bone health and other essential physiological functions. Even healthy seniors need more protein than when they were younger to help preserve muscle mass, experts suggest. Yet up to one-third of older adults don’t eat an adequate amount due to reduced appetite, dental issues, impaired taste, swallowing problems and limited financial resources. Combined with a tendency to become more sedentary, this puts them at risk of deteriorating muscles, compromised mobility, slower recovery from bouts of illness and the loss of independence.

A lot hinges on having the right needles. That’s why Terumo’s SurGuard®3 offers some very convincing benefits.

Sharper – Patients benefit from a more comfortable injection, as our needles are 10%* sharper than the market leader and sharpest on average among major brands Safer – Safety mechanism includes a lock for both the needle and the hub, and is designed to minimize the ability to be removed Smarter – Clinicians can choose how they activate the safety mechanism using their finger, thumb or hard surface as dictated by the clinical situation We make some great points. Whatever you’re looking for in a safety needle, SurGuard®3 from Terumo has you covered. For more information, call Terumo at 800-888-3786 or visit terumotmp.com to find your Terumo representative.

TERUMO and SurGuard are trademarks owned by Terumo Corporation, Tokyo, Japan, and are registered with the U.S. Patent and Trademark Office. ©2018 Terumo Medical Corporation 6/18.

All rights reserved. PM-00628. *Data on file. Terumo Medical Products, April 2016.

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WINDSHIELD TIME Chances are you spend a lot of time in your car. Hereâ&#x20AC;&#x2122;s something that might help you appreciate your home-away-from-home a little more.

Automotive-related news

Car? Not for me!

Retail auto sales in the U.S. could drop as much as 29 percent as alternatives to traditional vehicle ownership become more accessible and affordable, decreasing the number of miles consumed by personally owned vehicles.

This is according to the Cox Automotive Evolution of Mobility Study, released in mid-January. The latest study

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shows the cost of automobile ownership continues to be a major issue for many Americans, with nearly half of consumers surveyed believing car ownership is too expensive. Consumers are open to exploring new transportation methods versus owning, with more one-third (36 percent) of respondents interested in reducing the number of vehicles they own in the next five years.

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The glorious lightness of the MX-5

05.02.2019 09:48:00

Opioids more dangerous than car crashes

The 2019 Mazda MX-5 Miata may not be the fastA person is more likely to die from an accidental opioid est car out there, but it sure is fun, say the editors of overdose than from a motor vehicle crash, according to the Cars.com. The car is said to handle well, with power, National Safety Council. The odds of dying accidentally and is pretty fuel-efficient. “But the from an opioid overdose have risen to Miata magic is more than just what one in 96, eclipsing the odds of dying Tel Aviv-based the car can do,” they write. “It’s how in a motor vehicle crash (one in 103).

Eyesight has teamed it makes you feel, as well. Walking Preventable injuries are the third leadup with Samsung up to it, you notice the super-tidy ing cause of death, claiming an unprecdimensions. … It’s also simple to Electronics to produce edented 169,936 lives in 2017, and trailuse – the top opens and shuts with ing only heart disease and cancer. Of a “Driver Monitoring ease from the driver’s seat, but it’s the three leading causes of death, preSystem” to keep so light and easy to manipulate that ventable injuries were the only category drivers on their toes.

Mazda doesn’t bother with a power to experience an increase in 2017, acmechanism. Flip a handle, throw it cording to NSC analysis of the CDC The system will back, snap it down, and you’ve let the monitor a driver’s gaze data issued in December. A person’s sunshine in. There’s also the added lifetime odds of dying from any predirection, pupil dilation, security of the RF model, with its ventable, accidental cause are one in 25 eye openness, blink powered hardtop, but you’ll be giv– a change from one in 30 in 2004. ing up some of the Miata’s glorious rate and head position lightness with that heavier lid.” (FYI: Drive-in to detect levels of Last year, Cars.com named the 2018 ConnectedTravel®, collaborating with drowsiness and Volkswagen Golf GTI as its Most Honda, launched its mobile infotaindistraction.

Fun-to-Drove Car.) ment, commerce, and rewards platform,

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WINDSHIELD TIME called Honda Dream Drive. The system offers a proprietary voice-controlled user interface into a range of search, reservation, ordering and purchasing services integrated with Honda’s in-vehicle payment technology. Drivers and passengers can find and pay for goods and services such as fuel, food, coffee, movie tickets and parking. They are rewarded with points, redeemable at more than 50 brick-and-mortar locations as well as online retailers.

establish a baseline in user behavior, and then identify patterns and trends to customize the cabin accordingly. Another feature of the R.E.A.D. System is Kia’s music-response vibration seats, which adapt seat vibrations according to sound frequencies of the music being played.

Crash landing

There are more than 13 million auto accidents every year in the U.S., often leaving drivers confused and uncertain of what to do in the minutes following the colliTel Aviv-based Eyesight has teamed up with Samsung sion. CCC Information Services has produced a system Electronics to produce a “Driver Monitoring System” (Accident Advisor) – for sale to car makers – which will to keep drivers on their toes. The system will monitor a prompt drivers to capture facts and photos of the accidriver’s gaze direction, pupil dilation, eye openness, blink dent, and offer them the option to digitally notify their rate and head position to detect levels of drowsiness and insurer of the accident. Drivers will be able to search for collision repair shops and in conjunction with other There are more than 13 million auto accidents CCC offerings can in many instances every year in the U.S., often leaving drivers even get text message status updates confused and uncertain of what to do in the as their vehicle moves through the minutes following the collision. CCC Information repair process. Participating insurers will be able to receive accident docuServices has produced a system (Accident mentation from their policyholders, which can help the insurer improve Advisor) – for sale to car makers – which will claim handling time and the policyprompt drivers to capture facts and photos holder experience.

Keep your eyes on the road

of the accident, and offer them the option to digitally notify their insurer of the accident. distraction. A car manufacturer can decide what to do next – e.g., sound an alarm to alert the driver, suggest a rest, or activate more self-driving features.

Your car feels your pain Feeling like everything’s coming up roses this morning? Or maybe you’re feeling glum? Whatever the case, Kia’s “Real-Time Emotion Adaptive Driving (R.E.A.D.) System – under development – will personalize a vehicle cabin space by analyzing a driver’s emotional state. The technology uses sensors to read the driver’s facial expressions, heart rate and electrodermal activity. It then tailors the interior environment according to its assessment – potentially altering conditions relating to the five senses within the cabin. AI technology is said to enable the system to

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Mandatory breathalyzers

This year, California joined the majority of states that have laws requiring drivers with drunken-driving convictions to install breathalyzers in vehicles they own or operate, reports Kaiser Health News. The gadgets, known as ignition interlock devices, are mounted on the steering wheel of a vehicle and prevent it from starting if the driver’s blood-alcohol reading is above a predetermined level. In California, the breathalyzers are mandatory only for repeat offenders. Five other states – Georgia, Indiana, Massachusetts, Montana and Ohio – have similar laws. Thirty-two states and D.C. require the devices even for first-time offenders. The advent of such laws across the United States in the past 15 years has been accompanied by some good news; Deaths involving drunken driving are only about half of what they were in the early 1980s, though they have ticked back up in recent years.

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

Technology news 5G is coming. Fast.

5G is a set of technical ground rules that define the workings of a cellular network, including the radio frequencies used and how various components like computer chips and antennas handle radio signals and exchange data, explains the New York Times. But lay people need to know just one thing – it’s fast. We’ll be able to download movies in seconds. Streaming video will be a breeze. The virtual

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reality experience will be much less cumbersome than it is today. The faster networks could help spread the use of artificial intelligence and other technologies.

The kids are alright Expectant mothers, start your day confident in the wellness of your unborn child, with the Owlet Band. Specialized sensors housed in a fabric band that sits around the

wirelessly to enjoy clear, natural sound.” The turntable – which costs about $200 – has a built-in Bluetooth® transmitter. Featuring one-step auto playback, it automatically lowers the tone arm, finds the groove and plays the music. When the record ends, the tone arm automatically returns to its resting position.

Speed drying The Zero vacuum clothes dryer from MORUS is said to achieve low-temperature, low-energy-consumption and high-speed clothes-drying. The company says you’ll like the Zero for three reasons: 1) The drying process is faster, because the Zero allows the water in the clothes to Specialized boil at a lower temperature, sensors housed so the water will evaporate in a fabric band more easily; 2) vacuum drying can significantly reduce that sits around energy use, because it does the mother’s not need to heat the drum abdomen track to a high temperature befetal heart rate and cause the boiling point of water is lowered; and 3) kick count in the low-temperature drying second and third protects clothes. Overheattrimesters, sending ed tumble drying reduces real-time data to a the strength of textiles, and it is a main cause of fabric smartphone. wear damage.

Smart countertop oven

mother’s abdomen track fetal heart rate and kick count in the second and third trimesters, sending real-time data to a smartphone. It offers fetal heart rate tracking, fetal heartbeat recording, wellness notifications, automated kick counting, contraction tracking, and maternal sleep position indicators. The sensors are said to be extremely thin and are bonded to a stretchable knit fabric band, providing a form-fitting and comfortable feel.

Wireless turntable Sony Electronics Inc. announced the Sony PS-LX310BT wireless turntable, said to “fuse the much-loved vinyl sound quality with the convenience of connecting

Whirlpool Corporation’s Smart Countertop Oven automatically recognizes various types of food placed inside, and sets the time and temperature needed for optimal results, says the company. Small enough to fit on your counter, the oven’s algorithm is said to control the time and temperature for perfectly cooked broccoli, chicken, pizza and more, regardless of whether it’s frozen or fresh. The convection heating system is said to eliminate the need to preheat certain food types and maintain a uniform temperature throughout the oven to evenly cook the food. Pre-order from Whirlpool for $800.

Sweet dreams You work hard. So you deserve to be awakened and put to sleep gently. If your mom’s not around to do it, Google Assistant can. Use voice commands with Google Assistant to active sleep and wake lighting using Philips Hue functionality. Users can say “Hey Google, turn on Gentle Wake Up,” which will sync their Philips Hue lights with their morning

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QUICK BYTES

alarms with the Google Assistant.

Every time, the user sets their alarm on the Google Assistant, Philips Hue lights will naturally wake them up with a sunrise effect starting 30 minutes before the alarm. Users will be able to set the sleep feature by saying “Hey Google, sleep the lights at 10 p.m.”

The lights will change to a warm tone of white light, which will gradually fade out over 30 minutes. For more information go to www.meethue.com

Smart glasses

Just as users of smartphones see alerts and information on their mobile screens when they hold their phones, wearers of the Vuzix Blade AR Smart Glasses receive personalized alerts and information as a function of where they are looking with a visual overlay that pops into their field of vision.

Not only do they look good, but the Vuzix Blade AR Smart Glasses support app developers and applications running directly on the glasses. Just as users of smartphones see alerts and information on their mobile screens when they hold their phones, wearers of the Vuzix Blade AR Smart Glasses receive personalized alerts and information as a function of where they are looking with a visual overlay that pops into their field of vision. The platform includes an Android-based operating system, a cloud-based services platform that is being developed specifically for the Blade, and a growing number of apps and software, including Yelp and AccuWeather. They cost about $1,000 at www.vuzix.com

Charging by backpack The Mobile VIP+Backpack from Targus includes Qi-charging that allows users to carry and charge their Qi-enabled

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smartphone, such as the iPhone 8 Plus, iPhone X, or Samsung Galaxy S9. The case features an integrated charging holster designed to seamlessly secure the charging smartphone even if the backpack is bumped or dropped. The pack also incorporates an RFID-blocking pocket that helps prevent credit cards from being skimmed remotely.

What’s more, it is said to feature contoured shoulder straps and an airmesh back panel for comfort, a trolley strap to secure to rolling luggage, and a tuck-away water bottle holder.

Cost: about $200.

For the “mature” rep Now available for in-home senior care, CarePredict Home from CarePredict uses machine learning, smart wearables, and kinematics to quantify daily activities performed by older adults and predict certain health conditions. Its AI platform is said to consist of lightweight sensors and wearables, designed for seniors, to unobtrusively and autonomously collect data sets on senior’s activities and behavior patterns. These activities include but are not limited to eating, drinking, walking, grooming, sleeping, bathing, and toileting. Learning models can identify signs and symptoms of self-neglect indicative of depression, unusual toileting patterns indicative of a urinary tract infection (UTI), or increased fall risk due to malnutrition, gait changes, lack of rest, and dehydration.

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HEALTHCARE MANUFACTURERS MANAGEMENT COUNCIL

HIDA GOVERNMENT AFFAIRS UPDATE

Key Supply Chain Rules Take Effect This Fall If your company sells pharmaceutical products – and many medical-surgical dis-

By Linda Rouse O’Neill, Vice President, Government Affairs, HIDA

tributors do – there’s an important deadline coming this fall. The Drug Supply Chain Security Act (DSCSA) requires pharmaceutical manufacturers and repackagers to add product identifiers to (or “serialize”) pharmaceutical products, as of November 27 of last year. The next deadline under this rule, November 27, 2019, is the date after which distributors can only buy, carry, or sell (“transact”) in serialized products and are required to verify serialized product identifiers (PIs) for saleable product returns before they can be resold.

What this means for distributors Manufacturers and repackagers are now required to begin putting a PI on each package. The packages with the identifier must be the smallest saleable unit (set by manufacturers), and the identifier must be printed with a machine readable (2D) barcode and human readable text. After the 2019 deadline, distributors are not permitted to sell any products that do not contain the necessary PIs. Now is the time to make sure your trading partners are aware of these requirements. If your company operates a low-unit-of-measure program or a just-in-time program, it is responsible for making sure the smallest saleable unit it delivers possesses a product identifier.

Complying with this requirement could be a challenge for some distributors. For this reason, HIDA and its members have been reaching out to the Food and Drug Administration (FDA) and advocating for measures to make this shift easier. The agency has previously indicated that it is willing to work with the supply chain, and granted

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enforcement discretion on a portion of the DSCSA in 2017. While the FDA was willing to listen to healthcare suppliers’ input in the past, there is no guarantee that it will be flexible in the future.

Communication between distributors and manufacturers is vital As this next phase of DSCSA approaches, it is important for distributors to stay in touch with their trading partners to understand their readiness for complying with the law. This information will help distributors make decisions about their own operations as well as how to track what they sell to customers. As the FDA continues to release information and updates on the DSCSA, an open channel between you and your manufacturing partner will ensure no compliance measure is overlooked.

If you would like more information about this law or the FDA’s enforcement discretion, please contact us at HIDAGovAffairs@HIDA.org.

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corner

John Kropf: Getting better at getting better

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Fleet manager for a trucking firm. Investment advisor. Phy-

Racing Penguins

sician practice operations manager. Competitor in the Frostbite Series boat race off Lake Michigan … in November!

Take experiences such as these, and add an underlying belief in the power of teamwork, and one starts to get a pretty accurate picture of the professional development of John Kropf, national account manager for Henry Schein.

Raised in suburban Chicago for most of his growingup years, Kropf graduated with a finance degree from the University of Iowa in 2005. He moved back to Chicago in 2006, got a master’s of business administration from DePaul University in 2013, and joined Henry Schein in 2014.

He lives in the Chicago area with his wife, Kate, and two sons – Will and Ben.

His father, Gary, ended his working career as the vice president of sales and marketing for Allied Machine & Engineering in Dover, Ohio. His mother, Joanne, was a teacher at St. Vincent-St. Mary High School in Akron, Ohio (LeBron James’ alma mater, Kropf points out). She was nominated in 2010 as a “Top Private High School Teacher in the State of Ohio.” Both are retired and live in Florida.

(His sister, Karen is a management consultant with Boston Consulting Group.)

“My dad was always fixing and racing something when I was a kid,” he recalls. “Before I was born, it was motorcycles (on ice!), then it was sailboats, which is when I started to get involved.” By age eight, he was on Lake Michigan

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helping his dad as he raced a 28-foot sailboat. By age 11, he and his father were racing Penguins (11-foot long, twoman boats) in Burnham Harbor in what was called the Frostbite Series in October-November.

From about 1997 until 2015, Kropf ’s father raced a 1959 Austin-Healey Sprite (called a “bugeye” because of the placement of its headlights) with the Vintage Sports Car Drivers Association. (He is still involved in the Race Committee.)

“Around 2012, as a Christmas present, he gave me the opportunity to go to drivers school,” recalls Kropf. “I had my racing license for three years, and we got to share a couple ‘Enduros,’ where you each drive 30 minutes as a team.

It was an awesome experience to be on a track with such pieces of art and history, including Lotus Super Sevens, Corvettes, Porsches. But it was an even cooler experience to be able to share my dad’s passion with him and see what it was all about.”

At the University of Iowa, he began studying engineering, which speaks to a love of math. But after taking Thermodynamics and C++ Computer Programming in his sophomore year, he changed his mind and transferred into finance, with a minor in journalism.

found entrepreneurial opportunities, took care of their employees (co-drivers/students), etc.

“I was watching and helping 45 people run 45 small businesses.

“Additionally, I learned – without knowing it – about the power of relationships in negotiations. The better I got along with certain drivers and the longer I worked with them, the more likely I was to get them on board with my ideas and strategies. It wasn’t just a mathematical formula to get from point A to point B efficiently; it was trust on a personal level – both ways – that really drove success in that role.”

Fleet manager

over $1.3 billion in assets under managements in financial portfolios for individual families and 401(k) plans for small and large businesses.

After passing exams to receive his securities licenses, he became the analyst for the team, executing trades, including mutual funds, bonds, CDs, options and more.

He also had responsibility for running 401(k) enrollment meetings for corporate clients, and he maintained rate-ofreturn reports for customers as well as the firm’s internal due diligence files on certain funds, including ETFs, or exchange-traded funds.

“The most fun – and the most I learned – was finally having my own clients,” he says. He grew his own book of business, which included some NBA players. “We dealt with agents, marketing partners, family members, cash flow issues, etc. Every day was different.”

Perhaps the most important takeaway for Kropf was learning “the customer service aspect of managing a business, and the value to the client of taking things off their plate,” he says.

Investment advisor In 2006 Kropf moved back to Chicago and took a position as a portfolio administrator (unlicensed) for Mesirow Financial. He worked on a team of six people that had

“ You cannot earn new business without each piece of the puzzle fitting together – pricing, shipping, website, accounts payable, data, credit, customer service.”

His first job out of school was as a fleet manager for CRST, a trucking firm in Cedar Rapids, Iowa. He was responsible for managing a fleet of about 45 to 50 independently contracted trucks, doing everything from load-planning logistics, to time off and payroll, to fulfilling safety requirements, to training students, to improving efficiency.

“I mention the independently owned and contracted part, because I think the concepts around owning your own business were my biggest takeaway from my time at CRST,” he says.

“These drivers owned their own trucks, and they had the right to say ‘no’ and refuse loads – which is much different than your standard ‘per mile’ employed driver. I didn’t realize it at the time, but this is when I first started selling.

“A large part of that role was getting the fleet on board with the company’s objectives or load requests, which weren’t always aligned, to say the least. (Think Denver in the winter/snow.) I learned a ton about how these folks operated their businesses, managed expenses,

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corner “It was extremely important not to get caught up in how to make our own lives easy, but how to be ‘easy to do business with’ from the client’s viewpoint. In my opinion, what really separated the good advisors from the great ones was the level of service and personal touch that each customer received.

“Having people trust you with their money is a responsibility very different from most careers, and it is literally impossible without the trust of your clients.”

Teamwork Getting the MBA from DePaul opened his eyes to the power of working with a team of people to analyze and improve the operations of an organization.

healthcare practice operations people, Six Sigma black belts from manufacturing, a nurse, a CEO, and others on our team – all providing input to an elementary school. It was fascinating, and the end result/assessment provided tremendous value to the school district.”

Additionally at DePaul, Kropf was placed on a team of five people that provided pro-bono management consulting services to administrative leaders at a Chicago Public Charter School. “We helped them deploy software and processes that assisted the school with managing the coordination of activities/documentation around certain educational programs and requirements.

It was eye-opening to become submerged in some of the challenges and obstacles this school system was facing, and the dedication they had to delivering for the kids they were educating.”

Practice operations management

“While at DePaul, I met a professor, Kenneth Thompson, who really had an impact on me. I think his class was called ‘Performance Improvement,’ but it was basically ‘how to get better at getting better,’ as he put it.” Through Thompson’s involvement as a lead examiner for the Baldrige Performance Excellence Program, Kropf became a member of the Illinois Performance Excellence Board of Examiners in 2014.

“We had the opportunity to analyze the operations of an elementary school, and provide feedback,” he says.

“This experience really opened my eyes to the value of learning and applying strategies across industries. We had

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DePaul’s MBA program had an internship work/class credit component, designed to partner students with companies with short-term needs and perhaps permanent roles for applicants with the skills developed during the internship. With the help of contacts at what was then called Adventist Health Partners (now AMITA Health), Kropf secured an internship helping the organization revamp its budget process (from a volume/encounter -based system to an RVU-based system). “With my financial background and interest in process improvement, this seemed like an awesome opportunity,” he says. When an operations manager role opened up, he was offered the position. “This was operationally facilitating their growth (50 to 60 providers per year) and managing their ambulatory supply chain.”

After becoming associate director of operations in 2014, and following the creation of AMITA Health (a joint operating company formed by Adventist Midwest Health and Alexian Brothers Health System in Arlington Heights, Illinois), Kropf became more involved in business development.

For example, as a strategy to increase patient referral compliance and keep patients in the network, he helped transform a small call center into a Referral Coordination Center. “Our staff would follow the patient from the time a referral to a specialist was made, to obtaining any necessary insurance pre-authorization, to reaching out to the patient to schedule directly into the specialist’s calendar, to ensuring that all necessary referral paperwork was completed in the EHR.”

corner The system called for behavior changes at many different points.

“We were asking the practices to enter referrals into the EHR differently,” he explains. “We were asking the EHR system itself to be set up in new ways to do new things. And we were asking our specialists to give us access to their calendars – maybe the hardest sell of all.

“We were becoming a remote extension of some of our practices,” he says. “We moved the needle within the medical group on generating new specialty revenue, increasing our Meaningful Use 2 (now part of MACRA/MIPS) and Patient

Center Medical Home key metrics, increasing health system ‘keepage’ (that is, reducing leakage), and, most important, providing a valuable service to the patients by helping them navigate a sometimes confusing referral process.”

A good fit In 2016, Henry Schein had an opening for a field sales consultant calling on independent practices in Chicago.

“When I spoke with Lisa Keenan – zone general manager at Schein – about the role, she said Henry Schein was looking for team members who could help across the entire

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spectrum of practice management, not just the supply chain. Henry Schein’s Solutions Portfolio really appealed to me, and I thought it aligned with my skillset very well.”

Even with his experience with AMITA, Kropf had plenty to learn about the non-acute-care world. “What surprised me was how difficult it was to change behaviors or purchasing patterns, even if it made perfect financial, clinical, or operational sense,” he says. “As a rep calling on independent small practices, you need to make the financial piece make sense, but you also have to make it easy for them to do business with you.”

And the rep has to rely on a team of people to make that happen, he says. “You cannot earn new business without each piece of the puzzle fitting together – pricing, shipping, website, accounts payable, data, credit, customer service.

“I had to lean on my internal partners and teammates to identify opportunities, to locate the necessary data, and to develop a strategy for those opportunities. I was very lucky to have a capital equipment specialist to assist with CHC expansions; fantastic sales support to open new accounts; GPO and contract specialists to help me find and access new/best-cost basis; a business intelligence team to run, sort, and present data in ways that spoke to our customers; and regional and zone sales managers to open doors for me.”

Today, as a national account manager, Kropf has responsibility for three large Midwestern IDNs. “This role [is] a tremendous opportunity to see how providers in different markets and specialties are tackling challenges, and then to [share] some of these concepts with our other customers. I’m talking about things like acquisition implementation, formulary/catalog development, contract compliance, supporting value-based-care reimbursement and vaccine standardization. These are challenges all of our customers are addressing in some way or another.

Who better to learn from than other customers?”

The future is bright for reps who can identify their customers’ pain points and help them solve their problems quickly and efficiently, says Kropf. “If we can use our resources to help our customers hit their financial goals in creative ways, they are going to continue to involve us in their decision-making processes.”

The 1st podcast about sales reps for sales reps.

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Episode 1 Brian Taylor

Episode 3 Brad Connett

Episode 2 Eddie Dienes

Episode 4 Tony Melaro

Episodes can be found at www.repertoiremag.com/resources/podcasts

Industry news Road Warriors and Their Untold Stories – new podcast hosted by Repertoire Publisher Scott Adams “Road Warriors and Their Untold Stories” is an educational, funny, real, and entertaining podcast hosted by Repertoire Magazine Publisher Scott Adams and is perfect for sales representatives out in their cars making sales calls every day. “I am so excited to launch this program. We will be interviewing current and past sales reps throughout this podcast series.

My goal is to let them tell their stories and hopefully to gain some pearls of wisdom along the way,” says Scott Adams. “And there isn’t a better person to launch the series than Repertoire Founder Brian Taylor. Brian has been a sales rep in medical sales for 40 years whose sales/business stories could be a 10-part series in and of themselves.” To download the first episode, visit http:// www.repertoiremag.com/road-warriors-podcast-episode1-brian-taylor.html

Amazon-Berkshire-JPMorgan venture names Serkan Kutan as CTO The healthcare venture launched by Amazon, Berkshire Hathaway and JPMorgan Chase has named Serkan Kutan as its chief technology officer. Kutan is the former CTO of Zocdoc, an online medical appointment platform. On the LinkedIn post where he made the announcement, Kutan also posted a link to the venture’s career website, which is hiring for a range of roles, including clinical, communications, legal, strategy and research, and tech positions.

Kroger to add new heart surgery benefit with Cleveland Clinic Cleveland Clinic cardiac surgery expertise is now accessible at little or no cost to eligible Kroger Co. associates and dependents on the company-sponsored healthcare plan through the Cleveland Clinic Cardiac Concierge Program in partnership with Anthem Blue Cross and Blue Shield in Ohio and its affiliated health plans. The program provides access to complex cardiac surgery at the Cleveland Clinic

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Heart & Vascular Institute. To help support the best care for associates, Kroger also pays 100 percent of travel and accommodation expenses for eligible plan participants and a companion to visit Cleveland Clinic. Anthem arranges travel from the associate’s home to the Cleveland Clinic and back again through Healthbase, a global medical tourism facilitator.

Cardinal Health names new EVP, CIO Cardinal Health (Dublin, OH) announced that Brian Rice will join the company as EVP, chief information officer, and customer support services. Rice’s most recent role was SVP, CIO and global business services for Kellogg Company.

Rice will officially join Cardinal Health on February 4, 2019.

CHI and Dignity Health complete merger, form CommonSpirit Health Catholic Health Initiatives (CHI) (Englewood, CO) and Dignity Health (San Francisco, CA) have completed their merger. The new nonprofit, Catholic health system, CommonSpirit Health is headquartered in Chicago and serves communities in 21 states and includes 142 hospitals and more than 700 care sites, as well as research programs, virtual care services, home health programs, and living communities. CHI CEO Kevin Lofton and Dignity Health President and CEO Lloyd Dean will jointly lead CommonSpirit Health. As previously announced, the new organization will retain the names of local facilities and services in the communities in which they are located.

Measles outbreak in Washington state grows to 34 cases As of late January, three new measles cases had been confirmed in Clark County, Washington, bringing the total number of cases in the month-long outbreak to 34. The newly diagnosed cases each involve unvaccinated children between 1 and 10 years old, with 30 of the affected children being unvaccinated. Washington Gov. Jay Inslee declared a state of emergency due to the outbreak January 25. The measles outbreak spread to Oregon Jan. 25, with one confirmed case in Multnomah County.

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